Culturally unsafe practice in physiotherapy extends beyond Kiritaki Māori; it can occur with Kiritaki from various cultural backgrounds when their unique values, beliefs, and healthcare needs are not respected or understood. Cultural safety requires physiotherapists to be aware of the different cultural perspectives that influence a Kiritaki experience of care. Below are some examples of culturally unsafe practices with Kiritaki from diverse cultural groups:
- Disregarding the role of whānau
Example: A physiotherapist insists on treating a Kiritaki without involving their family and whānau despite the Kiritaki culture emphasising the importance of whānau support in decision‐making.
Cultural Context: In many cultures, family plays a key role in decision‐making and support during healthcare processes. For example, in Māori, Asian, Middle Eastern, and Pacific Peoples cultures, family involvement is critical in ensuring Kiritaki feels supported and understood.
Why it’s Culturally Unsafe: Excluding family and whānau members when they are integral to Kiritaki care can lead to misunderstandings and feelings of alienation or distrust in the system.
- Lack of understanding of traditional and indigenous healing practices
Example: A physiotherapist dismisses Kiritaki use of herbal remedies or alternative treatments as “unscientific” or “ineffective” without understanding the cultural context or offering an open discussion about combining these with conventional physiotherapy.
Cultural Context: Many Indigenous cultures, such as those of Māori, African, Native American, or Pacific Peoples descent, use traditional medicine and healing practices. These practices often involve holistic approaches to health that may not align directly with Western medical models.
Why it’s Culturally Unsafe: Dismissing these practices can undermine Kiritaki trust in the physiotherapist and healthcare system. A culturally safe approach would involve an open, respectful conversation and consideration of Kiritaki traditional healing preferences in the treatment and management plan.
- Assuming all patients from the same country or region have the same health beliefs
Example: A physiotherapist assumes Kiritaki from China will automatically follow traditional Chinese medicine or acupuncture as part of their rehabilitation, without asking whether the Kiritaki is open to or values such approaches.
Cultural Context: Chinese culture has a long history of using traditional medicine, but not every Chinese Kiritaki may identify with or wish to incorporate those practices into their care.
Why it’s Culturally Unsafe: Assuming uniformity in cultural beliefs can alienate Kiritaki and neglect individual preferences. Physiotherapists should always ask Kiritaki about their values, beliefs, and preferences regarding treatment options.
- Not respecting religious or spiritual practices
Example: A physiotherapist schedules treatment or sessions at times that conflict with Kiritaki religious and spiritual practices, such as prayer times, health practise or religious holidays, without asking for Kiritaki preferences.
Cultural Context: Many religious groups, such as Muslim, Jewish, or Hindu, have specific prayer times, dietary restrictions, and religious or spiritual observances that need to be respected during interactions.
Why it’s Culturally Unsafe: Disregarding religious practices can cause distress, feelings of disrespect, or create barriers to treatment. A culturally safe practice would involve understanding and accommodating such needs as part of overall care.
- Inappropriate use of language and communication styles
Example: A physiotherapist uses overly complex medical jargon when speaking to Kiritaki who speaks English as a second language (ESL) or does not attempt to use simpler language or interpreter services if necessary.
Cultural Context: Patients from various backgrounds (e.g., refugees or immigrants) may struggle with medical terminology and communication in English, and this could hinder understanding and engagement and be part of decision‐making.
Why it’s Culturally Unsafe: Miscommunication can lead to misdiagnosis, ineffective treatment, or non‐compliance. Providing clear, culturally appropriate communication is key to ensuring Kiritaki understanding and involvement in their care.
- Ignoring cultural views on gender roles
Example: A physiotherapist insists on a same‐gender treatment model for female Kiritaki from a Middle Eastern or South Asian background, where cultural norms may discourage physical touch by a member of the opposite sex.
Cultural Context: In some Muslim, Hindu, or Jewish cultures, gender roles and expectations around modesty and physical contact during healthcare may influence Kiritaki comfort level and decision‐making.
Why it’s Culturally Unsafe: Ignoring cultural views on gender and physical touch can cause emotional distress or refusal to engage in the session and treatment options. It’s important to ask and respect Kiritaki preferences regarding gender with regards to whom provides/delivers the session.
- Disrespecting dietary and health practices
Example: A physiotherapist does not acknowledge or respect Kiritaki dietary restrictions related to vegetarianism (such as in Indian or Buddhist cultures) or halal dietary laws (in Muslim cultures) when recommending rehabilitation or recovery strategies that involve food supplements or specific diets.
Cultural Context: Dietary practices and restrictions can be deeply tied to cultural and religious identity. For example, vegetarian diets may be followed for religious or cultural reasons, and halal food practices are followed by Kiritaki Muslim.
Why it’s Culturally Unsafe: Offering treatment plans that violate Kiritaki dietary restrictions or beliefs can cause discomfort, offense, and lead to non‐compliance with rehabilitation plans.
- Failure to recognise the impact of trauma
Example: A physiotherapist applies certain treatments without considering that Kiritaki may have experienced trauma (e.g., institutional mistrust, refugees from war zones or victims of domestic violence) that affects how they respond to physical touch or certain movements.
Cultural Context: Refugees and survivors of trauma often have specific sensitivities or triggers that need to be considered in the treatment and management plan. For example, patients from conflict areas may have experienced physical or emotional trauma that makes certain movements or touch uncomfortable.
Why it’s Culturally Unsafe: A lack of awareness of trauma can lead to re‐traumatisation or emotional distress during session. It is essential to create a safe, supportive environment where Kiritaki feel comfortable and have the option to set boundaries.
- Ignoring the importance of cultural identity in recovery
Example: A physiotherapist doesn’t ask about or recognise how Kiritaki cultural identity affects their approach to health or healing, such as disregarding a Kiritaki Māori cultural belief in whānau and community support for recovery.
Cultural Context: Some cultures emphasise the importance of community and social networks in healing. For example, Indigenous cultures often have community‐based approaches to health, and some communities may rely on church or community support groups.
Why it’s Culturally Unsafe: Not considering cultural identity can prevent the physiotherapist from providing holistic care that aligns with Kiritaki values and practices, which could hinder overall engagement and outcomes.
- Disregarding cultural preferences for modesty
Example: A physiotherapist requires Kiritaki from a South Asian, Middle Eastern, or African background to wear clothing that may be seen as immodest within their culture or religious practices during a session.
Cultural Context: Kiritaki from certain cultural backgrounds may have specific views about modesty, especially around body exposure, and may require more conservative clothing during assessment and treatment approaches.
Why it’s Culturally Unsafe: Disregarding cultural preferences for modesty can make Kiritaki feel uncomfortable, embarrassed, or unsafe, possibly leading to them disengaging from treatment.
UNSAFE PRACTICES WITH LGBTQI+
- Disrespecting or dismissing gender identity
Example: A physiotherapist misgenders a transgender Kiritaki, either intentionally or unintentionally, by using incorrect pronouns or referring to Kiritaki by their previous gender (before transition) without acknowledging Kiritaki gender identity.
Why it’s Unsafe: Misgendering can cause distress, reinforce feelings of invisibility, and damage the therapeutic relationship. It is crucial for physiotherapists to use Kiritaki preferred name and pronouns and to ask if uncertain. Failing to do so can feel invalidating and disrespectful.
- Assuming sexual orientation or gender identity
Example: A physiotherapist assumes Kiritaki sexual orientation or gender identity based on stereotypes, making comments or asking inappropriate personal questions about their relationships.
Why it’s Unsafe: Making assumptions about Kiritaki sexual orientation or gender identity can lead to discomfort, harm, and feelings of alienation. It is essential to create an inclusive, non‐judgmental environment where Kiritaki feel safe to disclose their identities on their own terms.
- Inadequate privacy and confidentiality regarding LGBTQI+ identity
Example: A physiotherapist discusses Kiritaki sexual orientation or gender identity with others without the patient’s consent, either in the clinic or with others outside the healthcare setting.
Why it’s Unsafe: LGBTQI+ individuals may face discrimination, stigma, or violence if their sexual orientation or gender identity is exposed without consent. Maintaining strict confidentiality is vital to protect Kiritaki privacy and dignity.
- Failure to address specific health needs related to LGBTQI+ individuals
Example: A physiotherapist neglects to ask or consider specific health risks or needs that may be relevant to Kiritaki LGBTQI+, such as hormone therapy effects in transgender individuals or higher risks of certain health conditions in gay or bisexual men.
Why it’s Unsafe: Not asking about or acknowledging specific health risks or needs for LGBTQI+ individuals can lead to missed opportunities for appropriate care, lack of understanding, and potentially negative health outcomes.
- Refusal of care due to sexual orientation or gender identity
Example: A physiotherapist refuses to treat Kiritaki because of their sexual orientation or gender identity, citing personal or religious beliefs.
Why it’s Unsafe: Discriminating against Kiritaki based on their sexual orientation or gender identity is not only unethical but also unlawful in many countries. It denies Kiritaki access to necessary healthcare and exacerbates stigma and marginalisation.
UNSAFE PRACTICES WITH OLDER ADULTS
- Ageism and stereotyping
Example: A physiotherapist assumes that older Kiritaki cannot participate in certain activities or that they are too frail for rehabilitation, leading to a lack of appropriate treatment or the assumption that Kiritaki won’t improve.
Why it’s Unsafe: Ageist attitudes can lead to underestimating older Kiritaki potential and result in lower quality of care. Kiritaki, regardless of age, should be treated with respect and have individualised management plans based on their unique capabilities, rather than assumptions about aging.
- Ignoring the impact of age‐related conditions
Example: A physiotherapist fails to take into account the specific needs of older Kiritaki with age‐related conditions (e.g., osteoarthritis, osteoporosis, cognitive changes) when assessing, treating and planning their approach.
Why it’s Unsafe: Not considering the impact of age‐related conditions can result in treatment that is ineffective or harmful. For example, performing high‐impact exercises on a patient with osteoporosis can increase the risk of fractures, or neglecting cognitive decline in Kiritaki with dementia may lead to confusion and stress during treatment.
- Disrespecting autonomy and independence
Example: A physiotherapist imposes treatment decisions on an older Kiritaki without considering their preferences, goals, or level of autonomy, assuming they have cognitive limitations without assessing them.
Why it’s Unsafe: Older adults have the right to make decisions about their care. Disregarding their wishes or assuming they are incapable of participating in decisions can lead to a lack of trust, non‐compliance, and reduced treatment effectiveness.
- Failure to adapt communication to the needs of older adults
Example: A physiotherapist speaks too quickly, uses complex language, or does not ensure that the older patient has understood instructions, particularly if Kiritaki has hearing impairments or cognitive decline.
Why it’s Unsafe: Effective communication is crucial for treatment success, and older adults may have specific communication needs. Ignoring these needs can lead to misunderstandings, increased anxiety, and non‐compliance with the overall plan.
- Overlooking the importance of social and emotional support
Example: A physiotherapist focuses solely on the physical rehabilitation of an older Kiritaki without considering the emotional and social factors that may impact their recovery, such as isolation, loneliness, or depression.
Why it’s Unsafe: The physical and emotional health of older adults are closely linked. Failing to consider social or emotional support needs can result in incomplete care, lower motivation, and poor recovery outcomes.
UNSAFE PRACTICES WITH BOTH LGBTQI+ AND OLDER PEOPLE
- Lack of culturally safe space
Example: A physiotherapy clinic does not create an inclusive and welcoming environment for either LGBTQI+ or older Kiritaki. This may include things like a lack of inclusive signage, insensitive language, or neglecting the physical needs of older Kiritaki (e.g., seating or accessible bathrooms).
Why it’s Unsafe: A physically and emotionally unsafe environment can cause Kiritaki to feel uncomfortable, discriminated against, and unwilling to return for treatment, undermining both their physical and mental health.
- Failure to use person‐centred care
Example: A physiotherapist applies a one‐size‐fits‐all treatment approach without considering the individual needs, preferences, and backgrounds of LGBTQI+ individuals or older Kiritaki. For example, treating an older adult with no regard for their previous level of physical activity or treating a transgender person without discussing their hormonal therapy and its effects.
Why it’s Unsafe: Not tailoring care to the individual’s needs based on their unique background, identity, and health conditions can result in ineffective treatment and potentially harm Kiritaki recovery and outcome.
CONCLUSION:
Culturally unsafe practices can cause significant harm by fostering distrust, reducing treatment efficacy, and potentially it can negatively impact Kiritaki‐physiotherapist relationship and affect Kiritaki outcomes and success of physiotherapy services.
Practising cultural safety involves continually engaging with Kiritaki, asking open‐ended questions, and being willing to adapt assessment and treatment approaches to meet the individual needs of Kiritaki from.
It is vital for physiotherapists to develop cultural competence and cultural safety, engage in inclusive practices, respect Kiritaki autonomy, and ensure a safe and supportive environment for Kiritaki, regardless of diverse cultural backgrounds (such as ethnic background, sexual orientation, gender identity, age). This can enhance and foster a therapeutic relationship built on respect, trust, and mutual understanding.