Comparación de los resultados de temperaturas

The following section will show that when the participants were asked about what cultural safety means to them, they talked about what nursing means to them. However this does not mean that cultural safety can be subsumed into nursing and neutralised as an ‘aspect’ of nursing. Cultural safety offers nursing a framework for clinical judgement and assessment guided by a conscious, active reflection in each nursing interaction. Cultural safety knowledge can alert the nurse to practice situations where communication, relationships and health care outcomes have the potential to be influenced by power, difference and identity and in this way provide a pathway for nurses to bring a critical analysis to their everyday practice. Ramsden’s (2002) claim that cultural safety is a bicultural relationship supports a view that there are two people in any nursing relationship and that these two people bring their unique cultures to bear on what happens in that relationship. It is through examining the nurse in relation to another person that meanings of cultural safety are formed.

When people speak, they are speaking who they are-what their culture is, what influences their thinking their values and beliefs and how self reflective they are - what are the social discourses and power arrangements operating in the speech, and what things are happening during the act of speech. (Labov & Waletzky, 1997, p. 74)

Following are brief statements of what cultural safety means for selected participants. Elizabeth considers cultural safety to be about good listening, being real, good manners and respecting another person. For Debbie, cultural safety means feeling right about what I am doing. Louise considers that cultural safety is about knowing your own beliefs, seeing the person in a wider, bigger, family situation and recognising her own stress. For Janis, it means the protection of individual clients or patient’s identity or beliefs, andbeing comfortable in yourself. Meaning for Sally is being respectful of another person's values and what is important to them. ForPatricia cultural safety involves looking at where the other person is coming from and what their issues are and what they need and how they need it provided. Cultural safety for Polly means having your beliefs and values respected by others and being party to the decision making and planning.

June considers cultural safety in terms of working with people who are different to you. Ruby suggests that it is about being able to check yourself, and recognise are you safe?’

Accounts of cultural safety in the talk of the participants identify that meaning is shaped by how the women position themselves in time, their values and beliefs about nursing, their identity and how they engage with their environment as individuals and as nurses. Although there is no consensus about the meaning of cultural safety, these accounts illustrate themes of meaning at work in the field of culturally safe nursing practice. These themes include, being a good communicator, knowing who you are, recognising difference, protecting identity, knowing what is important to people, being self reflective, participation, a sense of doing the right thing and working with a person in a context of their wider family and social relationships.

Cultural safety provides a cognitive framework which may assist in managing the subjective experience of nursing. An understanding of the way health care is influenced by power, difference and identity can provide the nurse with a mindfulness and alertness to when and how these factors are shaping the health care relationship and potential health care outcomes. A self awareness and consciousness of power and difference theoretically positions the nurse as an engaged person who practises nursing in a considered and reflective way, enabling her to create an environment for improved client focused health care outcomes.

As already established, cultural safety became a driver for unsettling notions of nursing as a caring, compassionate and informed profession. Instead it suggested that nurses in New Zealand and especially European Pākehā nurses were the product of a racist society born out of British colonial structures of power and control. This group were unconsciously ignorant of other worldviews and narrow in their understanding of the health needs of people who were different from them in part because it had not been part of their nursing education. Initially the concept not only disrupted the public concept of a gentle, white, middle class, apolitical nurse; it also disrupted nurses’ views of themselves. This disruption was more acute for nurses who were proactive in dealing with the publics’ response to cultural safety and in a less visible way for nurses who were engaged with everyday nursing and not directly involved in the conflict. In short, cultural safety called for a re-examination of not only what it meant to be a nurse but what it meant to be a culturally safe nurse.

Cultural safety sent a message to nurses that they were in fact not the caring health professional they had been taught to believe they were and this put them in conflict with what they knew to be nursing and what they were told was culturally safe care. Nurses were faced with an identity crisis and had to change. Scott (1992) asserts that there is nothing inevitable or predetermined about taking on a new identity. Scott notes that “a new identity will always exist in the format it

was given”. This means that a nursing identity was underpinned and shaped by 19 century concepts of what nursing was and was not. Scott also notes that “new identities are given within a particular political movement or at a particular historical moment” (p. 33). This means that cultural safety challenged the embedded identity of what a nurse was and challenged nurses to change practices so that they more appropriately met the cultural needs, as determined by clients.

While there are standard definitions of cultural safety, there is little information about how these definitions are translated into individual attitude and practices. A precursor to practising from a self aware position is that the registered nurse needs to have an understanding about what cultural safety means for her and how these meanings might shape how she practices. Weedon (2004) suggests that meaning is a way of organising the world and constructing reality and explaining how things are. Blaikie (2000) suggests “that everyday reality consists of meanings and interpretations that people give to their actions, the actions of others, social situations as well as natural and humanly created objects” (p.115). The following accounts of the multiple meanings of cultural safety makes visible the way in which cultural safety and nursing are constituted through unity, difference and schism. The stories draw out multiple perspectives and insights into these meanings through the lenses of time, experience and identity.