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Indigenous Health: Cultural Competency and Cultural Safety

Learning about aboriginal protocols and values

Cultural Competency - Links

The following are some organizations that provide insight into Indigenous cultural competency, and sometimes within the context of health:

The Aboriginal Nurses Association of Canada (ANAC):

The Indigenous Cultural Competency Training Program (Provincial Health Services Authority in B.C.):

Southwest Ontario Aboriginal Health Access Centre:

The Virtual Museum of Metis History and Culture:

The Saskatchewan Indian Cultural Centre:

 Aboriginal Health and Cultural Diversity Glossary: 



Cultural Competency - Articles

Hubbert, A. O. (2008). A partnership of a Catholic faith-based health system, nursing and traditional American Indian medicine practitioners. Contemporary Nurse: A Journal for the Australian Nursing Profession, 28(1-2), 64 - 72.

Hunter, L. M., Logan, J., Goulet, J.-G., & Barton, S. (2006). Aboriginal healing: regaining balance and culture. Journal of Transcultural Nursing, 17(1), 13–22. doi:10.1177/1043659605278937

Cultural Safety - Articles

Aboriginal Nurses Association of Canada. (2009). Cultural competence and cultural safety in First Nations, Inuit and Métis nursing education. Ottawa: Author.

Baker, C. (2007). Globalization and the cultural safety of an immigrant Muslim population. Journal of Advanced Nursing, 57(3), 296 – 305. doi: 10.1111/j.1365-2648.2006.04104.x

Browne, A. J., Varcoe, C., Smye, V., Reimer-Kirkham, S, Lynam, M. J., & Wong, S. (2009). Cultural safety in the challenges of translating critically oriented knowledge in practice. Nursing Philosophy, 10(3), 167 – 179. doi: 10.1111/j.1466-769X.2009.00406.x

Canadian Institutes of Health Research. (2007). Reducing health disparities and promoting equity for vulnerable populations strategic initiative (archived). Retrieved from

Doutrich, D., Arcus, K., Dekker, L., Spuck, J., & Pollock-Robinson, C. (2012). Cultural safety in New Zealand and the United States: Looking at a way forward together. Journal of Transcultural Nursing, 23(2), 143 – 150. doi: 10.1177/1043659611433873

Duke, J. (2009). Becoming a culturally competent health practitioner in the delivery of culturally safe care: A process oriented approach. Journal of Cultural Diversity, 16(2), 40 – 49.

Foster, C.H., 2006.  What Nurses Should Know when Working in Aboriginal Communities.  Canadian Nurse, Vol.  102, No 4, pp. 28-31.

Gerlach, A. J. (2012). A critical reflection on the concept of cultural safety. Canadian Journal of Occupational Therapy, 79(3), 151 - 158. doi: 10.2182/cjot.2012.79.3.4

Gebru, K., & Willman, A. (2010). Education to prepare culturally competent nursing care-a content analysis of student responses. Nurse Education Today, 30(1), 54 – 60.

Gebru, K., Khalaf, A., & Willman, A. (2008). Outcome analysis of a research-based didactic model for education to promote culturally competent nursing care in Sweden–a questionnaire study. Scandinavian Journal of Caring Sciences, 22(3), 348–356.

Grey, M., & McPherson, K. (2005). Cultural safety of professional practice enough patient therapy: A New Zealand perspective. Australian Occupational Therapy Journal, 52, 34 – 42. doi: 10.1111/j.1440-1630.2004.00433.x

Health Council of Canada, 2012.  “Empathy, dignity and respect: Creating Cultural Safety for Aboriginal people in Urban Health Care.”

Iwama, M. K. (2007). Embracing diversity: Explaining the cultural dimensions of our occupational therapeutic selves. New Zealand Journal of Occupational Therapy, 54(2), 16–23.

Johnstone, M. J., & Kanitsaki, O. (2007). Healthcare provider and consumer understanding of cultural safety and cultural competency in health care: An Australian study. Journal of Cultural Diversity, 14(2), 96 - 105.

Josewski, V. (2012). Analyzing ‘cultural safety’ in mental health policy reform: Lessons from British Columbia, Canada. Critical Public Health, 22(2), 223 – 234. doi: 10.1080. 09581596.2011.616878.

Kardong-Edgren, S., & Campinha-Bacote, J. (2008). Cultural competency of graduating US Bachelor of Science nursing students. Contemporary Nurse: A Journal for the Australian Nursing Profession, 28(1-2), 37 – 44.

Leininger, M. M. (2006). Culture care diversity and universality theory and evolution of the ethnonursing method. In, M. M. Leininger & M. R. McFarland (Eds.), Culture care diversity and universality: A worldwide nursing theory (2nd ed.)(pp. 1 – 42). Sudbury, MA: Jones and Bartlett Publishers.

Main, C., McCallin, A., & Smith, N. (2006). Cultural safety and cultural competence: What does this mean for physiotherapists? New Zealand Journal of Physiotherapy, 34(3), 160 - 166.

Mackay, B., Harding, T., Jurlina, L., Scobie, N., & Khan, R. (2011). Utilising the hand model to promote a culturally safe environment for international nursing students. Nursing Praxis in New Zealand, 27(1), 13 - 24. doi:10.1016/j.nepr.2011.12.004

Mahara, M.S., et al, 2011. “It Takes a Community to Raise a Nurse: Educating for Culturally Safe Practice with Aboriginal Peoples”.  International Journal of Nursing Education Scholarship, Vol. 8, No. 1, pp. 1-13.

Marr, M.A., et al, 2011.  “Thinking Outside the Box: Aboriginal Peoples’ Suggestions for Conducting Health Studies with Aboriginal Communities.”  Public Health, Vol. 125, No. 11, pp. 747-753. http://www.sciencedirect/science/article/pii/S0033350611002538

McCall, J., & Pauly, B. (2012). Providing a safe place: Adopting a cultural safety perspective in the care of Aboriginal women living with HIV/AIDS. Canadian Journal of Nursing Research, 44(2), 130–145.

McEldowy, R., & Connor, M. J. (2011). Cultural safety as an ethic of care: A praxiological process. Journal of Transcultural Nursing, 22(4), 342–349. doi: 10.1177/1043659611414139

McFarland, M. (2010). Madeleine Leininger: Culture care theory of diversity and universality. In A. M. Tomey & M. R. Alligood (Eds.), Nursing theorists and their work (7th ed.)(pp. 454 - 479). St Louis: Mosby Elsevier.

McFarland, M. M. & Eipperle, M. K. (2008). Culture care theory: A proposed practice theory guide for nurse practitioners in primary care settings. Contemporary Nurse: A Journal for the Australian Nursing Profession, 28(1-2), 48 – 63.

McLeland, A. (2011). Culturally safe nursing research: Exploring the use of an Indigenous research methodology from an Indigenous researchers perspective. Journal Transcultural Nursing, 22(4), 362 – 367. doi: 10.1177/1043659611414141

Millender, E. (2012). Acculturation stress among Maya in the United States. Journal of Cultural Diversity, 19(2), 58 – 64.

Morgan, M. G. (2010). Leininger’s theory of culture care diversity and universality in nursing practice. In M. R. Aligood (Ed.), Nursing theory: Utilization & application (4th ed.). Maryland Heights, Missouri: Mosby Inc.

Mkandawire-Vahlmu, L., & Doering, J. (2012). Study abroad as a tool for promoting cultural safety in nursing education. Journal of Transcultural Nursing, 23(1), 82 – 89. doi: 10.1177/1043659611423831

National Collaborating Centre for Indigenous Health & L. Baba, 2013.  Cultural Safety in First Nations, Inuit and Métis Public Health

Nguyen, H. T. (2008). Patient centered care: Cultural safety in Indigenous health. Australian Family Physician, 37(12), 990 – 994.

Nursing Council of New Zealand. (2011). Guidelines for cultural safety, the Treaty of Waitangi and Maori health in nursing education and practice. Wellington, NZ: Author.

Polaschek, N. R. (1998). Cultural safety: a new concept in nursing people of different ethnicities. Journal of Advanced Nursing, 27(3), 452 – 457. doi: 10.1046/j.1365-2648.1998.00547.x

Raymond, L. M. (2008). Developing a new bachelor of nursing course responsive to Australia's culturally diverse community. Contemporary Nurse: A Journal for the Australian Nursing Profession, 28(1-2), 17–22.

Richardson, F. (2012). Making a world of difference. Kai Tiaki Nursing New Zealand, 18(4), 2.

Richardson, F., & Carryer, J. (2005). Teaching cultural safety in a New Zealand nursing education program. Journal of Nursing Education, 44(5), 201 – 208. 

Richardson, S., Williams, T., Finlay, A., & Farrell. (2009). Senior nurses’ perceptions of cultural safety in an acute clinical practice area. Nursing Praxis in New Zealand, 25(3), 27 – 36.

Saca-Hazboun, H, & Glennon, K. A. (2011).Cultural Influences on Health Care in Palestine. Clinical Journal of Oncology, 15(3), 281 – 286.

Sherwood, J., & Edwards, T. (2006). Decolonization: A critical step for improving aboriginal health. Contemporary Nurse, 22(2), 178 – 190. doi: 10.5555/conu.2006.22.2.178

Stedman, A., & Thomas, Y. (2011). Reflecting on our effectiveness: Occupational therapy interventions with Indigenous clients. Australian Occupational Therapy Journal, 58(1), 43 – 49. doi: 10.1111/j.1440-1630.2010.00916.x

Tait, C.L., 2013.  “Resituating the Ethical Gaze: Government Morality and the Local Worlds of Impoverished Indigenous Women.”  International Journal of Circumpolar Health, Vol 72, pp. 1-6.

Vogler, J., Altmann, T. K., & Zoucha, R. (2010). Native Hawaiian attitudes of culturally sensitive healthcare provider traits and behaviors. Journal of Cultural Diversity, 17(3), 90 – 98.

Walker, R., Cromarty, H., Kelly, L., & St Pierre-Hansen, N. (2009). Achieving cultural safety in Aboriginal health services: Implementation of a cross-cultural safety model in a hospital setting. Diversity in Health and Care, 6 (1), 11 – 22.

Wilson, D. & Neville, S. (2009). Culturally safe research with vulnerable populations. Contemporary Nurse, 33(1), 69 – 79.

Woods, M. (2010). Cultural safety and the socioethical nurse. Nursing Ethics, 17(6), 715 – 725.  doi: 10.1177/0969733010379296

Ziedler, D. (2011). Building a relationship: Perspectives from one First Nations community. Canadian Journal of Speech-Language Pathology and Audiology, 35(2), 136–143.

Wilson, D. et al, 2013.  “Health Professionals Working with First Nations, Inuit and é Consensus Guideline.”  The Journal of Obstetrics and Gynaecology Canada, Vol. 35, No. 6 (Supplement 2), pp. S1-S52.

Racism and Indigenous health

What Does Cultural Competency Mean?

"Cultural safety [or cultural competency] within an Indigenous context means that the educator/practitioner/professional, whether Indigenous or not, can communicate competently with a patient in that patient‘s social, political, linguistic, economic, and spiritual realm" (Cultural Competency and Safety: A Guide for Health Care Administrators, Providers and Educators, National Aboriginal Health Organization, Ottawa, 2008, p. 4).