Book Reviews
Cultural safety in Aotearoa New Zealand
Dianne Wepa
ISBN: 1-877258-75-X 2006 240 pages
Sheryl Reimer Kirkham
Trinity Western University, Langley BC, Canada
This timely book brings together contributions from educators, researchers, and practitioners to speak to the centrality and complexity of cultural safety in the delivery of health care. The text accomplishes several important ends, including defining cultural safety, explicating the context in which cultural safety has developed as a concept and policy, illustrating cultural safety through a rich array of practice exemplars, and engaging in some of the current debates arising in the application of cultural safety and other critical theories. This range of features makes it a valuable contribution to the libraries of the targeted audiences of students and educators.
For students and practitioners, the book is accessible and grounded in practice.
They will appreciate the learning objectives, a list of key terms and concepts, learning exercises, case studies, and further resources such as recommended websites included in each chapter. Contributors provide excellent discussions of cultural safety in the fields of practice such as mental health; aged populations; midwifery; spirituality/religion; child, youth and families; and refugees and migrants. Scholars and practitioners alike will value the chapters on ethics and culture, and culturally safe research. The definitions of cultural safety presented in the preface, and referred to throughout the text, emphasize several interrelated components:
- self-reflection on the part of the health care provider;
- cultural safety as perceived by the recipient of health care;
- cultural safety addresses the intersecting dimensions of age, gender, sexual orientation, occupation, socioeconomic status, ethnic origin, migration experience, religious/spiritual beliefs, and disability; and
- the historical effects of colonization and ongoing social structures that systematically disadvantage groups of people must be accounted for in health care delivery.
These distinctive strengths of cultural safety as a reflexive framework for education, practice, and scholarship take us beyond prescriptive and/or exoticized approaches to culture to consider each individual's unique socially and historically located experience of health and illness.
For educators and scholars, the edited collection alerts them to some of the problematics that arise in the teaching and application of cultural safety. Irihapeti Ramsden's reflections in Chapter 1 of her evolving conceptualization of cultural safety in the context of teaching nursing students will resonate with educators in the field. Theoretical issues are raised in a spirit of promoting thoughtful analysis, often drawing on critical theories such as postcolonialism and feminism. For example, in Chapter 3, Dianne Wepa draws our attention to the distinctions between biculturalism (Aotearoa New Zealand's Maori-Pakeha context in which cultural safety originated) and multiculturalism, and the dangers of equating indigenous colonized histories with those of other immigrant groups. Yet, as argued by DeSouza (Chapter 11), official rhetoric that recognizes the legitimacy of Pakeha and Maori has tended to exclude migrant cultures that are non-White and non-indigenous. The very notion of culture is held up for scrutiny, as contributors acknowledge the importance of understanding group-based meanings and histories while resisting essentialisms; of viewing culture as shifting and evolving but in a context of powerful social inscription (as illustrated in Greenwood's Chapter 13 on the heterosexual matrix). Nonetheless, illustrating the complexity of these theoretical issues, writers slip at various points into the very essentialisms they warn against, positioning cultural groups as distinct entities. And, while the text takes us a considerable distance in unpacking these theoretical tensions, we are left with questions regarding how to apply cultural safety, with its original assumptions of biculturalism, in other diverse societies. Overall, the text makes an important contribution to the field of cultural safety and health by its practical applications and its engagement in key theoretical issues.
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