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1. Rheumatic Heart Disease and Social Determinants of Health

1. Briefly discuss Rheumatic Heart Disease and the cause, including factors that may have led to Shakira contracting the disease.

Identify and explain two social determinants of health that may have made Shakira more susceptible to the disease.
Explain how one of these determinants may have affected Shakira’s families decision-making around her care.

Include the standard treatment required
Include relevant Indigenous statistics for RHD compared to the mainstream population. 

2. Explain how you will provide culturally safe care as an Enrolled Nurse by defining and giving one example of the following terms:
(a) Cultural awareness
(b) Cultural sensitivity 

3. By acknowledging the impact of events and issues throughout the history of Australian and Torres Strait lslander people it helps the Enrolled Nurse gain insight into the current physical, mental, social, economic and political situations affecting Australian and Torres Strait lslander people and their engagement with community services and health systems.

3.1 In your own words briefly explain the objectives of The Aboriginal and Torres Strait Islander Act 2005. 
3.2 Considering the health generally of Aboriginal and/or Torres Strait Islander people provide an explanation in your own words of the significance of one the following and briefly explain how they may be affecting the day to day health and wellbeing of these people.

(a) The impact of European settlement/Colonisation
(b) Loss of land and culture
(c) Kinship/skin system
(d) Mabo case/ Terra Nullius
(e) Forced removal of children (‘Stolen Generations’) 

4. Successfully working in partnership with Australian and Torres Strait lslander people requires effective communication. Gaining their full participation by consulting with them and involving the individual and at times the community in their health care decisions is essential to providing culturally safe nursing care.

Select one of the following strategies and discuss how this strategy can assist the Enrolled Nurse to improve communication and build a rapport to provide culturally safe care. 

Consultation with community representatives
(a) Community participation in decision making
(b) Health clinics built in such a way that male and female areas are separate and have separate entrances. Both male and female health professionals are present.
(c) Kinship

5. Considering Shakira, briefly discuss two ways that an Enrolled Nurse could ensure effective communication when consulting with her and her family.

6. A culturally safe organisation consults with Indigenous Australian community leaders and workers. Health services should develop culturally appropriate policies and procedures that provide direction for workers dealing with Indigenous Australian individuals.

Choose one of the strategies below and briefly explain how this would ensure that Shakira and her family would feel comfortable accessing the service.
(a) Employing culturally and linguistically diverse staff throughout the health organisation.
(b) Choose one accessible resource related to a Shakira’s health issues that if available to health employees would assist.
(c) Displaying Aboriginal or Torres Strait Islander art and posters that are clearly visible from the entrance to the building. 

7. By regularly reflecting on situations you encounter in your work practice you will develop your own cultural safety practices.
How well do you integrate cultural safety into your practice as a student Enrolled Nurse? Briefly discuss one of the following questions.

(a) Do you understand how Indigenous Australian culture and history shapes Indigenous Australian people’s interaction with non-Indigenous society?
(b) Do you show you are prepared to re-shape your own values and perceptions to accommodate the needs of Indigenous Australian individuals and co-workers?

8. To evaluate the extent to which cultural safety is integrated in your own work and in your workplace it is a good idea to put yourself in the shoes of an Aboriginal or Torres Strait Islander individual.
(a) List two questions an Aboriginal or Torres Strait Islander may ask themselves when considering if they will access the health service.
(b) List two indicators of a culturally unsafe service

1. Rheumatic Heart Disease and Social Determinants of Health

1. Rheumatic Heart Disease (RHD) is a condition related to strep throat. A group ‘A’ bacteria known as Streptococcus causes this condition. The bacterium causes throat infection and if not detected and treated early, it can cause permanent damage to the heart leading to stroke or even death. In cases where a child experiences recurring or untreated throat infections, it can cause rheumatic fever. RHD is caused by overcrowding, poor sanitation, and air pollutions just to mention a few. Therefore, Shakira might have contracted the condition from this kind of environment. Other than the environment, the environment can also be inherited. In this case, Shakira might have inherited this kind of gene from her father or mother. Early diagnosis and treatment are essential (O’Sullivan, 2013). In Shakira’s case, she needs a daily dose of antibiotics until she is 25 years of age to prevent recurrence of the condition and to prevent the development of heart infections and other bacterial endocarditis.


  • Cultural Awareness

Cultural safety in health care delivery involves placing substantial consideration to cultural sensitivity and cultural awareness to all the patients (Nursing council of New Zealand, 2012). In this case, practicing nurses are expected to provide quality and safe health care by considering the issue of cultural diversity; this can be achieved by recognizing and respecting cultural diversities. Further, enrolled nurses should respect the rights of individuals from other cultures in order to meet their needs and expectations (Faculty of Health, 2013)

  • Cultural Sensitivity

According to the American Council of Gynecologists and Obstetricians, cultural sensitivity is the code of conduct whereby a practicing nurse has the knowledge and interpersonal skills that enable them to understand, appreciate and work with individuals from a culture different from their own. A good example of cultural sensitivity is the Amish couple who come from a minority group in America who do not consider enrolling for any kind of medical insurance because of their culture. After the couple went through a cesarean, is when a nurse advised them to enroll in Medicaid. In such a case, the nurse was culturally sensitive; this enabled her to recognize that the couple was not using the government aid. Therefore, by helping the couple enroll in Medicaid, the nurse will be in a position to reach the community (McGough, Wynaden & Wright, 2017).

3.1. The Aboriginal and Torres Strait Islander Act 2005 stipulate that the government to,

  • Involve the people in the formulation and the implementation of policies that affect them
  • Promote the self- management and self- adequacy of this people
  • Enhance and promote the overall development of this population (The Aboriginal and Torres Strait Islander Act, 2005).
  • Involve this group of people in the formulation and the implementation of policies by the Commonwealth, the State, territorial, and local governments without the deviation of responsibilities.

3.2. The ‘stolen generation’ is about how children and relatives remove themselves forcibly or voluntarily from their families. The separation has resulted in adverse intergeneration health problems (Dwyer, Willis & Kelly, 2014). The cause of the health problems is the trauma of the separation, which led to drug and substance abuse causing mental health complications. These complications have thereon bee passed to the subsequent generation through the parents. In this case, the offspring developed behavioral and emotional challenges exposing them hyperactivity, emotional and character disorder that means that they are also likely to engage in drug and substance abuse. Further, the stolen generation has poor parenting, this led to redundant intellectual development leading to depression, substance abuse, and suicidal (Dudgeon & Hirvonen, 2014).

2. Understanding Cultural Safety in Nursing

4. The participation in decision-making involves an input from the community and family due to the structure in kinship and family ties. In order for a nurse to communicate effectively, they should first inquire with the family in order to facilitate the information that is to be passed is understood by all. Further, the nurse should be respectful in the way they handle the patient and their family, they should also give the family ample time to discuss private affairs. The nurse should also be confidential when dealing with the information they acquire from the patient to avoid injury. For instance, if the nurse is dealing with a special case that does not require community intervention; they should handle the information discreetly (Bortoli, Coles & Dolan, 2015). In addition, nurses should build rapport and trust so that the patients can communicate openly with the nurses.

5. When dealing with Shakira and the family, the nurse should use indirect questions a strategy to collect clinical information. In this case, nurses should pose questions giving them to respond. The nurse should use clear and plain language that is easily understood. Secondly, the caregiver should pay attention to every detail by avoiding interruptions. Finally, the nurse should show that they have understood what the patient had said by giving a summary of the session while showing an understanding (Bennett, 2015).

6. In order to help Shakira and her family, a culturally diverse nurse should be employed. The nurse should be ready to accept and respect the behaviors, culture, systems, and policies of the patient. In addition, employing a culturally diverse nurse will help ease up the situation

7. I comprehend that the now- indigenous society are treated with mistrust. The mistrust stems from the era of the European settlement and the forceful separation of children from their families leading to the ‘stolen generation’. The mistrust is further heated as the indigenous people feel that they are alienated from the now- indigenous whose culture is separate from theirs. Therefore, they feel intimidated as their culture is different and they are being criticized for that (Beckett & Keen, 2015).

8 (a)

  1. Will I be stereotyped, criticized, discriminated, treated with contempt, or ignored by the health care provider?
  2. Can I fully trust the health care providers with my personal information?

8 (b)

  1. Judgmental, arrogant, and incompetent health care providers who intimidate patients
  2. Racism and discrimination that frightens patients making them powerless and uncomfortable


Beckett, J., & Keen, I. (2015). Encounters with indigeneity: writing about Aboriginal and Torres Strait Islander peoples. Aboriginal Studies Press.

Bennett, B. (2015). “Stop deploying your white privilege on me!” Aboriginal and Torres Strait Islander engagement with the Australian Association of Social Workers. Australian Social Work, 68(1), 19-31.

De Bortoli, L., Coles, J., & Dolan, M. (2015). Aboriginal and Torres Strait Islander children in child protection: A sample from the Victorian Children’s Court. Journal of Social Work, 15(2), 186-206.

Dudgeon, P., &Hirvonen, T. (2014). Dark chapters in Australian history: Adopted children from the Stolen Generations. InPsych: The Bulletin of the Australian Psychological Society Ltd, 36(4), 12.

Dwyer, J., Willis, E., & Kelly, J. (2014). Hospitals caring for rural Aboriginal patients: holding response and denial. Australian Health Review, 38(5), 546-551.

McGough, S., Wynaden, D., & Wright, M. (2017). Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study. International Journal of Mental Health Nursing.

O’Sullivan, B. (2013). Considering culture in Aboriginal care.

O’Sullivan, B. (2013). Aboriginal and Torres Strait Islander education: An introduction for the nursing profession. Cambridge University Press.

The Aboriginal and Torres Strait Islander Act 2005

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