Cultural Safety in Nursing: Alaska Pacific University’s Commitment to Health Equity
Authors: Marianne Murray, DNP, RN, CHSE, Director of Nursing Programs
Published August 2023
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity stresses that nurses are the key to supporting health equity through robust education, supportive work environments, and autonomy. A study, published by Clark, in the journal Nursing Research in 2017, found that patients who were cared for by nurses of the same culture were more likely to adhere to their treatment plans and to experience a better quality of life.
As an Alaska Native-serving and tribally-controlled university, Alaska Pacific University (APU) is committed to providing nursing programs that support the advancement of populations traditionally underrepresented in healthcare. The APU nursing programs demonstrate this commitment in three ways: specifically, our partnerships with organizations in the Alaska Tribal Health System; the commitment to delivering academic programs to students where they live; and the integration of culturally-safe healthcare practice into all aspects of the nursing programs. The overarching goal of this model is to ensure that more Alaska Native students will have access to healthcare careers. In addition, by expanding and diversifying the healthcare workforce with nursing professionals that understand the cultures and languages of Alaska Native communities, we are promoting improved health outcomes for the general population.
Cultural safety is the keystone framework across APU’s nursing program. Nursing faculty and staff recognize and value our diverse and culturally rich adult learners. The concept of cultural safety was first presented by Maori nursing students in New Zealand and offers an alternative to the previously accepted cultural competency model. Cultural safety focuses on “eliminating indigenous and ethnic health inequalities” by addressing “determinants of health equities, which includes institutionalized racism, and ensuring a healthcare system that delivers appropriate and equitable care” (Curtis et al., 2019). Cultural safety views culture as an individual’s unique combination of influences that make them who they are: age, generation, socioeconomic and political factors, geographic location, ethnic origin, disability, history, political influences, gender, sexual orientation, spiritual beliefs, and values (Baker &Giles, 2012; Mkandawire-Valhmu, 2019). Culturally-safe practice considers the dynamic cultural dimensions where people live their lives, while safely meeting their health needs and rights. Culture is best understood through personal history, gender, experience, and social position. Positioning in society can be a key to relationships and power dynamics. One of the key constructs of culturally safe healthcare is the recognition of power dynamics and relationships with patients in healthcare (Ramsden, 2002). Nurses are in a sacred position as both advocate and healers. Alaska Pacific University teaches nursing students to address inequalities in healthcare through the lens of cultural safety. APU Nursing students are taught to recognize and challenge unequal power relations and create trust with patients to promote healing. Students understand that the patient determines cultural safety. All students entering the nursing programs must complete a four credit prerequisite course in culturally safe healthcare.
Further demonstration of the commitment to increase diversity and access to healthcare programs can be seen in small rural Alaskan villages. For example in Bethel, Alaska, a practical nursing program has been established. The program has incorporated native Yupik language, customs, clothing, food and has ensured that simulations are culturally relevant to the Yupik population. The Bethel community have come together to help students be successful. The program is delivered in a unique method to ensure the students can support families.
The APU nursing programs also use a comprehensive holistic admission process with a focus on increasing diversity, inclusion, ensuring equity and providing accessibility APU’s commitment to access and equity in higher education is also demonstrated in our recruitment and admissions processes. All our admissions counselors are Alaska Native or American Indian, and our recruitment strategies incorporate virtual and in-person outreach to rural Alaskan schools, communities, and employers. Unlike most nursing programs nationally, undergraduate admission at APU is “test blind,” meaning that we do not consider standardized test score in admissions or financial aid decisions. This addresses concerns about uneven access to standardized testing and test bias, which results in an equity gap for populations underserved in higher education. With high demand, admission to our nursing programs is selective; it involves holistic assessment of candidates’ qualifications based on application materials and interviews.
The APU nursing programs are committed to increasing diversity, equity and accessibility to nursing programs in Alaska. The Culturally Safe Curriculum creates an upstream approach to nursing care that promotes health equity.
Baker, A. C., & Giles, A. R. (2012). Cultural safety: A framework for interactions between Aboriginal patients and Canadian family medicine practitioners. International Journal of Indigenous Health, 9(1), 123-139. doi:10.18357/ijih91201212390
Clarke S (2017) Cultural Congruent Care: A Reflection on Patient Outcome. J Health Commun. 2:51. doi: 10.4172/2472-1654.100092
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S.-J., Reid, P., 2019. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int. J. Equity Health 18 (1), 174. https://doi.org/10.1186/s12939-019-1082-3.
Mkandawire-Valhmu, L. (2019). Cultural safety, healthcare and vulnerable populations: A critical theoretical perspective. Abingdon, Oxon: Routledge.
National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Flaubert JL, Le Menestrel S, Williams DR, Wakefield MK, editors. Washington (DC): National Academies Press (US); 2021 May 11. PMID: 34524769.
Ramsden, I.M., 2002. Cultural safety and nursing education in Aotearoa and Te Waipounamu [Dissertation]. Victoria University of Wellington. https://www.nzno. org.nz/Portals/0/Files/Documents/Services/Library/2002%20RAMSDEN%20I%20 Cultural%20Safety_Full.pdf