Called to and elderly Indigenous woman (Anna) living in Wynnum who has experienced a seizure. Upon arrival the paramedic team is met by the patient’s daughter (Audrey) who is in her late 60s and she is the only caretaker of her mum. They have come from Cunnamulla community to get her mother examined by a specialist regarding the seizures that her mother often gets while bearing down on the toilet. Audrey expresses that this time it took her mother a while to recover from the seizure which is unusual to her and this is the reason that she wants her mother checked.
Besides Anna’s medical condition, Audrey and her mother are experiencing social and economic problems.
They have moved away from their community to Brisbane, which is a new and unfamiliar place for them, and Audrey is facing difficulties as she doesn’t know the area well and they have lost their connection to their community. Financial hardship that they are having is also building up more pressure on the situation.
How to clinically assess and manage Anna’s medical condition (seizure) in pre-hospital setting and assist them with their financial problems and overcome cultural issues will be discussed in this management plan.
Starting with the primary survey, there is no abnormal findings, but it would be better to consider asking ACP back up as the patient has gone through seizer and the risk of relapsing seizers should not be underestimated which in case needs drug therapy according to Queensland Ambulance services (QAS) Clinical Practice Guidelines (QAS, 2018), which is not in the scope of practice for 1st year paramedic student.
Moving to secondary survey, first set of patient’s vital signs are within the normal limits and there are no abnormal findings.
Audrey states that her mother usually gets seizures but recovers quickly as opposed to the last time that took her a while, Audrey says that her mother has been checked by a specialist and the seizures are related to a change in her mother’s blood pressure, but she doesn’t know the diagnosis. Further history taking is required at this stage, according to QAS clinical practice procedures more information about signs and symptoms, allergies, medication, past medical history (underlying illness), last food or medication intake and events prior to the event are needed to be asked (QAS, 2019).
All her medications should be checked to rule out any possible medication related cause of the condition and a thorough neurological status assessment should be undertaken according to QAS clinical practice procedures to find out if there is any neurological dysfunction. After completing primary and secondary surveys patient should be moved to a safe place to prevent injuries and the airway should be protected to prevent aspiration, supplemental Oxygen should be considered (Curtis & Ramsden, 2016) if SpO2 falls below 94%. Monitoring Anna’s blood pressure is of high importance because the seizures are related to a change in her blood pressure as well as hypotension is a cause of provoked seizures (QAS, 2016). As part of her management supportive care and reassurance should be considered (eTG Complete, 2017). Anna needs to be transported to hospital and the hospital should be pre-notified as appropriate (QAS, 2016).
Aboriginal people have their own believes regarding health and wellbeing. Health is defined as to be socially, physically, emotionally, spiritually and culturally well according to Aboriginal culture (Queensland Health, 2014). Moreover, Aboriginal people can have a fear and mistrust in Health care services and have a feeling of isolation and disempowerment (Queensland Health, 2014). Separation from their social support networks and community can be overwhelming and the fear to be judged can heighten their stress level (Queensland Health, 2014). As we have noticed that Anna and Audrey are Indigenous people and they have come away from their community to Brisbane city which is unfamiliar area to them, lifestyle is different to their culture and they no longer have that connection to their support networks and family which is overwhelming and can cause feeling of being disempowered.
To be able to provide better health care for people with diverse cultural backgrounds, health care workers must have the five cross cultural capabilities which are: self-reflection, cultural understanding, context, communication and collaboration (Queensland Heath, 2010). Health care workers must know their own culture first and be aware of it and have a good understanding of culture, then, should be able to know what social factors can impact on one person’s behavior. Also, a health worker should have effective communication skills to communicate with people of different cultures and be sensitive to diverse cultural norms and be capable of engaging individuals to decision making process. Opposed to western approach to health, which is determined by biomedical model, Aboriginal people follow holistic approach to health which consists of body, mind and spirit (Queensland Health, 2014).
To provide good health care service for Anna, having in mind all five cross cultural capabilities, a good understanding of own culture and the Aboriginal culture difference is crucial. Understanding Anna’s and Audrey’s beliefs regarding health and concept of health is important to actively engage them in communication and overall decision-making process. Other social factors that can impact on her health should be considered for example their socio-economic state. Language can be a barrier in communication as many Aboriginal people don’t talk English as a first language, allowing some time to build rapport and talking with them in simple English to explain the situation and actively listening to them can help in delivering information (Queensland Health, 2014). Varying norms of communication in Aboriginal culture regarding verbal and non-verbal communication should be understood for example eye contact and body language (Queensland Health, 2010).
There are services for Aboriginal and Torres Strait Islander people that they can access if they need emotional and cultural support like The Aboriginal and Torres Strait Islander Liaison Service. This service provides information, emotional and cultural support through Indigenous Hospital Liaison Officers for identified Aboriginal and Torres Strait Islander people, also the service can coordinate accommodation and travel of Indigenous people (Queensland Health, 2017).
Australian government provides services for people who can’t live independently and look after themselves as they become older and need help around the house. One service is “My Aged Care” that Anna can get help from because Audrey is struggling to look after her and taking care of the house. To access help from government-funded aged care services they can call 1800200422 and the staff will assess their needs and problems and manage a proper service to fet their needs (My Aged Care, n.d). My Aged Care service can help Anna and Audrey with shopping, cooking and personal care which they are really in need of it, because the kitchen is full of dirty dishes that Audrey couldn’t manage to wash and there are clothes that need to be folded and washed. My Aged Care service can manage Anna and Audrey’s shopping which gives Audrey the chance to focus only on her mother.
To manage Anna and Audrey’s financial problems, they can be referred to the Australian Government Department of Human Services. Audrey can be eligible for carer payment because she constantly takes care of her mother (Department of human Services, 2019). Centrepay is another service provided by Department of Human Services which is free and voluntary that pays bills as regular deductions from centrelink payments (Department of Human Services, 2019). Audrey can apply to Department of Human Services for carer payment and also can take benefit of centrepay to pay the bills which are all due with final notice stamped on them.
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