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Discuss the importance of self-determination to Indigenous Australians using ACCHS as an example of local communities exercising self-determination.

Discuss how the ACCHS model of comprehensive primary health care reflects Indigenous understandings of health and wellbeing.

Choose one program provided by your local ACCHS and discuss how it contributes to the health and wellbeing of the local Indigenous community.

Discuss the role of Aboriginal Health Workers (AHWs) and Aboriginal Health Practitioners (AHPs) in ACCHS in improving health outcomes for their local communities.

Understanding the ACCHS Model of Comprehensive Primary Healthcare

Self-determination is a procedure and a right exercised by the Aboriginal and Torres Strait Islanders Australians (McHugh, 2004). It includes their collective right in decision making. It is thus a central procedure and right for the Aboriginal and Torres Strait Islanders Australians. This is because it underpins the well being of the people culturally, as a community, family as well as individually. This helps these Indigenous communities in not only making decisions that address the health problems they are facing, but also taking control of their peoples’ future in the health sector. ACCHS is one of the examples of self determination initiatives taken by and for the health Aborigines in Australia.

ACCHS is a fundamental healthcare service that was initiated by the local Indigenous community. The healthcare service is also operated by the same local community of Aborigines. The main role of ACCHS is to provide healthcare services that are culturally appropriate, holistic as well as comprehensive to the Indigenous community. In addition, the ACCHS has a significant role in training as well as employing medical workforce from  Aboriginal people. This is an important aspect of self-determination. Another importance is providing best-practice health care services that are accessible to bigger percentage of the Aboriginal population. The ACCHS model is mainly focused on reducing the disadvantage the Aboriginals face when it comes to healthcare service deliverance. It reflects on the need for the improvement of the emotional as well as social well being of the Aborigines. The model entails cultural safety, health promotion, clinical services and the engagement of the community. The model also puts into consideration mental health, sexual health, chronic disease management and prevention as well as child and maternal healthcare for Aboriginal mothers and children. Family-centered healthcare has also been incorporated in the model to ensure the family is involved in their patients’ recovery (Weightman, 2013).

The Victorian Aboriginal Health Service (VAHS)  is a program provided by ACCHS in Melbourne. The program has ensured that its services are accessible to all the Aboriginals within my local area. In addition to making its healthcare services accessible, it has also improved the quality of the services it provides the local community. The system has incorporated the culture of the Aboriginals by providing a cultural safe environment. Their effort to understand and familiarize themselves with the way of life of the Aboriginals has been fruitful. The program has trained and employed some of the local members of the Aboriginal community to work as practitioners thus creating a diverse work environment. This has enabled the program to reach many of the local Aboriginals as they can identify with people from their community program. This has also aided in communication between healthcare givers and the recipients of such services.

Programs Provided by ACCHS

 AHW and AHPs are  defined as people of the Aboriginal descent who possess a CERT III (minimum qualification) in the field of clinical practice or primary healthcare (Mitchell & Hussey, 2006). They have many roles in the healthcare sector. They treat injuries and diseases as well as maintain health records. Moreover, they give input into planning, developing, implementing and monitoring, and evaluating health programs.  They are also responsible for educating those outside the Indigenous culture about the culture of the Aborigines. They independently or in partnership with other healthcare givers participate in management and follow up of cases. In addition, they act as interpreters and communicators on behalf of other health workers and clients.

The National Safety and Quality Health Service (NSQHS) Standards provide protection for the public against harm and ensure the improvement of the quality of health care services provided to the people (Boyd & Sheen, 2014). There are 8 NSQHS standards. They include: “clinical governance, preventing and controlling healthcare-associated infection, partnering with consumers, blood management, communicating for safety, comprehensive care, recognizing and responding to acute deterioration and medication safety”.  These standards have ensured that the Aboriginal and Torres Strait Islanders Australians receive quality healthcare services based on their needs. The NSQHS ensures that the Aboriginal and Torres Strait Islanders Australians receive person-centered care (Greenfield, Hinchcliff, Banks, Mumford, Hogden, Debono & Braithwaite, 2015).

The first strategy is by developing relationship with the Aboriginal and Torres Strait Islanders Australian communities (Bailey & Hunt, 2012). Engaging with the Aborigines will enable hospitals to have a more comprehensive understanding of the community. Those in hospital management and staff will be able to comprehend the experiences of the Aboriginal and Torres Strait Islanders Australians. Therefore, the hospitals will look for ways to improve the kinds of healthcare services they provide to their patients with regards to culture. Development and maintenance of relationships that are positive will promote successful engagement. One of the methods that can be used to develop such positive relationships with the Aboriginal and Torres Strait Islanders Australians is by having personal conversations with the members of the Aboriginal community. The hospitals can also hold monthly lunches or small events with the community to get a better understanding of their culture. Moreover, the hospital management can also have discussions with the community’s elders. Once they have accomplished the above; the hospitals will be able to accurately identify the Aboriginal patients. In addition they will be able to provide cultural sensitive care to the Aboriginal and Torres Strait Islanders Australians.

Role of Aboriginal Health Workers and Aboriginal Health Practitioners

Another strategy hospitals can utilize is the creation of a cultural safe hospital environment. This is because the Aboriginal and Torres Strait Islanders Australians are known to trust and prefer healthcare services that respect and acknowledge their culture (McBain?Rigg & Veitch, 2011). Therefore, each facility giving healthcare services to these communities need to consider their environment. It is crucial for hospitals to understand the need for a physical environment that displays the artwork and artifacts of the Aborigines is important. It will better the experience of the patients at the hospitals as they will feel more welcome and at par with the environment. In addition, the hospitals should ensure their staff is culturally diverse and includes Aboriginal staff. This will encourage the Aboriginals to be more comfortable to visit the hospitals for check ups and treatments. The hospitals can partner with local healthcare to determine the symbols, signs and displays that can be used by the institution.  Moreover, the hospitals can engage the locals when developing messages that explain how the hospitals deliver their services.  Some of the symbols, artifacts, artwork or signs hospitals can adopt include using the flags of Aboriginal/Torres Strait Islanders. However, creation of welcoming environments in hospitals will not be effective without implementing other strategies.

The Nursing and Midwifery Board of Australia (NMBA) is responsible for the regulation of the practices of nursing as well as midwifery (NMBA, 2008). The main objective of this board is to provide protection to the public. It develops codes, standards and guidelines that establish the necessary requirements for the safe and professional practice of the midwives and nurses in Australia. The Nursing and Midwifery Codes of Conduct spell out the professional behavior, legal requirements and conduct expectations that are to be followed by all the nurses and midwives in their practices in Australia. NMBA and Nursing and Midwifery Codes of Conduct enable nurses and midwives to provide better health services to all patients (NMC, 2015). They are required to be kind and compassionate in their practice and thus deliver safe medical care to all their patients. Moreover, the nurses and midwives in this field are able to ensure that their delivery of healthcare services to the Aboriginal and Torres Strait Islanders Australians is effectively executed.

The NMBA recognizes the link that exists between wellbeing and culture. One strategy that nurses can put in place to ensure they provide quality services to the Aboriginal and Torres Strait Islanders Australians is by improving their communication skills. The nurses and midwives need to be trained and educated on the culture of the Aboriginals. They need to perfect the verbal and non verbal skills to match the culture of these locals. For instance, the nurses need to be able to communicate fluently with the Aboriginal people in their native language. This is because most of these people have retained their language. Communication is an important aspect in the healthcare sector.  Nurses and midwives therefore have to engage with the community to understand their way of life, language and rituals so that they may not offend them during a visit at the clinic or the hospital (Durey, Wynaden, Thompson, Davidson, Bessarab & Katzenellenbogen, 2012). Ignorance may lead to mistrust as Aboriginal people do not take it lightly to people who show no respect and understanding of their culture (Jackson & Ward, 1999). They may thus avoid visiting professionals to get treated. The nurses as well as the midwives should also be familiar with what different non verbal gestures and body movements mean to the Aboriginals.

National Safety and Quality Health Service Standards

Nurses and midwives can show support for their rights and dignity as well as being role models. Nurses and midwives who do not share the same culture as the Aboriginal and Torres Strait Islanders Australians can be immobilized. They can then find ways in encouraging others on being supportive of the culture of the Aboriginals. This will help in reducing racism and discrimination based on gender (Larson, Gillies, Howard & Coffin, 2007). They should be able to uphold the privacy of their Aboriginal patients especially when it comes to gender and complex kinship relationships. This will prove their respect for the culture of the Indigenous groups and will encourage then to be frequent visitors at clinics whenever they need consultations or treatment.

References

Bailey, S., & Hunt, J. (2012). Successful partnerships are the key to improving Aboriginal health. New South Wales public health bulletin , 23(4), 48-51

Boyd, L., & Sheen, J. (2014). The national safety and quality health service standards requirements for orientation and induction within Australian Healthcare: A review of the literature. Asia Pacific journal of health management , 9(3), 31-37.

Durey, A., Wynaden, D., Thompson, S. C., Davidson, P. M., Bessarab, D., & Katzenellenbogen, J. M. (2012). Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nursing inquiry, 19(2), 144-152

Greenfield, D., Hinchcliff, R., Banks, M., Mumford, V., Hogden, A., Debono, D., ... & Braithwaite, J. (2015). Analysing ‘big picture’policy reform mechanisms: the Australian health service safety and quality accreditation scheme. Health Expectations, 18 (6), 3110-3122

Jackson, L. R., & Ward, J. E. (1999). Aboriginal health: why is reconciliation necessary?. Medical Journal of Australia , 170 (9), 437-441

Larson, A., Gillies, M., Howard, P. J., & Coffin, J. (2007). It's enough to make you sick: the impact of racism on the health of Aboriginal Australians. Australian and New Zealand Journal of Public Health , 31(4), 322-329

Mitchell, M., & Hussey, L. M. (2006). The Aboriginal health worker. Medical Journal of Australia , 184 (10), 529

McHugh, P. G. (2004). Aboriginal societies and the common law: a history of sovereignty, status, and self-determination . Oxford University Press, USA.

McBain?Rigg, K. E., & Veitch, C. (2011). Cultural barriers to health care for Aboriginal and Torres Strait Islanders in Mount Isa. Australian Journal of Rural Health ,19(2), 70-74

NMC. (2015). The Code for Nurses and Midwives.

NMBA. (2008). Code of Professional Conduct for Nurses in Australia.

Weightman, M. (2013). The role of Aboriginal community controlled health services in indigenous health. Aust Med Student J, 4, 49-52

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