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SAFELY EMBRACING CULTURE: THE ADEQUACY OF THE CULTURAL SAFETY PARADIGM...
Sentiments like ethnographic refusal and a call for greater respect for
persons and justice in Indigenous-centered healthcare are not merely
speculative. Several scholars have called for an adoption of Indigenous-based
tenants for research and healthcare practice, 5! most of which centre on a
humble and critical perspective of healthcare that allows for reflexive and
dynamic responsiveness to needs identified by and for Indigenous persons.
Willie Ermine, a Cree scholar, argues that there are more explicit ways
in which Indigenous understanding can be approached and created within
Westernizedsystems. Specifically, Ermine (2007) suggests the notion of “ethical
space”, which describes a “simultaneously philosophical, psychological,
and physical space"? wherein two parties from different value systems (i.e.,
cultures) create the opportunity for meaningful exchange. Ethical space
helps to reach the deliberative model of patient-provider relationships sought
out by cultural safety, but does not suffer the same linguistic or applicative
issues. In this way, this paradigm is as much about understanding what is
said as it what is not said (i.e., ethnographic refusal). Ethical space eliminates
presuppositions of power imbalances between Indigenous and non-Indigenous
parties. It explicitly encourages healthcare providers to meet their patients in
a space that allows for both parties to display their values and understand
each other. Promoting practices of this nature leads to “ethically sustainable
caring cultures” in healthcare® that “combine the pragmatic advantages of
tribal and indigenous regulation with efforts to transform our philosophical
and ethical landscapes”.
CONCLUSION
We need not depart from the cultural efficacy continuum to allow ourselves
to safely embrace culture through ideas like ethnographic refusal and ethical
space. Much like cultural awareness, sensitivity, and competency’s evolution
to cultural safety, there is the possibility of further progress up the continuum.
6 Kevin C. Snow et al., Guiding Principles for Indigenous Research Practices, Action Research,
14.4 (2016), 357-75.
6 Beavis et al., What All Students, 155.
© Sarah E. Nelson — Kathi Wilson, Understanding Barriers to Health Care Access through
Cultural Safety and Ethical Space: Indigenous People’s Experiences in Prince George,
Canada, Social Science and Medicine, Vol. 218 (2018), 25, https://doi.org/10.1016/j.
socscimed.2018.09.017 (accessed 5 December 2020).
Susanne Salmela —- Camilla Koskinen - Katie Eriksson, Nurse Leaders as Managers of
Ethically Sustainable Caring Cultures, Journal of Advanced Nursing, Vol. 73, No. 4 (2017),
871-882, https://doi.org/10.1111/jan.13184 (accessed 5 December 2020).
64 Tallbear, Native American DNA, 181.
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