To understanding

The previous section of Elizabeth’s talk positions her between two paradigms impacting nursing. She identifies tensions in reconciling her identity as a professional nurse and new developments in nursing knowledge. The next section of Elizabeth’s talk demonstrates her trajectory from resistance to understanding cultural safety and shows how her identity has been constituted through her experiences over time.

I asked Elizabeth what, in light of the early meanings she attached to cultural safety, she considered cultural safety meant for her now. She reflected on a recent personal experience which gave her insight into how cultural safety might apply to her nursing practice.

I’ve just been in a job where I felt terribly unsafe as a person and as a nurse, and I’m going to get tearful but that’s alright, and I went through the ‘Is there something wrong with me’ and I tried to deal with it prayerfully and I tried to change and everything, and then you [she] saw one of those silly things, ‘do not adjust your brain, reality may be at fault’ oh yeah, and I go, perhaps it is and I was feeling so unsafe I thought ‘Is this what’s meant by cultural safety?’ It was like a little light going on and I thought, do people, like new immigrants, is this is how they feel because all my nursing life I’ve been in a team where you could say to somebody “Oh my God” and know that you would get help, whereas where I’ve been working all you would get is criticism, or no help at all. And it

just made me think, “Hmm this is perhaps what it feels like you know”.

(Elizabeth)

This experience produced a sense of not feeling safe. Elizabeth identifies with what it might be like for new immigrants as a means of conveying a sense of ‘not fitting’ in or ‘feeling alienated’. Her own experience triggers an intuitive realisation or epiphany that led her to gain a deeper understanding of cultural safety. For her it was ‘like a light going on’.

The experience of feeling vulnerable created for Elizabeth a personal understanding of cultural safety, making it more meaningful for her. According to Bruner (1990), narrative makes a link between the ordinary and the exceptional and “stories achieve their meaning through explicating deviations from the ordinary in a comprehensible form” (p. 48). Elizabeth’s account demonstrates Bruner’s assertion. She is made aware of what is not there but only in the absence of what is usually present. Davies and Harre (1990) observe that, as speakers, people acquire beliefs about themselves and these beliefs do not always form a unified whole. They suggest that people shift from one to another way of thinking about themselves as the discourse shifts and as their positions in different storylines are taken up. Elizabeth makes a link between her own experience and that of an imagined other. Her earlier talk about her culture and her identity takes on a different hue, her experience matters, culture safety includes her and she can connect her experience with that of another person because of her own experience of being made to feel different and isolated.

Elizabeth then related a story illustrating what cultural safety meant for her now. Although this story mirrored what Elizabeth considered to be everyday nursing practice, her sharing of it brought out meaning for her and made it an exception to the ordinary. Out of a multitude of nursing stories she could have chosen to tell, she told this one. It is interesting to note that this story is a template for a common story within medical or surgical settings. At times of acute illness there can be a perception that, although the need for family to be near their family member is important, the life threatening nature of a situation can take precedence over this. This can sometimes create tension and conflict between the nurse, the person and the family. Elizabeth’s account captures the essence of cultural safety for her. She is caring for a person from a Pacific country. His situation is life threatening and her actions need to be swift and life saving. At the same time she is aware that his family needs to be close to him during this critical time to give him strength, support him and offer prayer.

The guy, I had to prepare him for theatre, he was exsanguinating and they [family members] kept coming in, coming in and coming in and in… …In the end I said “OK you let me do this bit, and then we’ll get you all in together and he can address you and then we’ll go to theatre”, ...and everybody was really happy about that. I got my bit done. I think what nurses, [rephrasing] …we have to value what we do, because what we have to do has to get done, you know what I mean, and it has to be done safely and it can be done in a negotiated way. (Elizabeth)

The repetition of kept coming in, coming in and coming in and in conveys the degree of tension that Elizabeth was feeling. She felt pressure between her requirements as a nurse to administer life saving intervention and to balance this with the need for family to be present. At this point Elizabeth had choices in terms of how she would or could assert her power in this situation. At times of pressure and tension it is more likely that the nurse will invoke her institutionally- legitimated professional power to manage a difficult situation. In this case she could have removed the family by claiming the need to address life-threatening circumstances. She chose otherwise and what happened next indicates that at some level of her consciousness she was reflecting, problem solving and using her clinical judgement to assess how she could address her needs as nurse, the patient’s needs and his family needs to do what they needed to do, to sustain them all at this time. Elizabeth then proposed a solution where the needs of all might be met through negotiation. Her words convey a confidence in her practice as a registered nurse and an ability to manage nursing needs and family needs in an authoritative, considered way in the face of high stress and a potentially life threatening situation. Such decision-making is born out of experience, maturity and confidence in her practice to combine acute nursing intervention and maintain the integrity of client and family. She orders her priorities and keeps the family involved in the nursing activities and has the confidence to offer a solution which she is aware may not be acceptable to the family.

Elizabeth then expanded on this story.

Nursing is a relationship; it’s not going to work if I say, “You’re too fat or you have to give up smoking.” It’s not going to work, not going to work for anyone, [it] has to be a relationship thing and if I say to these people “Look I have to get him ready for theatre because as you can see his life is in danger, but also you need to speak to him before he goes to theatre, are you happy? Yes fine.” Cultural safety is about good listening, being a real person and I don’t see why it has to be has to be made into something special with a capital C and a capital S. To me that’s just good manners, and an awful lot of the cultural safety to me sounds like listening and respecting that’s all it sounds like to me. (Elizabeth)

Elizabeth’s cultural safety practice is embedded in her everyday nursing. She does not consider that her practice is culturally safe, as she does not equate listening and respecting as indicators of cultural safety. Elizabeth’s early experiences with cultural safety have shaped her perception of it as a concept she cannot relate to. Before the advent of expectations of

culturally safe practice, nursing education was charged with inculcating qualities of care, respect, politeness and good manners into young nurses. For Elizabeth these qualities were not part of cultural safety which was something that radical nurses had dreamed up in a technical institute. Being a hospital-trained nurse excluded her from identifying or claiming cultural safety concepts as qualities that informed her nursing practice. This suggests that, for Elizabeth, cultural safety and nursing are incompatible. She believes nursing is concerned with a standard of behaviour, while cultural safety is about politics. Towards the end of our conversation she reflected on shifts in attitude over time.

One of the things when I first started nursing, it was in [place named], where there were Māori and there were Pākehā, that was in the late 70s, it was made very clear to us, you know, this is how Māori do things, you know, Pākehā they can have two visitors, Māori need more for example, you know. But in those days we were culturally insensitive to everybody because we had the bloody door shut and it was “No, it’s not two o’clock” you know. And children, we owned them, when they came into hospital we owned them and I have really noticed since then, that’s 30 years, we don’t own our patients anymore and I think, as I talk about it, it’s becoming clearer in my mind, this is what you were saying isn’t it, we still have to stop thinking that we own people. (Elizabeth)

As Elizabeth talks, there is a shift in consciousness about institutional power and at the same time she offers a caution that although this may have been an attitude in the past, the past is still part of the present. Three qualities of narrative according to Bruner (1990) include: meaning is given to action depending on the point of view and positioning of the speaker; narrative forges links between the exceptional and the ordinary; and meanings mean little unless they are shared and bought out into the public arena. Elizabeth’s narratives of her interpretation of what cultural safety means for her demonstrate how meaning for her is shaped by her positioning within different nursing discourses and over time. She makes a distinction between the ordinary, nursing and cultural safety, the exceptional. The last section of talk suggests that new meaning arose through the process of bringing her thoughts and reflections into the open through our conversation.