Though policies vary province to province, in Canada, physicians have the legal right to enforce what are known as Community Treatment Orders (CTOs) if they feel that a patient, who has been diagnosed with a mental illness, must be legally held responsible to follow a prescribed course of treatment while living in the community. This often includes some type of prescription medicine as well as regular doctor visits (Strohschein and Weitz, 2014, pp.169). When this legal right is used, it is a clear exercise of the power of physicians. Yet it is also a reflection of our culture and societal standards.
Answer the following questions:
1. There are well documented risks and side effects to many antipsychotic medicines. Should people be forced into compliance?
2. Who has the power to define what mental illness is in the first place? How do these definitions serve to reinforce societal norms?
3. Whose interests are really being served when mentally ill patients are legally obligated to take prescribed medications, despite the risks?
In this discussion, you will consider and debate some of the barriers to cultural safety by answering the following questions:
a. According to traditional nursing thought, all people should be treated the same, regardless of their differences. Explain why this can be problematic.
b. There are time pressures in the workplace. Certain tasks must be completed at certain times and within certain routines that the institution has set. However, developing relationships with clients takes time. Discuss how this issue could be addressed. (Hint: Remember that often taking time initially to understand someone’s needs can actually reduce the time needed in future encounters).
c. What other barriers to cultural safety can you think of? How might those barriers be overcome? Can they be overcome?
Something to Think About
“…although descriptions of cultural characteristics and practices can be useful to health care practitioners and researchers, they can also reinforce stereotypes and simplistic views of particular ethnocultural groups as outsiders, as different, and as ‘other’” (Aboriginal Nurses Association of Canada et al., 2010, pp. 18).
“Cultural safety takes us beyond cultural awareness and the acknowledgement of difference. It surpasses cultural sensitivity, which recognizes the importance of respecting difference. Cultural safety helps us to understand the limitations of cultural competence, which focuses on the skills, knowledge, and attitudes of practitioners. Cultural safety is predicated on understanding power differentials inherent in health service delivery and redressing these inequities through educational processes (Spence, 2001)” (Aboriginal Nurses Association of Canada et al., 2009, pp.2)
“While cultural competence is an important concept, it can sometimes overlook systemic barriers, which makes it inadequate to fully address health care inequalities. Cultural safety, however, promotes greater equality in health and health care…[as it addresses the] root causes of health inequalities” (Canadian Nurses Association, 2013, pp.3).
1. For this Discussion, answer the following questions:
a. Explain why cultural competence could be a step backwards.
b. How could having in-depth knowledge about an ethnic group actually be a bad thing when trying to practice culturally safe nursing?
For this discussion, answer the following questions:
1. If it is possible to improve the well being of a client by implementing the principles of cultural safety, why would anyone oppose doing so?
2. Culturally safe practices challenge existing power relations in many ways. Describe how.
3. Most of the burden (as well as the opportunities) involved with implementing cultural safety is currently being placed onto the shoulders of individual nurses. Explain why you think this is.
4. Given what you have learned, do you think it is possible to practice cultural safety in nursing at this moment in Canada? Why or why not?
1. Do you believe it fair to say that white culture and white identity are privileged in Canada and that with this social position comes social power? Remember, the argument is also being made that most white Canadians will not recognize their unearned privileges because it is the norm.
2. Answer the same question asked above, but this time imagine you are a member of a different racial group than the one you were born into. Would this change your answer?
3. The norms, the laws and many of the most powerful institutions in the country are formed around white ideals and ideas in such a way that they are usually not questioned. For example, white people are not racially seen or labeled as white. They are ‘just the norm.’ What are some of the possible consequences of this for people who, by no choice of their own, can never fit ‘the norm’? What can be done to change this situation?
1. Acculturation is the process by which immigrants increasingly adopt the lifestyles and habits of their host country. Explain the effect this has on health status. Does this mean that acculturation is a good thing, or a bad thing?
2. The decline in health is not the same for all immigrants. Discuss why.
3. There are noted, subtle differences in the health statuses of different types of immigrants to Canada. The economic immigrant class tends to have the best health upon arrive to Canada, and the refugee class tends to have the worse. Discuss the social consequences of this for immigrants as well as the possible consequences of acculturation.