Australia has a large and expanding population of people from a refugee background â€“ referred to as ‘refugees’. Refugees in general, and refugee women in particular, have distinctive and diverse health needs which require complex and conscientious responses from nurses and health systems. In the context of nursing refugee women in Australia, this paper will explore the need for cultural safety in nursing.
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It will then analyse the negative impacts of culturally unsafe nursing practices and health systems in Australia on refugees and refugee women. Finally, it will discuss how culturally safe nursing practice can (and should) be achieved in Australia to improve the health outcomes of refugee women and others of diverse backgrounds. The Nursing Council of New Zealand (2002: p. 7), which developed the concept of cultural safety, defines it as “the effective nursing â€¦ [care] of a person or family from another culture, [as] determined by that person or family”. Fundamentally, culturally safe nursing practice focuses on supporting diverse people to effectively access and engage with mainstream ‘biomedical’ health systems, and so reducing the high rates of poor physical and psychological mental health outcomes in these populations (Johnstone & Kanitsaki, 2007). Culturally safe nursing practice achieves this by attempting to deconstruct the inequitable power relationships between patients and health providers and systems, which are a significant barrier to health access and engagement for socio-culturally vulnerably groups (Anderson et al., 2003; Woods, 2010). This is achieved through a focus on culture. However, culturally safe practice does not involve nurses learning others’ cultures; indeed, diversity both between and among cultures is too significant to allow a nurse to do this meaningfully (Woods, 2010). Instead, culturally safe nursing involves a nurse reflecting on their own culture and on the legitimacy of others’ cultures in the context of the nursing care they provide (Mortensen, 2010). Belfrage (2007) notes that ‘cultural safety’ underpins the provision of the most effective health practice and systems for diverse groups in Australia. This is particularly true in the context of refugee health. The United Nations’ 1951 Refugee Convention, Article 1(A)2, defines a refugee as any person residing outside their country of nationality or residence due to fear of persecution (UNHCR, 2015). As a signatory to this Convention Australia has an obligation to assist with the resettlement of refugees, including a special category of refugees referred to ‘women at risk’ (Australian Law Reform Commission, 2015; Parliament of Australia, 2015b). In 2013-14, Australia resettled a total of 6500 refugees, approximately 3.2% of its total migrant intake (Parliament of Australia, 2015b). The majority of these refugees were from Afghanistan (39%), with significant numbers also from Myanmar (18%) and Iraq (13%) (Parliament of Australia, 2015b). In response to the Syrian refugee crisis, in 2015-16 Australia will significantly increase its intake of refugees within existing humanitarian quotas (Parliament of Australia,
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