Cultural Safety Toolkit

Nurses:

1.1 reflect on their historical, social, and political positionality;
1.2 reflect on their own culture, beliefs, and values, and how these influence ways of knowing, thinking, and doing.

Questions to reflect on:

• What are the values or beliefs that I have learned from family, community, or religion?
• How have my life experiences been shaped by things like race, gender, language, or income?
• What advantages or barriers have I had in life that might be different from others?
• What messages have I learned about “good” or “bad” health habits growing up?
• What attitudes do I have toward people who live, look, or speak differently than me?

Nurses:

1.3 critically reflect on emotions that arise when examining their positionality or privilege;

Questions to reflect on:

• What topics make me uncomfortable (e.g. racism, colonization, privilege, cultural traditions)?
• When do I feel defensive, frustrated, awkward, or unsure during care?
• How do I react when a client challenges my beliefs or questions my care?
• What situations make me feel caught off guard or triggered?
• What do I usually do when I feel uncomfortable (e.g. shutting down, changing the subject, getting irritated)?

Nurses:

1.4 identify and evaluate personal biases and stereotypes that may facilitate or hinder a culturally safe healthcare experience

Questions to reflect on:

• Do I make assumptions about a client’s education, values, or abilities based on how they look, speak, or act?
• Have I ever jumped to a conclusion about a client’s health, illness, or personal choices?
• Do I notice patterns in who I feel more comfortable with?
• When have I treated someone differently without realizing it at first?

Nurses:

1.5 Commit to intentional, lifelong, reflective practices; and
1.6 Continually seek opportunities to improve their ability to provide culturally safe care.

Questions to reflect on:

• What’s one belief or reaction I want to change in my practice?
• What will I do differently next time a similar situation happens?
• How can I keep learning about cultural safety (e.g. books, podcasts, trainings, conversations)?
• Who can I talk to for support, learning, and accountability?

Nurses:

2.1 reflect on power dynamics in nurse-client relationships.

Questions to reflect on:

• In my relationships with clients, who holds more power? Why?
• How might my role or title affect how comfortable clients feel?
• Do I listen more than I speak? Do I allow space for clients to lead?

Nurses:

2.2 reflect on the culture of their practice setting and how this impacts client care;
2.3 seek feedback on behaviour from trusted colleagues and clients; and
2.4 uphold respectful, inclusive, and non-discriminatory relationships with colleagues to contribute to safe care environments.

Questions to reflect on:

• What attitudes or behaviours are normalized in my workplace? Who do they serve and who do they leave out?
• Do all team members feel respected, included, and safe to speak up?
• How does my workplace culture affect the kind of care clients receive?
• Do I ask for feedback about how I interact with others and do I receive feedback with openness?
• What do I do when I witness disrespect, exclusion, racism, or discrimination in the workplace?

Nurses:

2.5 reflect on cultural awareness and cultural sensitivity as precursors to cultural safety;
2.6 accept that healthcare providers' attitudes, beliefs, and practices can facilitate or hinder culturally safe care.

Questions to reflect on:

• Do I understand the difference between cultural awareness, cultural sensitivity, and cultural safety?
• Am I willing to admit when my actions might make someone feel unsafe, even if it was not my intention?
• Do I focus on “being nice”, or on really listening to how my clients experience care?
• How might my habits or tone be helping or hurting someone’s trust?

Nurses:

2.7 acknowledge beliefs and practices that differ from their own without discrimination, regardless of age, sexual orientation, gender identity, occupation, socioeconomic status, ethnic origin, migrant experience, religious or spiritual belief, or disability;
2.8 commit to cultural humility.

Questions to reflect on:

• How do I react when a client’s beliefs or values are very different from mine?
• Do I judge certain behaviours or traditions without realizing it?
• Do I try to understand where people are coming from before offering advice?
• How do I stay open and curious instead of assuming I already know?

Nurses:

3.1 understand that the care recipient (client, family, and/or community) determines whether a healthcare encounter is culturally safe.

Questions to reflect on:

• Do I ask clients if they feel comfortable and/or respected during care?
• Have I ever assumed something was fine without checking how it felt for the client?
• What do I do if a client seems withdrawn, quiet, or unsure?

Nurses:

3.2 offer the choice to involve the client’s family, support people and other community-based supports and providers (e.g., Elders, patient advocates, community health nurses, etc.) to facilitate and support culturally safe client care.
3.3 co-create and incorporate plans of care that include cultural rights, values, spiritual beliefs, customs, and practices without judgment or bias.

Clients may feel safer and more supported when they are not alone, especially if cultural or spiritual guidance and support is important to them.

Questions to reflect on:

• Do I assume clients want to be alone or make decisions by themselves?
• Do I ask who they want involved in their care?
• Have I ever dismissed a request to involve an Edler, an advocate, or other community supports?
• Do I ask about spiritual, cultural, or personal needs when care planning?
• Am I open to adapting routines or treatments to reflect what the client values?

Nurses:

3.4 respect the client’s right to respect and dignity and refrain from placing judgment, labels, stigma, and/or eliciting humiliating behaviour (which may be intentional or unintentional) toward the client;
3.5 engage in clear, respectful, and inclusive communication that fosters mutual trust and affirms the client’s lived experience.

Questions to reflect on:

• Do I speak and act in ways that show respect? Even when I am busy or under pressure?
• Have I ever used a label like “non-compliant” or “frequent flyer” ?
• Do I validate client’s stories, or do I minimize or question them?

Nurses:

3.6 respect and support the client’s right to informed decision-making and informed consent.

Clients have the right to know, understand, and choose what happens to their body and health, even if their choices are different from yours.

Questions to reflect on:

• Do I make sure the client understands their options in plain language?
• Do I give them time to decide?
• Am I respectful if they decline a treatment or choose another path?

Nurses:

3.7 take appropriate action when others act in a discriminatory manner, including following NANB’s Practice Guideline Duty to Report and reporting instances of racism and discrimination to your employer and regulatory body.

Questions to reflect on:

• Have I ever witnessed a colleague say or do something discriminatory?

• What stopped me from speaking up and what would help me act next time?
• Do I know how to report racism or discrimination in my workplace or to NANB?

Nurses:

4.1 recognize the widespread and often hidden impacts of trauma and violence on individuals, families, and communities.

Questions to reflect on:

• Do I assume trauma only means physical or visible abuse?

• Do I consider how racism, colonization, poverty may have caused trauma?
• How do I respond when someone avoids care, is guarded, or does not seem to trust me?

Nurses:

4.2 through a trauma-informed lens, prioritize emotional safety in care settings by being mindful of tone, body language, physical and social environment, and client preference.
4.3 avoid re-traumatization by using non-judgemental, empowering language and practices, such as consent before touch, that support client autonomy and control.

Questions to reflect on:

• How does my voice or body language make people feel?
• Do I provide the client enough space and time, or do I rush?
• What parts of my environment might feel unsafe or overwhelming to someone?
• Do I explain what I am doing before I touch someone?
• Do I give the client choices, even in small things?
• Do I avoid language that sounds blaming, rushed, or dismissive?

Nurses:

4.4 promote trust through transparency, consistency, and collaborating in care planning and decision-making; and
4.5 apply a strengths-based approach that recognizes and affirms clients’ capacities, cultural identity, and community supports.

Questions to reflect on:

• Do I explain the “why” behind what I’m doing?
• Do I follow through on what I say I will do?
• Do I include the client in making decisions or just tell them what’s happening?
• Do I notice what the client is doing well?
• Do I ask about cultural and community resources they already use to cope?
• Do I build care plans around what gives the client meaning, identity and connection?

Nurses:

5.1 understand how structural inequities, rather than individual characteristics, influence access to care, including socioeconomic, political, and historical conditions;
5.2 acknowledge that structural oppression and structural racism are real, may interfere with care.

Questions to reflect on:

• Do I recognize how income, race, language, immigration, and other factors affect access to care?
• Do I understand how racism and structural oppression exist in healthcare and other organizations?

Nurses:

5.3 help colleagues (e.g., nurses, allied health professionals, physicians) identify and eliminate attitudes, language, and behaviours that negatively impact a client’s safe healthcare experience;
5.4 create positive and culturally safe work environments by role modelling anti-racism and anti-oppressive practices and supporting the rights and safety of clients and colleagues;
5.5 contribute to inclusive and equitable healthcare teams by promoting respect, psychological safety, and collaboration.

Questions to reflect on:

• Have I heard jokes, labels, or comments that could make someone feel unsafe, unvalued, or unheard?
• What everyday behaviours or routines might be normal for some staff but harmful or silencing for others?
• How do I actively model equity, respect, and inclusion in my workplace?
• Do I make space for underrepresented voices in team meetings or decision-making?

Nurses:

5.6 advocate to address barriers that impact culturally safe care;
5.7 identify and advocate to change or eliminate policies and practices that negatively impact culturally safe environments;
5.8 advocate for the expansion and uptake of culturally safe and anti-racist policies, practices, procedures, and mandatory professional development from employers.

Questions to reflect on:

• Are there policies, intake forms, or standard operating procedures that make assumptions about language, race, gender, or family structure?
• Who was considered when these rules were made and who may have been left out?
• Have I ever felt frustrated by a policy but didn’t question it because “that’s just how it is”?
• Do I know the process for raising concerns about systems or suggesting changes in my workplace?
• Am I using my position to push for fairer, more culturally safe practices?

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