Essay: Social Determinants Of Health And Nursing Care Among Aboriginal And Torres Strait Islander People.

Case Study

This assessment is designed to develop critical thinking and responsiveness to how social determinants of health impact Aboriginal and Torres Strait Islander people’s health and nursing care.

Marli is a 7 year old Aboriginal girl from a remote community in the North West Region of NSW. Marli attends the local primary school with her 3 brothers and 2 sisters and has never been to the city before. Over the last 2-3 weeks, Marli has not been feeling well, she has had sharp, stabbing pains in her chest when she breathes, is running out of breathe quickly when playing with her brothers and sisters and has a cough that is making her light headed. Marli also has Asthma but she can’t remember where she last used her ‘puffer’, Marli thought that not using her puffer was maybe why she was unwell. Marli’s mum, Sharon, is a single mum and has had trouble getting Marli into see the Doctors at the local Community Health Centre, Sharon doesn’t have a car and her other family members lives out of town. Sharon was starting to get quiet worried about Marli’s pains in her chest and that her lips would go blue after she had been coughing for a long time. A family member offered to take Sharon and Marli to the hospital in the neighbouring town after hearing Sharon’s concerns. The small, 10 bedded hospital has one Doctor available at all times, the Doctor was very concerned about Marli and felt she needed urgent care from a larger hospital that has more resources. Marli and Sharon were quickly flown to a metropolitan hospital by the Little Wing’s safe flight transport for treatment.

You are working on the Paediatric ward while on your student placement. The Registered Nurse you are working with has informed you, that you are allocated the new admission from ED, a young Aboriginal girl who has been flown in from ‘somewhere’ for queried pneumonia and potential of uncontrolled asthma. The In- Charge Nurse handing over, seems to be unhappy about this admission, she continues on to make remarks about the appearance of the young girl and her mother and how they probably ‘won’t even look Aboriginal’, she continued on laughing to the other nurses and suggested that ‘they will just want everything for free’. The Registered Nurse you are working with went bright red and whispered to you ‘this is very inapproiate’ and she quickly turned and rushed away. Marli and Sharon arrive to the ward soon after, you introduce yourself and ask if you can check Marli’s vital signs. Marli doesn’t look at you but looks at her Mum. Sharon apologises as Marli has never been on a plane and is feeling very scared, they have never left her community before and never seen a hospital this size.

Please answer the following questions and consider what you have learnt from weekly learning materials and the case study:

In your answers you must consider:

- The social determinants for Aboriginal and Torres Strait Islander peoples, including access, funding, housing, employment, infrastructure and education.

- Present health care inequalities and strategies/promotion/frameworks that are current in today’s health care system.

- Explore potential personal biases and/or personal lens relating to Aboriginal and Torres Strait Islander peoples.

Your work must be supported by relevant, contemporary literature and a minimum of 6 references, 2 of these references must be from Aboriginal and/or Torres Strait Islander authors.

1. Identify what health services and resources you are aware of that could help support Marli and Sharon in the hospital admission? And why it is important?
   
   
2. Identify and discuss how you could encourage and engage a culturally safe environment for Marli and Sharon?
   
   
3. Briefly describe the social determinants of health and inequalities that Marli and Sharon have faced in regards to Marli’s health?
   
   
4. Reflect on how you felt about the handover from the In-charge nurse?

For Aboriginal and Torres Islander people health care is a holistic concept that affects the physical, cultural, spiritual and social wellbeing of an individual and the society at large. In this case study Marli who is the patient had been accompanied to the hospital by her mother Sharon following pneumonia and asthma attacks that needed her to be flown to a metropolitan hospital for emergency services. There are several health services and resources that can be offered by the metropolitan hospital to support them during hospital admission. These include primary health care services offered by the Aboriginal health unit such as access to an Aboriginal Health liaison officer (Heiss et al., 2015). Marli and Sharon being of Aboriginal origin expect to see a health worker of their own descent to feel more comfortable about the services being offered.

This officer should be present when the treating teams are assessing Marli’s medical condition. They play a crucial role in liaising, advocating and providing support throughout the admission process. They can do this by contacting the other family member upon patients request as well as making internal and external referrals upon request by the patient. They should also be given emergency services provided by the hospital since Marli had been referred after acute attack pneumonia and asthma conditions. These services should be culturally sensitive to make them feel culturally safe and avoid fear of discrimination such as racism (Browne et al., 2010). For example, a welcome to the emergency department brochure can be given to them make them more informed of the services being offered. Marli and Sharon can also be provided financial assistance on the cost of services they will receive. These services are funded by the department of health Australia under the Indigenous Australians’ Health Program to improve services delivery to these people.

Cultural sensitivity is important when dealing with patients of Aboriginal origin. In this case I can create a culturally safe environment for Marli and Sharon by building a good rapport with them (Durey et al., 2011). This is important in helping them overcome individual barriers such as fears and perceptions that they may have in regard to the treatment they are receiving. I will do this by first welcoming them in a warm and friendly way and use a non-threatening voice tone and body language. This will also involve identifying a common topic such as asking them where they come from, if they or their family members have received the hospital services before as well as informing them more about the services. The other way is through proper communication, this involves being conscious of the non-verbal language they may use such as hand signs, body language and facial expressions. This is important since individuals of Aboriginal origin only speak Standard Australian English as their third language or dialect. Therefore, if I communicate in English the dialect differs and due to their community influences the meaning of the words may vary. The differences in voice tone and colloquialisms may also obscure the meaning and as such I may not be able to understand the essentials cues from them.

Social Determinants of Health and Access to Health Care

There are several social determinants of health and inequality that Marli and Sharon faced in regards to Marli’s health. These include difficulty in accessing the necessary medical services that Marli needed (Cameron et al., 2014). This is the reason as to why Marli and Sharon travelled a long distance through flight to access this emergency services. This really affected Marli who went through cultural shock as she had never boarded a plane and had never been out of the community before. The mother also confirmed they had never been in a big hospital and as such they may have felt isolated and vulnerable in a foreign place. Difficulty in accessing quality services is also due to financial incapability. As seen from this case study the registered nurse pointed out that Sharon and Marli only wanted free services and concluded that the whole admission was inappropriate, this shows the financial strains that Aboriginal people undergo while accessing health services. The other factor is racism which started way back during the British colonization as a result it created a social stratification along with the racial lines (Durey et al., 2016). This greatly affected the health services of the Aboriginal people in terms of resources, freedom, power and control. This is evident in this case study when the registered nurse expressed her concerns based on the appearance of Sharon and Marli and went to say due to this they would want everything for free since they cannot afford the services. Poor early childhood education is another factor that leading to poor health in these people (Scott & Robinson, 2011). As seen from the case study Marli had not been using her puffer and this could be due to lack of knowledge on the importance of the puffer and as a result she became severely ill.

Working with Marli and Sharon both of Aboriginal origin was a learning experience that brought about different feelings towards the whole situation. When the nurse in charge informed me that I was allocated a new patient in the emergency department I was excited as this would sharpen my skills more in the field.  However, I started getting scared when the nurse in charge painted a negative picture about the patient based on their Aboriginal origin. Clearly, she seemed unhappy about the whole admission process and this was evident from the remarks she made about Marli and her mother on how they wanted free services and the whole situation was inappropriate. Being a student on placement this really made me anxious as I did not have enough experience to deal with patients from the aboriginal origin (Hart et al., 2015). 

Cultural Sensitivity and Competence in Nursing Care for Aboriginal and Torres Strait Islander People

During my first encounter with Marli and Sharon, when I asked to take Marli’s vital signs she was unresponsive and seemed quite uncomfortable. I later learnt that she was scared since she had not boarded a plane before and had never been out of their community. She had also not been in such as big hospital and may have felt scared in this new place. When the whole situation of Marli and Sharon became clear to me I felt really sorry for them. Based on chapter 5 of the laws set by the parliament of Australia once an Aboriginal patient arrives in a government hospital an Aboriginal Liaison officer should be present when the treating teams are assessing the patient’s condition in order to provide emotional, cultural and social support to them and their families. This was not the case for Marli and Sharon and as such they may have felt scared, isolated and vulnerable (Campbell, 2014). Reflecting back on this situation I feel I should have been more assertive and question why these services were not provided to them.

References

Askew, D., Lyall, V., Ewen, S., Paul, D., & Wheeler, M. (2017). Understanding practitioner professionalism in Aboriginal and Torres Strait Islander health: lessons from student and registrar placements at an urban Aboriginal and Torres Strait Islander primary healthcare service. Australian Journal Of Primary Health, 23(5), 446. https://doi.org/10.1071/py16145

Browne, A., Smye, V., Rodney, P., Tang, S., Mussell, B., & O'Neil, J. (2010). Access to Primary Care From the Perspective of Aboriginal Patients at an Urban Emergency Department. Qualitative Health Research, 21(3), 333-348. https://doi.org/10.1177/1049732310385824

Cameron, B., Carmargo Plazas, M., Salas, A., Bourque Bearskin, R., & Hungler, K. (2014). Understanding Inequalities in Access to Health Care Services for Aboriginal People. Advances In Nursing Science, 37(3), E1-E16. https://doi.org/10.1097/ans.0000000000000039

Campbell, T. (2014). A clash of paradigms? Western and indigenous views on health research involving Aboriginal peoples. Nurse Researcher, 21(6), 39-43. https://doi.org/10.7748/nr.21.6.39.e1253

Durey, A., McAullay, D., Gibson, B., & Slack-Smith, L. (2016). Aboriginal Health Worker perceptions of oral health: a qualitative study in Perth, Western Australia. International Journal For Equity In Health, 15(1). https://doi.org/10.1186/s12939-016-0299-7

Durey, A., Wynaden, D., Thompson, S., Davidson, P., Bessarab, D., & Katzenellenbogen, J. (2011). Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nursing Inquiry, 19(2), 144-152. https://doi.org/10.1111/j.1440-1800.2011.00546.x

Hart, B., Cavanagh, M., & Douglas, D. (2015). The “Strengthening Nursing Culture Project” – an exploratory evaluation study of nursing students’ placements within Aboriginal Medical Services. Contemporary Nurse, 51(2-3), 245-256. https://doi.org/10.1080/10376178.2016.1150190

Heiss, A., Miller, L., Somerford, P., McEvoy, S., & Bessarab, D. (2015). Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia. Australian Health Review, 39(4), 429. https://doi.org/10.1071/ah14102

Scott, K., & Robinson, E. (2011). Voices in Australia's Aboriginal and Canada's First Nations Literatures. Clcweb: Comparative Literature And Culture, 13(2). https://doi.org/10.7771/1481-4374.1747