Introduction
The fact that Canada is a multicultural society makes hard to practise cultural safety in nursing, only for it to be compounded by the brain-drain of nursing professionals to other countries like the United States. The foreign nurses that come to replace the local nurses have to get orientation training whose effectiveness is questionable. The creeping of corporate ideology into the medical world is further making it harder for them to care for the patients in a professional and humane manner, as will be expounded.
Concept of Cultural Safety in Nursing
Cultural safety is defined by Maori nurse leader as the recognition of shared respect, meaning, experience and knowledge. It also includes gaining new knowledge together in a dignified manner and being keen listeners. One is necessitated to have a reasonable understanding of conflicts and histories of oppression in order to be able to practice cultural safety (Arieli et al, 2012). Nursing profession entails treating of patients in a multicultural environment and having colleagues from diverse backgrounds. Recognizing and appreciating the differences exhibited by others results in one acquiring cultural competence, having cultural sensitivity and acknowledgement of misunderstandings and their potential effects. Actions that fail to respect or uphold the cultural identity and wellbeing of an individual in nursing are the ones classified as culturally unsafe (Polaschek, 1998).
Current Culture of Health and Health Care in Canada
Canada’s health care system is public funded and managed provincially. The province administrators follow regulations set up by the federal government. All the citizens of Canada are covered by this health care system which is a socialized group of health insurance plans. The citizens are covered for preventive care; medical care from physicians even in private practice; access to hospitals dental care and additional medical services. All citizens qualify for medical coverage regardless of their medical history, living standards or personal income. This is done with only a few exceptions. This health care is given credit for Canada’s high life expectancy and extremely low mortality rates (canadian-healthcare.org, 2013).
Canada Health Act is legislation that puts in place the conditions that provinces or territories in Canada must fulfill in order to receive funds for use in provision of health care services. The five main principles in the Canada health act include public administration, comprehensiveness, universality, portability and accessibility. Public administration principle requires that the provincial health insurance administration be done by public officials and at no profit. They must be accountable to their area of administration, and they are subject to periodic audits. Universality ensures that all the insured residents receive the same level of healthcare. Portability allows the residents who move from one province to another to have the cover from the home province still effective for a specified period of time. It also happens for residents that move out of the country (canadian-healthcare.org, 2013). All the insured citizens have reasonable access to healthcare facilities while healthcare providers and facilities are given the compensation due to them by the government.
As the health insurance of Canada is handled by the territories or provinces, new residents to any particular province must apply for health cover. Upon coverage, they are issued with health cards. They have waiting periods that pass before they are granted the health cards, which should not exceed three months as specified in the Canada Health Act. In some provinces, some premiums are required for provision of health services, but one may not be denied such services for failing to pay the premiums. The provinces provide cover for other services in addition to the ones specified in the Health care act. These additional medical services include prescription medicines, physiotherapy and dental services (canadian-healthcare.org, 2013). Provision of these additional health services is not provided for in the act and their rendering maybe affected by new government policies.
Health culture in Canada
The use of medicine to improve health care in Canada plays a minimal role, as reported by Public Health Agency of Canada (2013). The other factors that influence the health of Canadians are mainly lifestyle based. These factors include income and social status; gender; ethnic culture; health services; social support networks; employment or working conditions; education; personal health practices and coping skills; biologic and genetic endowment; physical environment; social environment. Though each of the factors is important individually, they are also to a certain degree interrelated.
The prevalence of diseases in a population tends to decrease with increase in income. Higher income means access to better living conditions and there less susceptibility to disease. Higher income is likely to make the persons more satisfied with life and less likely to be stressed. 73 percent of Canadians in the highest income group responded as being in very good or excellent health compared to only 43% in the lower income group (phac, 2013). Canadians in the high income brackets tend to live longer and have improved health compared to their companions in the low income bracket. Persons with strong social support networks have a greater sense of satisfaction and well-being which results in them having higher immune systems. it has being observed among Canadian people that persons with strong family ties tend to have better health compared to those having broken or malfunctioning families (phac, 2013). Canadians with low levels of education are likely to face unemployment and have poor households. They tend to die younger than the educated ones. Education gives a person problem solving skills that makes them able to make healthy choices not only for themselves, but for their households also.
Studies on Canadian working women have revealed that they spend as many hours working for unpaid jobs such as doing household work as they do in the waged jobs. This done for a long time without support results in them being dissatisfied with their jobs. Their stress levels also tend to increase almost being twice as much as that that of the males. This is the most significant effect on the health of Canadians influenced by work conditions. Other work related factors such as unemployment, underemployment stressful or unsafe work result in poorer health (phac, 2013). This is because it makes individual as if they are not in control of their lives.
The physical environment in which Canadians live has effects on their health. Of late, asthma cases have risen and it is believed to be caused by increase in air pollution. The destruction of the ozone layer affects those involved in outdoor activities as they get their skin exposed to ultraviolet rays. Smoking is responsible for about 25% of all the deaths that occur in Canada of persons aged between 35 and 84 (phac, 2013). The Aborigine ethnic group are the heaviest smokers with a smoking rate that is four time the rate for the rest of the Canadian population. Second hand cigarette smoke is considered to cause more health damage to the population than all the other emissions combined. Other lifestyle risks include young mixing drugs with alcohol which render their effects more potent and raise their possibility of causing harm to these users. The diet of most Canadians is high on fats, which further promotes the incidences of cancer and obesity as well.
The health services in Canada have been shifted from providing treatment to focusing on disease and injury prevention practices. This has resulted in substantial reduction in the length of hospital stay and care has been transferred to the community and homes. This has placed on families financial, physical and emotional burdens. The demand for home care has raised concerns over the equitable accessibility of this facility for all. Many low and moderate income earners in Canada still find some health services such as dentistry, eye care, counseling, and prescription drugs out of reach. This is because these services are not covered by the government sponsored health care and are considered additional medical services.
Social Structure of Nurses’ Work
The goal of most healthcare reforms being effected in most western countries, Canada included is to improve the quality and accessibility to healthcare. These reforms are majorly driven by corporate ideologies that have immense influence. The working conditions of nurses in Canada have been worsened by the Canadian health care reforms. The work of nurses is organized on how nurses participate in corporate ideology and within scarcity (Rodney & Varcoe, 2014). The body care and emotional labour of nursing is limited and devalued by practices that try to foster some sort of efficiency.
Nursing practice is affected by cost constraints which result in increased workload, higher uncertainty and less control on how they spend their time. Strategies targeting reduction in the time spent in the hospital have resulted in increased patient acuity and turnover. Nurses having the corporate ideology imposed on them organize their work to create a sense of efficiency. A common ideology is that of scarcity. The nurses working environment is on a daily basis filled with images and ideas that resources are scarce (Rodney & Varcoe, 2014). This may lead to some actions such as nurses putting diapers on competent patients because they do not have time to assist them to the toilet. This is because time is regarded as a limited resource in the corporate world.
In an earlier study, the participant nurses revealed that scarcity is a major driving force in the health care system and in organization of the nursing practice. They also expressed concerns over not being able to practice according to their professional standards. They felt there were discrepancies between the care they were able to provide and the care they valued. The nurses further shared that they did not have enough to give the emotional care required by their parents. Time is used mainly to pursue corporate goals instead of providing care for the patients. These ideas of scarcity coupled with cost constraint measures are the ones that therefore structure the nurses’ work. Nursing work has become structured as efficient practice due to corporate streamlining (Rodney & Varcoe, 2014).
Nurses providing direct health care have their intellectual and emotional labour, their time and their wellbeing sacrificed for the sake of efficiency. Hence, they end up being treated as disposable in the above four ways. Intellectual labour is not valued, and it is not uncommon to have workloads that get in the way of the nurses’ achieving their professional standards of providing services. Nurses’ emotional labour is compromised by being perpetually busy and not being able to offer emotional support to their patients. Nurses suffer frustration, anxiety and self-blame regarding the services they are able to provide due to having to work under the stress of workload (Rodney & Varcoe, 2014).
Possibilities and difficulties in practicing cultural safety in nursing
Canadian health care plan is always highly politicized both in the national and local politics of the territories of Canada. One of the contested issues is the inclusion of private general practitioners in the plan. Some claim that their inclusion is likely to make access to health header for the lower income persons while their opponents are of a different opinion. another is the poor working conditions of the government employed medical professionals, most of whom emigrate to other countries such as the united states making Canada have a deficit in their number. They are then replaced by nurses from the foreign countries.
The foreign nurses are not familiar with the social norms of Canada and are prone to making mistakes in caring for the patients. They have to be given courses to orient them to the culture the people of Canada so as to serve them effectively. Canada has a multicultural society with persons from various cultures. There are Native Americans who happen to mainly form the low income group. There are persons from Europe, Asia and African origin (Mc Laughlin & Braun, 1998). All these persons have different cultures and a nurse has to accommodate them when caring for them in order to have served them well. It is through doing this that it is possible to practice safety culture while serving the patients.
For the Native Americans, illness is viewed as a state of imbalance between the ill person and the nature around him, the supernatural forces rather than a physiological state. They tend to trust more their medicine men known as shamans. Persons of African origin value their families and church a lot and place a lot of emphasis in spiritual healing (Mc Laughlin & Braun, 1998). They usually have extended kinship ties with a key family member that must be consulted before any major decision is made. Such a person is requires to authorize a radical medical procedure such as an operation.
Hispanics have a fatalistic view towards illness. They consider ill health to be the will of God or a punishment for previous sins. They may often prefer home medication or consult healers. Most are likely to go for medical services as a civil duty. Asians are more receptive and have respect for the recommendations given by medical professional. Their culture lays emphasis on maintenance of harmony and therefore conflicts are avoided. Being sick is an indication of lack of harmony within oneself and his or her surrounding and brings with it a feeling of shame and self-blame. Such persons are reluctant to reveal mental conditions to avoid being stigmatized by their community. Canadians of European ancestry adopt the mainstream culture and are easier to deal with compared with others (Mc Laughlin & Braun, 1998).
For a nurse to practice cultural safety well, she/he has to be aware of the different cultural dispositions of the patients and colleagues as well. To get along with the colleagues is a simpler task compared to doing the same for the patients without offending them. The basic training they get plus the orientation program for foreign nurses helps to a certain degree.
Conclusion
Cultural differences affect how patients react to illness, medical interventions and the possible effects of medications. The progress of an illness and the reception of a patient’s family to the medical care given are also influenced by their culture. The cultures also determine how the dying and the dead are managed and the bereavement patterns. All these factors should be taken into consideration by nurses as they carry out their duties. In case a nurse is not sure how they should handle the patients in a multicultural setting, they should follow the following strategy. First, they should try as much as possible to find out about the culture of their parents. The nurse should than pay close attention to the body language of the patient to detect whether the patient or the family is in conflict. The nurse should further as the patient open-ended questions to find out their expectations and assumptions. All the while, the nurse should remain non-judgmental when given information that differs from their values (Mc Laughlin & Braun, 1998). Finally, the nurse should follow the guidelines given by the patient on how to communicate with their families and between those families and other medical practitioners.
Reference
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Mc Laughlin, L., & Braun, K. (1998). Asian and Pacific Islander cultural values: Considerations for health care decision-making. Health and Social Work, 23 (2), 116-126.
phac. (2013). What Makes Canadians Healthy or Unhealthy? Public Health Agency of Canada. Retrieved from: < http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php>
Polaschek, N. (1998). Cultural safety: a new concept in nursing people of different ethnicities. Journal Of Advanced Nursing, 27(3), 452-457. doi:10.1046/j.1365-2648.1998.00547.x)
Rodney, P., Varcoe, C. (2014). Constrained agency: the social structure of nurses’ work. The sociology of health, illness & healthcare in Canada. (pp.216-227). Toronto, ON.: Nelson Education Ltd.
