Tag Archives: cultural safety

Complimentary Criticism

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This week I attended the Aboriginal and Torres Strait Islander Cultural Practice Program –  a one day workshop facilitated by Stan Savo. Stan is a Cultural Capability & Workforce Advisor and he does his job terrifically well. He’s an engaging, upbeat and authentic bloke, who delivered many pearls of wisdom on the day. This blog post is about just one of them.

Passive vs Active Communication

Stan spoke about it not being uncommon for Aboriginal and Torres Strait Islander people, especially those who are from a rural/remote area and find themselves in a big hospital, to be disinclined to openly disagree with staff, or to nod or passively agree just to get an uncomfortable conversation over and done with.

Although it sounds counter-intuitive at first, Stan said it’s not necessarily a bad sign if an Aboriginal/Torres Strait Islander person expresses frustration or anger with you. He said something like, “If they are growling at you maybe it’s because they think you can do better, and they want you to know. Maybe it’s a good thing.”

Rupture and Repair

It was timely information for me. An Aboriginal man I’ve been working with was really angry with me the day before the workshop. He was a bit sweary (it wasn’t abuse, it was lalochezia) and clearly frustrated, but he was making sense. He said I should have seen him more promptly than I did after he had let a nurse on the ward know he was having an increase in psychiatric symptoms. I apologised, and we shook hands at the end of the session, but he was still cranky with me. I was worried that I had buggered-up our therapeutic relationship. Rapport and trust take time and effort to establish, but can be lost quickly and easily.

I saw him again yesterday, and we chatted for nearly an hour. Our conversation was half about clinical stuff, and half about non-clinical stuff (“non-clinical conversation” also known as “yarning” in Aboriginal/Torres Strait Islander terms, or “phatic chat” in whitefella way). In keeping with the rupture-and-repair nature of relationships, our therapeutic relationship had a rupture on Tuesday and was repaired on Friday. Just as Stan Savo said, being growled at isn’t necessarily a bad thing.

White Middle-Class Reframe

How does a white middle class nurse like me feel OK about being growled at? It feels bad, and sometimes a little scary, when someone gets angry with you. Here comes a white middle-class reframe (it’s probably the whitest thing you will read today):

I like restaurants. A lot.

If I go to a new restaurant and the food/service is a bit underwhelming, I pay the bill, leave, never go back again, and if anyone asks about the restaurant I’ll probably tell them not to bother.

However, if it’s one of my favourite Cairns restaurants, it’s a different matter.

For example, I’ve probably been to Mondo about a million times in the last 20-something years. On a couple of those million occasions my favourite dish (Sizzling Mexican Fajitas!) has been not up to scratch. On both occasions I let the wait staff and kitchen staff know that today’s fajitas were not at the usual standard. It’s a bit uncomfortable, but it’s important. I care about Mondo’s Sizzling Mexican Fajitas being good. Even if it’s a rare occasion, if they’re not good I want to make sure that staff know that there’s been a slip-up. It’s a bit awkward, but in reality – even though I’m not on their payroll – I’m helping helping the Mondo quality assurance program.

I don’t complain about dud meals in restaurants I don’t care about. I just don’t go there anymore.

I do complain about dud meals in restaurants I care about. I want to go back, so offering an honest critique is an investment in their quality.

Complimentary Criticism

Here’s the thing:

Criticism can be complimentary, in both senses of the word: it’s free and it’s an expression of approval. Approval, as in, “I know you can do better, and I’m encouraging you to do so.”

If someone is growling at us, let’s resist the reflex to get defensive or hurt, and listen for helpful suggestions. This is especially important in the tricky business of crossing cultural barriers, where often we don’t even know what we don’t know.

One Last Thing

Stan Savo’s workshop was full of pearls of wisdom. This blog post has honed-in on just one of them. However, I know it wasn’t Stan’s closing message. This was:

End

Thanks for reading this far. As always, your feedback is welcome in the comments section below.

Paul McNamara, 23 November 2019

Short URL meta4RN.com/cc

Recommended Reading

Geia, L., Hayes, B. & Usher, K. (2013) Yarning/Aboriginal storytelling: Towards an understanding of an Indigenous perspective and its implications for research practice, Contemporary Nurse, 46:1, 13-17, DOI: 10.5172/conu.2013.46.1.13

Queensland Health (2014) Aboriginal and Torres Strait Islander patient care guideline https://www.health.qld.gov.au/__data/assets/pdf_file/0022/157333/patient_care_guidelines.pdf 

Queensland Health (2015) Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying (version 2) https://www.health.qld.gov.au/__data/assets/pdf_file/0023/151736/sorry_business.pdf

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My White Privilege

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As far as I know it started with Cory Bernardi. On 31 January 2018 Cory wrote these two untruths, amongst others:
1. “The nursing and midwifery board, from 1 March this year, will insist their members acknowledge “white privilege” on demand.”
and
2. “Nurses must acknowledge white privilege and voice this acknowledgment [sic] if asked – which is compelled speech.” Source www.corybernardi.com/nursing_bruised_egos

Neither of these statements are remotely true.

When Cory and his political party repeatedly Tweeted the lie, I was really irritated that nurses were being intentionally misrepresented by non-nurses, and responded:

.

Please do not trust me because I’m a nurse.
Please do not mistrust Cory because he’s a politician.
Please read the actual policy yourself.
Read it and make up your own mind. The relevant section is a one-pager:

Nursing and Midwifery Board of Australia (01/03/18) Code of conduct for nurses, via http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

See how it says nothing at all about white privilege? You’d think that would be the end of the story. But no.

A few weeks later another non-nurse started trotting out the same nonsense as Cory Bernardi. This time it’s a bloke called Graeme Haycroft chatting to Peta Credlin on SkyNews. Graeme was on TV representing an organisation called Nurses Professional Association of Queensland (NPAQ). He acknowledged that his organisation was the only one that was fighting the new code of conduct, and that the Australian Health Practitioners Registration Authority and all the mainstream nursing unions have agreed to it. Graeme also acknowledged that he was quoting from the glossary of the code, not the code itself. Nevertheless Graeme and Peta broadcast the lie that nurses and midwives would need to stop and discuss their white privilege with their Aboriginal and Torres Strait Islander patients, before providing any clinical care [source].

Doesn’t that sound unbelievable?

Well, that’s because it is.

Don’t trust me because I’m a nurse.
Don’t mistrust Graeme because he’s setting-up a business.
Read the actual policy yourself.

NPAQ describes itself as an alternative to the Queensland Nurses and Midwives Union, which is the Queensland branch of Australia’s largest union: the Australian Nursing and Midwifery Federation. At the end of the SkyNews segment it becomes clear what Graeme’s interest in this matter is. Remember, he’s not a nurse. He’s described as the founder of NPAQ. Graeme makes it very clear that he’s making a pitch for more members to join NPAQ instead of the union. It’s just that he’s misrepresenting the truth to do so. The little rascal.

OK, got it.

Graeme needs a lever to make his business work. That’s probably all we need to know about him and NPAQ.

But the lie is a contagion. The media is its vector.

The lie was spread on South Australia’s Today Tonight, it pops-up in news.com.au and affiliates  some UK papers, and via a Melbourne political blogger & illustrator who explained her understanding thus: “…nursing staff are required to acknowledge white privilege using dialogue & communication.”

Aha! Now I see the problem!
Yoda they are reading like.
Backwards talking are they.
Twisted are the words being.

The actual excerpt from the glossary (that is: the glossary, not the policy) reads “…cultural safety provides a de-colonising model of practice based on dialogue, communication, power sharing and negotiation, and the acknowledgment of white privilege.” Turning the words around backwards creates a slightly different meaning. That’s what Cory, Graeme and Peta have done. The little rascals.

Look, these people have pretty good language skills. I don’t think they’re stupid. I don’t think they’re making an naive error. I think their actions are intentional. I think they are intentionally misrepresenting a single phrase in the glossary as a policy instruction. I think they’re being loose with the truth. I reckon they’re as dodgy as.

Even if they not dodgy, they’re the wrong people to be commenting.

Cory Bernadi is not a nurse.
Graeme Haycroft is not a nurse.
Peta Credlin is not a nurse.
The various journalists who repeated the lie are not nurses.

Yet each of them have taken it upon themselves to speak on behalf of nurses and about nursing policies that nurses were consulted and collaborated on.

It’s infuriating!

I’ve been muttering into my iPad thinking/saying things like, “Keep your uninvited uninformed opinions to yourselves you irritating bunch of arseclowns!”

And that’s when the penny dropped.

That’s when I realised that Cory, Graeme, Peta and the journos were giving me a lesson in white privilege.

I was getting angry that these people dared to speak on my behalf, on my area of experience and expertise, without consulting with me or others from my nursing background.

How dare they?

It’s as if they don’t respect nurses. It’s as if they don’t really understand nurses, the nursing world view, our nursing political systems or our nursing culture.

I’m not used to shabby treatment like that. White blokes like me with a steady job don’t get much practise in being patronised, belittled or having our opinions hijacked in the mainstream media.

The mainstream media is much more likely to misrepresent Aboriginal and Torres Strait people (looking at you Sunrise). They’re not alone: refugees, Africans, Muslims and Asians cop their fair bit of flack too (looking at you Pauline Hanson). It goes further: women who dress too slutty or not sexily enough, or are too skinny, too fat, too bossy, or too opinionated will also cop it in the media – especially if they have one of those race or religion things going on as well.

But not me. I’m a white employed male. I don’t usually cop that crap.

What Cory, Graeme and Peta have done is they’ve given me a small taste of what it’s like to have your self-identity misappropriated and misrepresented. They’ve shown me what it’s like when non-nurses assume the voice of nurses. These three, and others, talking about- and over- nurses gives me a small taste of how disempowering and degrading it would be to have that happen all the time.

The discredited rants of Cory, Graeme and Peta will be a brief flash-in-a-pan, and I probably didn’t need to get angry. However, they have helped me to reflect. It has given me a small insight into how it must be a nagging irritation for those who often have their identities misappropriated and misrepresented.

I acknowledge that I have privileges as a white employed man. I don’t take those privileges for granted, and am grateful for my good fortune. #countingmyblessings

Although Cory, Graeme and Peta have amplified my insight, I don’t intend to thank them. I still think they’re as dodgy as.

 

Addit

NPAQ are trying a fear argument now (see Twitter). It needs rebuttal.

I was introduced to this definition of cultural safety as a student nurse (1988-1991). It’s a good fit for nursing. It’s a humble, nurturing mindset. Nurses understand that pain, nausea, kindness and cultural safety are all subjective patient experiences.

Wait. There’s more.

There are better credentialed and more articulate responses to this matter than mine,

Recommended references/readings include:

  1. Tara Nipe (25/03/18) On the matter of privilege (this is the blog that I wish I wrote: it’s much clearer and more succinct than mine)
  2. Joint statement by the Australian Nursing and Midwifery Federation, the Australian College of Nursing, the Australian College of Midwives and the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (23/03/18) Cultural safety: Nurses and midwives leading the way for safer healthcare 
  3. Ruth DeSouza via Melissa Sweet/croakey (26/03/18) Busting five myths about cultural safety – please take note, Sky News et al 
  4. Janine Mohamed, CEO @CATSINaM (24/03/18) Cultural safety matters – the conversation we need to keep having
  5. Media Watch (26/03/18) White privilege outrage
  6. Luke Pearson (24/03/18) The truth behind the Nursing Code of Conduct lie
  7. Sarah Stewart (29/03/18) Fake news and lies! Nurses, midwives and white privilege 

End

Thanks for reading.

As always your comments are welcomed in the section below.

Paul McNamara, 28 March 2013

Short URL: meta4RN.com/white

+update on 29/03/18 re typos + references/recommended reading

+update on 30/03/16 as rebuttal to NPAQ

Thinking Health Communication? Think Mobile.

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Uptake of mobile phones is pretty extraordinary in Australia. Our population has recently topped 23,000,000 (ABS) yet we have over 30,000,000 (ACMA) mobile phones in use. Are our health agencies keeping up with this?

This video above and blog post below explain the rationale for using SMS for health communication, and provides examples drawn from clinical practice.

IMG_1910Why Use SMS?

Many health agencies block the number on outgoing calls. From my experience in a role where I made phone contact with everyone who was referred to the service, I estimate that only one in every three or four calls are answered from a blocked number. From the same role, I found voice-to-text messaging for unanswered calls more common than voicemail by a similar factor – three or four to one. Although voice-to-text accuracy has improved remarkably over the last couple of years it’s still prone to muddling words. The other thing about voice-to-text is that it is difficult to confer detail or convey tone – both of which are important when addressing people who have been referred to a mental health service.

SMS1To get around this problem I made a number of template messages on the work mobile phone (a hideously clunky-to-use Nokiasaurus), and used these template messages as an adjunct/alternative to voicemail and voice-to-text. Most of the templates included my name, position, the name of the service, and a shortened URL. The rationale was to use the SMS as an introduction.

The wording of the SMS templates was done with input from a very skilled and passionate Consumer Consultant. Nevertheless, when i first started using them I was wondering whether we had got the tone and/or language wrong. There were very few prompt replies.

In my personal life SMS conversations have a pretty quick tempo: I send a message, you reply within a minute or so; I send a photo, you send an emoticon straight back.  A snappy way to communicate.

My Australian accent and this man's Japanese accent made verbal communication difficult and imprecise. SMS solved that.

My Australian accent and this man’s Japanese accent made verbal communication difficult and imprecise. SMS solved that.

Using the SMS template above rarely yielded a quick reply. People returned contact sometimes within a few hours, but more typically a day or so later. I imagine (guess) that they were waiting until they were in a place and a head-space where they would feel comfortable (or less uncomfortable?) talking to a mental health nurse they’ve never met. Fair enough – I’d do the exact same thing if the tables were turned.

The slowest return contact from a SMS was six weeks. That lady introduced herself by saying, “I was hoping I wouldn’t have to make this call, but things have changed now. I need some help please…”

Why use a short URL?

Simply, so that those with smartphones can easily visit the web site to see what we’re on about. The web presence and short URL are important, I think – it puts information about your service, alternative services, and other resources directly into someone’s hands.

Each SMS is only 160 characters long (why is a Tweet only 140?), and the full URL at 76 characters long would take-up nearly half the message: http://www.health.qld.gov.au/cairns_hinterland/html/pmh_referral_pathway.asp whereas by using a URL shortener we only use 17 characters http://qld.so/pmh

What is lost in corporate branding is made-up for in practicality.

Is it that big a deal – do people actually access the internet from their phone? You betcha! As you can see below, the market penetration of smartphones is highest amongst the age groups most associated with childbearing (i.e.: the perinatal mental health target demographic).

Mobile phone, smartphone and tablet usage. Source: Australian Communications and Media Authority (2013) Communications report 2011–12 series Report 3: Smartphones and tablets: Take-up and use in Australia. Commonwealth of Australia

Mobile phone, smartphone and tablet usage.
Source: Australian Communications and Media Authority (2013) Communications report 2011–12 series Report 3: Smartphones and tablets: Take-up and use in Australia. Commonwealth of Australia

Is This All a Bit White & Middle-Class?

Put the info where it's always handy: on your client's phone. Brochures are so last century.

Put the info where it’s always handy: on your client’s phone.
Brochures are so last century.

This is a question us whitefellas who live in parts of Australia where there are a lot of first-nation people need to be checking on all the time. We don’t want to bugger-up an opportunity to do our bit towards closing the gap in health outcomes. So, in regards to mobile phone/internet use, it was interesting to see these three observations in the Joint Select Committee on Cyber-Safety report on the inquiry into Issues Surrounding Cyber-safety for Indigenous Australians (which was released last week):

  • “As for other young people in the community, mobile phones are a valuable communication tool for Indigenous youth who are enthusiastic adopters of the technology.” (3.5)
  • “Research shows that mobile phones, where coverage is available, are the preferred communications device for many Aboriginal and Torres Strait Islander peoples.” (3.8)
  • “Smartphones have emerged as the preferred online platform, given limited household internet connectivity and the life circumstances of many Indigenous Australians.” (3.2)

referralThis information together with my clinical experience makes me feel pretty confident to say that mobile phones are not just a middle-class whitefella thing.

In 2011-2012 19% of perinatal mental health referrals I received were for Aboriginal and Torres Strait Islander women, and 99% of all people referred had a mobile phone number cited on their referral.

However, I was less successful in engaging Indigenous than non-Indigenous women via phone. I recognise and accept that my gender and cultural background are barriers for some, but it may also be that the template SMS messages might not be user-friendly across cultures. It’s not for me to say really, cultural safety is “an outcome of nursing and midwifery education that enables safe service to be defined by those that receive the service” (Ramsden 2002). With that in mind, it would be a good idea to revisit the wording of the SMS templates with some Indigenous health professionals and service users before replicating/adapting this communication strategy .

The Small Print

IMG_1906Please do not phone the numbers used in the screenshots as a way to access perinatal mental health or me. The funding period for that role was 23/08/10 – 30/06/13 (more info here).

The screenshots with text in green blocks used on this page and in the video are all of fair-dinkum exchanges of communication, but were manipulated via my personal smartphone to capture the way the conversation flowed (forwarded the actual SMS messages to my personal phone from the work Nokiasaurus).

The screenshots with text in blue blocks are completely fictional, made only for illustrative, artistic and/or comic affect.

It should be obvious that I am not representing any organisation here; if you’re still wondering please visit meta4RN.com/about and see Q13.

References

Australian Communications and Media Authority (2013) Communications report 2011–12 series Report 3: Smartphones and tablets: Take-up and use in Australia. Commonwealth of Australia

Image: International Morse Code, from Page 96 of Radio Receiving for Beginners. Rhey T. Snodgrass and Victor F. Camp (copyright 1922 by The MacMillan Company, New York), sourced via http://commons.wikimedia.org/wiki/File:International_Morse_code.png

Joint Select Committee on Cyber-Safety (June 2013) Issues Surrounding Cyber-Safety for Indigenous Australians. The Parliament of the Commonwealth of Australia: Canberra

Ramsden, I. (2002) Cultural Safety: Kawa Whakaruruhau, Massey.

End

As always, your comments/feedback are welcome.

Paul McNamara, 29th June 2013

Short URL: meta4RN.com/mobile