文化安全實踐－－臺灣多元族群的護理照護

Practicing Cultural Safety: Providing Nursing Care to Taiwan’s Increasingly Diverse Population

隨著全球化與跨國人口移動的加速，醫療體系正逐漸呈現高度文化多樣化的特徵。在臺灣，人口結構的變遷使臨床照護環境出現更多元的文化背景病人。文化安全因此成為當代護理實務中促進公平醫療與提升照護品質的重要理念。此概念強調以病人的主觀照護經驗為核心，並透過反思醫療互動中的權力關係與制度性偏見，建立尊重且具包容性的醫療關係。本文探討文化安全在臺灣護理情境中的實務意涵，並以原住民族病人、跨國移工與外籍病人、性與性別少數族群，以及外籍配偶與新住民四類文化多元族群為分析脈絡。研究顯示，語言差異、健康識能落差、文化信念差異與社會支持不足，皆可能影響病人對醫療體系的信任、照護參與及治療遵從性。當醫療人員缺乏文化敏感度與反思能力時，臨床互動中可能出現溝通落差與隱性排除，進而影響照護品質。透過強化跨文化溝通、促進病人參與決策、培養專業反思能力，以及建立支持文化安全的制度環境，醫療體系可逐步發展更具包容性與公平性的照護模式。文化安全因此提供一個重要的專業框架，有助於在多元文化社會中提升病人信任、改善照護經驗並促進健康平等之權益。

With the increasing pace of globalization and transnational migration, healthcare systems are becoming more culturally diverse. In Taiwan, demographic changes have introduced increasing numbers of patients from diverse cultural backgrounds into clinical care environments, presenting new challenges for nursing practice. Cultural safety has emerged as an important framework for promoting equitable healthcare and improving the quality of patient care. Under this concept, patients’lived experiences and perceptions of care are used as central indicators of healthcare quality, and healthcare professionals are encouraged to reflect critically on the power dynamics and institutional biases within their healthcare interactions. In this article, the practical implications of cultural safety in nursing practice are discussed in the context of four culturally diverse populations in Taiwan: indigenous residents, migrant workers and other expatriates, sexual and gender minorities, and non-Taiwanese spouses and new immigrants. Language barriers, varied levels of health literacy, culturally shaped health beliefs, and limited social support are all factors that may influence patient trust, engagement in care, and adherence to treatment. When healthcare providers lack cultural sensitivity and reflective awareness, communication gaps and subtle forms of exclusion may occur in clinical encounters. Strengthening cross-cultural communication, encouraging patient participation in decision-making, fostering professional self-reflection, and creating institutional environments that support culturally safe practice are essential strategies to improving care. Therefore, cultural safety offers an important framework for developing strategies to enhance patient trust, improve care experiences, and advance health equity in multicultural healthcare settings.