Doctor of Philosophy
School of Nursing, Midwifery and Indigenous Health
Williamson, Moira Jane, Dealing with diversity: incorporating cultural sensitivity into professional midwifery practice, Doctor of Philosophy thesis, School of Nursing, Midwifery and Indigenous Health, University of Wollongong, 2008. http://ro.uow.edu.au/theses/2068
Caring for women from culturally and linguistically diverse (CALD) backgrounds is a daily occurrence for Australian midwives. It is an expectation of professional bodies such as the Australian College of Midwives and health care services that all midwives will provide culturally appropriate care. However it is not clear how cultural sensitivity is used in practice when caring for CALD women and there is even less information on how this is achieved when midwives are caring for Indigenous women. This is especially important as the Indigenous population has experienced oppression and discrimination and this has been evident in their health provision and care.
The aim of this research was to explore:
• How midwives define culture and incorporate cultural sensitivity into their practice;
• The strategies midwives use when providing care for Indigenous women;
• The factors which impact on how midwives provide care to women from different cultural backgrounds.
Semi-structured interviews were conducted with thirty two midwives in three different geographical locations within New South Wales (NSW). A modified grounded theory approach was used for the data collection and preliminary analysis. The intention was not to produce theory but to ensure a systematic process. As the study proceeded, the emerging findings were explored with and compared to relevant theoretical perspectives and the work of theorists which best supported the investigation of the topic. In this case, an analysis of discourse and the work of theorists such as Foucault were identified as the most fruitful approach.
The findings showed that the participants used a number of discourses about the ‘other’ when describing their practice with women from CALD backgrounds, including Indigenous women. I have called these discourses: the discourse of cultural difference, the discourse of social justice and the discourse of denying difference.
When discussing the concept of ‘culture’, most participants referred to customs and traditions, a perspective which tends to see culture as static and unchanging. They had been encouraged to view culture in this way by their educational preparation, reinforced by much of the nursing and midwifery literature. As a result, participants tended to expect CALD and Indigenous women to conform to what they themselves believed were cultural norms. Some were challenged in this view during their practice but, for many, the routines of busy hospitals allowed little time for reflection. More recent approaches in the literature have emphasised ‘cultural safety’, which advocates being aware of the social, political and economic factors which impact on clients, but it is still unclear how this concept may be operationalised in practice.
The study findings also identified that the context of care has a significant impact on the way in which midwives provide care, as issues of power and control circulate within health care services. The thesis concludes by discussing the utility of using the concept of culture in midwifery education and practice
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