A PDF version of this Standard can be downloaded here.
Introduction
Physiotherapists in Aotearoa New Zealand practise within a culturally diverse environment. They are required to be competent when engaging with health consumers whose cultures may differ from their own, and with colleagues and other health professionals from diverse backgrounds.
Health consumers’ cultures affect the way they understand health, well-being and illness, the choices regarding their health, how they access health care services and how they respond to interventions.
Culture may include, but not be limited to age, gender, sexual orientation, race, socio-economic status (including occupation), religion, ethnicity and organisational culture, physical or mental or other impairments. Cultural competence is a contemporary term that encompasses concepts, which are holistic and patient-centred.
Te Tiriti o Waitangi – Treaty of Waitangi
The Board acknowledges Te Tiriti o Waitangi/Treaty of Waitangi as a founding document of Aotearoa New Zealand, which informs legislation, policy and practice and aims to reduce the health inequalities between Māori and non-Māori. It recognises and respects the specific importance of health services for Māori as the indigenous people of Aotearoa New Zealand.
To practise effectively in Aotearoa New Zealand, a physiotherapist needs to understand the relevance and be able to apply the Tiriti o Waitangi/Treaty of Waitangi principles, whilst promoting equitable opportunity for positive health outcomes within the context of Māori health (models), including whānau (family health), tinana (physical health), hinengaro (mental) and wairua (spiritual health).
Physiotherapists in Aotearoa New Zealand must be able to work effectively with people whose cultural realities are different to their own. To achieve this, they require a working knowledge of factors that contribute to and influence the health and well-being of Māori communities including spirituality and relationship to the land and other determinants of Māori health.
Physiotherapy standards of cultural competence are integrated both implicitly and explicitly throughout all physiotherapy competencies. These are incorporated in the Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct and the Physiotherapy practice thresholds in Australia and Aotearoa New Zealand.
Culturally competent physiotherapists contribute to improved and equitable outcomes for health consumers and all those working in the health sector through:
- the understanding of their own culture and that of the consumer and the organisation where they are employed
- continued development of confidence in the physiotherapist-patient relationships
- improvement in communication with, and increased information gained from, patients
- improved communication with other providers and colleagues
- development of appropriate patient-centred goals
- increased engagement with treatment plans ensuring better health outcomes
- increased patient, whānau and family satisfaction
- having advancing knowledge and understanding of the diverse cultures where they are employed.
New Zealand Law
New Zealand Bill of Rights Act 1990
The Code of Health and Disability Services Consumers’ Rights 1996
Cultural competence is a process of continuing self-development for the betterment of patients. As such, physiotherapists must demonstrate the appropriate awareness and knowledge, attitudes, and skills of cultural competence.
1. Awareness and knowledge
To work successfully with health consumers of different cultural backgrounds, a physiotherapist must demonstrate appropriate awareness and knowledge including:
- recognition that Māori and other cultures’ definitions of health may involve multiple dimensions that extend beyond the physical and medical diagnoses
- an awareness and acknowledgement of their own limitations of cultural knowledge and an openness to ongoing learning and development
- an awareness of a patient’s right to identify with any cultural parameters that they choose
- an understanding that patients may identify with multiple cultures
- An awareness that a patient’s culture may have an impact on:
- their perceptions of health, illness and disease
- their access to health services
- the delivery of health care practices
- their interactions with medical professionals and healthcare systems
- treatment preferences.
2. Attitudes
To work successfully with health consumers of different cultural backgrounds, a physiotherapist must demonstrate appropriate attitudes including:
- a preparedness not to impose their own values on patients
- a willingness to understand their own cultural values and beliefs and the influence these have on their interactions with patients
- a commitment to ongoing development of their own cultural awareness and practices including those of their colleagues and staff
- promote and actively support a culturally bias-free environment
- a willingness to appropriately challenge the cultural bias of individuals or health systems where this will have a negative impact on patients.
3. Skills
To work successfully with health consumers of different cultural backgrounds, a physiotherapist must demonstrate appropriate skills including:
- establishing a rapport with health consumers of other cultures, and respectfully inquire about the cultural background and beliefs of the patient
- identifying how a health consumer’s culture might inform the physiotherapist-patient relationship
- identifying actions (conduct), which may be appropriate and inappropriate
- considering the health consumer’s cultural beliefs, values, practices, and social rules in developing a relevant treatment plan for the patient
- including a patient’s whānau, family and community in their physiotherapy care, where appropriate
- working cooperatively with individuals and organisations in a patient’s culture
- working with other healthcare professionals to provide integrated culturally competent care
- communicating effectively by:
- recognising that communication styles of patients may differ from their own and modifying these as required
- working with interpreters as required.
- acknowledging any cultural dissimilarity when discussing a patient-centred treatment plan
- reflecting on and improving their own practice to ensure equitable outcomes and demonstrating life-long learning in cultural competence.
Related resources
Aotearoa New Zealand Code of Ethics and Professional Conduct (2018) Principles 1 and 4
Physiotherapy practice thresholds in Australia & Aotearoa New Zealand (2015) Cultural competence (pp 11- 12) and Key competencies 1.3, 1.4, 2.1, 2.2, 4.1, 5.1, and 7.2
ACC (2008). The Māori patient in your practice.
Bacal, K., Jansen, P., Smith, K. (2006). Developing cultural competency in accordance with the
Health Practitioners Competence Assurance Act. New Zealand Family Physician, 33 (5), 305-
Durie, M. (2005). Nga tai matatu: Tides of Maori endurance. OUP Catalogue.
Kingi, T. R. (2007). The Treaty of Waitangi: A framework for Māori health development.
Main, C., McCallin, A., Smith, N. (2006, November). Cultural Safety and Cultural
Competence:what does it mean for physiotherapists? NZ Journal of Physiotherapy, 34 (3),
160-166.
Ratima, M., Waetford, C., Wikaire, E. (2006, November). Cultural competence for
physiotherapists: reducing inequalities in health between Māori and non-Māori, New Zealand.
Journal of Physiotherapy, 34 (3), 153-159.
New Zealand Journal of Occupational Therapy, 54(1), 4-10
Online education: www.mauriora.co.nz: Foundation Course in Cultural Competency
Souza, R. (2008). Wellness for all: the possibilities of cultural safety and cultural competence
in New Zealand. Journal of Research in Nursing, 13, 125-135.
Tae Ora Tinana. Maori partner of Physiotherapy New Zealand. http://physiotherapy.org.nz/about-us/our-structure/tae-ora-tinana/
Waitangi Tribunal Te Rōpū Whakamana i te Tiriti o Waitangi. Meaning of the treaty.
https://www.waitangitribunal.govt.nz/treaty-of-waitangi/meaning-of-the-treaty/
Waitangi Tribunal Te Rōpū Whakamana i te Tiriti o Waitangi. Principles of the treaty.
https://www.waitangitribunal.govt.nz/treaty-of-waitangi/principles-of-the-treaty/