Culturally Safe Nursing Research

Cultural Safety

Cultural safety in nursing practice and research is an important concept and a term used extensively within New Zealand, Australia, and Canada (Wepa, 2005). A similar term, transcultural nursing care, is used in North America. Cultural safety provides a theoretical framework that enables effective relationships based on the understanding that the patient may have a worldview that differs from that of the nurse (Ramsden, 2002). It requires nurses to explore their own culture and the potential negative impacts of their beliefs and practices on those they work with (Meyst, 2005; Nursing Council of New Zealand, 2005). Transcultural nursing care is also a well-developed and tested theoretical framework. The theory was developed by Madeline Leininger and also affects clinical practice, academic preparation, and nursing research. Research in transcultural nursing focuses on discovering largely unknown and vaguely known cultural care and health concerns from two perspectives: the emic perspective focuses on the local, indigenous, and “insider’s culture,” and the etic perspective focuses on the outsider’s world, especially professional views (Leininger, 2000).

Fitting Into a Westernized Paradigm

Aotearoa/New Zealand assimilates all cultures into the dominant Europeanized Westernized culture (Southwick, 2001). Therefore, it is argued that nursing education provides a monocultural learning environment in tertiary institutions (Spence, 2001). It is a culture into which Maori are invited and in which the assimilation of Maori occurs. This is a combined immersion for Maori into both Westernized health and Westernized educational cultures. In saying this, however, there appears to be three different groups in Aotearoa/New Zealand: those who retain their Maori identity, tau iwi (non-Maori), and Maori who have not retained their Maori identity and live wholly a Westernized life style. These groups are not clearly identified or defined, and diversity among, and within, these groups are a result of colonizing experiences, interethnic marriages, urbanization, socioeconomic status, educational experiences, and technological advances (Wilson, 2006). Therefore, today, many Maori are struggling to maintain their Maori identity in an educational system/culture that supports minimal recognition of their language, culture, and traditions.

Kaupapa Maori Research

Because of this, a research approach that was guided by and steeped in the philosophy of Kaupapa Maori was used for the project reported here and is referred to as Kaupapa Maori Research (Bishop, 2008) “Kaupapa Maori is a means of proactively promoting a Maori-view as legitimate, authoritative and valid in relationship to other cultures in New Zealand” (Bishop & Glynn, 1999, p. 65) It is methodology steeped in the principles, culture, and philosophy of being Maori; Kaupapa Maori is important because it provides an entry point into research for a people or a set of communities who have found research to be exploitative and “basically useless” (L. T. Smith, personal communication, August 2005).

Method Versus Methodology

There often appears to be some confusion (in my experience) between the meaning of research methodology and method especially at the undergraduate and postgraduate study levels. What is the difference between methodology and method? As defined by Crotty (2003), research methods are

the techniques or procedures used to gather and analyse data related to some research question or hypothesis . . . [whereas a methodology is] the strategy, plan of action, process or design lying behind the choice or use of particular methods and linking the choice and use of methods to the desired outcomes. (p. 3)

Hence, the method and methodology work in partnership with each other. For instance, using a Kaupapa Maori approach, the kaumatua (elders) guide the research process ensuring that appropriate kaupapa and dialogue take place. This process is steeped in the principles, culture, and philosophy of being Maori. Therefore, the research process contains the threads of the methodology within it, for instance, the process should be carried out in a respectful, ethical, correct, sensitive manner and be beneficial for the indigenous people involved in the research (Porsanger, 2002).

Westernized Academic Research

Traditionally, researchers have developed research that has perpetuated colonial values, but in addition it has also marginalized indigenous knowledge, learning practices, and processes. Westernized academic research, which has mainly focused on solving “indigenous issues” or searching for answers to a series of questions regarding indigenous people, has passed the power and control over to the nonindigenous world because during the past few centuries this research has been used for the interests of a particular (academic) group, or individuals, who have been almost exclusively nonindigenous (Bishop, 2008). Academic and political careers, economic and professional gain, and the profitable use of indigenous knowledge and natural resources are just a few of the benefits that the nonindigenous world has obtained with the help of research on indigenous issues (Porsanger, 2002). This research is a disempowering process for people who are used merely as passive objects of Westernized research (Smith, 2008), leaving them cynical and cautious toward research (Prior, 2007). Therefore, indigenous people are tired of research primarily, as they have experienced being treated as objects and also because research has taken extensive indigenous knowledge from them and given very little or nothing back to the indigenous people, who have been used as sources of information (Smith, 2008).

Culturally Safe Research

How can a research methodology be developed into a culturally safe framework on which to develop and base indigenous research methods? Any research is related to power and control, and indigenous researchers take these issues seriously. Developing indigenous research as part of a decolonization process is one way of rectifying the disempowerment and also enabling the proper treatment of indigenous participants. In this process, there is a commitment to indigenous people of their right to self-determination, not only from an economical or political view point but also with respect to research (Smith, 1999). The usefulness of this approach is that it allows indigenous people to make their own decisions about the research question/topic and research process without any outside interference. It gives indigenous people control over their ways of knowing and being and the development of indigenous knowledge. To this end, indigenous researchers from Australia, Aotearoa/New Zealand, Canada, and the United States have included academic discussions regarding the indigenous peoples’ project of reclaiming control over indigenous ways of knowing and being, and this project implies better control over research on indigenous issues (Porsanger, 2002).

Decolonization of Research

The decolonization of research as well as people’s thinking has recently become one of the most discussed issues in indigenous research, primarily among those who belong to the growing generation of indigenous researchers (Smith, 1999). The process of decolonization requires critically evaluated methodologies as well as ethically and culturally acceptable approaches to the study of issues involving indigenous people: a practice that enacts with imperialism and colonialism at many levels and one of those levels is concerned with critiquing the underlying assumptions, motivations, and values that inform the research process (Smith, 1999). The decolonization of research methods from an indigenous researcher’s perspective, according to Smith (2008), is the focus on concepts and worldviews and coming to know and understanding theory and research from the researcher’s perspective. This enables the indigenous researcher to decolonize theories, develop indigenous methodologies, and make visible that which is special and needed to indigenous peoples. This whole process allows indigenous research to break free from the frames of Westernized epistemologies that are suited to Westernized academic thought but which are very foreign to indigenous ways of thinking (Porsanger, 2002). Decolonizing research methods requires a shift in the research paradigm: the use of indigenous approaches and the development of indigenous methodologies that are suitable for both indigenous and, in some cases, nonindigenous researchers (who work in partnership with the indigenous people). For example, the Alaskan Yupiaq scholar George Kanaqluk has shown in his studies that Westernized “theoretical,” “ready-to-use” methods must be reconsidered and reworked in indigenous research and that the researcher should not start from a theoretical point but rather from that of the indigenous ethical protocols, in order to develop methods that will suit the indigenous population (Kanaqluk, 2001). There has, however, been ongoing debate over who should be able to do research with indigenous populations.

Nonindigenous Researchers

There are disadvantages when nonindigenous researchers research indigenous people even when indigenous people are in control of the research. One of the disadvantages of the above is the publication of research reports in which nonindigenous researchers as the authors of the research are seen as the voices of indigenous people when disseminating the research findings (Jahnke & Taiapa, 1999). The above point is important as I would argue that, nonindigenous researchers, as Bishop (1999) suggests, can work in partnership with indigenous people in research and tell their stories in a limited way. However, they are unable to develop indigenous epistemologies without an understanding and lived experience of indigenous philosophy, culture, and principles.

The counterclaim that indigenous researchers are qualified to research indigenous people can also be a concern. An indigenous researcher may not have the skills to carry out research competently or be culturally safe simply because of his or her ethnicity. Problems arise when a nonindigenous researcher or a researcher who claims to be indigenous and works within a Westernized thinking paradigm analyzes and reports research findings. In these cases the underlying philosophy, culture, and principles of the indigenous people are not considered; hence, “their” meaning of the findings are not fully explored and the richness of the data is lost. This also occurs within academic circles (e.g., universities) when academics critique indigenous research through a false lens, claiming to be indigenous but critiquing solely from a Westernized paradigm and again losing the true meaning of the data analysis. As described above, this is the essence of power and control but the concern is the disempowerment of the indigenous researcher and the loss of valuable indigenous knowledge.

Wilson (2008) suggests that indigenous women have comparable experiences of mainstream services despite concepts of cultural safety, competence, and transcultural care embedded in nursing body of knowledge. Wilson and Neville (2009) suggest that these vulnerable people are exposed to dominant epistemologies and sociocultural lenses that can exacerbate their vulnerability. According to Spence (2001), this prejudice is associated with ethnocentrism and leaves in this case the researcher disempowered.

Indigenous Methodologies

Indigenous ways of thinking, understanding, and approaching knowledge have long been delineated to some as nativist or even illogical and contradictory discourse (Smith, 1999). Similarly, the quest for indigenous methodologies has been interpreted by academia as a political gesture by indigenous peoples in their struggle for self-determination (Porsanger, 2002). Contrary to those beliefs, it must be acknowledged that indigenous methodologies already form part of a body of knowledge regarding indigenous people and are seen by some as having theoretical value. However, indigenous knowledge differs between different groups.

Each group of indigenous people has cultural concepts that are specific to that particular group, and it is also evident that some of these indigenous ways of putting a specific mark on research have already been developed. For example, in Aotearoa/New Zealand, the Maori scholar Graham Smith has developed a methodology using Maori culture, principles, and philosophy to create a specific Maori research methodology called Kaupapa Maori (Smith, 1999). Alternatively, another Maori scholar, Russell Bishop (1999), has used the Maori concept of whanaungatanga as a methodological framework for research. As a concept, whanaungatanga has many meanings and may be translated as connectedness, mainly between kin, extended family, individuals, ancestors, and the environment. A key part of this is that it is not just about “kin connectedness and task engagement but it is also a focus on the group rather than on the self” (Bishop, 1999, p. 215), the important part of belonging to a collective. This particular indigenous methodology is based on indigenous epistemology and ontology and enables the collectiveness of the group to remain intact. It articulates a reciprocal relationship between the researcher and the researched, who must become “a family” and be interconnected in a reciprocal way in the process of the research project with which they are involved. The word family is interpreted here as whanau, but whanau also has many meanings. Both of the above-mentioned methodologies have been developed from an indigenous perspective to enable research by Maori, with Maori, and for Maori. Both the Kaupapa Maori and Whanaungatanga methodologies have cultural safety as a key component in their research approaches and, like all research, has to be approved by an ethics committee at the proposal stage of the research. The ethics committee is made up of both Maori and non-Maori, and the cultural safety of the participants is thoroughly examined before approval for the research is gained.

The Research Process Embedded in the Indigenous Methodology

The study analyzed Maori women nursing students’ experience of education and interpreted the context of their experiences. It examined issues such as the part culture played in the student’s learning, demographic variables (e.g., family and financial support, prior education), personal attributes (e.g., self-confidence, self-discipline, spiritual beliefs, family support, motivation, and ambition), institutional factors (e.g., interaction with faculty and institutional support), lecturers/mentors behaviors (which included classroom and practicum interactions with students), and their influences on the students’ success.

Although I have previously indicated that I perceived my choice of methodology to be critical to the success of my research, the choice of a Kaupapa Maori methodology worked well with the research question. A Kaupapa Maori methodology meant working within a Maori philosophy approach, understanding and developing within a Maori worldview and adhering to cultural principles. A Kaupapa Maori research approach is summarized as including the following:

Although it was decided to follow Smith’s (2008) use of an indigenous methodology in the form of a Kaupapa Maori research approach, what did that actually mean in practice? Kaupapa Maori research is based on an indigenous philosophy that encompasses all that is important to the Maori. This includes the importance of collective thinking, which links whanau/hapu/iwi (family, subtribe, tribe) and tied in with that, whakawhanaungatanga (extended family and connectedness). A collective in Kaupapa Maori research meant working for the “good” of the participant group as opposed to the individual. Smith (1999) suggests, “Many Maori researchers may argue that our project as Maori researchers is not intrinsically about the pursuit of knowledge but rather about the ability to make a positive difference to our communities” (p. 12) or in this case Maori students.

In a practical sense, how does a Kaupapa Maori research approach differ from a Westernized research methodology? Every methodology provides a lens by which the research question of the proposed study can be developed to provide answers in a distinct way. A Kaupapa Maori methodology provides a lens by which Maori can work with Maori in research, which is embedded in Maori principles, culture, and philosophy. Therefore, the validity, legitimacy, and importance of a Maori worldview, beliefs, and experiences were central to this study. The Kaupapa Maori constructs that were included within the framework of this study included mentorship, whakawhanaungatanga (extended family and connectedness), whanau (family), and networking, following Maori protocol, participation, challenge, and reflection. These constructs identify the necessary focus of a Kaupapa Maori methodology. A brief description is given here of these constructs:

Mentorship involves the support and guidance of elders and is an important part of Maori research. It is also part of consultation.

Whakawhanaungatanga is the process of establishing relationships. It traditionally involved the whole whanau/extended whanau (connected by kin). Connectedness refers to many facets including connection with the land, with whanau/extended whanau, with the data, with the research whanau.

A modern concept of whanau is referred to as a metaphorical whanau (Bishop, 2008). This concept of whanau attempts to develop practices based on similar principles to a traditional whanau and includes aroha (love), awhi (helpfulness), and tiaki (guidance), whereas the traditional whanau concept is a group of people connected by kin.

Networking entailed making a connection with other Maori, especially during the process of this 5-year study, so that Maori Kaumatua, colleagues, educators, students, nurses, and significant others were kept informed regarding the process and progress of the study.

Following protocol is important and included presenting the researcher appropriately by introducing myself properly so that others could make a connection with me and also so that at non-Maori presentations I could ground myself properly and safely.

Participation involved the participants within the work and included ongoing dialogue and co-construction of the findings. Participation also involved connection through genealogy and meaning related to being Maori.

Challenge can be negative or positive. I have always experienced challenge as a positive process. In this study, challenge occurred at the student conference. Normally, the speaker is allowed to complete the korero and then may be challenged from the floor regarding more information regarding his or her korero. I also interpret challenge of my work as positive. I perceive challenge as someone caring about my work or making sure that I am doing it according to the “rules,” keeping students and myself safe or suggesting ways of “doing things better.”

The process within this framework included initially identifying a need of relevance to Maori (which included the experiences of Maori nursing students from three regions in Aotearoa/New Zealand), then to seek the consent of the wider “whanau group” (via presentations to two National Maori Students Annual conferences and ongoing networking). Then, as the data were gathered, the participants were provided with transcripts, which they were able to amend if they wished. A copy of the findings went out to the participants again to amend as they wished. Finally, each participant and a number of institutes, including those in the participating regions, received a copy of the finalized report. The process enabled the group to explore the tensions that underpinned the Maori women students’ experiences as they attempted to position themselves within Western institutions.

The analysis of the data included the fact that the participants (students) gained inner strength, a move toward self-determination that enabled them to succeed in a Western paradigm. These processes were the key to their personal growth. They included the ability to fit in and make a connection. The findings also suggested there was financial struggle for Maori women. This was complicated because of the responsibility of children, lack of education (therefore restricted access to higher paying employment), and family expectations. Success also depended on a pseudo-family group forming within the institute that supported each other and enabled the students to experience love and belonging as well as increased self-esteem. The group members helped each other through sickness, child care, study groups, shared resources, and so on. The stronger the support, the stronger the students pushed each other.

In conclusion, indigenous methodologies enable a culturally safe research process to occur. One in which the research focus is on the needs of the participants and the participants are empowered to drive the research, thus knowledge is developed that is of benefit in this case to the indigenous nursing students and future indigenous nursing students. An indigenous methodology in the study enabled a reciprocal relationship to form between researcher and participants. This allowed the group to become a collective or, as they suggested, a whanau and to share their stories. This methodology differed from a Western research methodology in that it embraced participation, networking, tribal consultation, elder mentoring, connectedness, and followed Maori protocol. There are, however, several concerns with using an indigenous research methodology in that its success depends on who the researcher is and who critiques it as an academic study. In the former, cultural safety of the participants may be at risk, and in the latter, valuable data may be lost and the cultural safety of the researcher may be at risk. However, when the research or critique process embraces a Kaupapa Maori protocol, which includes tribal consultation and elder mentoring, then researcher or critique is deemed appropriate.