Challenges on the path to cultural safety in nursing education

Abstract

ARIELI D., FRIEDMAN V.J. & HIRSCHFELD M.J. (2012) Challenges on the path to cultural safety in nursing education. International Nursing Review59, 187–193 Aim: The purpose of this study is to identify central challenges to be addressed in cultural safety education. Background: In recent years, the idea of cultural safety has received increased attention as a way of dealing with diversity in the nursing profession, especially in divided societies. The idea of cultural safety goes beyond recognizing and appreciating difference, to an attempt to grappling with deeper issues like inequality, conflict and histories of oppression. Methods: The paper is based on formative evaluation, using action research, of an academic nursing programme in Israel, involving Jewish and Arab students. Part of this research dealt with the integration of cultural safety education into the curriculum. Findings: The study revealed four challenges in cultural safety education: making it safe for minorities to present their culture to the majority group (‘the ambassador's dilemma’), dealing with tendency of groups to deny the existence of conflict (‘the one big happy family fantasy’), making dynamics of oppression discussable (‘the oppressed and the oppressor’) and creating conditions in which people can freely choose their individual and group identities (‘the threat of identity’). Conclusion: Cultural safety education may be experienced as unsafe for many participants. Better understanding of the challenges of cultural safety education is necessary for making it more effective.

Implementing Anti-Racist Pedagogy in Health Professional Education: A Realist Review

“…While this approach was found to increase students' understanding of cultural knowledge and respectful partnerships [38], it was less effective for understanding power, privilege and oppression [38] and in connecting the social determinants of health to racism [37]. Intergroup dialogue [39,40] is an approach that gathers students into small, peer-facilitated groups based on social identity in order to foster cooperative learning and communication between the groups. Students were found to have increased cultural competency in knowledge, skills, and awareness domains [39].…”

“…Students were found to have increased cultural competency in knowledge, skills, and awareness domains [39]. In Arieli's study, students had to negotiate a number of challenges, such as feeling the need to be the 'ambassador' for their culture, feeling comfortable expressing their identity, and difficulties of discussing the dynamics of oppression [40]. A slightly different approach, black-white teaching partnership, was described by Gollan and O'Leary [41] in which instructors from different social identity groups are co-leaders in teaching, modeling accountability, awareness of whiteness, and critical self-reflection in the process.…”

“…Instructors who were skilled in recognizing and responding to conflicts, potentially distressing opinions, and defensive responses among students helped to facilitate learning environments in which critical discussions emerged [40,43,45]. While few studies looked at the process of gaining experience in anti-racism teaching skills, Holland [56] found that the journey took place over several years, through a process of self-reflection that was gradual and punctuated with 'awakenings'.…”

“…In this context, moving students into mixed groups was met with initial resistance but ultimately had a positive impact on challenging stereotypes [59]. Intentionally dividing students by social group identity as a pedagogical strategy was found to foster an awareness of the pre-existing tensions between groups, but also led some students to feel silenced or like traitors if they did not agree with other members of their social group [40].…”

“…For instance, allowing a student to show a video clip in class created turmoil among students that lasted for weeks [40].…”