Australia, indigenous people recognize themselves as belonging to Aboriginal or Torres Strait Islander or by descent, and also identified as the same by the society. A resistance has been observed in them to access hospitals for healthcare. Therefore, healthcare professionals need to plan, implement and maintain appropriate policies for their treatment. Also, cross-cultural awareness training should be given to paediatric hospital staff. (Munns & Shields, 2013, p. 22)
How would you support Rianna and her family in this situation?
The poor health status of Aboriginal and Torres Strait Islander Australians is well documented, and has been the subject of official policy and program attention for many years. The mainstream health system has responded to increased funding and clear portfolio responsibility, with increasing attention to the burden of illness that Aboriginal people experience and the need for effective health care (Dwyer et al., 2014). I would thus make arrangement for proper treatment of Rianna and for her aunt’s stay with her. I would utilise four elements of PDSA (Plan-Do-Study-Act) cycle, generated by Edward Shewhart, for the treatment, i.e. (i) P — plan the change to be tried; (ii) D — implementing the planned changes; (iii) S — study or critically analyse the result of the change applied, briefing the result found; and (iv) A — adjust the plan accordingly, scheduling the next phase and implanting and observing the fluctuations. I would also instruct the liaison officer to make sure they continue the treatment and does not think about DAMA (Discharge against medical advice) (Durey et al., 2012, p. 147).
2- Discuss the challenges that you see within this scenario and how would you deal with them in your clinical context?
As mentioned earlier, the building rapport process prior to medical examinations is the most critical task. Thus, a culturally respectful conversation is most apt for understanding the patient’s medical history and present health condition. I would be respectful when discussing the prior treatment of Rianna otherwise it might hurt her beliefs. Before physical examination, I would explain the need to touch her, and why and where and would allow her aunty Kalinda to be by her side so that she is comfortable while undergoing treatment. Language proves to be another barrier, thus, as Rianna is not old enough, I would explain the diagnosis and cause of her illness to her aunty in a simple language with the help of visual aids. I would also ask Rianna about certain choices, if available, of oral medicines or injection to make her more comfortable in co-operating and following the line of treatment. Adhering to medication is another critical issue so I will make sure that her aunty Kalinda understood all the prescribed medicines clearly by keeping my language simple and using hand gestures and visual aids on prescription regarding doses and asking her twice about the medication. I would also inform her aunt about the pain management in a culturally respectful way (Queensland Health, 2014, pp. 11-14).
3-Consider Family-centred Care.
Paediatric health facilities often come across a universal term i.e. family-centred care (FCC), which means that the child admitted is not just an individual patient but the central part of a family and their welfare depends on their child’s well-being, specifically in traumatic events. As defined by Mikkleson, “family-centred care is characterized by a relationship between healthcare professionals and the family, in which both parts engage in sharing the responsibility for the child’s healthcare” (cited in Shields, 2015, p. 140). I would therefore try to place Rianna’s bed in a children’s ward, as it would facilitate her healing process. I would also try to make arrangements for her aunt’s stay and food with her to make both of them more comfortable in each other’s company. I would try to educate aunty Kalinda and cleaning and domestic staff about the basic concept of family-centred care, so that they incorporate their share in making the process smooth. Thus, FCC does not just mean making her aunt stay with her; rather it means to make a pleasant rapport with the family and patient. Being a healthcare professional, to make sure that family-centred care works effectively, I must explain the medication and create a good communication and partnership with Rianna’s aunt, making the FCC effective (Shields, 2015, pp. 139-142).
4- Consider Australian Aboriginal cultural, social, geographical factors influencing access to health.
In Australia, it has been reported that the health of the Aboriginal people has been influenced by various cultural, socioeconomic and geographical factors. Many Aboriginal people and healthcare practitioners raised their concern regarding the health and welfare of the Aboriginal population and many point these problems to lack of money, transportation, language and cultural barriers. The issues regarding access to health included distance and conveyance issues in the first place; then economic and social cost of travelling the distance for care; availability of services and affordability of these services. Most Aboriginal people experienced these issues in some way or the other. Interviews of Aboriginal people identified many cultural factors like etiquettes, social networks, ethics and beliefs, taboo and commitment, empathy, and kinship structures that affected access to health (Mcbain-Rigg&Veitch, 2011, p. 71). Other geographical factors like lack of transport service near their area, travelling extensively to long distances while unwell, personal safety specifically when buses drop them late at night or early in morning, financial concerns as many are unable to bear the costs of travelling, difficulty in coordinating travel, scheduling appointments and cancellations, etc. play a pivotal role in restricting their access to health (Kelly& Willis, 2014, pp. 110-112).
5-How to provide culturally appropriate healthcare.
Most of the nurses usually care for culturally diverse people. According to Leininger, (1988) “care is the essence of nursing and the central, dominant, and unifying feature of nursing” (cited in Williamson & Harrison, 2010, p. 763) and culturally diverse people have different expectations from the care giver. Thus, for providing culturally appropriate healthcare, the nurses must have the knowledge of other cultures as well as understand the culture specific expressions, signs, and significance of specific and different cultures. She also believes that views of the patients are an essential part of cultural care as these views convey the meanings, signs and expressions of their culture. The healthcare professional should understand these without considering the patient’s past experiences, status in society, education level or socioeconomic condition. Homer (2000) also suggests from an Australian viewpoint that cultural diversity denotes recognising different cultural groups and their varied needs. There has been an agreement that healthcare practitioners should be aware of their personal cultural values, outlooks and attitudes to improve their understanding of culturally diverse people. (cited in Williamson & Harrison, 2010, p. 764) Majority of cases use culture specific clinical nursing care plan, recommended by the text Culture Care Diversity and Universality, A Worldwide Nursing Theory, framed especially to facilitate nursing care decisions and to act in accordance to the consistent cultural beliefs, ethics, practices and lifestyle of people. Thus, it is healthcare professionals’ responsibility to provide appropriate healthcare irrespective of a patient’s position in the society (Williamson & Harrison, 2010, pp. 764-767).
6- How to create a culturally safe environment for Rianna and her family whilst in hospital (what support is there? consider Aboriginal Liason Officer).
Cultural safety means respecting diversity and encouraging an ethical standard of practice on the non-Aboriginal health workers’ part where they acknowledge and respect Aboriginal people’s welfare, cultural distinctiveness, necessities and expectations (Durey et al., 2012, pp. 145-146). Thus, to make Rianna and her aunty Kalinda feel more safe and comfortable, I would make arrangements for an indigenous liaison officer from the hospital staff. IHLOs (Indigenous hospital liaison officers) play an essential role to provide required assistance and support to the Aboriginal patients. They also provide encouragement, sponsorship, emotional and practical backing, recommendations and appointments, discharge planning, etc. In terms of cultural care, they offer cultural safety and associations (internally as well as externally with other communities) and can also offer assistance to patients in understanding the information regarding their hospitalisation, medication and treatment, especially if they face a problem with the language of the healthcare professionals. Thus, the liaison officer can help aunty Kalinda to understand all the information, if she missed anything from my language or gestures (Queensland Health, 2014, p. 9). Some patients prefer female care providers due to their past experiences so I would also ask Kalinda about their preferences regarding the same (Phiri, Dietsch & Bonner, 2010, p. 109).
7- Consider nursing cultural sensitivity and cultural competence
Care is an integral part of nursing, as no curing can be achieved without caring, and caring includes understanding the cultural background of the patients and care for them accordingly. Therefore, nurses need to be sensitive towards the cultural diversity to become culturally competent. Cultural competence includes understanding their outlook towards the worldly things and of patients, avoiding stereotyping and misuse of technical knowledge. To become culturally competent, nurses need to be sensitive towards the cultural information, as it enhances the quality of care and upturns health outcomes, and then applying the knowledge in a sensitive, innovative and expressive ways for the well-being of the patient. They should be conscious of the culture dynamics, value this diversity, must have long-standing cultural knowledge, and their attitude should reflect their understanding of this cultural diversity when delivering service to their culturally different patients (Ansuya, 2012, p. 5). Therefore, I would inform the nurses attending to Rianna and Kalinda about their cultural background, the place they are coming from and the treatment she received at home, so that the nurses can understand the sensitivity of the case and attend and care for them accordingly, to facilitate the healing process. Nielson (2010) describes that the healthcare fostered and provided by Aboriginal nurses to their patients from cultural foundations seems connected to their Indigenous ancestry (Stuart & Nielsen, 2010, p. 98). So, I would also try to check and appoint, if any, an Aboriginal nurse, if available in the staff, so that the best care can be provided to Rianna.
Ansuya. (2012). Transcultural Nursing: Cultural Competence in Nurses. International Journal of Nursing Education, Volume 4(1), pp. 5-7.
Durey, A, Wynaden, D, Thompson, SC, Davidson, PM, Bessarab, D & Katzenellenbogen, JM. (2012). Owning Solutions: A Collaborative Model to Improve Quality in Hospital Care for Aboriginal Australians. Nursing Inquiry, Volume 19(2), pp. 144-152.
Dwyer, J, Willis, E & Kelly, J. (2014). Hospitals Caring for Rural Aboriginal Patients: Holding Response and Denial. Australian Health Review, Volume 38(5), pp. 546-551.
Kelly, J & Willis, E. (2014). Travelling to the City for Hospital Care: Access Factors in Country Aboriginal Patient Journeys. Australian Journal of Rural Health, Volume 22(3), pp. 109-113.
McBain-Rigg, KE &Veitch, C. (2011). Cultural Barriers to Health Care for Aboriginal and Torres Strait Islanders in Mount Isa’, Australian Journal of Rural Health, Volume 19(2), pp. 70-74.
Munns, A & Shields, L. (2013). Indigenous Families’ Use of a Tertiary Children’s Hospital in Australia’, Nursing Children and Young People, Volume 25(7), pp. 16-23.
Phiri, J, Dietsch, E & Bonner, A. (2010). Cultural Safety and Its Importance for Australian Midwifery Practice’, Collegian, Volume 17(3), pp. 105-111.
Queensland Health. (2014). Aboriginal and Torres Strait Islander Patient Care Guidelines. Available at: https://www.health.qld.gov.au/atsihealth/documents/patient_care_guideline.pdf [Accessed 12 Sep. 2016].
Shields, L. (2015). What is “Family-Centered Care”? European Journal for Person Centered Healthcare, Volume 3(2), pp. 139-144.
Stuart, L & Nielsen, A. (2010). Two Aboriginal Registered Nurses Show Us Why Black Nurses Caring for Black Patients is Good Medicine. Contemporary Nurse, Volume 37(1), pp. 96-101.
Williamson, M & Harrison, L. (2010). Providing Culturally Appropriate Care: A Literature Review. International Journal of Nursing Studies, Volume 47(6), pp. 761-769.
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