Becoming a Culturally Competent Health Practitioner in the Delivery of Culturally Safe Care: A Process Oriented Approach

Abstract: The ongoing evolution of cultural competence and cultural safety in the health disciplines over recent decades is apparent. This paper presents an argument, within a process-orientation, that advancing cultural competency leading to culturally safe care for vulnerable people develops in tandem with advancing generic skills ana is dependent on these skills. A framework, extrapolated from Benner and her colleagues' concept of 'skills of involvement' , provides a guide for assessing the advancement of these competencies. Included are some ideas for implementing the framework in practice environments. Key Words: Cultural Competence, Cultural Safety, Process, Generic Competence, Assessment Cultural competence and culturally safety entered into the lexicon of health disciplines in the late 20th century. Cultural competence is the term used for the development of skill needed in health discipline practitioners, for example nursing, medicine, social work, clinical psychology, occupational therapy, pharmacy, osteopathy, for working with clientele who come from cultures that differ from that of the practitioner. Cultural safety, a term developed in Aotearoa/New Zealand and currently used internationally, focuses on culturally safe care as a health outcome. This paper builds on the growing body of knowledge on cultural competence and cultural safety. It presents these as complementary constructs. To make both these constructs more consistent with emerging views of what constitutes capable practitioners in the twenty first century the paper argues that cultural competence and cultural safety are always in a process of evolving and that they emerge from and are embedded in generic competence. In the first instance, the paper examines a process orientated, generic notion of prof essional competence interlinking this with cultural competence and cultural safety. Transposition of the process oriented framework demonstrating the shifts involved in moving from novice to expert, developed by Benner and her colleagues (Benner, Tanner, & Chesla, 1996), into more specific cultural competence is then presented as a guide for tracking its evolving nature. Included are some ideas on implementation of the framework in a practice environment. A process perspective of culture taken from Hatrick Doane and Varcoe (2005) and Dean (2001) informs our process orientation to cultural competence and cultural safety. These authors observe that culture, the shared values, ideas and identity of a group, which structures their understanding of and actions in the world, is existentially lived by groups. As people and groups change and transform within an everchanging environment, so does their understanding of their culture. Such a transformative perspective differs qualitatively from the behaviourist view of culture, an objective attribute that influences how people live, which provided the basis for earlier developments of cultural competence and cultural safety. This process perspective highlights difficulties with cultural competence models based primarily on understanding the values and practices of different ethnic groups. BACKGROUND The main impetus for the present focus on cultural competence and cultural safety in the international arena emerged from inequalities in the health status of marginal groups and a drive to improve this situation (Australian Government - National Health and Medical Research Council, 2005; National Centre for Cultural Competence, 2002; Nursing Council of New Zealand, 2005; Ramsden, 2000). The beginnings of cultural safety in Aotearoa/New Zealand arose from concern about the health outcomes for the indigenous Maori population. In the United States and Australia, because of the drive to improve the health outcomes of marginal groups, specific agencies operate to assist organisations to develop policy and programmes for cultural competence. Cultural competence and cultural safety is also relevant to other groupings, for example, older people, people with specific gender or sexual orientation, religious beliefs, and disabilities (Dean, 2001; Nursing Council of New Zealand, 2005). …