Introduction: Practising nurses and midwives are urged to enrol in a unique program to make Cultural Safety and Cultural Humility best practice in working alongside and when providing care for Aboriginal and Torres Strait Islander patients and communities.
The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) launched its Murra Mullangari program on 16 March to also mark Close the Gap Day ahead of the United Nations’ International Day for the Elimination of Racial Discrimination on 21 March.
This article is published by Croakey Professional Services as sponsored content as part of a series celebrating CATSINAM’s 25-year history of collective and individual activism. See their campaign portal.
Aboriginal and Torres Strait Islander readers are advised that this article mentions a person who has passed away.
Croakey Professional Services writes:
The values and beliefs of those who provide healthcare to Aboriginal and Torres Strait Islander communities is a central area of study in CATSINaM’s ground-breaking Murra Mullangari program.
The first Indigenous-developed Cultural Safety program for nursing and midwifery to also include Cultural Humility has been a very long journey, according to CATSINaM CEO Professor Roianne West, who said Elders and ancestors had for five decades been calling for education that took into account colonial power structures.
“It’s the very first time a program like this has been done outside of the university sector and a program that really sets the standard for Aboriginal and Torres Strait Islander health and Cultural Safety education. It adds the additional dimension that’s unique to CATSINaM, and that’s the aspect of Cultural Humility,” Professor West said.
Murra Mullangari means “the pathway to wellbeing” and is a term gifted to CATSINaM by Aunty Dr Matilda Williams-House, a Ngambri-Ngunnawal Elder and CATSINaM Matriarch.
Clinically safe practice in nursing and midwifery is not possible without culturally safe practice, Professor West told last week’s webinar to launch ‘Murra Mullangari: Introduction to Cultural Safety and Cultural Humility e-learning program’.
“Clinically safe nursing practice that happens without culturally safe nursing practice is actually racism and something that we want to address,” she said.
Murra Mullangari is an eight-hour program completed over eight weeks and is specifically developed for practising nurses and midwives in clinical and non-clinical roles at any stage of their career. However, others can also undertake this program.
The course content includes the origins, influences and implications of Cultural Safety and Cultural Humility in practice settings; the culture of power in Australia and in nursing and midwifery; and the achievements of Indigenous health, nursing and midwifery leaders. It extends studies in nursing undergraduate programs and is expected to be the foundational course in a suite of Cultural Safety programs that CATSINaM will lead in coming years. Professor West said research would be conducted to evaluate the efficacy of Murra Mullangari.
Cultural Safety is an important aspect of CATSINaM’s aim to significantly increase the Indigenous nursing and midwifery workforce.
Australia’s Chief Nursing Officer Adjunct Professor Alison McMillan told the launch webinar:
We know that a pathway to building the Indigenous nursing and midwifery workforce is to increase Cultural Safety practice for the wider nursing and midwifery workforce and the Cultural Safety of processes and systems.
There is no safe healthcare without Cultural Safety.”
A whole learning process
Aunty Dulcie Flower OAM, a CATSINaM founding member and a Registered Nurse for more than 60 years, told the webinar that Cultural Humility “is something that you learn; you’re not born with this, it’s a whole learning process”.
She said Cultural Humility involved a relationship of trust between nurses and midwives and their Aboriginal and Torres Strait Islander patients, treating people with cultural respect, and ensuring privacy and confidentiality.
The CATSINaM Cultural Humility model is based on principles where Humility is understood as Relational and Contextual and occurs through Insight, Hindsight and Foresight. Therefore, Cultural Humility is a journey of lifelong learning about the power, attitudes, trust and safety afforded to nurses and midwives.
Auntie Dulcie was the first Torres Strait Islander nurse involved in the formation of the Redfern Aboriginal Medical Service and is an Elder of the Erub Nation.
She said in a video for Murra Mullangari that the course would give nurses and midwives skills that will last a lifetime.
“You will make a difference to the way you nurse your patients and ensure that their culture is respected and that your own culture is also respected,” she said.
Dr Karen Martin, CATSINaM Education and Training Lead, said the course explored aspects of Australia’s historical, political, systemic and social factors, and their impact as a culture of power on nursing and midwifery systems – and on the delivery of healthcare to Aboriginal and Torres Strait Islander peoples.
“It is underpinned by Aboriginal knowledges and, therefore, Aboriginal pedagogy,” she said.
The culture of power
The term ‘Cultural’ in Cultural Safety is not about cultural identity, ethnicity or traditions. Rather, it’s about the ‘culture of power’, which involves processes of “unlearning, relearning and transforming” existing relationships to, and benefits of institutional, collective and personal power.
CATSINaM has led the development of Cultural Safety policy and practices across the healthcare sector in Australia, informed by the work of Māori nurse and scholar Dr Irihapeti Merenia Ramsden.
Dr Ramsden’s work has transformed the power dynamics in nursing and midwifery education, practice and policy around the world.
She explained in her PhD thesis that Cultural Safety turns the gaze on health professionals to examine their own power, beliefs, attitudes, behaviours, practices and understand the relationship to systems and issues such as institutional racism. Cultural Safety is therefore not about transcultural concepts such as ‘cultural awareness’, which promotes the “othering” of patients and staff and what she called “cultural voyeurism”.
Close The Gap campaign
The annual Close The Gap Campaign Report released last week found that Aboriginal and Torres Strait Islander communities and organisations are leading the way in transforming Australia’s health and community services, policies and programs – despite the ongoing impacts of systemic racism, natural disasters and pandemics.
“However, despite the cultural safety, intellect and integrity that Aboriginal and Torres Strait Islander people and communities bring to solutions, governments and mainstream organisations still fail to recognise and invest in Aboriginal and Torres Strait Islander leadership and capacity,” the report said.
The Close The Gap report, prepared by the Lowitja Institute for the Close the Gap Steering Committee, of which CATSINaM is a member, uses a strengths-based framework to demonstrate how Aboriginal and Torres Strait Islander ways of knowing, being and doing present culturally safe, place-based, and appropriate solutions.
The CATSINaM Murra Mullangari program is a clear example of such leadership and capacity.
An Indigenous-led movement in Cultural Safety and Cultural Humility
Greg Rickard, Professor of Health at the University of Tasmania and one of 26 people who was a participant in the pilot of Murra Mullangari, said the program challenged non-Indigenous health practitioners to look at Cultural Safety and Cultural Humility from “a power perspective” to understand the impact of colonisation and racism on healthcare for Indigenous patients.
“My hope is that, together with Aboriginal and Torres Strait Islander peoples, we can start to understand and address the many factors impacting on Closing The Gap on health inequalities between Indigenous and non-Indigenous peoples,” he said in a video message to the webinar.
“The Murra Mullangari program takes us all on a journey, no matter what our knowledge and experience we may have working with Aboriginal and Torres Strait Islander peoples.”
Professor Rickard said he had for many years been concerned about cultural awareness and cultural competency programs that were “about” Indigenous peoples, emphasised health deficits and disenfranchised Aboriginal and Torres Strait Islander communities.
Dallas McKeown, a Yuwaalaraay woman, was another participant in the pilot. She said the self-reflection in the program led her to “dig deep personally”, often finding herself in a vulnerable place – “and that’s cool because you learn from that place”.
Dallas added: “Murra Mullangari is like a really good curry. It leaves you wanting more.”
Watch the webinar launch of Murra Mullangari: Introduction to Cultural Safety and Cultural Humility e-learning program.
Dr Irihapeti Merenia Ramsden PhD thesis: Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu; Victoria University of Wellington, Aotearoa, New Zealand; 2002.
‘Creating an Indigenous-led movement for Cultural Safety in Australia’ by Adjunct Professor Janine Mohamed and Professor Roianne West; Croakey Health Media.
Close the Gap Campaign Report 2022 – Transforming Power: Voices for Generational Change; Lowitja Institute.
This article was funded by CATSINaM and edited by Professor Roianne West and Dr Karen Martin. It was written on behalf of Croakey Professional Services by Linda Doherty, and also edited by Dr Tess Ryan and Dr Melissa Sweet.
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