培育文化安全的護理能力

Enhancing Nursing Competence in Cultural Safety

「文化安全」不僅關乎於身體層面的保障，更著重於道德層面與照護關係的需求。醫療服務是否「安全」，應由病人而非醫療從業者加以定義；唯有在病人感到被尊重、不受貶抑、且其權益未被剝奪的情況下，照護關係方能稱為文化安全。醫護教育亟須培養學生對多元文化的理解與尊重，並教導其提供公平且安全的臨床照護環境。本文從解構理論的觀點，討論文化安全與實踐消除健康不平等。在實務層面上，文化安全是一個從文化覺知開始，進而發展文化敏感度，最終達成文化能力的漸進歷程。教師的文化教學能力可從三大核心面向進行建構：基礎能力、引導技巧與課程設計能力。這三類能力相互支撐，不僅有助於教師營造兼具包容性與跨文化敏感性的學習環境，也能有效促進學生發展文化安全的護理能力，以達到提升病人的照護品質與健康福祉的目標。

Cultural safety extends beyond physical protection to encompass moral considerations and the relational dimensions of care. The determination of whether healthcare is“safe”rests with patients rather than healthcare professionals, and only when patients feel respected, free from denigration, and assured their rights are upheld can care be considered culturally safe. Accordingly, healthcare education must cultivate respect in students for cultural diversity and prepare them to deliver equitable and culturally safe clinical care. In this article, a deconstructive perspective is used to examine the potential of using cultural safety as a framework for addressing health inequities. In practice, cultural safety represents a developmental process progressing from cultural awareness to cultural sensitivity and, ultimately, cultural competence. The cultural teaching capacity of educators may be strengthened through the three interrelated domains of foundational competence, facilitation skills, and curriculum design. Together, these can foster inclusive learning environments and support the development in students of culturally safe nursing practices, which are essential to enhancing quality of care and patient health and well-being.