Assessment 1:First Nations Health and Cultural Safety Critical Reflection

Purpose 

Becoming a culturally safe practitioner is an ongoing journey. It requires critical reflection and questioning of ‘self’ and your own cultural lens to develop an awareness of how ways of knowing and doing are influenced by intersecting dimensions of your own cultural identity and broader societal factors. It requires you to be prepared to challenge pre-conceived ideas or long-held assumptions through critical analysis of what has informed those views, and subsequently exploring and validating new ways of seeing the world and new ways of delivering health care. 

Critical self-reflection facilitates the shift in ways of knowing, being and doing needed to build culturally safe practices. This shift is transformative, involving both learning and unlearning. This reflective assessment task will require you to demonstrate critical reflection of your learning experience, reflecting on both what you have learnt and have needed to unlearn, and to consider your next steps for developing culturally safe and responsive practice when working with First Nations Peoples.

Task details

This task involves a critical reflection on Cultural Safety ,Respectful Communication.

CLINICAL SCENARIO

My experience as a patient, Odette Best

While I was working as a nursing director, I was admitted to a large tertiary hospital as a patient. I was diagnosed with a double ear infection, which required hospitalisation for intensive intravenous (IV) antibiotic treatment and pain management. I had a cannula inserted to receive IV antibiotics in the emergency department and was administered Fentanyl subcutaneously. I was prescribed Endone for pain relief. When I was admitted to the ward, I was not asked whether I identified as Aboriginal nor was I asked about my occupation.

Four hours after being admitted to the ward, my pain began to escalate. I requested Endone from the Registered Nurse (who had not introduced himself at the beginning of his shift). He looked at my medication chart and went to get the pain relief. He returned and offered me two Panadeine. I questioned him about what medication I was being offered, and he explained that ‘these are Panadeine’. I stated that the doctor in the emergency department had written me up to receive Endone. 

The nurse replied that ‘We don’t give Endone out willy nilly and Panadeine should hold your pain’. My pain soon escalated severely, and I became highly agitated. The nurse avoided me.

Shortly after this encounter, the Aboriginal Hospital Liaison Officer arrived. I asked how she knew I had been admitted and she explained, ‘You identified within the emergency department and the box had been ticked’.

I rang a friend who worked at the hospital as an anaesthetist. In my highly distressed state, I asked him to come and see me. Simon (the anaesthetist) took my chart and read through my notes to ascertain my clinical history and reason for admission. He then took my chart to the nurses’ station and asked why I was not receiving adequate pain relief, as written up. Within a few moments the nurse appeared with the prescribed dose of Endone. The Registered Nurse in charge of the shift also arrived, and apologised for the error. I then asked not to be looked after for the rest of the shift by my designated nurse

Applying the Cultural Safety Principles

1. Reflect on your own practice

• • Considering the practice of the Registered Nurse in the scenario, what areas of practice should he reflect on and why?
  • What potentially were the beliefs, values and attitudes that influenced his culturally unsafe practice?

1. Seek to minimise the power differentials

• • Describe examples of how the nurse used power differentials in his care giving
  • Describe examples of how the nurse could have minimised power differentials

1. Engage in discourse with the client

• • Describe the discourse in which the nurse should have engaged - what important conversations did not happen?

1. Undertake a process of decolonisation

• • Describe the lack of understanding about decolonisation demonstrated by the nurse

1. Ensure you do not diminish, demean or disempower others through your actions

• • Name the actions of the nurse that are diminishing, demeaning and disempowering.

Your reflection should: 

1. Summarise new knowledge gained from engagement with the learning activities. This could be a summary of one or multiple concepts. This may include multiple reference points i.e., describe where the learning started and identify key activities that further developed your understanding and how this occurred. Reflect on your emotional responses (thoughts and feelings) to the learning experience. This is mapped to the LEARNING criterion on the rubric. 
2. Clearly identify and describe any unlearning that took place through engagement with the learning activities.Here you should discuss any pre-conceived ideas, assumptions or biases that have been challenged and transformed. This should include critical analysis of what has informed those previously held views and reflection on your emotional response (thoughts and feelings) to having those views challenged. This is mapped to the UNLEARNING criterion on the rubric.
3. Finally, consider what your next steps can be in your learning or unlearning journey. Your discussion should demonstrate an understanding that being culturally responsive and safe is an active and ongoing process. This is mapped to the NEXT STEPS criterion on the rubric.

Instructions

Please use clear topic sentences to introduce each paragraph and signpost which element of the reflection you are completing in each paragraph.

Your response should be written in first person. As a personal reflective piece, you are not required to reference your own thoughts. However, if you include First Nations voices and knowledges in your discussion you need to appropriately acknowledge and reference the sources with both in-text references and an end-text reference list using APA 7. 

This is a professional piece of writing, and your responses need to be respectful of the Aboriginal and Torres Strait Islander Peoples who have shared their knowledges with you. Your language and writing should demonstrate an understanding of culturally safe communication, including adopting a strengths-based approach and an understanding of appropriate terminology when referring to First Nations peoples. Please reflect on how your writing and language could be interpreted prior to submitting your final document. 

Headings and/or bullet points or flow charts are not suitable for this reflective genre. It should be one cohesive piece of writing.

*This assessment task has been designed by Dr Shirley Godwin, proud Badimaya woman of the Yamatji people from the central mid-west of Western Australia, and Senior Lecturer.

Assessment Requirements Brief Summary

This reflective assessment required students to demonstrate their ability to become culturally safe practitioners through critical self-reflection. The task was framed around a clinical scenario (Odette Best’s hospital experience) and aimed to assess the student’s ability to:

• Reflect on personal practice and identify culturally unsafe behaviours.

• Analyse power differentials in clinical interactions and explore ways to minimise them.

• Evaluate communication and highlight missed opportunities for respectful engagement.

• Understand decolonisation in healthcare practice and identify where it was lacking.

• Identify diminishing, demeaning, and disempowering actions taken by the nurse.

• Summarise new knowledge gained, including emotional responses to learning.

• Identify unlearning of biases/assumptions through critical analysis.

• Plan next steps in developing culturally safe, responsive, and respectful practice.

The response needed to be written in first person, as a professional and cohesive reflective piece, using respectful language and culturally safe communication.

Mentor’s Step-by-Step Guidance to the Student

Step 1: Interpreting the Purpose

The mentor first explained that the reflection was not only about the nurse’s mistakes but also about the student’s own journey in learning and unlearning. The focus should remain on cultural safety principles, critical self-reflection, and ongoing professional growth.

Step 2: Structuring the Reflection

The mentor guided the student to follow a clear structure aligned with the rubric:

1. Learning – new knowledge gained from the scenario and learning materials.

2. Unlearning – challenging assumptions, biases, or preconceived ideas.

3. Next Steps – actions to continue developing cultural responsiveness.

Step 3: Reflecting on the Scenario

• The mentor asked the student to unpack the nurse’s practice, identifying where cultural safety was compromised.

• The student was guided to discuss how power was misused (e.g., dismissing pain, withholding medication) and how power differentials could have been reduced.

• The mentor highlighted the importance of discussing the lack of respectful communication and missed opportunities for engagement.

Step 4: Understanding Decolonisation

The mentor explained that decolonisation involves recognising and challenging systemic biases, as well as validating First Nations’ knowledge. The student was encouraged to show how the nurse’s behaviour reflected a lack of this understanding.

Step 5: Linking to Personal Reflection

The student was guided to move beyond critique of the nurse and reflect on personal thoughts, feelings, and biases:

• What assumptions did they previously hold about cultural safety?

• How did this learning experience challenge and transform their views?

• What emotions arose when confronting these issues?

Step 6: Planning Next Steps

The mentor asked the student to set realistic, actionable next steps such as:

• Continuing education on cultural safety and First Nations health perspectives.

• Practicing respectful, strengths-based communication in clinical settings.

• Actively questioning and addressing personal and systemic biases in healthcare practice.

Final Outcome and Learning Objectives Achieved

The student produced a reflective essay that:

• Analysed the nurse’s unsafe practice through the lens of cultural safety principles.

• Reflected on personal learning and unlearning, acknowledging biases and assumptions.

• Identified strategies to minimise power differentials and foster respectful discourse.

• Showed an emerging understanding of decolonisation in healthcare.

• Proposed next steps to continue their journey toward becoming a culturally safe practitioner.

Learning Objectives Achieved:

• Developed awareness of how personal and systemic factors influence practice.

• Demonstrated the ability to critically reflect on cultural safety and respectful communication.

• Recognised the importance of ongoing learning, unlearning, and self-reflection.

• Understood the role of power, privilege, and decolonisation in shaping healthcare delivery.

The mentor’s step-by-step guidance ensured that the student’s final work was not only professionally written and respectful but also deeply reflective, aligning with the purpose of building culturally safe and responsive healthcare practice.

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