從文化敏感到文化安全－－護理專業在多元社會中的實踐轉化

From Cultural Sensitivity to Cultural Safety: Transforming Nursing Practice in a Multicultural Society

隨著全球化與人口流動的加速，醫療照護場域日益呈現高度文化多元化，護理人員面臨愈加複雜的跨文化挑戰。「文化敏感」理念雖能提升對文化差異的理解與尊重，然多著重於知識的累積，較難處理醫療互動中的權力不對等與結構性不平等問題。「文化安全」則強調照護品質應由病人主觀經驗界定，並關注權力關係、批判性自我反思、病人主體性及結構性脈絡。本文旨在探討護理專業由文化敏感轉向文化安全之理論轉化，並分析其在臨床實務、護理教育與制度層面的應用與挑戰。透過文獻整合與分析發現，文化安全有助於重構護病關係，強化病人參與及信任，並提供回應多元社會健康不平等之重要途徑。在臺灣社會情境下，面對新住民、跨國移工及跨性別族群等多元族群之健康議題，文化安全具有高度實務與政策意涵。未來應持續將其融入護理教育、臨床實務與制度設計，發展具在地脈絡之文化適切性照護模式，以提升照護品質並促進健康公平。

With the acceleration of both globalization and population mobility, healthcare settings have become increasingly culturally diverse, presenting nurses with more complex cross-cultural challenges. Although cultural sensitivity promotes understanding and respect for cultural differences, its emphasis on knowledge accumulation limits its effectiveness in addressing the power imbalances and structural inequalities embedded in healthcare interactions. In contrast, cultural safety underscores that quality of care should be defined by patients’subjective experiences and highlights the important influence of power relations, critical self-reflection, patient autonomy, and structural contexts on care quality. In this article, the author examines the theoretical transition from cultural sensitivity to cultural safety in the nursing profession and analyzes the implementation of cultural safety in clinical practice, nursing education, and healthcare systems and its related challenges. The results of literature synthesis and analysis show that cultural safety facilitates the reconstruction of nurse–patient relationships, strengthens patient participation and trust, and provides a vital approach to addressing health inequities in multicultural societies. In the Taiwanese context, the health concerns of diverse populations, which include new immigrants, migrant workers, and transgender individuals, underscore the practical and policy implications of cultural safety. Future efforts should continue to integrate cultural safety into nursing education, clinical practice, and institutional design to develop culturally appropriate care models grounded in local contexts to further enhance care quality and promote health equity.