Individual racism can be defined as the type of racism where the beliefs, actions and the attitudes of any individuals are featured by the preference of race. It is mainly based on the belief of dominant or the inferior culture depending upon the dogma of the behavior (Gair, et al., 2015). Institutional racism on the other hand can be defined as discrimination based on the color and the ethnic background of a person in the society (Vukic et al., 2012). It is evident from these definitions that the aboriginal communities of Australia have been suffering from institution racism due to their past history and the stigma centering them. These two types of racism in context of aboriginal people can be compared and contrasted to show the correlation between them (Vukic et al., 2012). The similarity between the two types of racism is that both contain the element of discrimination in them. Individual racism may lead to institutional racism (Gair, et al., 2015). For example a non-indigenous student showed racist attitude towards an aboriginal student. The other non-indigenous students might get influence by this and can generate a predetermined notion regarding the stigma surrounding the aboriginal community (Gair, et al., 2015). On the other hand institutional racism cannot lead to individual racism; this is because institutional racism comes from one person to be formulated in to an institution (Vukic et al., 2012).
Despite of the constant efforts to improve the health status of the aboriginal Australians, it still remains equal to the third world countries. With passing time the number of aboriginal enrolled nurses is increasing, but the number is still too low to be taken into considerations. A number of initiatives had been taken to enhance the participation of the aboriginal people in the profession of nursing. ANAC has taken initiatives to recruit more aboriginal nurses and equipping all the nursing with the training to provide a culturally safe care and abolish the myth or the trend of whiteness in nursing. (Sedgwick et al., 2014).
The cultural awareness and the cultural safety training is given to the health care professionals for improving the health of the aboriginal and the Torres Strait Islander. Cultural awareness can be define as the sensitivity to the similarities and the differences that exists between two different cultures and use this in optimal communication with the person belonging to a culturally different background. Cultural awareness regarding the aboriginals encompasses the health care professionals, who are in charge of providing care to the aboriginal community, to understand about the different cultures and the traditions of the aboriginals (Gerlach, 2012). Aboriginals are community-centered and posses many strange health care beliefs. Cultural awareness training provides information about the life and the history of colonization of the Australians (Gerlach, 2012). It is necessary to understand that the dark past of the aboriginals plays an important role to the social determinants of health and the current physical and the mental status of the aboriginals.
Cultural safety on the other hand refers to the refers to the actions and the initiatives that helps individuals such as health care professionals to respect, recognize and nurture the cultural needs and the requirements of the people (Gerlach, 2012). It means working from the cultural perspective of others. The cultural safety training helps a person to understand how to respond according to the cultural requirements of people (Nielsen et al., 2014).
Reporting and responding are the first two aspects of the 5R's of reflection.
Reporting- I was in charge for providing care to an adolescent 18 years, aboriginal boy with mental problems, drug abuse and few episodes of self destruction. The boy was admitted with a cut on his wrist.
Responding- As a nurse my first duty is to look after the physical needs of the patient as the boy was bleeding. Although reported of violence the boy did not show any symptoms of violence and allowed me to do the nursing. I wondered what caused the boy to act like this and really wanted to look at the matter form the grass root level. According to the ethics of nursing each person has got the right to get health care support irrespective of the caste and creed.
The scenario helped me to assume that the history of colonization has been carried over even after many generations have passed and can be responsible for the current condition of the aboriginal people.
Since the time of European invasion of Australia in the year 1788, the aboriginal people were oppressed in to a world that was quite unnatural to them for more than thousands of years (Anderson & Kowal, 2012). At first there was influx of invaders who transmitted diseases which almost destroyed the whole Sydney tribe. It was the aboriginal people that inhabited the land for hundreds of years, but were later on colonized by the colonizers, who were led to believe that the land was ' no one's land' (Australians together.org.au. ,2018).
Just like in other colonized countries, the Europeans were of an unshakeable concept of superiority that was sustained by the belief of Christianity (Anderson & Kowal, 2012). They captured the lands that were more productive and viable, exterminating the aboriginal people. The land that was economically useless was only returned to the indigenous people. The idea of the aboriginal racism became institutionalized when all the Australian states except Tasmania enacted the legislations that severely restricted the aboriginal population Australians (together.org.au. 2018). They were prohibited from enjoying the vicinity of the township (Anderson & Kowal, 2012). They required the permission from the whites in every aspect of life. Aboriginals were only allowed to work in areas that were reserved by the police and the Christian missionaries. The pure whites were considered as superior and the aboriginals and the half bloods where justified by the ideologies of racism (Anderson & Kowal, 2012).
Within the hospital system only the aboriginals have faced racist barriers for gaining appropriate health care. In spite of being only three quarter of the population, the aboriginal people have to go through many procedures such as having to wait for longer for a surgery or referred later for a specialist doctor (Durey et al., 2012). There are many such systematic differences in the care provided by the clinical settings that had contributed to the low level of trust that the aboriginal people have for the hospitals. According to the 2008 National Aboriginal and Torres Strait Islander Social Survey, 60 % of the aboriginal people have felt that the hospitals could not be relied upon which reflected in the fact that the Aboriginal people are five times as likely to leave hospitals at their own risk without any medical advice (Australian Health Ministers Advisory Council ,2012). The aboriginal literacy rates are low and this literacy gaps between the aboriginal students are becoming large and persistent (Vukic et al., 2012). Regarding employment the aboriginal had to display exemplary behavior. All the tribal associations in the Western Australia were dissolved, except the filial relations that worked in armed forces and able to speak English and references from at least two white Australians. They received only one third of the wages received by the White Australians (Vukic et al., 2012). For many years they had been abused by offensive titles. They were being discriminated in terms of the job quality, in terms of promotion and remuneration.
Cultural safety helps the nurses to go beyond the cultural difference. It exceeds the safety of the culture, recognizes the importance of accepting the difference. Culturally safe care helps the health care professionals to address the racism and the inequalities of health and redressing the inequalities through the educational processes (Gerlach, 2012). The inequities can be addressed through the lens of the cultural safety (Cameron et al.,2014). The nurses will be able to acknowledge the fact that human beings are all the bearers of the same culture. It enables the nurses to consider the concepts of discrimination and racism (Stansfield & Browne, 2013). The term cultural safety is associated to upholding of the human rights, dignity, safety, empowerment and autonomy. According to Cameron et al.,(2014) cultural safety is an extended concept of cultural awareness and cultural sensitivity. The application of the cultural safety in nursing means that the patients will be taken care of just as the non-aboriginals without any delay in referrals (Durey et al., 2012).
Culturally safe care is essential in midwifery practice for example an aboriginal woman would definitely not want to share the birthing information or other gynecological information with a male midwife (Brown et al., 2016). Again the caseload midwifery practice should also be used such that a fixed midwife is involved throughout the course of pregnancy. The concept of traditional healer is quite popular in the aboriginal health beliefs (Douglas,2013). A culturally aware non aboriginal nurse might take assistance from these traditional healers in order to provide comprehensive care to a particular patient (Macaulay, 2009).
The modules of my course have helped me to believe how the history of the colonization has affected the health and the well being of the aboriginals. It has informed us with the fact how the aboriginals have survived the climatic change and how they were being ousted from their motherland. I believe that there are distinctive cultural and the ethnic difference between the aboriginals and the non aboriginals. The learning has helped me to understand how the aboriginal spirituality is related to the nature and the animistic world. This deep knowledge has long been the core aspects of the aboriginal spirituality and it natural that the physical well being is associated with the mental and the spiritual well being of the aboriginal (Macaulay, 2009). I have learnt that According to Anderson & Kowal, (2012) the aboriginal lifestyle was based on kingship with the environment. Wisdom and truth had helped the aboriginals from time immemorial to use the nature to the fullest. For the aboriginal people it was their sacred duty to protect the environment hence all the sacrifices such as killing of animals as a part of their rituals were done in complete balance with the environment (Brown et al., 2016). I have studied and have realized that that the barrier to the health outcomes of the aboriginals is the deficit thinking. If I needed to build an action plan I would definitely think of a strength based approach as it would help to view the situations realistically and complement the strength and the opportunities of the aboriginals. According to me the government policies should include policies that would help the aboriginals in easy access to health care, proper insurance facilities, community health care programs like vaccination programs, HIV awareness programs, availability of low cost medicines, setting up of low cost grocery shops, maternal and antenatal care and several more.
My study and research has made me believe that there are various variables that had actually contributed to the life expectancy, physical and the mental health problems of the aboriginal population. I have understood that it is due to the past bitter experience of the indigenous population that they can no longer rely upon the westernized model of treatment. Racism and discrimination have kept them aloof from the modern health care dominated by the white people. While encountering a case related to substance abuse among an aboriginal boy, I found that widespread substance abuse is not merely due to the reckless lives of the adolescents, but was surprised to found that there lay the legacies of land colonization and war. The discrimination with the aboriginal students leads to school dropout shutting down different career opportunities. As a nurse I found it is extremely necessary to practice a culturally safe care nursing in order to address the issue. I have realized that communication enhancement, emergency care, multidisciplinary concept can help to built up a non hostile environment for the aboriginals. Empathy, community celebration and therapeutic relationship with the patient always improve the patient outcomes (Macaulay, 2009).
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