Sentencia del Tribunal Supremo

Sixteen registered nurses, all women, responded to the advertisement. I will refer to the participants sometimes as participants and sometimes as the women who participated in the research. The participants reflected a range of backgrounds related to class, ethnicity and sexuality. They were employed in the following areas: two in general medical/surgical units, one in mainstream Māori community mental health, two in iwi providers of community health services, one in an oncology unit, one in specialised surgical unit, one diabetes nurse educator, one acute crisis mental health service, two aged care, one community mental health service, one youth health service, one forensic rehabilitation service, one practice nurse and one manager. Their ages ranged from mid 20s to 60s and they reported their time in nursing practice as being from one year to 30 years.

In this section the 16 women participants are introduced. Collectively their entry into nursing reflects particular stages in the development of cultural safety in nursing education and its arrival within nursing practice environments. This historical positioning has been a factor in shaping the meaning of cultural safety for each woman and influences how she applies cultural safety knowledge in practice. The narratives identified that nurses who had been in practice for some years and had not been through a cultural safety programme, came to learn about cultural safety through their everyday nursing practice and the accumulation of nursing experiences where they had to learn how to negotiate and mediate difference in an unconscious way. The more recently graduated participants came to nursing practice knowing about cultural safety and with a more conscious and reflective awareness of power and the effect of this on client care.

Janis graduated as nurse in the 1950s long before cultural and notions of difference were considered a factor in the delivery of nursing care. She was of the school where you nursed people regardless of their culture, at a time when there was little or no awareness of the relationship between culture, beliefs and attitude of the nurse on the care of the client, and even less on the impact of eighteenth, nineteenth and twentieth century colonising philosophies on the health care of Māori. Elizabeth and Polly underwent hospital-based nursing education programmes in the early 1970s and before the beginning of the transfer of nursing education to tertiary education institutions. Elizabeth had no formal education in cultural safety but had many years of experience working in various hospitals and community health care agencies in New Zealand and other countries. This means that her many years of practice and working with different people enabled her to recognise concepts of cultural safety when she came in contact

with it in the late 1980s early 1990s. In the 1980s, Polly began work as a registered nurse in an emergency department. During this time, she studied toward gaining a Bachelor of Arts degree at University. Exposure to key Māori academics and ideas about power, along with the emerging data about social and health inequalities between Māori and Pākehā, made her more aware of issues of power and difference in levels of health care access. These factors, together with her involvement in the anti racism education, the organised protests against the 1981 South African Springbok rugby tour and her being lesbian, position her as an outsider and therefore different within her nursing community. In the late 1980s she went into teaching nursing and cultural safety.

June underwent a hospital-based general nursing education running parallel to technical institute nursing education in the mid 1970s. She later went on to do her psychiatric nursing registration and Bachelor of Nursing. For her there was little teaching about concepts of difference and she came to her understanding of power and inequality from teaching in a nursing programme in a polytechnic where the curriculum was based on Te Tiriti o Waitangi and values of difference in relationship. These values were embedded within the structure of the organisation as well as in the nursing curriculum. Joy graduated in the mid 1970s, and was an early recipient of nursing education in a polytechnic. Cultural elements in relation to health care were just starting to be brought into the public domain through the political activism of young Māori and Māori academics and she was part of the first group of students who visited a Marae to learn about Māori health in an attempt to enable Pākehā nurses gain an understanding of Māori culture. In the 1980s Joy became a lecturer in nursing and specialised in teaching cultural safety and had recently returned to nursing practice.

Both Sally and Mary graduated in the late 1980s from Polytechnics. This was a time when bicultural concepts were being introduced into nursing education programmes and cultural safety was starting to be talked about. Sally was on the shoulder of bicultural nursing and cultural safety and her early grounding was in bicultural relating in Aotearoa New Zealand. As a new graduate she experienced the full impact of the public, political and social controversy surrounding cultural safety. The cultural content of her nursing programme exposed her to transcultural concepts of caring which preceded biculturalism in Aotearoa New Zealand context, therefore her point of reference is transcultural care and this has shaped her ideas and practice about the concept of culture in nursing. Jill and Kate’s formative experience of learning about culture was when they were required to visit a Marae as part of their cultural education. The

purpose of this was to assist students to engage with Māori and to learn about Māori tikanga in the hope that this would help them to provide appropriate care when caring for Māori clients. By the time Rose graduated in the mid 1990s cultural safety education was firmly situated within a critical theory framework within nursing education and focused on analytical deconstructions of institutional and personal power. The earlier transcultural approaches had been superseded by cultural safety which was now part of the formal curriculum. However the tensions between learning about bicultural practices were often blurred with concepts of transcultural nursing, the North American model. Cultural safety became the driver for education relating to nursing across difference and continues to be so today. As a student Rose, like Sally and Amanda, was exposed to the intense public controversy and animosity toward cultural safety.

Chris and Barbara are older women who graduated in 2003. By now concepts of difference in a broader context were embedded within the curriculum and these concepts became more visible alongside the institutional and personal critiques of power. The ages of Christina, Debbie, Jill, Louise, Patricia, and Ruby range between 30 and 55, and they graduated as registered nurses in 2005. The approach to teaching cultural safety varied across technical institutes and polytechnics. For some of these institutions there was a focus on cultural safety as applying to Māori populations, while for others cultural safety was incorporated into caring and communication aspects of nursing. The controversy of the late 1990s, as explained in chapter two, was not part of the experiences of these women; nevertheless, they are sometimes exposed to the legacy of this historical controversy in their practice as registered nurses. This sometimes put them in conflict with what they were taught about cultural safety and what they experienced in practice in relation to cultural safety in their work setting. Even though they had the consciousness and knowledge about power and its impact on health outcomes, they were, and are, not always in a position to act on their knowledge.