The clinic also provide services to lesbian, gay, bisexual, transgender people, intersex (LGBTI) community equally with strong implementation of Anti-Discrimination Act and follow equal employment opportunities for this community (Seear & Fraser, 2014). This medical centre has been accredited with The Royal Australian College of General Practitioners (RACGP) providing equal rights and services to LGBTI community at the medical centre. Victoria, Australia is one of the most progressive and advanced jurisdiction that work for LGBTI peoples’ rights. The services at Vineyard Centre aims at becoming more responsive towards the issues of gender identity, sexual orientation and intersex variations understanding the importance of specific health and wellness needs of these LGBTI community people (Britt et al., 2013).
The medical clinic focuses on addressing the health and wellbeing issues of LGBTI community. Vineyard centre acknowledge the resilience and strength of this community by providing healthcare services that help them to overcome challenges and recognition of the diverse experiences. They provide healthcare services that identify and recognize LGBTI community needs and conduct programs that address discrimination that directly contributes to poorer health outcomes. In the current Victorian healthcare scenario, The Health and Wellbeing Action Plan 2014-2018 for LGBTI community prioritizes five strategies through inclusive practice promotion via improvement in access of mainstream healthcare services, improvement in understanding of emerging health and wellbeing LGBTI communities (Veltman & Chaimowitz, 2014). It also work in addressing stigma and discrimination, improvement of access to appropriate and current information and encouragement and supporting health promotion activities for LGBTI communities. Each priority is being encouraged and supported by strategic directions improving LGBTI health and wellbeing.
Vineyard centre is also working towards the above mentioned strategies by providing health services to LGBTI community at their clinic. They are providing more respectful, inclusive and responsive services responding to the LGBTI communities and individuals. This medical clinic in coalition with mainstream Victorian access, provide targeted healthcare deliveries to LGBTI community people. There is undertaking of health and wellbeing resources, policy formulations, undertaking research and organizational training at the medical clinic that provide support to LGBTI healthcare needs (Hardiman, Makregiorgos & Foster, 2014). As they provide services irrespective of gender, ethnicity or cultural background, this medical centre address stigmatization and discrimination that is experienced by LGBTI communities. The Action Plan in Victoria is also investing in a program that tackles discrimination assisting them to increased access to mainstream healthcare services for LGBTI communities (Bobier, Boonstra & Brick, 2015). At the Vineyard Clinic, the nurses perform PAP SMEAR test for the lesbians that would be helpful in preventing sexually transmitted diseases (STDs) like HIV. The Gay community prostate cancer patients are also provided healthcare services like HIV testing and regular check up that support the fact that Vineyard Medical Centre supports LGBTI communities as it is practiced at a GP clinic. Policy considerations are also important that greatly supports LGBTI people at the clinic strengthening their inclusion in the mainstream healthcare services discussed in the subsequent section.
LGBTI taskforce in Victoria, Australia was established in 2015 to identify government priorities that ensure healthcare services and programs are inclusive for this community (Moe, Perera-Diltz & Sepulveda, 2014). The working group includes healthcare services that help to improve the responsiveness of mainstream healthcare services addressing LGBTI communities’ issues. The Victorian Government is working with collaborative partners like healthcare professionals, community representatives and researchers providing varied health care services in sectors like clinics and nursing homes developing and promoting best practice policies. Similarly, Vineyard Medical Clinic needs to work in collaboration with healthcare professionals like GPs to safeguard the physical and mental needs of this targeted community. The clinic should synthesize advice from Victorian Government setting out own guidelines and a holistic approach to health and wellbeing of LGBTI communities. The individual practitioners and GPs should work in collaboration with the social workers in providing culturally sensitive care services for LGBTIs.
Victorian Government is working in partnership with the social workers and researchers in establishing a peer-led rapid syphilis and HIV testing trail. There is provision of accessible, affordable and convenient rapid HIV testing for the gay men and men have sex with men (MSM). Vineyard Medical Centre is also working towards removal of barriers to HIV testing with improved testing rates for the gay patients and time-to-time prostate cancer check.
After drawing comparisons from Victorian government, Vineyard Medical Centre is supporting LGBTI persons welcoming them and working in legal legislation of Australia accredited to practice. Literature suggests that this practical setting is supporting LGBTI community with promotion of inclusive practice (Shields et al., 2012). LGBTI community feels comfortable while using mainstream health services in improving the health and wellbeing of LGBTI individuals and communities. The Victorian Government is working with community agencies to undertake LGBTI by developing inclusive practice aiming at improving the experiences of these individuals accessing health services (Ussher et al., 2016). The healthcare professionals at the Vineyard Clinic need to provide training to healthcare professionals for developing resources and targeted delivery to LGBTI wellbeing and mental health. Drug and substance abuse among LGBTI is also addressed at the Vineyard Clinic when compared to the practice at a GP clinic. Short and long-term goals adopted by Vineyard Clinic are gradually working towards the inclusion of LGBTI community into the mainstream. Promotion of inclusive practice for LGBTI health, improvement in understanding responsiveness to emerging health concerns of this community and providing culturally sensitive care services can help in meeting the diverse and specific LGBTI peoples’ needs in Victoria, Australia.
At the clinic, I observed that nurses manage wound like general or chronic wounds as per doctor’s instructions and supervision. They assess the wound and change the dressing according to the type of wound. Moreover, they provide necessary information on care needs, answer queries of patients after they are discharged from the clinic. Nurses also attend to the questions of the patients that they feel to ask. This practice is supported in literature where the basic principles of wound management is followed where wound need to be free of devitalized tissue and infection clear to promote proper healing. The general principle for chronic wound management is dressing depending on type of wound that is also practiced for the dead space elimination, control of exudation, prevention of bacterial overgrowth and better management of the patient (Reddy et al., 2012).
The nurses at Vineyard Clinic explicitly manage chronic diseases as directed by doctors with regular checking and monitoring. Nurses at the Vineyard clinic, work with multi-disciplinary team including patients for the well management of chronic diseases like diabetes, cardiovascular diseases, cancer or asthma. At the Vineyard clinic, nurses care for the complex care needs of the patients with chronic diseases and managed well under the supervision of the doctors (Tinetti, Fried & Boyd, 2012). The nurses at this practical setting talk to patients and carry out a physical observation to know how they look and how they manage their daily life while living with the disease. Chronic diseases management requires regular check up, this practice is supported in literature where the GPs plan and coordinate with patients in arranging routine follow-ups. Services provided by GPs take into account the medical condition of patient and care needs through a structured approach.
At the Medical Centre, immunization or vaccination is also conducted well by the nurses for diseases ranging from Prolia to Boostrix with polio in it to B-12 and Readron. Researchers suggest that immunizations or vaccinations like those that Prolia is used for the treatment of osteoporosis in postmenstrual women having high risk for bone fracture. Researchers suggest that Boostrix with polio in it is an inactivated poliomyelitis vaccine for the prevention of whooping cough, polio, tetanus and diphtheria belonging to a group of medications protecting children, adolescents and children. B12 shots are also administered to people for the treatment of low vitamin levels and Reardon is an immunotherapy vaccine as stated in the literature. According to Centers for Disease Control and Prevention (CDC), vaccinations and immunizations are important to be administered at the right time to improve immunity against a particular disease that is being followed by Vineyard Clinic under standard guidelines (Centres for Disease Control and Prevention CDC, 2012).
Sterilization is another important responsibility undertaken by nurses at the clinic to prevent hospital-acquired infections and to disinfect patients and medical staffs. They soak the instruments followed by thorough washing and rinsing, packing away in sealed envelope and then placed in sterilization unit. Then, it is documented in book that includes load number, type of instrument and batch number. At the clinic, there is meticulous cleaning of instruments with water and detergent ensuring use of enzymatic cleaners and disinfectants (Rutala & Weber, 2013). CDC supports this practice, sterilization should take place by placing the instruments in steam under pressure called autoclaving, chemical or heat vapor or dry heat. However, steam treatment is not followed at the clinic.
Vineyard nurses also perform home health assessments in community. They regularly measure the pulse rate, blood pressure and rhythm of patients with an assessment of their prescribed medications, continence and immunization status for the diseases like tetanus, influenza and pneumococcus. They also assess the physical function like activities of daily living (ADLSs) and note of last sickness, psychological status,, cognition, mood and also social functioning. They work towards the overall, physical, social and mental wellbeing with needs assessment and check for capability of caregivers. They perform the health needs assessment as per the standards by looking into the factors that affect health in the community encompassing physical, social, poverty, and behavior and lifestyle environment of individuals. This package help nurses to consider all the risk factors in the community and make an assessment accordingly. The current literature supports this practice stating that while performing a health assessment, they look for social isolation, community needs, oral health, dentition and nutritional status of individuals helping them to make a health assessment plan according to their needs (Armijo?Olivo et al., 2012).
Nurses also perform triaging that involves booking, rebooking, cancellation of appointments, chasing results and informing patients in case of abnormal results. They believe that it is their key responsibility to keep patients updated and in absence of nurses, receptionist performs housekeeping duties. They keep their clients updated with latest lab reports where the doctors send message to nurses to advise them and keep them out of anxiety. This practice is well stated by World Health Organization (WHO) triaging guidelines, keep the patents that arrive at the clinic and give them messages on a priority basis depending on lab reports and priority signs. This shows nurses work in accordance with the standard triaging guidelines (Duke, 2016).
Erin who has the competency to perform it also performs venesection at the Vineyard clinic. They work in accordance with the WHO guideline on venesection that is indicated to treat selected conditions namely polycythaemia/erythrocytosis (reduction of red cell mass), hereditary haemochromatosis (removal of excess body iron) and PCT (reduction of hepatic iron) (Lim & Ho, 2017).
At the Vineyard Clinic, the patients are welcomed to talk to the nurse and discuss their mental health issues and the nurses identify any future risk can be nip in the bud of mental health issue. At the clinic, Judy having experience over 15 years in building rapport and helping patients with their mental health needs (Jorm, 2012). Mental Health guidelines suggest that clients with mental health issues should to be welcomed irrespective of any barriers and inclusion of mental health services that is followed at the clinic.
Nurses for patients who show signs of constant raised BP levels perform blood pressure monitoring at the clinic. They instruct patients to keep the patients under holtering machine for 24 hours to measure heart activity. America Heart Association (AHA) outlines this practice as if there is any case of abnormal reading, the doctor is informed and care planning is done accordingly (Rizos et al., 2012).
For the surgical procedure arrangement, nurses set the trolley with dressing instruments, prepare sterile gloves for doctors and other necessary equipments. Pap smears are also performed for cervical cancer, prostate cancer and other HIV testing performed at the centre for all clients. Australian Immunization Register (AIR) is also maintained by Vineyard performing regular immunization of kids ensuring convenient in the community to get access to childcare and kindergarten and eventually school.
Nurses at the centre perform the main job of referrals that help nurses to make appropriate referrals for further help. Similarly, they make care plans for patients with questioning rounds, and provide information to patients and specialists along with healthcare professionals provide a collaborative care for that particular client.
The practices at GP clinic like nurses treat wounds, apply and remove dressings, administer immunizations, vaccinations, treat ailments supporting roles in diagnosing and treatment decisions for clients. They assist GPs in healthcare facilities, performing duties like administration of treatment, delivery of patient care, monitoring of vital signs, handling emergencies, performing tests and recording patient behavior. These practices are well performed by nurses at Vineyard Centre supporting current practice and recommendations. The nurses work for the community where they plan care for every client who visit the clinic, advise them, arrange appointments with GP and educate them. They help clients to manage their health conditions, empowering them and providing patient education. They take patient samples, specimens and swabs with regular blood pressure and sugar levels working in partnership with other healthcare professionals planning care. Writing records and keeping notes up-to-date of the patients is another job of nurses at the Vineyard Centre. Booking, cancellation, informing clients during in case of abnormal results, supporting mental health needs and making referrals are also practiced by nurses at the centre.
References
Armijo?Olivo, S., Stiles, C. R., Hagen, N. A., Biondo, P. D., & Cummings, G. G. (2012). Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. Journal of evaluation in clinical practice, 18(1), 12-18.
Bobier, L., Boonstra, H. D., & Brick, P. (2015). in the context of health behavior, chronic disease prevention, and intervention. Evidence-based Approaches to Sexuality Education: A Global Perspective.
Britt, H., Miller, G. C., Henderson, J., Bayram, C., Valenti, L., Harrison, C., … & O’Halloran, J. (2013). General Practice Activity in Australia 2012-13: BEACH: Bettering the Evaluation and Care of Health (No. 33). Sydney University Press.
Centers for Disease Control and Prevention (CDC. (2012). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)–United States, 2012-13 influenza season. MMWR. Morbidity and mortality weekly report, 61(32), 613.
Duke, T. (2016). New WHO guidelines on emergency triage assessment and treatment. The Lancet, 387(10020), 721-724.
Hardiman, A., Makregiorgos, H., & Foster, G. (2014). Gay, Lesbian, Bisexual, Transgender and Intersex (GLBTI) Health and Wellbeing Plan 2014.
Jorm, A. F. (2012). Mental health literacy: empowering the community to take action for better mental health. American Psychologist, 67(3), 231.
Lim, H. Y., & Ho, W. K. (2017). Performing therapeutic venesection in a doctor’s surgery. Australian Family Physician, 46(3), 98.
Moe, J. L., Perera-Diltz, D., & Sepulveda, V. (2014). Beyond competence: Fostering LGBTQQI ally development through supervision. Journal of LGBT Issues in Counseling, 8(4), 389-401.
Reddy, M., Gill, S. S., Wu, W., Kalkar, S. R., & Rochon, P. A. (2012). Does this patient have an infection of a chronic wound?. Jama, 307(6), 605-611.
Rizos, T., Güntner, J., Jenetzky, E., Marquardt, L., Reichardt, C., Becker, R., … & Ringleb, P. (2012). Continuous stroke unit electrocardiographic monitoring versus 24-hour Holter electrocardiography for detection of paroxysmal atrial fibrillation after stroke. Stroke, 43(10), 2689-2694.
Rutala, W. A., & Weber, D. J. (2013). Disinfection and sterilization: an overview. American journal of infection control, 41(5), S2-S5.
Seear, K., & Fraser, S. (2014). Beyond criminal law: The multiple constitution of addiction in Australian legislation. Addiction Research & Theory, 22(5), 438-450.
Shields, L., Zappia, T., Blackwood, D., Watkins, R., Wardrop, J., & Chapman, R. (2012). Lesbian, gay, bisexual, and transgender parents seeking health care for their children: a systematic review of the literature. Worldviews on Evidence?Based Nursing, 9(4), 200-209.
Tinetti, M. E., Fried, T. R., & Boyd, C. M. (2012). Designing health care for the most common chronic condition—multimorbidity. Jama, 307(23), 2493-2494.
Ussher, J. M., Perz, J., Kellett, A., Chambers, S., Latini, D., Davis, I. D., … & Williams, S. (2016). Health-related quality of life, psychological distress, and sexual changes following prostate cancer: a comparison of gay and bisexual men with heterosexual men. The journal of sexual medicine, 13(3), 425-434.
Veltman, A., & Chaimowitz, G. (2014). Mental health care for people who identify as lesbian, gay, bisexual, transgender, and (or) queer. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 59(11), 1.
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