Rheumatic Heart Disease (RHD) is caused by an abnormal autoimmune response to group A streptococcal infection and causes cardiovascular diseases, especially in younger people (Marijon, Mirabel, Celermajer, & Jouven, 2012).
Social determinants of Rheumatic Heart Disease –
The social determinants of Rheumatic Heart Disease include poverty, malnutrition, and overcrowded housing; which further reflect the health inequities faced by indigenous communities in developed countries such as Australia (Kerdemelidis, Lennon, Arroll, Peat, & Jarman, 2010).
In case of Shakira; poverty and malnutrition has made her more susceptible to disease.
Standard treatment –
The standard treatment requires consultation with a cardiologist, neurologist and rheumatologist. Patients with positive cultures for Streptococcus pyogenes are given penicillin if allergy to penicillin is not present. Alternatively, benzathine benzylpenicillin may be given. Salicylates are helpful for relieving pain. Rheumatic heart failure responds well to corticosteroids in addition to ACE inhibitors, beta blockers, diuretics, and digoxin.
Indigenous statistics for RHD compared to the mainstream population –
Australia has highest prevalence of rheumatic heart disease (RHD) in the world with some 2-3% of the NT Aboriginal population affected by the disease (Co-operative research center for aboriginal health, online).
Cultural awareness is the initial step to provide culturally safe care and it involves awareness of Aboriginal and Torres Strait Islander norms, values and principles (AIDA, 2013).
Cultural sensitivity is the next step where self-exploration occurs and an individual can take different positions on a continuum, according to setting or community (ibid). The final outcome is the culturally safe care.
To practice cultural safety while providing care as an enrolled nurse, following points will be taken care of.
Aboriginal and Torres Strait Islander Act 2005 has been formulated; for social, cultural and economic development of Aboriginal persons and Torres Strait Islanders by their full participation, and to develop self-sufficiency and self-management among them, and to ensure co-ordination between state and the islanders while formulating policies (Office of Legislative Drafting and Publishing, 2012).
The term ‘stolen generations’ refers to about 0.1 million Indigenous Australian children who were forcibly removed from their parents and raised by church organisations, fostered or adopted by non-Indigenous families, or given to state institutions; with a mistaken belief that those children were better-off in a non-indigenous social environment (Read, 2014). The forced removal of children had a huge impact on the health and well-being of these children along with the fact that they had no access to their own heritage and culture (ibid). These children offen suffer from malnutrition, RHD and other diseases. It also affects their psychological and mental health and well-being (ibid).
International as well as Australian evidence had suggested the important role of Indigenous community participation for effective healthcare delivery among Indigenous children and families (SNAICC, 2012). Community participation in decision making also ensures a culturally safe lens to view the important role of; family, kinship, cultural values and community ties; in the care and well-being of children. Aboriginal and Torres Strait Islander families have a support system in their community ties, which help them address the challenges of poverty and disadvantage and this ensures community controlled child-welfare and protection (ibid). The decisions regarding healthcare of communities must be effectively communicated to them and should be demand-driven i.e. it should address community needs. The community knows best about their grass-roots health problems and their determinants and hence the community should be represented while designing their health-care programmes.
5. Enrolled nurse must ensure effective communication when consulting with Shakira and her family. The communication should be two-way communication where the nurse should also consider view-points and suggestions of Shakira’s family members as how they can best take-care of her. Enrolled nurse must learn their native language and must communicate in a way; Shakira’s family can easily understand and reciprocate. The nurse should look for social cues while communicating with the family, along with clinical cues; as it would help her in clinical reasoning (Levett- Jones et al, 2010).
6.c. One of the strategies that would ensure that Shakira and her family would feel comfortable accessing the service will be; Displaying Aboriginal or Torres Strait Islander art such as posters that are attractive and clearly visible from the entrance to the healthcare setting. Such a strategy will reflect cultural awareness and cultural sensitivity.
7.b. A nurse should have the ability of clinical reasoning which is more than mere clinical judgement (Levett- Jones et al, 2010). For a good clinical reasoning ability, it is important to integrate cultural safety into the practice. Here, while planning nursing care for Shakira, cultural safety will help re-shaping our own values and perceptions which will further help accommodating the needs of Indigenous Australian individuals and co-workers. The values and perceptions about lives of these communities also re-shape as we work with them. The perceptions about diseases and health states also re-shape as we come to know more social determinants while working in field.
8.a. Two questions an Aboriginal or Torres Strait Islander may ask themselves when considering if they will access the health service will be,
8.b. Two indicators of a culturally unsafe service are,
References
Australian Indigenous Doctors’ Association, (AIDA). (2013). Position Paper Cultural Safety for Aboriginal and Torres Strait Islander Doctors. Medical Students and Patients. Canberra: AIDA.
Co-operative research center for aboriginal health, [Online]. Rheumatic Heart Disease Backgrounder. Retrieved from web address,, https://www.lowitja.org.au/sites/default/files/docs/15-RHDMediaBackgrounder.pdf. Lowitza Institute.
Kerdemelidis, M., Lennon, D.R., Arroll, B., Peat, B., Jarman, J. (2010). The primary prevention of rheumatic fever. J Paediatr Child Health, 46(9), 534–48. doi: 10.1111/j.1440-1754.2010.01854.x.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.
Marijon, E., Mirabel, M., Celermajer, D. S., Jouven, X. (2012). Rheumatic Heart Disease. Lancet, 379(9819), 953-64. doi: 10.1016/S0140-6736(11)61171-9.
Office of Legislative Drafting and Publishing. (2012). Aboriginal and Torres Strait Islander Act 2005. Canberra: Attorney-General’s Department.
Read, P. (2014). Reflecting on the stolen generations [online]. Indigenous Law Bulletin, 8(13), 3-6. Retrieved from web address,https://search.informit.com.au/documentSummary;dn=546123571212449;res=IELAPA.
Secretariat of National Aboriginal and Islander Child Care, (SNAICC). (2012). Genuine Participation of Aboriginal and Torres Strait Islander Peoples in Child Protection Decision-making for Aboriginal and Torres Strait Islander Children: A Human Rights Framework. Melbourne: Secretariat of National Aboriginal and Islander Child Care.
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