INFORMING NURSING EDUCATION: THE MEANING AND EXPERIENCE OF CULTURAL SAFETY AS EXPRESSED BY NURSES IN THE PACIFIC NORTHWEST
Dekker, Lida Jean
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The purpose of this dissertation was to explore how selected nurses in the United States (U.S.) Pacific Northwest are adapting and incorporating concepts of Cultural Safety into their clinical and education practices. The pioneering work of the New Zealand nurses to incorporate the transformative concepts of Cultural Safety into their education programs and nurse practice laws inspires and informs this study. U. S. nurses have not yet implemented a framework that is effective in defining culture broadly and reducing health disparities between the dominant culture and multiple minority cultures. Cultural Safety combined with Critical Race Theory may offer such a useful framework to inform nursing cultural competence in the United States. Connecting historical, social, political and health issues with meanings and experiences of nurse educators helps to establish a foundation for incorporating reflection and Cultural Safety in contemporary nursing education. A hermeneutic phenomenological study was conducted in order to explore the meaning and practice of Cultural Safety with five nurse educators and practitioners, and to constructively critique U.S. nursing education related to how cultural competence has been taught. Study findings are presented as four themes common to each participant's story. The themes are positionality, embodiment, reflection and the inherent tension in a Cultural Safety stance. Within positionality are themes of self-identity, power differentials, and critiques of the status quo or meeting a need. Embodiment contains ways of incorporating Cultural Safety into personal life, clinical practice, teaching and scholarship. Reflection is self-identified by participants as a conscious practice, as well as demonstrated in highly articulate narratives. As a critical process, the Cultural Safety stance has an inherent tension that is expressed in the desire for transformation in nursing education and practice which links to positionality and embodiment. There are overlaps and interplays between and among the themes that may be viewed in an encompassing theme of choosing to live one's life in the role of advocate. Challenges of the advocacy role are portrayed in a proposed model for transforming current common U.S. concepts of cultural competence to be more effective in providing care to an increasingly culturally complex society.