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Cultural bias here in this example, that does not just reflect a "simple misunderstanding" of language but reveals a greater failure in the sense that the nurse did not see the patient as someone who understands, leading to the patient being compromised for potential unequal treatment. Overall, I do believe that with every conversation, every piece of reflective work, with every patient interaction, I remain hopeful that a healthcare system that is more culturally respectful, culturally inclusive and without cultural bias is possible in all parts of Australia. Author Traci Travers Assoc Dip Aboriginal Studies, RN, BN, Grad Dip Corrections Health and Forensic Nursing, Grad Dip Sexology, Grad Cert University Learning and Teaching is Lecturer in Nursing in the Discipline of Nursing/School of Health/Faculty of Medicine and Health at the University of New England, NSW Australia As a First Nations Academic from Biripi, I acknowledge and pay respects to the Anaiwan, the Traditional Owners of the land on which I live and work, and their neighbours, the Gumbaynggirr, Dunghutti, and Gomeroi.
As an Indigenous travel nurse working across many nations and countries, what Australia has to offer, working remotely in Aboriginal and Torres Strait Islander communities has brought privileges, most are not fortunate to experience.
The unique challenges bring their own rewards that require an experienced skill set of patience, flexibility, understanding and most importantly a great sense of cultural responsiveness.
However, during my travels throughout the Northern Territory and Far North Queensland I have encountered situations that have left me unsettled: cultural bias among my peers.
As a First Nations nurse working for Aboriginal and Torres Strait Islander communities, this is an uncomfortable reality, but one that needs addressing if we are truly going to meet the equitable health needs of First Nations people, regardless of the nurse's background.
It's a privileged position working in community. Although more times than not, lam not on my own Country. Over time, have noticed my role swaying towards voluntarily serving as a bridge in assisting nurses to connect more genuinely with Aboriginal and Torres Strait Islander patients, in terms of cultural practices vs clinical education.
As well as my clinical load, I often felt an increase in cultural load. More times than not my cultural responsibility found me advocating for the community values and traditions, to other nurses who may not fully understand or appreciate the ways of living.
An example I have observed many times is nurses directly informing the patient, on what they believe the patient must do, or even a sense of dismissiveness in communication. This is not primary care; this is not holistic care. This is cultural bias in presuming the patient does not know what the nurse is talking about and often the nurse spoke their own version of pidgin English, to convey their message.
This is a deep assumption that where English is a second, sometimes third language that the patient does not understand, which leads to disrespect for the patient and culture whilst being on their Country. The fact remains, First Nations people understand English.
Cultural bias here in this example, that does not just reflect a "simple misunderstanding" of language but reveals a greater failure in the sense that the nurse did not see the patient as someone who understands, leading to the patient being compromised for potential unequal treatment. This situation was not an isolated incident, I would see this often during the day, every day. This was a generalised response when communicating with Aboriginal and Torres Strait Islander peoples.
What happens in these moments is the subtle erasure of cultural respectwith the assumption that the patientis not understanding and now is placed in an inferior position by the cultural bias of the nurse. I have finished many shifts with the thought, does the patient leave the clinic with a feeling of being unheard or even undervalued? If so, would this suggest there is a divide caused by cultural bias. Does cultural bias contribute to increasing the divide?
While I have the utmost respect for remote nurses, at no time am | saying thatall remote nurses come with cultural bias, I would like to stress again - this has been my observation whilst working as a travel nurse. It's incredibly important - more like essential that nurses who work with First Nations peoples have a clearer perspective on how Aboriginal and Torres Strait Islander people perceive healthcare, something which is bound in identity, spirituality, history and cultural context on Country. The one size fits all approach does not work - it may cause harm.
While I'm not responsible for educating every nurse, there is a sense of cultural duty to ensure First Nations peoples receive culturally safe care. As a First Nations nurse navigating cultural bias and as a First Nations nurse this isn't just about tackling cultural bias, it's about creating a space where patients can be culturally respected.
This will require the nurse to firstly recognise that their practice could do better in terms of much self-reflection and self-awareness in recognising their own cultural bias and assumptions that perpetuate stereotypical behaviours. This is known as cultural responsiveness; however, I think to address this, nurses should adopt an approach of cultural humility which includes a willingness to learn from the patient.
Through my journey in working in remote locations within Australia as a First Nations nurse, I have come to understand and observe - that our role extends far from just providing clinical care. Itis about assisting in the healing and bridging of cultures. Overall, I do believe that with every conversation, every piece of reflective work, with every patient interaction, I remain hopeful that a healthcare system that is more culturally respectful, culturally inclusive and without cultural bias is possible in all parts of Australia.
Author
Traci Travers Assoc Dip Aboriginal Studies, RN, BN, Grad Dip Corrections Health and Forensic Nursing, Grad Dip Sexology, Grad Cert University Learning and Teaching is Lecturer in Nursing in the Discipline of Nursing/School of Health/Faculty of Medicine and Health at the University of New England, NSW Australia
As a First Nations Academic from Biripi, I acknowledge and pay respects to the Anaiwan, the Traditional Owners of the land on which I live and work, and their neighbours, the Gumbaynggirr, Dunghutti, and Gomeroi. I also pay respects to cultural knowledge holders and Elders, past, present, and emerging, and acknowledge my Elders of the Biripi Nations.
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