建立文化安全的照護環境－－組織文化與政策支持

Establishing a Culturally Safe Care Environment: Organizational Culture and Policy Support

原住民族健康不均等的根源，不僅源於生物醫學與個人健康行為，更深受歷史創傷、殖民經驗與社會邊緣化影響。因此，在制定健康政策與提供照護服務時，應納入文化脈絡與族群觀點，並以「文化安全」作為核心理念，以回應原住民族對醫療體系之信任與需求。文化安全不僅涵蓋文化覺察、敏感度與能力，更進一步強調權力關係的反思與轉化，促進以受照護者為中心之照護模式。本文分析醫療與長照體系在實務上面臨之挑戰，包括標準化流程與文化差異間的衝突，並提出制度化策略，以提升照護品質與減少結構性不平等。同時，以《原住民族健康法》為例，說明政策與法律在推動文化安全中的關鍵角色。建構文化安全照護環境需從政策、組織到教育全面推動，透過文化尊重與制度支持，促進醫療體系轉型，達成多元共融與健康公平之目標。

In addition to biomedical factors and individual health behaviors, historical trauma, colonial experiences, and social marginalization are all critical factors that shape profoundly the health inequities experienced by indigenous peoples. Therefore, it is critical that cultural contexts and indigenous perspectives be incorporated into both health policy formulation and healthcare provision processes, with“cultural safety”serving as a central guiding principle to ensure healthcare systems earn the trust and serve the needs of indigenous clients. Cultural safety emphasizes cultural awareness, sensitivity, and competence as well as the critical reflection upon and transformation of traditional power relations to promote a truly patient-centered model of care. In this paper, the practical challenges faced by healthcare and long-term care systems, including tensions between standardized procedures and cultural differences, are examined, and institutionalized strategies are proposed to enhance quality of care and reduce structural inequalities. Moreover, the pivotal roles of policy and legislation in advancing cultural safety are highlighted using Taiwan’s Indigenous Peoples Health Act as an example. Establishing culturally safe care environments requires a comprehensive effort spanning policy, organizational structures, and education. Leveraging cultural respect and institutional support, this effort holds the potential to facilitate the transformation of healthcare systems and ultimately achieve the goals of diversity, inclusion, and health equity.