Cultural Safety for LGBTQIA+ People: A Narrative Review and Implications for Health Care in Malaysia
1.1. Cultural Safety
The effective nursing practice of a person or family from another culture, and is determined by that person or family. Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability.
The nurse delivering the nursing service will have undertaken a process of reflection on his or her own cultural identity and will recognise the impact that his or her personal culture has on his or her professional practice. Unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and well being of an individual. (p. 7)
2. Materials and Methods
3.1. Existing Cultural Safety Frameworks
3.2. Power-Enhancing Care
3.3. Inclusive Healthcare Institutions
3.4. Continuous Education and Research
3.5. Promotion of Visibility
3.6. Individualised Care
Limitation and Recommendation for Future Research
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Allwright, Goldie ||Cultural safety is “an outcome of care that results from providers who respectfully engage with clients and who recognise and address power imbalances (p. 553).” Cultural safety requires leaders in healthcare structures to reflect on past and present relationships between health professionals and the broader community and should be supported to acknowledge and act on power imbalances.|
|Baldwin, Dodge ||Cultural safety seeks to improve the health of minority populations through addressing “the role of institutions and social structures in perpetuating health disparities and, further, tasks both providers and institutions with addressing the social inequity that is reproduced within health care” (p. 1302). Cultural safety “places the shared responsibility of the provision of quality care on providers, the systems they work in, and the larger institutions of medicine, through which to approach these changes (p. 1311). Cultural safety involves recognising “both the social marginalisation and the cultural expertise of [LGBTQIA+] people, creating—with the input of [LGBTQIA+] people—and practicing standards that are cognisant of [LGBTQIA+] diversity and responsive to patients’ [LGBTQIA+] identities, and actively monitoring for unintended biases and micro-aggressions by providers and staff” (p. 1313).|
|Carrier, Dame ||Cultural safety involves developing a baseline of knowledge about indigenous and ethnic LGBTQIA+ culture and recognising that some individuals are affected by intergenerational trauma due to colonial process, racism, and stigmatisation. Healthcare providers ought to examine and address their own assumptions and biases about LGBTQIA+ people and dismantle barriers that exist for these patients. Carrier et al. also recommended healthcare providers to foster a feeling of welcomeness and to dismantle stress for patients to enhance the therapeutic relationship.|
|Crameri, Barrett ||Cultural safety “builds on cultural awareness and cultural sensitivity … [and] is characterised by individual staff reflecting on their own values and beliefs and the services they provide” (p. 21).|
|Davies, Robinson ||Cultural safety promotes “a health care environment that is safe for people: where there is no assault, challenge or denial of their identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience of learning, living and working together with dignity and truly listening” (p. 225).|
|Kellett and Fitton ||Cultural safety “presents a framework that moves beyond a reduction of complex individual experience to a list of assumed qualities, and the need to understand a group is replaced with acceptance” (p. 4). Kellet and Fitton emphasised the reflexivity aspects of cultural safety, noting that healthcare providers ought to “be aware of the social inequalities and biases that have historically affected individuals from this group, as well as cognisant of their own biases and assumptions, and the power (im) balance that in necessarily present in any professional encounter” (p. 4). They further described cultural safety as an emancipatory approach that can lead to advocacy and challenging of cisheteronormativity at interpersonal and institutional levels of healthcare delivery.|
|Lerner, Martin ||Cultural safety utilises a framework that “encourages genuine acceptance of individuals rather than more common efforts to understand a group by reducing their complex experiences to a list of assumptions” (p. 423). Cultural safety “promotes caring for the unique experience of each individual and does not assume that the provider understands a [LGBTQIA+] patient’s situation … and expects providers to think about how they can adapt care to best support the individual [LGBTQIA+] person at the specific time they are providing them care” (p. 423).|
In order to implement a cultural safety lens, Lerner et al. outlined three factors that healthcare providers should be aware of:
|Mukerjee, Wesp ||Cultural safety involves “understanding histories, safety needs, power imbalances and the influence of staff values and beliefs on service delivery” (p. 4). Cultural safety is “defined by the patient rather than the healthcare provider and … requires that healthcare providers prioritise the patient narrative, build community partnerships, and reflect upon the inherent existing power imbalances involved in patient care” (p. 4).|
|Ross, Hammond ||Cultural safety has a reflexive focus which calls for structures to reflect on their cultural norms and create opportunities for more inclusive, equitable, and just practices.|
|Whitney, Greene ||Cultural safety prioritises “the safety of clients in interactions as opposed|
to the competency of the clinician” (p. 2). Healthcare providers working on a culturally safe framework need “to not only be aware of cultural difference, but also consider historical and contemporary power relationships and implement reflective practice” (p. 2).
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Tan, K.K.H.; Ling, S.A. Cultural Safety for LGBTQIA+ People: A Narrative Review and Implications for Health Care in Malaysia. Sexes 2022, 3, 385-395. https://doi.org/10.3390/sexes3030029
Tan KKH, Ling SA. Cultural Safety for LGBTQIA+ People: A Narrative Review and Implications for Health Care in Malaysia. Sexes. 2022; 3(3):385-395. https://doi.org/10.3390/sexes3030029Chicago/Turabian Style
Tan, Kyle K. H., and Sai Ang Ling. 2022. "Cultural Safety for LGBTQIA+ People: A Narrative Review and Implications for Health Care in Malaysia" Sexes 3, no. 3: 385-395. https://doi.org/10.3390/sexes3030029