The clients in your care will come from vastly different backgrounds and have varied life experiences. Having knowledge of and respecting an individual’s cultural background is crucial to being able to provide person-centred care.

What is Culturally Safe Care?

Culture refers to values, customs, languages, social structures, beliefs, patterns of human activity and shared experiences - the symbolic structures that provide meaning and significance to human behaviour (Engebretson 2016; Rawson 2019).

Culture is fundamental to how we live and informs how we interact with the world (Rawson 2019).

Cultural safety involves being mindful of the similarities and differences between cultures and using this knowledge to inform your communication with members of different cultural groups (HETI 2018).

In healthcare, this means you must act in a way that recognises, respects and nurtures your client’s identity while ensuring you meet their needs, expectations and rights. Instead of working from your own perspective, it’s important to consider the cultural perspective of the person you are caring for (HETI 2018).

You can make a difference in the lives of your clients by doing your own research (see SBS's Cultural Atlas) and by incorporating cultural awareness into your care.

Cultural Safety in the NDIS Practice Standards

Individual values and beliefs is a requirement of the NDIS Practice Standards under Core Module 1: Rights and Responsibilities.

This Practice Standard aims to ensure that NDIS participants receive supports that respect their culture, diversity, values and beliefs (NDIS 2021).

NDIS providers must meet the following quality indicators:

• Participants’ cultures, diversity, values and beliefs are identified and responded to sensitively, at the participants’ direction
• Participants are supported to practice their culture, values and beliefs whilst receiving care.

(NDIS 2021)

Diversity in Australia

Statistics from the most recent national Census in 2021 reveal how culturally diverse Australia is, with just over one-quarter (27.6%) of Australians being born overseas (ABS 2022).

In fact, over half (51.5%) of Australians were either born overseas themselves (first generation Australian) or had one or both parents born overseas (second generation Australian) (Khorana 2022).

As of 2016, there were over 300 separately identified languages spoken in Australia. More than one-fifth (21%) of Australians spoke a language other than English at home (ABS 2017).

As a health professional, you should be able to appropriately and sensitively care for clients of all backgrounds, including:

• People from culturally and linguistically diverse (CALD) backgrounds
• Aboriginal and Torres Strait Islander people
• Members of the LGBTIQ+ community
• People living in rural or remote areas
• People living with mental illness
• People living with cognitive impairment (e.g. dementia)
• People living with disability
• People who have been separated from their parents by forced adoption or removal
• Care leavers
• Veterans
• People living at socio or economic disadvantage.

(DoH 2017)

Unfortunately, the perception of Australia’s healthcare system among people of culturally and linguistically diverse (CALD) backgrounds is far from positive.

People from diverse cultural backgrounds (including Aboriginal and Torres Strait Islander people) are also known to have difficulty accessing and using healthcare services in Australia, leading to poorer health outcomes (Khatri & Assefa 2022; White et al. 2019; AIHW 2023).

The potential for error in the absence of culturally-aware healthcare is vast. Misunderstandings, miscommunication and culturally-unsafe care by healthcare professionals are often reported (Johnstone & Kanitisaki 2006). People of a non-Anglo-Saxon background have cited feelings of powerlessness, vulnerability, loneliness and fear (Garrett et al. 2008).

Language Barriers in Home Care

Language barriers have been found to have significant adverse effects on care, including:

• Increased difficulty accessing healthcare
• Poorer health outcomes
• Reduced satisfaction for both the client and staff
• Decreased quality of care
• Increased costs and time required for services due to the need for interpreters.

(Shamsi et al. 2020)

Providing Culturally Safe Care

Culturally safe and sensitive practice is defined by the Medical Board of Australia (2020) as:

• Understanding how your own culture, values, attitudes, assumptions and beliefs influence your practice
• Acknowledging the social, economic, cultural, historical and behavioural factors influencing the health of different communities
• Respecting diverse cultures, beliefs, gender identities, sexualities and experiences
• Genuinely making an effort to adapt your practice, when required, to provide culturally safe care
• Challenging assumptions based on gender, disability, race, ethnicity, religion, sexuality, age and political beliefs.

The following are some practical tips for providing culturally safe care:

• Consult with clients and their families/carers about aspects of their cultural traditions or religion that are important to them.
• Access resources that can help you gain insight into different languages, ethnicities or religious traditions and migration/refugee experiences of migrants in Australia.
• Use culture-specific information as a guide to facilitate questions - as not all people from the same cultural or religious background identify in the same way.
• Always avoid stereotyping and making assumptions about someone else’s culture, heritage, language or needs.
• Be aware of judging other people's behaviour and beliefs according to your own life experiences.
• When required, involve an interpreter in the client’s care. If this isn’t possible, work with their family to create a list of important words or phrases for staff. They may include: ‘Are you comfortable?’ or ‘Are you in pain?’
• Ensure the client is not isolated in their care. Ways to prevent this may include engaging with their cultural community or asking volunteers to visit the client.
• Learn how to pronounce clients’ names correctly.

(Centre for Cultural Diversity in Ageing 2024; Rawson 2019)

Culture-specific information allows us insight into the lives of people who share ethnicity, language, religion or other characteristics that individuals identify with, or groups that they belong to (Centre for Cultural Diversity in Ageing 2024).

While culture-specific information will inform your work with individual clients, keep in mind that within any cultural group, peoples' values, behaviour and beliefs can vary greatly (Centre for Cultural Diversity in Ageing 2024).

Acronyms to Remember

ABCD for Cultural Assessment

Learn and remember the ABCD Cultural Assessment Model developed by Kagawa-Singer & Backhall (2001). Make it part of your routine to take time to discuss the following with the clients in your care, as well as their families:

(Kagawa-Singer & Backhall 2001)

The ACCESS Model for Transcultural Care

(Narayanasamy 2002)

Conclusion

Although we, as healthcare professionals, constantly strive to provide sensitive, compassionate care, there is no doubt we may find ourselves in situations that challenge us. Although we don’t need to have a comprehensive understanding of every cultural and ethnic norm of all those who live in our society, we do need to make an effort to communicate with our clients and understand their needs in order to provide culturally safe care.

Respecting the dignity and human rights of each client is fundamental to providing quality care.