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1. Discuss the influence of community, culture and religion in influencing health care practice.
2. Evaluate the distribution of healthcare resources in relation to healthcare needs and concepts of health and wellbeing.
3. Justify a position on the influence that globalisation will have on nursing workforce culture.
4. Appraise social and ethical wellbeing within the context of equity and cultural safety.
5. Discuss the concept of Indigeneity and critically compare the demography, context and lifestyles of different cultural and Indigenous groups.
6. Explore and describe contemporary Australian Indigenous health services,organisations and issues, and include the socio-cultural factors that impede health care provision.

Social Determinants of Health and Aboriginal Australians

The assignment would mainly focus on the importance of providing culturally competent care to patients coming from various cultural backgrounds. Often nursing professionals are seen to be culturally unaware of the traditions and preferences of culturally different people. Therefore, they cannot provide culturally competent care and culturally sensitive services (Cullen et al., 2018). The thesis statement is – “In order to develop skills and knowledge to provide appropriate person centred care to such cohorts of people, it is important for the professionals to develop a detailed ideas about the different demographic, lifestyles, cultures, preferences, thinking procedures and many others.

Once the nurse develops culturally competent care, it would help the patients to develop trust on the professionals and their compliance would increase (Fisher et al., 2016). Therefore, nursing professionals need to develop in-depth knowledge about the different aspects of that culture to provide proper care. In this assignment, a patient of Aboriginal background is selected and accordingly reflection and discussion is made on the different contributing factors to ill health and how treatment approach would be initiated.

            A patient named Gary Meguro of the age 65 years and of the Aboriginal, origin had visited the healthcare centre with symptoms of cardiovascular disorders. He is not fond of the western healthcare system personally but the request of his sons and daughters have made him to visit the centre today. I conducted a close analysis and found out many symptoms present in him that showed that he was suffering from heart arrhythmia or irregular heartbeat. Some of the important symptoms that associate with this form of heart disorders are fluttering of the chest, racing heartbeat, chest pain and discomfort as well as shortness of breath. Light-headedness and dizziness were also found to be present in him.

            On close analysis of the statistics of the Aboriginal people affected by cardiovascular disorder, a wide health gap can be identified between the Indigenous Australians and that of the Indigenous Australians. Heart Foundation in the nation has provided important statistical data that support the disorders. In the year 2016, 13% of the total deaths occur among the Indigenous Australians occur die to heart diseases. If comparison is made between the Indigenous Australians and that of the non- Indigenous Australians, it can be seen that the former cohort of the population is 70% more likely to die from circulatory disorders than that of the latter (Mitrou et al., 2014).

The Bio-Psycho-Social Model of Care for Aboriginal Patients with Cardiovascular Disorders

In the year 2012-2013, about 12% of the Aboriginal people were found to have reported of having diagnosed with circulatory system. In comparison to the non- Indigenous Australians, the Indigenous Australians are 20% more likely to report having the circulatory disorders. Therefore, one can reach to a conclusion that only targeting the biological determinants might not help in providing a holistic approach to care (Browne et al,. 2017) . Therefore, other important social and psychological aspects are also important.

            I believe that bio-psycho-social approach is the best model of care that would help in treating the person with proper procedure. This care framework has helped professionals to realise that only caring and providing intervention for the biological determinants of health, the disorder will not be cured and the patient might suffer from such poor health condition again (Chenhall et al., 2018). This model of care shows that psychological as well as social model of care are extremely important for the nursing processionals to develop idea. In this arena, I found that social determinant of health tend to play a very important role. Social determinants of health determine the living conditions in the society where the individuals are seen to take birth, grow up and survive.

In case of the Indigenous Australians, a number of social determinants of health come into play. Nurses need to develop proper critical thinking skills by which they can identify the social determinants of health of the patient and provide suggestions and resources to modify factors for safe living (Brewster et al., 2017).

            One of the social determinants that increase the risky behaviours in the individuals making them more vulnerable to heart disorders is poor education and health literacy. The Indigenous Australians have low level of education rates in comparison to that of the non- Indigenous Australians with very few people attending the higher education. Therefore, they cannot develop ideas about how the risky behaviours make them more vulnerable to heart disorder and the steps they need to take to prevent the disorder (Baum & Friel, 2017). Poor health literacy causes them to make poor health decisions that results them to suffer more.

Therefore, I realised that it is important for me to educate Gary as well as help him to develop health literacy. Once he becomes aware of the risk factors, the chances of the person being addicted to the risky behaviours would reduce. Therefore, with this critical thinking, I allotted him a patient education session and counselling session for behaviour change.      

Educating Patients with Low Health Literacy

            World Health Organisation had also selected addiction as one of the social determinants of health that can affect the quality of life of individuals. Through my research, I have found that smoking tobacco and drinking rates are quite higher in the Indigenous Australians than the non- Indigenous Australians (McPhail & Macaky, 2018). One of the main reasons for this issue is the social custom and tradition associated with the culture of the Indigenous Australians. The researchers are of the opinion that smoking tobacco is a part of their culture and both males and females in this culture are seen to smoke from very young age.

By applying this theory and linking this fact with the smoking habit of Gary, it can be stated that smoking habit of the patient with more than 10 cigarettes per day has worsened the situation. Therefore, I believe as a nurse I can engage in cognitive behavioural therapy as well as smoking session therapy so that he can overcome the behaviour and develop better quality life.

            Another important social determinant of health that also remains intricately associated with the condition of Gary is his poor socio-economic status. As they have poor economic stability, they cannot afford to but organic foods which are nutrient dense. They are mainly seen to buy cheap quality fast foods which are calorie dense. Therefore, they tend to become obesity by putting on huge amount of weight mainly by abdominal fat. Researchers have conducted studies which have shown rate of obesity, physical inactivity, level of cholesterol and similar others to be higher in the Indigenous Australians than the non- Indigenous Australians (Couzos et al., 2016).

Therefore, from this situation, I analysed the factor that Gary should be taught about the different risk factors like cholesterol, hypertension, and obesity, high level of cholesterol and others and how they affect his life. Moreover, nurses also need to advocate about food quality that the Indigenous Australians intake. Accordingly, proper steps and policies should be developed so in order to provide the cohort with costly but healthy nutritious foods.

            Through these approaches, I believe that I can help Gary by developing better living conditions that would enable him to live by effectively managing cardiovascular issues. While caring for Gary, I need to ensure that I am following the 4 dimensions of wellness and life successfully or not. Researchers have argued that only providing care for physical development of health in individuals can never allow them to lead disease free lives bit would in turn results in repeated episodes of suffering and poor quality lives (Newman et al., 2015). I have studied that caring for four important dimensions of life are important to help patient develop wellness in their lives and assure them a balance in their life. While caring for the patient,

Engaging in Cognitive Behavioural Therapy and Smoking Session Therapy

I need to make sure that I address the physical, mental, emotional as well as spiritual needs of the patient named Gary. Researchers have supported this aspect stating that providing holistic care to patients covering all the important aspects of their wellness will ensure peace and happiness and would help them to get well soon. The first part of the assessment would be the physical domain that mainly physical body as well as their health. For the treatment of the cardiovascular disorder, I will conduct the necessary diagnostic tests and accordingly advice medications for his physical development. The second domain would be to test mental well being of Gary. This would mainly include consideration of his intelligence, mindset as well as growth as an individual.

Following this, I would be focussing on the emotional well being of the patient (Vallesi et al., 2018). In order to assess this aspect, I would be mainly trying to focus on his feelings, maturity as well as relationships of the patient with other people. Spiritual well-being of the patient would be assessed by discussing his faith, traditions, and relationships as well as religions and other beliefs. After analysing all the requirements of the patient, specific community services would be referred to him according to the outcomes of the assessment (Marmot, 2017). In this way, I would be successfully able to ensure that not only his physical determinants develop but ensure quality of his life gets better.

            Another important aspect is called the cultural competence. Every nursing professionals need to develop skills and knowledge by which they can provide culturally competent care to the patients. I have seen that when professionals follow culturally competent care, they can effectively maintain the dignity and autonomy of the person and as a result, the patient feels respected (Munns et al., 2016). He might feel that the professionals respect their cultural traditions and this helps in creation of strong bonds and compliance. I need to follow Aboriginal traditions and cultures while providing care and accordingly need to modify my verbal and non-verbal communication skills so that it aligns with cultural preferences of the patients (Markwick et al., 2015).

While treating Gary, it is very important for me to ensure that my verbal and non-verbal skills ensure meeting the cultural styles of their communication. One of the things that I should focus is the effective rapport development with Gary.  Researchers are of the opinion that Indigenous Australians do not feel comfortable in opening up any conversation with strangers. They also do not like revealing personal information to others. Therefore, in order to gather details about Garry, I would first engage in informal conversations with the patient. This informal conversation would help in easing out the situations and he would start feeling comfortable. When he feels comfortable with me, then only I would proceed with the medical diagnosis.

The Importance of Addressing the Four Dimensions of Wellness

            Their cultural traditions allow brief period of silence during communication and considers them as the way of showing respect to the speakers. However, western mode of communication does not prefer long gaps of silence and immediately tries to fill them up. Therefore, I should develop this cultural awareness and should respect the silence that Gary might follow during conversations. This would make him feel that his traditions are respected and this would help in development of bonds. Another important criterion is the maintenance of the eye contact (Phillips et al., 2016). Unlike the western healthcare communication style, professionals are advised to maintain eye contact with the patients as eye contact is a medium of showing self-respect and importance to a person.

However, in case if the Indigenous Australians, this might be considered as rude and disrespectful. Therefore, I need to have the knowledge of this cultural tradition and never maintain eye contact with Gary. This aspect would make him feel respected and this would result in development of effective bonds with me. When the patient would see that culturally competent care is provided to him, his negative feelings about the Western healthcare system would reduce and he would have positive relationships with the professionals and ensure compliance with the advised interventions (Fisher et al., 2018).

            From the above discussion, it becomes clear that I need to provide care to patients that align with the different cultural preferences and traditions of the patient. Moreover, only attending to the biological determinants or the physical aspects of the patient can never help in providing holistic care to the patients.

Therefore, as a professional, I need to consider the different social determinants of and psychological determinant of health as well. Moreover, it also becomes important for the nursing professionals to make the patient feel comfortable through effective communication style that also align with their culture. Therefore, only providing clinical interventions would not be enough for the development of health of the patient. Nurse should ensure empathy and compassion in her non-pharmacological approaches as well so that patient centred care is ensured and patient satisfaction is maintained.

References:

Baum, F., & Friel, S. (2017). Politics, policies and processes: a multidisciplinary and multimethods research programme on policies on the social determinants of health inequity in Australia. BMJ open, 7(12), e017772.

Brewster, D. R. (2017). Growth faltering, child rearing and social determinants of health in Aboriginal community children. Journal of paediatrics and child health, 53(1), 5-7.

Developing Cultural Competence in Nursing Professionals

Browne-Yung, K., Ziersch, A., Baum, F., & Gallaher, G. (2016). 'When you sleep on a park bench, you sleep with your ears open and one eye open': Australian Aboriginal peoples' experiences of homelessness in an urban setting. Australian Aboriginal Studies, (2), 3.

Chenhall, R. D., & Senior, K. (2018). Living the Social Determinants of Health: Assemblages in a Remote Aboriginal Community. Medical anthropology quarterly.

Couzos, S., & Thiele, D. D. (2016). Aboriginal peoples participation in their health care: A patient right and an obligation for health care providers. Aboriginal and Islander Health Worker Journal, 40, 6.

Cullen, P., Clapham, K., Hunter, K., Porykali, B., & Ivers, R. (2018). PW 1898 Embedding multi-sectoral solutions to address transport injury and social determinants of health in aboriginal communities in australia.

Fisher, M., Battams, S., Mcdermott, D., Baum, F., & Macdougall, C. (2018). How the Social Determinants of Indigenous Health became Policy Reality for Australia's National Aboriginal and Torres Strait Islander Health Plan. Journal of Social Policy, 1-21.

Fisher, M., Baum, F. E., MacDougall, C., Newman, L., & McDermott, D. (2016). To what extent do Australian health policy documents address social determinants of health and health equity?. Journal of Social Policy, 45(3), 545-564.

MacPhail, C., & McKay, K. (2018). Social determinants in the sexual health of adolescent Aboriginal Australians: a systematic review. Health & social care in the community, 26(2), 131-146.

Markwick, A., Ansari, Z., Sullivan, M., & McNeil, J. (2015). Social determinants and psychological distress among Aboriginal and Torres Strait islander adults in the Australian state of Victoria: a cross-sectional population based study. Social Science & Medicine, 128, 178-187.

Marmot, M. (2017). The health gap: Doctors and the social determinants of health. Scandinavian journal of public health, 45(7), 686-693.

Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E., & Zubrick, S. R. (2014). Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health, 14(1), 201.

Munns, A., Toye, C., Hegney, D., Kickett, M., Marriott, R., & Walker, R. (2016). The emerging role of the urban-based aboriginal peer support worker: A Western Australian study. Collegian, 23(4), 355-361.

Newman, L., Baum, F., Javanparast, S., O'Rourke, K., & Carlon, L. (2015). Addressing social determinants of health inequities through settings: a rapid review. Health Promotion International, 30(suppl_2), ii126-ii143.

Phillips, C., Fisher, M., Baum, F., MacDougall, C., Newman, L., & McDermott, D. (2016). To what extent do Australian child and youth health policies address the social determinants of health and health equity?: a document analysis study. BMC public health, 16(1), 512.

Vallesi, S., Wood, L., Dimer, L., & Zada, M. (2018). “In Their Own Voice”—Incorporating Underlying Social Determinants into Aboriginal Health Promotion Programs. International journal of environmental research and public health, 15(7), 1514.

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