Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Browse subjects
  3. Medicine
  4. Nursing
  5. Content listing

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

1453 results in Nursing

Page 52 of 73

  • 8 - Navigating the ethics in cultural safety

  • from Part 2 - The foundations of cultural safety
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 111-124

  • Summary

    Introduction

    Caring is an ethical activity with a deep moral commitment that relies on a trusting relationship (Holstein, 2001 ). Health professionals are expected to be caring, skilful, and knowledgeable providers of appropriate and effective care to vulnerable people. Through universal services they are expected to meet the needs of both individual clients and broader communities, which are activities requiring sensitivity and responsiveness. In an increasingly complex globalised world, ethical reflection is required so that practitioners can recognise plurality: in illness explanations; in treatment systems; in the varying roles of family/whānau or community in decision making; and in the range of values around interventions and outcomes. To work effectively in multiple contexts, practitioners must be able to morally locate their practice in both historical legacies of their institutional world and the diversifying community environment. This chapter examines the frameworks that health professionals can use for crosscultural interactions. I then explore how they can select the most appropriate one depending on the person or group being cared for.

    Ethics

    Ethics is a part of all our actions as humans and as nurses. Ethics is about how nurses talk to their clients, how they respond to difference and how they make decisions. The word originates from the Greek word ‘ethos’, which refers to habits and character. Ethics can be seen in all religions, philosophies and cultures, even in those language groups that do not use the term. In the context of health, having an ethical framework provides a shared means of collectively and systematically examining varying viewpoints related to moral questions of right and wrong. Ethics is also a generic term used to refer to the ways people can think about, understand and examine how best to live a ‘moral life’ (Beauchamp & Childress, 2001 ). Ethics involves critical thinking and asking questions to highlight the appropriate course of action. It requires health professionals to consider and reconsider the taken for granted (Beauchamp & Childress, 1983 ). When working with people, it is inevitable that health professionals will confront an ‘ethical problem’ – a situation that raises questions that cannot be answered with a simple rule or fact.

  • 2 - Cultural safety and the Nursing Council of New Zealand

  • from Part 1 - Setting the scene
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 26-35

  • Summary

    Introduction

    This chapter focuses primarily on the relationship between cultural safety, the Treaty of Waitangi, Maōri health and the legislative requirements of the Nursing Council of New Zealand (‘the Nursing Council’). This includes the ongoing requirements for enrolled nurses, registered nurses and nurse practitioners to demonstrate competence against the competencies for their designated scope of practice. Through the use of practice examples from a registered nurse and student nurse, we consider how nurses demonstrate competence in relation to cultural safety and the Treaty of Waitangi (‘the Treaty’). The use of reflective questions at the end of each practice example enables you to consider your own practice and the examples that you may be able to draw from your practice to demonstrate competence.

    Legislation and standards

    Under the Health Practitioners Competence Assurance Act) 2003 (‘the Act’), the Nursing Council governs the practice of nurses by setting and monitoring standards and competencies for registration which ensures safe and competent care for the public of New Zealand (Nursing Council of New Zealand, 2011a ).

    Cultural safety , the Treaty and Maōri health are aspects of nursing practice that are rel ected in the Nursing Council’s Education Programme Standards for the Registered Nurse Scope of Practice (‘the Standards’). The Standards for the registration of nurses require that the content of theory- and practice-related experience in nursing programmes include cultural safety, the Treaty and Maōri health. Competencies outlined in the scopes of practice for nurses (Nursing Council of New Zealand, 2009 , 2010 ) require the nurse to practise nursing in a manner that the client determines as being culturally safe and to demonstrate the ability to apply the principles of the Treaty to nursing practice. Additionally, the Nursing Council’s Code of Conduct for Nurses (Nursing Council of New Zealand, 2012 ), requires nurses to respect the cultural needs and values of clients, and practise in compliance with the Treaty. Nurses are assessed against the competencies on an ongoing basis. As the regulatory authority, the Nursing Council is committed to enabling nursing workforce excellence.

  • 10 - Child, youth and family health care

  • from Part 3 - Fields of practice
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 141-158

  • Summary

    Introduction

    The major focus of my nursing practice has been in child and family care in the acute hospital child health setting, adolescent and adult alcohol services and drug rehabilitation. Coupled with my research in the area of nurses’ understanding of parenting in hospital, and nurses’ and parents’ emotional communication in hospital, I have developed a i rm resolve that health professionals must have a working knowledge of culturally safe practice. Nowhere is this more critical than in the care of the child, youth and family. In this chapter, the concept of cultural safety as it relates to child, youth and family health is explored. As a Pākehā , I am aware of ways the health system in New Zealand has benefited my culture to the detriment of others’, in particular, Māori. With this in mind, the transfer of power from health professionals to families and children is contended as fundamental to this process. The ensuing discussion is from my experience and perspective, so it does not attempt to discuss another culture’s perspective. Relevant statistics are examined; appropriate care plans, assessments and interventions discussed; and a tool to evaluate care provided to child, youth and families in Aotearoa New Zealand is presented.

  • 6 - Te Tiriti o Waitangi/Treaty of Waitangi 1840

  • from Part 2 - The foundations of cultural safety
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 79-99

  • Summary

    Introduction

    In the 1800s New Zealand was a very different country to the British colony that emerged after February 1840. Although the Maōri world was changing, a decade before the signing of the Treaty of Waitangi (‘the Treaty’) Maōri retained their autonomy. At this time it was estimated that the Maōri population was approximately 150 000 (Kingi, 2005 ). Pre-1830 Maōri were a vibrant and healthy people. They were international traders within and outside of New Zealand, with their own bank. They had total guardianship of their 66 million acres, resources and other assets.

    During the 1830s resident Europeans, however, were few - about 1400 in the North Island and 500 in the South Island. With increasing European settlement came the introduction of arms and what was known as the musket wars resulting in notable decreases in the populations of some iwi. Traders and settlers exploited resources, and while some missionaries and traders purchased smaller pieces of land, speculators acquired large amounts of land. Furthermore, missionaries introduced Christian beliefs and practices (Orange, 2004 ).

    Nonetheless, in direct contrast to promising developments associated with international trade, the health of Māori visibly declined due to the harmful impacts of introduced diseases, warfare and social change. In addition to declining health, Māori had increasing concerns about the lawlessness of settlers in Aotearoa New Zealand. This led to Ma¯ ori leaders petitioning the British Government to address this matter. In 1832 James Busby was appointed the British ‘Resident’ in New Zealand, responsible for the law and order of British subjects, backed by periodic visits from a warship from Sydney Royal Navy squadron. Busby also encouraged Māori chiefs to organise themselves into an entity more recognisable to the British Government to make and enforce British style ‘laws’ (Orange, 2004 ). This approach was unusual, as in some countries that the British migrated to, the indigenous people were almost ignored or brushed aside because they lacked the military and social organisation to resist settlement (Sinclair, 1980).

  • 17 - Nursing and working with disability

  • from Part 3 - Fields of practice
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 252-264

  • Summary

    Introduction

    Disability identity is a difi cult concept because for some it is a personal decision and for others it is political. Māori are very clear that they do not identify as disabled or as people with disabilities. Māori preference to identify from a kaupapa Māori (primarily Māori) and a whakapapa (genealogical) cultural context is nothing new - what is new for many providers of health and disability services is the insistence by Māori that they be referred to as whānau hauā and not as having disabilities.

    When I began my own journey into nursing in 1979, I do not recall ever having to understand any individual culturally or identify a person as having a disability. It was not until I returned to training in 1991 that I first began learning about cultural safety in nursing. It was also the first time I heard the term ‘disability’ which I came to understand as a political identity. In 1993 I could not complete my nursing due to early signs of primary progressive multiple sclerosis and chronic obstructive pulmonary disease from my mother who smoked around me as a child. I left nursing to undertake university study in a social science field and later completed a PhD. In the United States, nurses with disabilities are allowed to continue to practice nursing due to the American Disabilities Act (1990), after they fought for it. In New Zealand, however, this is not necessarily the case. While there are some nurses with disabilities practising, I am personally aware of several who, due to their diagnosis, have felt that they were bullied out of the profession. However, whether they can work or not depends on their nursing environment. Since my own journey in health and disability services as a client, student and practitioner, I have found that the nursing fraternity has a lot to learn about disability, in particular, to whānau hauā and other cultural identities, who are largely ignored by both the cultural and disability communities (Hickey, 2008).

  • 16 - Māori health

  • from Part 3 - Fields of practice
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 235-251

  • Summary

    Introduction

    The right to experience health and well-being by accessing necessary determinants of health, and encounter quality health services is embedded in the principles of social justice, equity and rights. For Māori, their rights extend beyond the human rights afforded to everyone living in Aotearoa, to include Te Tirit o Waitangi/ Treaty of Waitangi (‘the Treaty’) and, more recently, the United Nation’s Declaration on the Rights of Indigenous Peoples (signed by New Zealand in 2010). Article 24.2 states that: ‘Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health’ (United Nations , 2008 , p. 9). Article 3 of the Treaty affirms Māori, as tangata whenua, the same (equal) rights as others living in Aotearoa, which includes health (Durie, 1998). Moreover, the Treaty guarantees tino rangatiratanga - the right to control their life.

    Māori and their whānau live with signii cant disparities and inequities in their health status and health outcomes compared to other groups living in Aotearoa, despite their rights to equality in health and self-determination. They are subjected to a ‘one size i ts all’ style of health services that invariably does not accommodate their health or cultural needs (Wilson & Barton, 2012).

  • 9 - Being a culturally safe researcher

  • from Part 2 - The foundations of cultural safety
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 125-138

  • Summary

    Introduction

    New Zealand legislation like the Health and Safety in Employment Act (1992) is aimed at ensuring that all workers, including researchers, remain physically safe. However, there has been less attention to other dimensions of the safety of researchers or the people we encounter in the course of research. An international exception is the UNESCO Universal Declaration on Bioethics and Human Rights (2005) which addresses the domains of medicine, life sciences and related technologies and seeks ‘respect for human dignity, human rights and fundamental freedoms ’. In this chapter, we reflect on the links between culture, safety and research. In particular, we consider how cultural diversity in contemporary New Zealand society requires us to consider cultural aspects of the conduct of research.

    It is our contention that research involving other people should be founded on principles of partnership . Mason Durie ( 1988 ) has asserted that, following the principles of the Treaty of Waitangi, a working partnership between Māori and non-Māori will be central to the success of any Māori health research. This view has been endorsed and elaborated on in subsequent documents such as the Health Research Council of New Zealand’s Te Ara Tika: Guidelines for Māori Research Ethics (undated). In this chapter we explore the notion of ‘partnership’ in research as a key element of culturally safe research and argue that Durie’s assertion can, and should, inform (and even transform) social and health research in Aotearoa New Zealand – whether it involves Māori or not.

  • 7 - Exploring prejudice, understanding paradox and working towards new possibilities

  • from Part 2 - The foundations of cultural safety
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 100-110

  • Summary

    Introduction

    It is not enough to understand what we ought to be unless we know what we are; And we do not understand what we are, unless we know what we ought to be.

    (T. S. Eliot, 1935 )

    T. S. Eliot reminds us of the relationship between our beliefs and values, and our interactions, interpretations and responses. He also describes the inextricable interrelationship of past, present, and future events and meanings. Exploring past and present meanings of ‘culture’ in the context of New Zealand nursing is an essential part of future development. This chapter begins by tracing the evolving meaning of culture within the context of New Zealand nursing. It then describes the meaning of cultural difference from a nursing perspective and explores the notions of prejudice, paradox and possibility in relation to nursing practice.

    Nurses in New Zealand have experienced considerable public criticism for their efforts towards a fairer and more equitable health service. The introduction of cultural safety in nursing and midwifery education has been, and continues to be, the subject of much debate. Nursing people from cultures other than one’s own is a complex and contradictory undertaking and ‘striving towards right’, in this context, lives in the tensions and prejudices of nursing practice. Success is achieved when possibilities are recognised and the nurse and the person from another culture understand each other.

  • 5 - Culture and ethnicity

  • from Part 2 - The foundations of cultural safety
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 65-78

  • Summary

    Introduction

    The common catch-phrase ‘Culture! We don’t have a culture!’ is often the reply to the question: ‘What is your culture?’ when it is posed to New Zealanders today. Since the implementation of cultural safety in the schools of nursing and midwifery, students have been introduced to concepts that were not as evident in most programmes prior to the early 1990s. Topics such as culture and the dynamics of power are now commonplace within these programmes. Similarly, with the movement towards ‘doing with’ as opposed to ‘doing for’ the client, students are required to possess an awareness of their values, beliefs, biases and prejudices. The first step towards cultural safety, therefore, is for a person to have sufficient awareness of their own culture.

    So, for many students who ascribe to the dominant culture and values in Aoteroa New Zealand, they may well ask the question: ‘Why do I need to learn about my culture?’ This is particularly difi cult for students to reflect on if they believe that they are just ‘normal’ and culture is something Maˉ ori or immigrants possess. The short answer is that once there is clarity about people’s own values and beliefs (which are key components of culture) and how they affect their living, then they are in a better position to appreciate that other people do things differently. Nurses and midwives work with people from a range of cultures and circumstances. To be effective, therefore, they must become aware of their own culture and the impact this has on their practice. Nurses and midwives can unknowingly place other people’s cultural perspectives at risk. This is exhibited when people avoid going to a health service because they perceive the health professional to be disrespectful of their cultural practices and traditions.

  • 13 - Culturally safe care for ethnically and religiously diverse communities

  • from Part 3 - Fields of practice
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 189-203

  • Summary

    Introduction

    Cultural safety is borne from a specii c challenge from indigenous nurses to Western healthcare systems. It is increasingly being developed by scholars and practitioners as a methodological imperative towards universal health care in a culturally diverse world. The extension of cultural safety, outside an indigenous context, reflects two issues: a theoretical concern with the culture of healthcare systems and the pragmatic challenges of competently caring for ethnically and religiously diverse communities.

    As discussed throughout this book, the term ‘culture’ covers an enormous domain and a precise dei nition is not straightforward. For the Nursing Council of New Zealand (‘the Nursing Council’) ( 2009 , p. 7), for example, ‘culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability’. In an attempt at a precise two-page definition, Gayatri Chakravorty Spivak ( 2006 , p. 359), captures the reflexive orientation required to grasp how the term ‘culture’ works:

    Every definition or description of culture comes from the cultural assumptions of the investigator. Euro-US academic culture . . . is so widespread and powerful that it is thought of as transparent and capable of reporting on all cultures. […] Cultural information should be received proactively, as always open-ended, always susceptible to a changed understanding. [. . .] Culture is a package of largely unacknowledged assumptions, loosely held by a loosely outlined group of people, mapping negotiations between the sacred and the profane, and the relationship between the sexes.

  • 14 - Working with the aged

  • from Part 3 - Fields of practice
  • Edited by Dianne Wepa, Hawkes Bay District Health Board
  • Book:
    Cultural Safety in Aotearoa New Zealand
    Published online:
    21 June 2018
    Print publication:
    18 May 2015, pp 204-221

  • Summary

    Introduction

    Frail older residents living in one long-term care facility and the nurses, caregivers and healthcare assistants caring for them, took part in a field study (Kiata & Kerse, 2004). In the facility, which was located in a large New Zealand city, most of the health professionals were of Pacific Island descent and the majority of residents were European (Pākehā). The purpose of the study was to explore how Pacific Island caregivers and Pākehā care recipients in the facility negotiated their way through the giving and receiving of care. Intercultural issues that arose are examined and used in this chapter as illustrative examples.

    Caregivers were sanctioned by management to participate in the research and encouraged by reassurances of coni dentiality. Caregivers were interviewed by two researchers - one young man of Pacific origin, the other a middle-aged Pākehā woman. The frailty of the residents meant that they tired quickly, so shorter interviews were conducted. Residents were quick to become teary during interviews. This may have been part of certain illnesses, such as stroke, or these emotional outbursts may also have been due to the interest shown when asked to share their stories. Certainly, the majority stated that the ‘nurses’ were ‘always so busy’ (Miss E, 90s), and how they were reluctant to bother them. Participant observation was added to interview data, and information and understanding through thematic analysis. Conducting this research gave insight into the everyday lives of those who live and work in residential care.

  • 4 - Personhood and human dignity

  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 51-69

  • Summary

    The concepts of personhood and human dignity are widely used in contemporary healthcare ethics. This chapter provides a brief overview of how the concept of human dignity came to be so important in healthcare ethics, and examines how the concept’s widespread use and relationship to the concept of personhood have led to problems regarding its meaning and relevance. A practical solution is then presented.

    The rise of the concept of human dignity in healthcare ethics

    The word dignity is derived from the Latin dignus, which means worthy. Since dignity refers to worth, human dignity refers to the worth of the human. What makes the concept of human dignity important for ethics is that, unlike the dignity of a queen or the dignitaries at an awards ceremony, which expresses the worth or status of particular human individuals in relation to others, human dignity is meant to express a worth that is equally shared by all human individuals. It is not meant to be dependent upon their social status, economic wealth, race, gender or anything else. Moreover, it is meant to affirm a worth beyond price. Human individuals are said to be moral goods or ends in themselves, not merely good or useful as means to achieving other ends.

  • 11 - Conscience and the healthcare professional

    • By Brigid McKenna, Office of Life, Marriage and Family in the Archdiocese of Hobart, Tasmania
  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 174-192

  • Summary

    If all the world hated you and believed you wicked,

    while your own conscience approved of you and absolved

    you from guilt, you would not be without friends.

    – Charlotte Brontë, Jane Eyre

    Conscience is widely recognised as a universal, yet highly personal, human phenomenon. In recent times, however, the role of conscience in public and professional life has increasingly been challenged. This chapter explores whether conscience is indeed the ‘friend’ or ‘foe’ of healthcare professionals and all those who seek their services. It proposes a definition of conscience that is grounded in traditional ethics, and introduces the reader to the concept and practice of conscientious objection. This is followed by an analysis of challenges to the legitimacy of conscientious objection in a contemporary healthcare system, and a discussion of how the case for or against conscientious objection ultimately depends on competing models of healthcare and professionalism. The chapter concludes with proposals for how conscientious objection might best be accommodated in a contemporary healthcare setting.

    What is conscience?

    Most people – including most scholars – presume that conscience exists, and that its function is to alert us to a potential conflict between values and to indicate which values should guide our choices (Morton & Kirkwood, 2009).

  • 1 - Why study healthcare ethics?

  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 1-13

  • Summary

    Studying any discipline is worthwhile simply for the knowledge it brings and the skills in reasoning that can be learned and honed. For healthcare professionals, study – formal and informal – is part of the vocation: competence and excellence are not benchmarks to be achieved once in a lifetime and then relegated to the shelves, as one might a sporting trophy. Rather, the health professions demand a commitment to lifelong learning. Part of that professional commitment is an awareness of and engagement with the ethics of health and healthcare. The skills of this philosophical discipline are just as vital as clinical skills and the various dimensions of physiological and psychological knowledge that are essential for the work of a healthcare professional.

    Why ethics?

    Ethics has been an important sub-set of philosophy since the time of the ancient Greeks. For those early philosophers, there were three big questions to be answered by every human being and every society:

  • What does it mean to be or to exist?

  • How do we know – what is knowledge and how do we go about knowing?

  • How should we live – what is a good life?

    • It is the third of these questions that is the core concern of this book.

Page 52 of 73