Culturally Safe Work Practices

You have learnt about different cultural values, now you need to consider how you will apply them in the wellbeing industry. Let’s look at applying Pacific values in the workplace as an example.

Family

It is important to understand that family, family connections, ancestry and relationships are valuable. Rather than insisting on an individual approach, you must work in partnership with the person and their family and include them in any decision making, if that is their preference. Some people may feel more comfortable if another family member speaks on their behalf. This can lead to a longer meeting time so that the group can consult before making any decisions.

Collectivism

It is important to acknowledge, understand and respect that Pacific people value a collective and communal approach rather than an individual one, for the person being supported. It is also important to understand that family includes extended family. Some things may take longer, as Pacific people discuss issues and concerns with their family and the community in a collective and holistic way.

Respect

Observing the correct etiquette or ‘way of doing things’ is an important aspect of respect and maintaining dignity. As a support worker you need to respect the importance of the qualities of humility, commitment to the community, facilitation rather than command, and supporting Pacific people to participate in all the decisions that affect them. Pacific people respect individual and family input. Dignity, and respect for this, can play an important part in medical experiences. A person’s concern for their dignity may, in some cases, outweigh concerns about their health. If health issues are not explained properly that person may refuse certain procedures.

Reciprocity

It is important to understand that there are give and take obligations within relationships for Pacific people. The person being supported, and their family will be helped by others and will help others when they are able. Pacific people mutually help and support each other through the contribution of money, time, people and things that are needed. An imbalance in the reciprocity process can indicate a lack of respect for the relationship.

Spirituality

It is important to understand and respect the person’s prayers, ceremonies and spiritual beliefs, and the importance of these to the person you are supporting. The Pacific person may frequently make reference to God and it will be important for that person to attend ceremonies where possible. Customs and protocols have developed over time, and demonstrate the traditional or ‘right way’ to act. 

Fonofale model

Use the Fonofale model, which recognises the interconnected dimensions of Pacific identity, such as spirituality, family, culture, environment, and physical health. Addressing these aspects holistically promotes well-being.

Talanoa approach

Adopt the talanoa approach, a Pacific communication style that encourages open dialogue and sharing of stories. Use this method to create a safe and comfortable space for Pacific individuals to express their concerns and needs.

These culturally safe practices promote respectful and effective interactions within the health and well-being setting, fostering an inclusive environment that recognizes and values diverse identities and experiences.

Tikanga (practice) and kawa (protocols)

• Acknowledging cultural protocols and protecting people’s rights to follow them. This helps build trust and confidence in a relationship. It might include practices such as taking your shoes off at the door of someone’s home, or making sure that there is space and opportunity for karakia to be said before sharing a meal.
• Behaving appropriately in people’s homes, residential facilities and in meetings.

Rangatiratanga (authority)

• Understanding that the client and their whānau need to have a sense of control over what happens to them in a health or wellbeing setting in order to maintain their independence.
• Recognising, respecting, and valuing the tangata’s cultural identity at all times.
• Encouraging and supporting the person and their whānau to make their own choices.
• Providing holistic support so that the person and their whānau have their values supported and their social, spiritual and emotional needs met.
• Ensuring the whānau’s voice is heard when writing a personal plan or goal setting and in any interviews.

Kaumātuatanga (later life)

• Understanding the valuable role of kaumātua and kuia within whānau and the community.
• Having organisational policies and procedures that support the cultural values important to people.
• Respecting, recognising, and celebrating elders within their services.

Whakapapa (genealogy)

• Understanding the importance of family and whānau links and relationships.
• Recognising and respecting a person’s cultural identity by encouraging the person to identify the things that are culturally important to them.
• Establishing a positive and supportive relationship with the person’s family and whānau, including them in the person’s support.
• Recognising how important it is that a person is supported by family and whānau, and for the workplace to ensure cultural considerations are included in policies and procedures.

Whānaungatanga (connectedness)

• Having policies and procedures that recognise and reflect the importance of family and whānau in a person’s life.
• Providing opportunities for discussion and allowing time for decisions to be made.
• Ensuring that decisions made for the benefit of one person do not undermine the wellbeing of others involved.
• Ensuring support workers show they understand the importance of family and whānau in the person’s life and include them when developing personal plans.

Mauri ora (good health)

• Mauri ora in the workplace aims for people to have a balance between emotional, spiritual, culturalcultural, and physical health.
• Workplaces should have policies and procedures that protect people’s quality of life and wellbeing as well as the things that are most valued by people and their families and whānau.

Wairuatanga (spirituality)

• Respecting and recognising the tangata’s unique spirituality, faith, beliefs, and religion and allowing opportunities for people to practise their beliefs and values.
• Recording a tangata’s spiritual beliefs and practices in their personal plans.
• Having systems in place for support workers to learn about spiritual belief systems they are not familiar with so they can keep the person culturally safe.
• Giving support workers access to support from chaplains, tohunga or kaumātua.

Tapu and noa (sacred and non-sacred)

• Understanding these concepts and applying them in your support work, for example, not placing combs and brushes on a surface where food is placed.
• Being educated and informed about their rights and responsibilities as employees for the people being supported.
• Communicating safely and sensitively during everyday routines and interactions with workmates, members of the multidisciplinary team, the tangata being supported and their whānau/families.
• Knowing what is culturally important to the person and recognising when a person is feeling unsafe.

Kaitiakitanga (guardianship)

• Understanding that the resources and practices that best meet the total needs of the person are preferred to the cheapest resources and practices.
• Demonstrating best practices, for example, in service delivery models, the number and expertise of staff employed and providing effective training.
• Demonstrating behaviours that reflect responsibility for safely supporting a person and their whānau/ family, for example, always following safety directions.
• Ensuring that the tangata and their whānau /family know exactly what is happening and what resources and supports are available to them, for example, advocacy services, whānau Māori chaplains, Māori providers and other support services.

Mana (prestige)

• Understanding the value of mana by valuing, acknowledging, and protecting people’s standing in the community and their status in their whānau/family, hapū and iwi.
• Empowering people and their whānau/family to make decisions that best benefit them holistically, so their values are supported and respected. Respecting and recognising the rights of the people they support.
• Displaying quality and integrity in your work, for example, honesty, respect and sharing power in a reciprocal (‘give and take’) relationship.

Manaakitanga (hospitality)

• Having opportunities for staff to participate in training and education about cultural safety and awareness. This ensures that people are valued and respected, especially by those who may be a different age, gender, religion, ethnicity, immigrant status or sexual orientation.
• Making people new to the service feel valued and welcome in the workplace. This helps build ongoing goodwill.
• Behaving in ways that make the person and their family and whānau feel valued, respected, important and welcomed.
• Supporting the person and their whānau/family in a professional manner. By asking, not assuming, and by advocating for the person and their whānau.

Whakarite mana (working correctly)

• Working within the job guidelines and scope of practice, adhering to role descriptions.
• Complying with specific workplace policies and procedures on privacy, safe work conditions and the person’s wellbeing.
• Understanding and complying with the intentions and principles of the Treaty of Waitangi.

Socio-cultural “factors” and socio-cultural “identity” are not the same. While socio-cultural factors can influence socio-cultural identity, they are not the same thing. Socio-cultural identity is a more personal and individual experience, while socio-cultural factors are external conditions that can shape that experience. Understanding one’s socio-cultural identity is important as it helps individuals to appreciate and celebrate their own cultural heritage, as well as to respect and appreciate the diversity of others. It also helps individuals to understand the social and cultural context in which they live, and how that context shapes their experiences and perceptions.

Socio-cultural factors

Socio-cultural factors refer to the social and cultural conditions and influences that shape the behaviour, beliefs, and values of individuals or groups in a society.

As we have found out previously these factors can include things like language, religion, education, social norms, and economic status, among others.

An example of a socio-cultural factor could be someone who has the influence of religion on a particular society. For instance, religion may play a significant role in shaping the behaviour and beliefs of the individual, and this can then affect various aspects of their lives. This could include their attitudes toward social and political issues, their lifestyle choices, and their relationships with others.

Socio-cultural identity

On the other hand, socio-cultural identity refers to the sense of belonging and identification that individuals or groups have with a particular culture or society.

It includes the social and cultural aspects of a person’s identity, such as their ethnicity, race, gender, sexual orientation, and nationality.

An example of socio-cultural identity could be a person’s sense of belonging and identification with a particular ethnic or cultural group. For instance, a person who identifies strongly with their Hinduism heritage may feel a sense of pride in their cultural traditions and values, and this may shape their worldview and perspective on various social and political issues.

Traditional healthcare practices hold significant importance within the realm of medical care, often being undervalued. These age-old methods are prevalent across various nations and have garnered growing recognition, as indicated by the World Health Organization's statement that "the demand for its services is increasing" (Medicine Strategy 2014-2023).

Taken from this medicine strategy many countries now recognize the need to develop a cohesive and integrative approach to healthcare that allows governments, healthcare practitioners and, most importantly, those who use healthcare services, to access traditional medicine in a respectful and cost-efficient manner.

The WHO Global Centre for Traditional Medicine (GCTM) is a knowledge centre for traditional medicine.

Watch: The WHO Global Centre for Traditional Medicine (2:39 Minutes)

Before watching this video, consider: have you ever used a traditional medicine, either from your culture or another culture? Did you find it effective?

Watch the following video and reflect on how you view traditional medicine use.

Research activity

Traditional Chinese Medicine (TCM) has evolved over thousands of years. Use web resources to research TCM and answer the following questions:

1. What are some of the components of TCM?
2. What does modern science say about TCM ingredients and processes?

Traditional Māori healthcare

Traditional medicine has been practised in the Pacific islands over many years, and Pacific people have continued to use these methods after migrating to New Zealand.

Te Whare Tapa Whā

Te Whare Tapa Whā is a holistic model of health and well-being that was developed by Sir Mason Durie in 1984 to provide a Māori perspective on health.

The model depicts the overall health of a person as a wharenui (meeting house) with four walls representing four dimensions of the person’s well-being. If any one of these walls is missing, weakened or damaged, the person’s health suffers, and they will become unwell unless that wall is restored.

The four cornerstones (or sides) of Māori health are whānau (family health), tinana (physical health), hinengaro (mental health) and wairua.

For many Māori modern health services lack recognition of taha wairua (the spiritual dimension). In a traditional Māori approach, the inclusion of the wairua, the role of the whānau (family) and the balance of the hinengaro (mind) are as important as the physical manifestations of illness.

The idea behind Te Whare Tapa Whā is that when someone is having trouble with one of these dimensions of their well-being, they can draw on the strength of the other three dimensions while they work on the area where they are feeling under pressure. This model presents these five dimensions as being equally important to the overall health and well-being of the individual.

Cultural diversity means a number of different cultures, societies or people of different origins, religions and traditions all living and interacting together by communicating, connecting and collaborating with one another in some way.

As a support worker, you will most likely work in a very culturally diverse environment, with many people whose cultures are different from your own, e.g. elderly, or young people, Māori, Europeans, Chinese, Pacific people, nurses, etc.

Supporting cultural diversity

It is important to research and act in line with the customs and protocols that are acceptable for the person’s culture. If you don’t know, ask, or make clear that you don’t know what is expected.

Identifying strategies

There are strategies that you can use as a health and wellbeing support worker to ensure a culturally safe environment and a service that meets the cultural needs of the tangata you support.

Most strategies are based on being aware that a person’s culture is different from your own, and finding out how you can support their culture. Click on the plus icons below to display some strategies.

Remember to review and evaluate the strategies you use to support diversity in the workplace.

Cultural sensitivity and client outcomes

• Empowering clients to take ownership of their health can lead to better self-management and outcomes.
• When healthcare providers take cultural norms into account, they can better promote health behaviors that align with those norms. This can lead to more successful health promotion efforts.
• Including the family in the discussion and planning of the care plan is also beneficial:
  • the family may be more supportive if they have been involved
  • family will be able to advocate for the client
  • conflict may be reduced
  • family will be able to support the client to achieve agreed goals and outcomes
  • equity in resourcing to access services

Personal safety and the safety of the tangata you support is important. Personal safety includes being aware of situations that may put you at risk. Organisational policy and procedures provide guidance on how to act when you feel your personal safety may be at risk.

You may feel your personal safety is at risk when:

• working with aggressive clients or their whānau
• a client is making suggestive sexual comments
• taking a client to an appointment
• providing support to a client in their own home
• taking clients on an excursion

Strategies to manage potential risk to your personal safety include:

• using common sense and being practical
• ensuring the support you provide is practical and fair
• recognising when a situation may put your safety at risk and reacting early enough to prevent a risky situation
• always respecting the client and their whānau/family
• following organisational policies and procedures
• following a client’s risk management plan

You may put yourself at risk if you think you can handle a ‘risky situation’ on your own and do not seek help from your supervisor or other staff members. It is important to always follow organisational guidelines.

Minimising risks

It is important to identify and minimise potential risks when supporting clients. 

Using the NZ Government WorkSafe - Health services website, identify some risks to your personal safety that you may encounter as part of support work, and some strategies you could implement to manage those risks. Complete the form below. 

De-escalation

In any workplace there will be conflict of some sort. “De-escalation” is a strategy used to calm a hostile situation which, if not addressed, could potentially cause harm to yourself or another.

When de-escalating there are two key concepts to remember:

1. It is important to recognise that reasoning with an angry person may not be immediately possible. The first and only objective in de-escalation is to reduce the level of agitation so that discussion becomes possible.
2. De-escalation techniques might seem counterintuitive, as they challenge our innate 'fight or flight' responses. Yet, they are essential tools for us as support workers. To be effective, we must remain calm and centred. We need to be professionally detached when faced with heightened emotions. Therefore, these skills require practice to become useful. 

Factors that can contribute to anger include:

• loss of personal power
• maintaining self-esteem
• fear
• perceived failure
• seeking attention
• displaced anger
• psychological or physiological causes

Potential signs of agitation in clients:

• raised voice
• rapid speech
• high pitched voice
• fidgeting
• shaking
• balled fists
• erratic movements
• wild gesturing
• pacing
• aggressive posture

Activity

Read Sandra Ryan’s article on communication and de-escalation in the health sector and reflect on Sandra’s technique for de-escalation. 

Ethical behaviour

Ethics means treating everyone fairly, being honest, and respecting different cultures. Behaving ethically requires doing the right thing, rather than what is easy or convenient. Because everyone has their own culture, beliefs and morals, there can sometimes be differences in opinion, which can lead to differences in our actions that could offend the clients we are working with.

Being ethical in the health and wellbeing sector means showing traits that care about people's well-being and rights while following the ethical principles of the organisation they work in. All workers are part of a multidisciplinary team and must therefore work within the company's codes of practice, and policies and procedures related to the type of work that they are carrying out. Following these guidelines will help to ensure that you behave ethically and competently. 

As we have now discovered, cultural needs refer to the specific cultural values, norms, and practices that are unique to a particular group of people.

In certain instances, we may find it necessary to completely adjust our approach to align with the specific cultural requirements of a particular group. For instance, if a method is centred around individual accomplishments and competitive measures, it might not be appropriate for a culture that highly values collective cooperation and family unity.

Adapting such methods involves modifying the approach, techniques, or language used to harmonize with the cultural norms, values, and practices of the community.

It's important to acknowledge that this process could also entail seeking insights from others to better understand and appreciate the culture of the individuals we're assisting. This knowledge is vital for designing processes and approaches that are culturally suitable and effective.

Ultimately, self-reflection on our communication methods based on cultural needs is an essential stride in constructing comprehensive and impactful methodologies that genuinely serve the needs of all individuals and communities involved.

Dressing appropriately

It is important to consider whether your clothing is appropriate for the workplace and clients you are working with.

In some cultures:

• Modesty is important.
• Clients may refuse to allow support workers of the opposite sex to undress or shower them (e.g. Hinduism, Muslim).
• Clients may wear religious jewellery or items and may not allow support workers to remove these items.
• Shorts, jandals, short skirts, or strapless clothing are not to be worn.
• Some clothing types are not allowed inside places like churches, mosques, temples, etc.
• Sloppy and overly casual clothing is seen as disrespectful.

Useful tips when greeting a new client:

• Cover arms and legs as a sign of respect.
• Seek permission before the removal of any items.
• Always discuss workplace guidelines about your service first in terms of:
• If visiting at homes, remove your shoes or seek permission from co-ordinators for the use of alternative methods, e.g. use of shower caps over shoes.
• Observe clients for changes in their behaviour when you are wearing a uniform; if so, use alternative measures.
• When greeting, read cultural profiles beforehand and follow the client’s lead.
• Be open and ask your client about their preferred cultural process.

Person-centred care

Person-centred approaches are widely used in the New Zealand health sector. It can be seen as a ‘toolbox’ of ways to listen and gather information that enable clients to share decisions about their health and wellbeing.

The 8 principles of person-centred care are:

1. respect
2. emotional support
3. physical comfort
4. information and communication
5. continuity and transition
6. care coordination
7. involvement of family and carers
8. access to care.

If you would like to find out more, head to Patient-centred care for healthcare providers

Watch: Person-Centred Care Guideline (5:37 Minutes)

Watch the following video, which explains person-centred care. You may want to note down the key guidelines summarised towards the end of the video and keep them for your own reference. 

Holistic health

As part of patient-centred care and supporting a person with their health and wellbeing needs, it is important to consider ALL of their needs, not just what they need physically. You need to make sure you have a holistic approach to your support work.

A holistic approach means to provide support that looks at the whole person, not just their mental health needs. The support should also consider their cognitive, physical, emotional, social, and spiritual wellbeing. A holistic approach focuses on a person’s wellness and not just their illness or condition.