COMMUNICATION

In this module we discuss the principles of culturally appropriate, safe and sensitive communication that facilitates trust and the building of respectful relationships and effective partnerships with Aboriginal and/or Torres Strait Peoples.

You will cover the following as part of the cultural safe communication capability:

Descriptor 1: Cultural Safety in Healthcare: Terminology and Definitions

Descriptor 2: Culturally Safe Communication

Descriptor 3: Strength Based Knowledge

Descriptor 4: Partnerships with First Peoples Health Professionals, organisations and communities.

Descriptor 1: Cultural Safety in Healthcare: Terminology and Definitions

Introduction

This topic introduces students to key terminology that is used in the context of developing and delivering culturally safe health-care to Australia’s First Peoples.

Learning Outcome

Upon the completion of this topic you should be able to:

  • Identify why partnerships with First Peoples health professionals, organisations and communities are important, and;
  • select a possible plan to respectfully acquire cultural information.

Attaining cultural safety is a multi-step process, that originated in the nursing profession, which enables safe service to be defined by the recipients of the service. The steps to gaining cultural safety are defined below.

Cultural Safety in Healthcare: Terminology and Definitions

Key Terms

Cultural Awareness: Stage 1 of Cultural-Safety

Cultural awareness is recognising that differences and similarities exist between cultures. Learning about the histories that impact First Peoples health is crucial to this awareness.

The acquisition of knowledge pertaining to differences between groups. Cultural awareness allows us to see that we are all shaped by our own cultural background which influences how we interpret the world around us, perceive ourselves and how we relate to other people (Durey, Thompson & Wood, 2011).

Cultural Sensitivity: Stage 2 of Cultural-Safety

Possessing an understanding of, and therefore sensitivity towards, individual differences, uniqueness and diversity. Cultural sensitivity grows when we start to see the influences of our own culture and acknowledge that we have biases. This can be an eye-opening experience, and it may take courage and humility. With cultural awareness and sensitivity comes a responsibility to act safely and respectfully (NACCHO, 2017).

Cultural Safety:

The way in which respect for culture is established within an organisation such as a health service. It is about overcoming the cultural power imbalances of places, people and policies to contribute to improvements in Aboriginal and Torres Strait Islander health (AIDA Cultural Safety Fact Sheet, 2017).

The goal of cultural safety is for all people to feel respected and safe when they interact with the health care system. People are supported to draw strengths from their identity, culture and community. A cultural safe health professional is able to deliver a safe service of care as determined by the recipient of that care (NACCHO, 2017).

Cultural Capability:

Refers to a lifelong learning process of acquiring knowledge, attributes and skills that can be applied to known and unknown circumstances in response to delivering culturally appropriate care.

The holistic approach to identifying and assessing behaviours and understandings of culture. It refers to the means by which knowledge, skills and attributes can be applied to known and unknown circumstances in response to delivering culturally appropriate care to Australia’s First Peoples (Department of Health, 2016).

Cultural Humility:

The ability to maintain an interpersonal stance without judgement or bias, that is other-oriented in relation to one’s cultural identity and that are most important to the person (Hook, Davis, Owen, Worthington & Utsey, 2013). Involves listening without judgement and being open to learning from and about others. It involves learning about our own culture and our biases. It is a building block for cultural safety.

Descriptor 2: Culturally Safe Communication

Introduction

This descriptor introduces students to verbal and non-verbal communication cues of Australia’s First Peoples. The topic has a progressive focus on building skills for students to be able to engage in respectful and culturally safe communication. Communication, and culturally safe communication, is the foundation for building positive relationships with Australia’s First Peoples.

Please use the following link from the Share Our Pride website for Respectful Relationships with Australia's First Peoples.

Learning Outcome

Upon the completion of this topic you should be able to identify the skills of culturally safe communication when interacting with Australia’s First Peoples.

Communication

Evidence has repeatedly shown that First Peoples are more likely to access health services that:

  • communicate respectfully;
  • have some understanding of culture, and
  • build good relationships

Skills that assist in culturally safe communication with Australia’s First Peoples include, but are not limited to:

LANGUAGE

English may not be the first language spoken by the client. Different dialects such as Kriol or Aboriginal English may be used (revisit diversity from Module 1). Avoid using complex words and jargon, explain why you need to ask questions, use diagrams or images to explain instructions and terms as they will not always be familiar to patients.

Don’t equate a lack of English to be a lack of intelligence. Processing information in a second dialect is not a smooth process, so processing information in a second or third language is very complex, especially when you are not well.

If required, seek help from local First Peoples staff.

TIME

In Western culture, emphasis is placed on time to meet deadlines and schedules. Time is perceived differently by First Peoples cultures, as more value is placed on family responsibilities and community relationships.

SILENCE

Silent pauses should be acknowledged, and a need to fill these silent moments should be avoided as one could be gathering their thoughts. Silence during conversations is normal and should not be interpreted as a lack of understanding.

EYE-CONTACT

Some (not all) First Peoples may be uncomfortable with direct eye contact, especially if unfamiliar. Avoidance of eye contact is customarily a gesture of respect.

KINSHIP NETWORKS

Kinship is a fundamental characteristic of First Peoples social organisation and family relationships. Please view the following video (1 minute 8 seconds) from Reconciliation Australia:

LISTENING

Active listening is a crucial skill in communication. Avoid selective hearing, use paraphrasing to clarify the message you have received, reflect feeling and demonstrate empathy where appropriate and avoid talking over the client.

NON-VERBAL COMMUNICATION

Some non-verbal communication cues (hand gestures, facial expressions etc.) used by First Peoples can have different meanings in the Western context. Be mindful of your own non-verbal communication, body language and how it can be interpreted.

QUESTIONING

In First Peoples cultures, indirect questioning is the approach most preferred. Direct questioning may lead to misunderstandings, discourage participation and make it difficult to obtain important information.

DECISION MAKING

Due to family kinship structures, decisions often involve the input of other family members.

Further information

Queensland Health - Communicating effectively with Aboriginal and Torres Strait Islander Peoples

University of Sydney - Learn about Aboriginal Kinship systems

Descriptor 3: Strength Based Knowledge

Introduction

This descriptor introduces students to the concept of strengths-based approaches to First Peoples health. The topic prepares students to be able to balance knowledge and communication of health.Taking a strength–based perspective for health practice is key in promoting resilience and empowerment within our clinical practice.

Learning Outcome

Upon the completion of this topic you should be able to define strengths based approaches and interpret how these can be used when working with First Peoples clients and communities.

Content

What is a strengths based approach?

A strengths based approach builds the clients on their strengths, specifically seeing them as resourceful and resilient when they are in adverse conditions. Another unique characteristic of this approach is that it is client led and centered on outcomes in the future individual’s set of strengths (McCashen, Wayne 2005).

Further reading: Personal Strengths & Weaknesses Defined

The strength-based approach represents a paradigm shift—a movement away from a deficit-based approach which can lead to a long list of things considered to be ‘wrong’ with a patient's health (Pattoni, 2012).

The deficit-based model fails to provide sufficient information about strengths and strategies to support a patient's health outcomes.

Research has shown strength-based approach, encourages health professionals to:

  • understand that healthcare is dynamic, complex and holistic
  • understand that people view health in different ways
  • start with what’s present—not what’s absent—and write about what works for that patient.

The strength-based approach consists of questioning strategies to identify what works for the patient and how it works so that those strategies can be continued and transferred into other areas of health care.

It is important to focus on factors that support an individual’s health rather than focusing on factors that cause the individual’s ill health.

Descriptor 4: Partnership with First Peoples Health Professionals, Organisations and Communities

Introduction

This descriptor develops students’ knowledge and understanding of partnerships with First Peoples health professionals, organisations and communities and how they impact working with First Peoples. A partnership approach is crucial to all health care practice and ensure that we are promoting equality and self–determination in clinical practices.

Learning Outcome

Upon the completion of this topic you should be able to:

  • identify why partnerships with First Peoples health professionals, organisations and communities are important, and
  • select a possible plan to respectfully acquire cultural information.

Partnerships

Partnerships are important as they:

  • improve communication
  • promote mutual and cultural respect
  • create opportunities for innovative, strategic projects
  • enhance the capacity
  • are collaborative
  • yield better health outcomes
  • inform professional practice and,
  • are vital to improvements in First Peoples Health (Taylor & Guerin, 2014)

Awareness of the governance structures of both the mainstream and First Peoples health care allows us to establish where and with whom, is most appropriate to form partnerships. These can be with organisations such as National Aboriginal Community Controlled Health Organisation (NACCHO) and their state, territory, regional and community affiliates.

More information on NACCHO visit National Aboriginal Community Controlled Health Organisation

Aboriginal Community Controlled Health Services (ACCHS) are primary health care services that are initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it.

For more information on ACCHS in your local area, please visit NACCHO Members Services.

National Aboriginal and Torres Strait Islander Health Plan 2013 - 2023

For more information on partnership and shared ownership refer to the Strategic Framework section of the National Aboriginal and Torres Strait Islander Health Plan 2013 - 2023.

Community Controlled Health Services

View these videos to answer questions in the quiz

National Aboriginal and Torres Strait Islander Health Organisations

If you identify as a First Peoples student studying a health-related degree we strongly encourage you to apply for membership with the relevant First Peoples health organisation/s. These organisations will be an invaluable resource throughout your First Peoples health journey.

Allied Health

Indigenous Allied Health Australia (IAHA) is a national not for profit, member based Aboriginal and Torres Strait Islander allied health organisation and endorsed charitable institution. IAHA’s purpose is to strive for Indigenous Australians to have access to professionally and culturally responsive allied health services and Indigenous allied health professionals that are recognised and part of a holistic approach to Aboriginal and Torres Strait Islander health and well-being.

Find out how to become a member here

Medicine

The Australian Indigenous Doctors' Association (AIDA) purpose is to contribute to equitable health and life outcomes, and the cultural wellbeing of Aboriginal and Torres Strait Islander Peoples. AIDA does this by striving to reach population parity of Indigenous medical students and doctors, and supporting a culturally safe healthcare system.

Find out how to become a member here

Nursing and Midwifery

The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives is the peak body representing Aboriginal and Torres Strait Islander nurses and midwives across Australia comprised of Aboriginal and Torres Strait Islander Peoples. As the website explains This means we are on a lifelong journey together to fulfill our cultural obligations and commitments to our communities, families and ourselves. We are also experts in our own health, and as such, we need to work together to make sure we determine our own future and create positive change for our Peoples when accessing health services.

Find out how to become a member here

Women

The National Aboriginal and Torres Strait Islander Women’s Alliance (NATSIWA) was established in 2009 to empower Aboriginal and Torres Strait Islander Women to have a strong and effective voice in the domestic and international policy advocacy process.

The National Women’s Alliances (the Alliances) represent over 180 women’s organisations from across Australia. They bring forward the views, voices and issues of Australian women and, in particular, women from marginalised and disadvantaged groups. The Alliances take the lead in ensuring that the voices of as many women as possible are heard, especially those who in the past have found it difficult to engage in advocacy and decision making.

Find out how to become a member here

NOW TAKE THE QUIZ FOR COMMUNICATION...

References

Durey, A., Thompson, S.C. & Wood, M. (2011). ‘Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutionalised racism and misunderstandings in communication’

Hook, JN., Davis, DE., Owen, J., Worthington, EL., Jr., & Utsey, SO. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology,
https://www.aida.org.au/wp-content/uploads/2018/07/Cultural-Safety-Factsheet_08092015.docx.pdf

https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/summary

http://www.coaghealthcouncil.gov.au/Portals/0/National%20Cultural%20Respect%20Framework%20for%20Aboriginal%20and%20Torres%20Strait%20Islander%20Health%202016_2026_2.pdf

McCashen, Wayne (2005). The strengths approach. Bendigo, Australia: St Luke’s Innovative Resources.

Pattoni, L. (2012) Strengths-based approaches for working with individuals.