Health Studies Health Studies Conference Papers coda Year 2007 Opening our eyes-shifting our thinking: The process of teaching and learning about reflection in cultural safety education and practice Wendy Scott Desley Turia Kay Laracy Rose McEldowney Fran Richardson Sue MacDonald Whitireia Community Polytechnic, wendy.scott@whitireia.ac.nz Whitireia Community Polytechnic, desley.turia@whitireia.ac.nz Whitireia Community Poytechnic, kay.laracy@whitireia.ac.nz Victoria University of Wellington Whitireia Community Polytechnic, Fran.Richardson@whitireia.ac.nz Nursing Council of New Zealand This paper is posted at coda. http://www.coda.ac.nz/whitireia healthstud cp/1
Opening our eyes- shifting our thinking The process of teaching and learning about reflection in cultural safety education and practice
Presenters Wendy Scott, Whitireia Community Polytechnic, Porirua, NZ Des Turia,, Capital & Coast Health & Whitireia Community Polytechnic, Porirua, NZ Kay Laracy,, Whitireia Community Polytechnic, Porirua, NZ Dr Rose McEldowney,, Victoria University of Wellington, NZ Fran Richardson, Whitireia Community Polytechnic, Porirua, NZ Sue MacDonald, Nursing Council of NZ (in absentia)
From Whitireia Community Polytechnic, Porirua City to Baruch College CUNY, New York
The curriculum at Whitireia Community Polytechnic
Cultural safety is one of twelve criteria required by Nursing Council of New Zealand for the auditing and accreditation of all undergraduate nursing education programmes in New Zealand
Positioning cultural safety Cultural safety shares some commonalities with Leininger s s Culture Care Theory (1996). A difference between the two is that cultural safety is explicit in identifying the inherent power of the nurse in health care relationships relates to the experience of the recipient of nursing care and extends beyond cultural awareness and sensitivity - it is an outcome of care provides consumers of nursing services with the power to comment on practices and contribute to the achievement of positive outcomes and experiences for them enables consumers to participate in changing any negatively perceived experience of care
Characteristics of a culturally safe nurse The nurse delivering culturally safe care has undertaken a process of reflection on her/his own cultural identity,and will recognise the impact that their personal culture has on client care. Unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and well being of an individual and/or their family (Nursing Council of New Zealand, 2005)
Cultural safety is derived from the articles of the Treaty of Waitangi (1840) and given expression through the principles of partnership, protection, participation and Tino Rangatiratanga (self determination) as defined by the Royal Commission on Social Policy (1988).
Background to the research
Purpose of the research An evaluation of using practice exemplars as a reflective process in teaching and learning about cultural safety
The literature Key theorists informing the study- Dewey (1933) Schon (1993) Freire (1972) Mezirow,, (1971, 1981) Boud & Walker (1998) Greenwood (1998) Atkins & Murphy (1993) Johns (1993) Cooney (1999) Taylor (2000) Cotton (2001)
Reflection defined Reflection aims to produce change in the reflector through a process of critical thinking. This change has the potential to inform practice (Taylor, 2000) Schön (1993) developed the idea of the reflective practitioner - notions of reflection in and on action We think about what we are doing even as we are doing It it might be a point of surprise or unexpectedness the thought is turned back on the action and this causes focusing on the knowing that is implicit in the action (p.55) Mezirow (1978,1981,1990) a a student s s perspective is transformed through the process of becoming critically aware of how and why their world comes to constrain the way they see themselves and their relationships ( p.23)
The research questions What is the effectiveness of using practice exemplars as an assessment process in third year cultural safety courses? How effective is the teaching of reflection in/on action as part of third year cultural safety courses?
Participant profiles Ethnicity Pre registrati on Post registrati on No. of particip ants Total class numbers & percentag e % of total no particip ants Maori 6-6 11 (25%) 46% Pacific 2-2 6 (13.6%) 33% Other (Asian) - - - 1 (2.3%) - Pakeha /Europea n 4 1 5 26 (59.1 %) 21% Total 12 1 13 44 (100%) 29%
Participant profile cont. Age range 30-40 years Each had successfully completed the cultural safety paper All completed the narrative exemplar reflecting on aspects of culturally safe or unsafe practice
Critical interpretive inquiry This approach fits with our values beliefs and work as cultural safety educators A critical interpretive position involves a paradigmatic blurring between the critical and interpretive approach to qualitative inquiry This position focuses on issues of social justice praxis context agency counter hegemony voice difference
Some influences on thinking and interpreting Liberatory pedagogical work (Freire,1972) Theorising on hegemony and agency (Gramsci,1971) neo-marxist educators (Apple,1981 & Giroux,1983) Post structural work (Foucault, 1977) Critical education theorists (Popkewitz( & Fendler,1999) Teaching for social change (Trifonas( Trifonas,, 2003) Racial identity theory (Tatum,1992) Interpretive inquiry in nursing (Diekelmann( Diekelmann,, 2001)
Managing the ethical process Several Maori researchers have written about undertaking research with Maori participants who often become objects of research within dominant Eurocentric research frameworks (e.g., Bishop, 1996; Smith, 1999). As Pakeha researchers we needed to manage the process to ensure the participants were culturally safe.
How we did this Two registered nurses (one Maori and one Samoan) were selected as interviewers Culturally appropriate and culturally safe and able to converse in the participants first language (for example Maori, Samoan or English) Independent liaison and support people were available for participants (Maori, Pacifika and Pakeha)
Data Collection Audio taped interviews Transcribed Returned to participants for clarification of meaning and any additions, changes or deletions Tapes stored and used to check intonation
Research findings Opening our eyes - shifting our thinking Creating a safe space (for the student ) to be unsafe (Personal safety) Showing constraint and tenacity (Power/powerlessness) Waking me up (Reflection) Showing the way (Teaching and learning) Disrupting dominance (Cultural safety)
Creating a safe space to be unsafe Watching over me There are lots of nurses out there willing to help us and give us information but there are some nurses out there, they look at us, look at our skin, our colour and they think we have brown brains. They underestimate us
Showing constraint and tenacity I I didn t t want to criticise her nursing practice, and at the end of the day she s s the nurse and she d d been at it for like 20 years or something, and here I am only a third year nursing student
Waking me up making a leap in thinking recognising racism externalsing the experience recognising when and when not to act coming to realise witnessing in the moment working it out in my head becoming more aware why am I thinking like this
Coming with knowing a a lot of staff had trouble working with him and I found that it was just more a matter of simply understanding what he wanted but people just couldn t t seem to put the effort into trying alternative ways of communicating. He[the patient] was put in a little box simply because they [the staff] felt they couldn t communicate and it had to be verbal English just because you don t t speak the lingo doesn t t mean they don t t have the same need for respect.
Coming to know When I first came in I was very naïve about a lot of things I thought it was all bullshit doing cultural safety I I said oh what a lot of crap I I was very anti it and like reflective listening was like oh please, get over yourself let s s not do this then just doing it and moving on you actually use it. It s s really informative with the reflective listening and everything. they teach you so many different tools and how to stand up for yourself if cultural safety had not been in the course I would have gone full on at her and then I would have been kicked out they teach you to open your eyes open up and see what s s going on and just take a different avenue. Yes it makes you think.
Showing the way Witnessing the reality of practice Being receptive to the teachable moment (student and teacher) Creating space for thinking to occur Developing trust by supporting and encouraging Engaging in dialogue Responding to difference and diversity Valuing opinions and willing to be vulnerable Growing as a nurse
It gave me such a widening of my knowledge, a widening of my thoughts and that was through the delivery in the classroom. It was also the sharing of the other members of the class it just confirmed a lot of stuff that was there that I hadn t t really put the cultural safety tag on. I I think the tutors have done an effective job a good job a really good job in teaching reflection because it made sense to me and it s linking it to practice theory with practice. I learnt all this in the classroom took it away with me. I thought alright they can t t be teaching us about this for nothing better give it a try and that s s what I did and that s s when I started to appreciate linking theory with practice.
It s s amazing when you look at different cultures, they make us look at that it wasn t t just about Maori culture, it was about dominance and power and how you can harm your relationship with them (the client) and so you transpose that and take it into the clinical setting. I I found reflection to be a really useful tool and a wonderful part of my learning I I think that what the cultural safety paper has really spelt out is that you have your own self and you need to be aware of what your own stuff is this is about becoming a real nurse..from a plastic nurse to a real one.
Disrupting dominance Being culturally safe is determined by the people you look after. Cultural safety is about two different cultures, not based on colour or your own values but the person you look after, and their values. How the person who you are looking after perceives your practice as safe an example is that they talk to you.
Current thinking Improved health outcomes-cost cost Contexts for teaching- models/approaches Challenges for teaching Reflection as an artful act
Conclusion We have used a critical framework to guide our teaching of reflection and have modelled this in our research process As this is a work in progress we see that there is still fine tuning and further developments to be undertaken These might include undertaking further research both nationally and internationally to explore how students come with a knowing,, or come to know about reflection