Date Published: June 19, 2019
Publisher: Public Library of Science
Author(s): Jasmina Fejzic, Michelle Barker, Joseph Telfair.
The Code of Ethics of pharmacy practitioners in Australia recognises the obligation to provide care to patients in a culturally safe and responsive manner. The aim of this exploratory study was to examine how Australian community pharmacists understand and experience the concept of ‘culture’ in their everyday practice environment.
Voluntary, semi-structured interviews were conducted at community pharmacy placement sites in South-East Queensland, Australia. Pharmacists were asked to recall an incident that evoked their cultural awareness during the course of their practice. The question stated, verbatim: “We are preparing our students to be pharmacists in a highly multicultural community. Can you think of an incident where you learnt something about another person’s culture or it made you more aware of your own culture? Please briefly describe the incident.” Reportable responses were collected from 59 of the 92 visited pharmacists. These responses were audio-recorded and transcribed. The data were collated and analysed through iterative, reflexive, thematic analysis using constant comparison.
The responses provided a rich selection of lived experiences within Australian multicultural pharmacy practice, describing professional dilemmas, fears and the strategies employed to overcome practice challenges. Six main response categories were identified: (i) Language/communication challenges, (ii) Cultural attitudes and behaviours, (iii) Exposure to culture due to pharmacy location, (iv) Religion, gender, and age, (v) Prejudiced/perceived racist attitudes and discrimination towards ‘other’ cultures, (vi) Perceived ‘sameness’ of different cultures. The study has provided valuable insights into community pharmacists’ experiences of culture in their day-to-day professional practice, also highlighting the associated strategies used to maintain a high standard of practice. There is merit in ensuring that the pharmacy curriculum and professional development programs are designed to respond to the ethical obligation of pharmacists to practise in a culturally safe, responsive manner that acknowledges and incorporates the importance of culture, cultural differences and intercultural relations, while addressing culturally unique needs in a skilled and professional manner.
Australia is culturally and linguistically diverse (CALD). It has been enriched by the contribution of people from many nations and its policies remain committed to maintaining a culturally diverse, tolerant and open society where the language needs of CALD populations are addressed . The oldest continuing human culture on earth, Aboriginal and Torres Strait Islander peoples, have lived on the continent for more than 50,000 years and their history and culture have also uniquely shaped the Australian nation [1,2]. The majority (75%) of Aboriginal and Torres Strait Islander peoples live in cities and non-remote areas, representing 3% of the total Australian population of 24.5 million [3,4]. Since colonisation, Australia has been an immigrant nation, with 28.5% of its current residents born overseas, and its population identifying with around 300 ancestries [1,5].
Ethical clearance (PHM/03/10/HREC) was provided by the University’s Human Ethics Research Committee. Visits and interviews were conducted at 92 community pharmacy placement sites by the first-named author (while placements were in progress) in South-East Queensland, Australia as part of the regular Master of Pharmacy (MPharm) placement course activities. These placements (also known as practicums) involved ten days of community pharmacy placement over ten weeks (one day per week). Placement site visits were part of the Pharmacy School’s regular quality assurance to support preceptors and engage with them as educational partners through individual conversations. The preceptors (registered community pharmacists) were notified of these scheduled, one-off visits two weeks prior to the visit. Preceptors were advised of the aims of the visit. Primarily, the purpose of the meeting was to seek preceptors’ evaluation of the student’s performance during the placement. The research question relating to this study was the first question asked during the interview with preceptors (community pharmacists).
Reportable responses to the culture question were collected from 59 of the 92 visited preceptors, since 22 were ‘too busy’ to participate in the research component of the interview, while 11 of the remaining 70 preceptors chose not to comment on the ‘culture question’. The researchers noted that this experience was congruent with the results of the recent systematic review reporting that the most common barriers to participation in pharmacy practice research are a lack of time and workload . In some instances, participants had to conclude the interview and recommence their work before the interviewer sought basic demographic details, which is why demographic data was collected for only 45 participants. This sub-cohort of practitioners practiced pharmacy for 13.5 years on average, and 59% were female, which, coincidentally, matched the gender distribution of Australian pharmacists . The rationale for asking the research question arose as a means of obtaining a succinct ‘snapshot’ of the pharmacy practice events that pharmacists associate with culture. Pharmacists’ responses varied in scope, quite candidly, intricately, and reflectively detailing a rich selection of their lived experiences within Australian multicultural pharmacy practice. Some also described ongoing professional dilemmas, fears, and the strategies they employ to overcome any concerns. The respondents’ observations were classified into six categories (number of mentions in parentheses), namely: (i) Language/communication challenges (36), (ii) Cultural attitudes and behaviours (22), (iii) Exposure to culture due to pharmacy location (13), (iv) Religion, gender, and age (12), (v) Prejudiced/perceived racist attitudes and discrimination towards ‘other’ cultures (6), (vi) Perceived ‘sameness’ of different cultures (4). Some individual respondents mentioned several issues classified across the corresponding themes. Overall, the most common cultural associations were language and communication challenges, and cultural attitudes, beliefs and behaviours. Each theme is discussed in detail, illustrated by exemplar quotes from participants.
The study has provided invaluable insights into community pharmacists’ experiences of culture in their day-to-day professional practice in multicultural Australia. It also highlighted the associated challenges and strategies they use to maintain a high standard of practice in intercultural situations in the workplace. Clearly, many pharmacists are attuned to the complexities involved in meeting the needs of clients, peers and pharmacy students from CALD backgrounds. For others, culture was not particularly salient. The exploratory study indicates there is merit, therefore, in ensuring that the Pharmacy curricula and professional development programs are designed to respond to the ethical obligation of pharmacists to practise in a culturally safe and responsive manner that acknowledges and incorporates the importance of culture, cross-cultural relations and differences, and addresses culturally unique needs in a skilled and professional manner . To ignore the complex influence of culture on practice, would, to borrow Oberg’s metaphor , constitute ignoring the very medium in which we swim.