A study of kawa whakaruruhau/cultural safety education and its effect on the nursing practice of recently graduated registered comprehensive nurses

Abstract

In the past nursing care has been provided by an otherwise unaware nursing workforce, operating from stereotypical attitudes, and this has resulted in serious impairment to service delivery. Cultural safety was developed by Maori in response to the need to provide appropriate nursing care to minority groups, which did not impose these assumptions held by the majority nursing workforce. In turn, it addressed the disparities in health status between Maori and non-Maori. Its acceptance into nursing education has been turbulent, made more so by the excessive involvement of the media. In 1993 a former nursing student at Christchurch Polytechnic made some serious allegations in the media, and in 1995 a Waikato Polytechnic nursing tutor also made public his concerns over cultural safety education. Cultural safety became an extremely controversial topic, ensuing extensive public debate. It eventuated in both an Inquiry by Nursing Council and one by Parliament's Education and Science Select Committee. As a Maori Registered Nurse educated in both Cultural Safety and Taha Maori (its predecessor) I am extremely interested in the implications of cultural safety education for holistic nursing care. I therefore chose to investigate the effect of this component of nursing education on the nursing practice of a group of recently graduated Registered Nurses. Qualitative evaluation methods were employed for the research methodology of this study, in particular qualitative interviewing methods. Kaupapa Maori research methodologies have also been discussed and employed. The study has investigated one three year period of nursing education (1992 - 1994) at one polytechnic. This period of time covers the developmental era of cultural safety education. At this stage, it was largely tikanga based, its objectives and assessment procedures were not well defined, and the teachers of cultural safety were not necessarily required to be Registered Nurses nor have any social science education. Aspects of this education have since changed. Therefore, this thesis, beside making a significant theoretical contribution to the topic, is useful in demonstrating just how far cultural safety education has moved on. In comparing the participants' intended and perceived learning outcomes of the cultural safety education they received, the differences were vast. Similarly in comparing Maori and non-Maori perceptions of cultural safety education, the differences were many. The main finding of the study was, whilst reaffirming the validity of the need for the teaching of cultural safety, the manner in which it was delivered has been brought into question. This accords with the Nursing Council's Inquiry into cultural safety education.