Discuss about the Community Nursing Practice.
The theory of social determinants of health recognizes that the inequality and population health is greatly determined by interconnected social factors. The access to mainstream primary health care services and low standard of healthcare infrastructure among the Indigenous population are the main social determinants of health among the Aboriginal and Torres Strait Islander people in Australia. There is a wide gap between the Indigenous and non-Indigenous health status in Australia (Baum et al., 2013). Currently, the Aboriginal and Torres Strait Islander people have a low access to primary healthcare services that fulfil their physical, mental and psychosocial needs. The Indigenous people are facing a lot of barriers in accessing the primary healthcare in proper time. There is a long gap in the life expectancy among the Indigenous and non-Indigenous population. The low level of education and unemployment are the main social determinants of health that affects the health and well-being of the Indigenous people in Australia (Mitrou et al., 2014).
The low level of health infrastructure like in terms of housing, food, clothing and sanitation results in poor health outcomes among the Indigenous population. They experience a lot of socio-economic disadvantage like low gross household income, unemployment rate and level of education. The inequality and poverty that these communities experience is a reflection of the treatment they receive. All these social determinants have an association with the overall health of the Indigenous population. The low level of literacy and poor education are linked to the poor health status and greatly affects the capacity of the Aboriginals to use the health information (Priest et al., 2012). The low level of income reduces the accessibility of the primary healthcare services and medicines that affects the Aboriginal and Torres Strait Islander peoples’ health. The poor infrastructure like run-down or overcrowded housing contributes to communicable diseases and associated with poverty. The inequality in status of health that the community is experiencing can be greatly linked with the systemic discrimination (Aspin et al., 2012).
According to Davy et al., (2016) the Aboriginals and Torres Strait Islander people experience high level of discrimination that acts as a barrier in accessing the mainstream primary health care services in terms of chronic disease like diabetes. The paper addresses the issues that hinder the Indigenous people in accessing the primary healthcare services. The low level of education and high level of unemployment influences the Indigenous population accessibility to primary healthcare. They face discrimination on grounds like healthcare costs, provision of transport, close consultation and in the identification and addressing of the healthcare needs of the Indigenous people by the community members. The Indigenous people face discrimination regarding the high cost of healthcare and poor communication with the healthcare professionals. Discrimination is greatly affecting the health of the community people as there is absence of culturally inappropriate services, lack of proper transport to reach the primary healthcare centers, high cost of healthcare services and low level of engagement with the healthcare communities.
According to Kelaher, Ferdinand & Paradies, (2014) racism is practiced towards the Indigenous people in terms of access to healthcare services in chronic diseases like hypertension and cardiovascular diseases. The effect of discrimination is greatly manifested in the primary healthcare services that are compromising the Indigenous health and well-being. There are great health disparities in the healthcare settings where the “White, Anglo-Australian cultural dominance is witnessed while delivering primary healthcare to the Indigenous Australians. Moreover, there is institutional racism encountered where the standard forms do not account the kinship structures of the Indigenous people at different locations. There is poor quality of healthcare as there is interpersonal racism prevailing among the Indigenous patient and healthcare provider regarding interest and lack of awareness that undermines quality of care and relationships. There is high level of psychological stress among the Indigenous population in the healthcare setting that acts as an indicator of risk for mental illness.
In the case scenario, Mr. Kay does not have proper housing and sleeps in his car in his daughter’s driveway. His left lower leg skin is torn with the car door while sleeping in the car Moreover, he has poor access to healthcare services and that resulted in poor health outcomes. He does not have any access to transport services that would take him to the Aboriginal healthcare center. The Aboriginal healthcare Service is taking care of him providing him primary healthcare services for his kidney disease and hypertension as he has no access to mainstream primary healthcare services.
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Nursing intervention |
Rationale |
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1. As a nurse, one should try to build a relationship with Mr. Kay. 2. The nurse should listen actively to the patient to develop a patient-nurse relationship. 3. By offering appropriate closings and greetings helps to promote trust and well-being and eradicate the fear of racism from the patient (Treloar et al., 2014). 4. By being friendly and calming there is increased understanding of each other. 5. By listening to the concerns and healthcare needs of the patient. 5. By respectfully calling the name of the patient. 6. By following up the patient and knowing what is the concerns and needs of the patient. 7. The anticipation of the needs of the patient in a primary healthcare setting (Herring et al., 2013). 8. Educating the patient so that he is able to understand his physical condition and consequences of the disease. 9. Educating and understanding of the auditory or visual limitations of the patient. 10. By being honest and consistent with the nurse’s plan of care (McDonald, Jayasuriya & Harris, 2012). 11. The nurse should follow the patient through commitments. 12. The nurse should treat Mr. Kay respectfully. |
1. This would help to know him as he would be able to feel comfortable and reduce his overall anxiety. Moreover, this would also be able to know the patient apart from his disease and physical condition. 2. By listening empathically to Mr. Kay, the nurse can access the priority needs, treatment options and plan of care. This also helps to demonstrate value and appreciation. 3. When a nurse greets a patient in a primary healthcare setting, it helps to establish a working relationship and promote positive rapport posing a way to therapeutic outcome. 4. This quashes any kind of miscommunication and helps to develop mutual respect and trust between the nurse and Mr. Kay. 5. Apart from physical needs, when the patient’s concerns are being assessed, it would help to build rapport and trust with the nurse and employ acceptance to care. 5. By calling a patient by his name, it shows respect and the patient is at ease and feel more comfortable. 6. This would help the nurse to assess the patient’s concerns apart from health and also helps to build credibility. 7. By anticipating the needs of the patient, it helps to build trust in the care plan of the nurse. Moreover, the patient feels that the nurse care about him and will provide with the best plan of care. 8. This greatly helps to assess the ongoing consequences of the patient along with the physical conditions and understand the best treatment options available for the patient. It also helps to provide the patient-centred care and understanding of the healing process. 9. This helps to assess the level of education that the patient has regarding his medical condition and also provide opportunities for questions. 10. This helps to facilitate trust and the patient would feel comfortable under the patient provision of care. Moreover, the patient would feel secure and find the plan of care trustworthy. 11. This would help Mr. Kay feel that the plan of care is greatly dependable and predictable. 12. This would reduce the anxiety in the patient regarding his physical and mental health condition. Moreover, the patient would feel that they are valued and their concerns are being heard. |
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1. The nurse should integrate the ways to understand and know Indigenous culture by demonstrating cultural competency (Thackrah & Thompson, 2013). 2. By addressing the institutional barriers in terms of institutional and interpersonal racism. 3. The nurse should be prior informed about the Indigenous knowledge, beliefs, values and culture. 4. By overcoming the language barrier and health disparities. 5. By integrating Indigenous knowledge into Western biomedical care models (Loftin et al., 2013). 6. Effective communication that would align with the Indigenous cultural norms (Quine, Hadjistavropoulos & Alberts, 2012). 7. By engaging Aboriginal healthcare providers in the provision of care. 8. By incorporating Indigenous culture that does not exist in the western lifestyle. |
1. This would help the nurse to assess the patient’s culture and make him believe that his culture is being valued. 2. This would help to provide access to the barriers that Mr. Kay faces regarding the access to primary healthcare services. 3. This would help the nurse to provide the Aboriginal health nursing that addresses the concerns and needs of the patient. 4. This would help the nurse to understand the complex Aboriginal needs and support Aboriginal knowledge practice. 5. This integration would help to provide holistic care to the patient with the access to mainstream primary healthcare services. 6. This would make Mr. Kay feel that is culture is being valued and there is no threat to racism. 7. This would help to make Mr. Kay comfortable to seek care under the provision of one’s own community people. 8. This would help the nurse to make Mr. Kay belief that he is not racially discriminated and his culture values and beliefs are being addressed along with physical needs. |
References
Aspin, C., Brown, N., Jowsey, T., Yen, L., & Leeder, S. (2012). Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC health services research, 12(1), 143.
Baum, F. E., Laris, P., Fisher, M., Newman, L., & MacDougall, C. (2013). “Never mind the logic, give me the numbers”: Former Australian health ministers’ perspectives on the social determinants of health. Social Science & Medicine, 87, 138-146.
Davy, C., Harfield, S., McArthur, A., Munn, Z., & Brown, A. (2016). Access to primary health care services for Indigenous peoples: A framework synthesis. International Journal for Equity in Health, 15(1), 163.
Herring, S., Spangaro, J., Lauw, M., & McNamara, L. (2013). The intersection of trauma, racism, and cultural competence in effective work with aboriginal people: Waiting for trust. Australian Social Work, 66(1), 104-117.
Kelaher, M., Ferdinand, A., & Paradies, Y. (2014). Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities. Med J Aust, 201(1), 44-47.
Loftin, C., Hartin, V., Branson, M., & Reyes, H. (2013). Measures of cultural competence in nurses: an integrative review. The Scientific World Journal, 2013.
McDonald, J., Jayasuriya, R., & Harris, M. F. (2012). The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus. BMC health services research, 12(1), 63.
Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E., & Zubrick, S. R. (2014). Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health, 14(1), 201.
Priest, N., Mackean, T., Davis, E., Waters, E., & Briggs, L. (2012). Strengths and challenges for Koori kids: Harder for Koori kids, Koori kids doing well–Exploring Aboriginal perspectives on social determinants of Aboriginal child health and wellbeing. Health Sociology Review, 21(2), 165-179.
Quine, A., Hadjistavropoulos, H. D., & Alberts, N. M. (2012). Cultural self-efficacy of Canadian nursing students caring for Aboriginal patients with diabetes. Journal of Transcultural Nursing, 23(3), 306-312.
Thackrah, R. D., & Thompson, S. C. (2013). Confronting uncomfortable truths: Receptivity and resistance to Aboriginal content in midwifery education. Contemporary nurse, 46(1), 113-122.
Treloar, C., Gray, R., Brener, L., Jackson, C., Saunders, V., Johnson, P., … & Newman, C. (2014). “I can’t do this, it’s too much”: building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers. International journal of public health, 59(2), 373-379.
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