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Discuss about the Overcoming Disparities In Management Of Acute Coronary Syndromes.

Issues/problems


Issues/problems

Person-centred Goal

Interventions/ Actions

Who is responsible

Evaluation Criteria and date

Paul has been suffering from depression due to his recently developed health problems such as eye problems due to the cataract surgery and his hepatitis C

Effective communication incorporating the cultural competency and respect for the aboriginal people can be set as a person-centred goal in such cases as Paul. The communication should also include consideration that the care should be based on the continuous healing relationships.

A person centred goal to manage depression in such patients can involve the tele-health interventions (Radford et al., 2014)

The Aboriginal Health Worker from the local Aboriginal Community Health Service.

Evaluation criteria includes diagnosis by the primary care nurses

Another problem is the lack of knowledge about his health issues especially hepatitis C. he and his family both lack information and resources in regards to hepatitis c

Here the patient centred goal comprises of free share of knowledge and information between and among the patients and the care partners along with the physicians and the other care givers. It is required in a patient-centred environment that all members of the care team — including the patient should be aware of the health status of the patient and the care plan.

Community based interventions that include the bio-psycho-social factors of subgroups in terms of race, gender, and ethnicity. This is in order to incorporate more accurate and described prevalence rates and to create effective interventions. Additionally it is conducted to find the common variables that exists among successful interventions (Lawrence, Hancock & Kisely, 2013).

The Aboriginal Health Worker from the local Aboriginal Community Health Service.

Evaluation criteria includes survey and evaluation through questionnaires by the health care workers.

In the Aboriginal community, the prevalence of higher rates of chronic diseases is evident in the aged population, in addition to the prevalence of higher disability rates (Condon et al., 2013). Such issues demand more support for these aboriginal individuals in their later years. However most of them fail to receive even the basic care needs. The aboriginals living in their own homeland often lack services that are related to the older care services in remote parts of Australia (Parker & Milroy, 2014). They often are required to travel for long distances for receiving basic medical care when they require it.  However I the past few years, developments have been seen in the government programs that have in established with the aim of helping the communities and especially the aged care organisations to include the Aboriginal people more, through The Aboriginal and Torres Strait Islander Health Framework (2014) (Holland, 2014). The National Aboriginal and Torres Strait Islander Flexible Aged Care Program aims to support the culturally appropriate aged care services for older Aboriginal and Torres Strait Islander people who are close to home and community. These services also include residential and home care.

According to the reports, 15% of the aboriginals are more than the age of 50, among which only few of them received permanent residential aged care.  In order to address the inequality that these indigenous Australians face in order to access the care, some programs and places have been allocated within the care system of the aged (Parker & Milroy, 2014). These programs have been specifically designed for the people who are identified as being the part of the Aboriginals and the Torres Strait islander community. To be specific, the Indigenous Australians have the right to access aged care services by approaching the National Aboriginal and Torres Strait Islander Flexible Aged Care Programme. By the year 2015, this program had established 802 operational places, which were predominantly located in rural and remote Australia (Holland, 2014).

There has been a long established disparity existing between the indigenous and non-Indigenous Australians' health status and care. However in recent years, steps have been taken in order to reduce these disparities by implementation of person centred care to the individuals of the aboriginal community. Firstly cultural competence is an important factor in founding of an effective clinical and patient centred care. Cultural competence is quite crucial for those healthcare professionals who pursue to provide an elevated level of quality care most of the  patients (Allen, Ottmann & Roberts, 2013). In order to do so the cultural safety should be attained through cultural awareness and development of cultural sensitivity. Cultural awareness is the first step that is taken toward understanding the difference between what constitutes a cultural group, their rituals, customs along with their behaviours and practices. While cultural competence tends to focus on the strength of the health system in improving health and wellbeing by integration of culture into the health service delivery (Ilton et al., 2014).

Person-centred Goal

The Aboriginal and/or Torres Strait Islander people have been seen to use the term social and emotional well-being compared to the term mental health. For them, the social and emotional well-being is perceived in a holistic manner and it is often influenced through various factors that includes access to appropriate health care, the welfare of the whole community along with cultural identity, a sense of kinship, spirituality and a connection to country (McCalman et al., 2014). Additionally physical limitations or impairments, experience of significant grief and loss along with racial discrimination by society or the service providers also impact their well-being. It is seen that provision of health services that reflects this given definition of social and emotional well-being and is able to address the factors that influence it, is appropriate to meet the needs of Aboriginal community (Lin et al.,  2013).

In cases of depression in these people, especially the ageing individuals, it is seen that the efficacy of antidepressant medications or psychotherapy is not that significant, hence more specific and actionable care systems are required. In a study, it was reported that focusing on patient-centered care is improved the quality of the relationship between the patient and the doctor, leading patients to feel that they are more involved in the care process and to make them comfortable with plans for treatment. All of these factors also contributed to improvement of patient satisfaction (Kingsley,Townsend, Henderson-Wilson & Bolam, 2013). Implementation of the tele-health interventions resulted in the patients having good rapport in addition to a therapeutic alliance with the healthcare workers, which even showed to contribute to remission of depression rates at 6 months. The patients felt that their values and goals were considered while recommending treatments.


In relation to prevalence of hepatitis C, literature reveals that impact that stigma and lack of Hepatitis C virus knowledge have a significant on the decision-making of aged individuals about their care and treatment. However despite such condition, the patients tried engaging in self-care activities and proactively seemed to seek treatment for HCV (Kingsley, Townsend, Henderson-Wilson & Bolam, 2013). Hence for such cases recommendations have been made in terms of Community based interventions that include the bio-psycho-social factors of subgroups in terms of race, gender, and ethnicity (Johnston et al., 2013). This is in order to incorporate more accurate and described prevalence rates and to create effective interventions. Additionally it is conducted to find the common variables that exists among successful interventions (Browne, Hayes & Gleeson, 2014).

Interventions/ Actions


In conclusion it can be mentioned that the demonstrated impact of ‘closing the gap’-related investment in the Aboriginal Community Controlled Health Services (ACCHSs) provide further signs of positive change that will be occurring in the next two decades. The policies that are developed for providing importance to the health care of the patients, show try to display respect to their autonomy, in addition to the achievement of a quality of life that is optimal. The choice of the treatment options, in addition to the place of the care should be decided by the patients. In spite of the several challenges that are faced in providing health care to the older adults of the aboriginal community, the health care professionals must strive to understand the complex dynamics that exists in their culture and territoriality.

References

Allen, J., Ottmann, G., & Roberts, G. (2013). Multi?professional communication for older people in transitional care: a review of the literature. International Journal of Older People Nursing, 8(4), 253-269. Retrieved from: https://doi.org/10.1111/j.1748-3743.2012.00314.x

Browne, J., Hayes, R., & Gleeson, D. (2014). Aboriginal health policy: is nutrition the ‘gap’in ‘Closing the Gap’?. Australian and New Zealand Journal of Public Health, 38(4), 362-369.

Condon, J. R., Garvey, G., Whop, L. J., Valery, P. C., Thomas, D. P., Gruen, R., & Cunningham, J. (2013). Aboriginal and torres strait Islander Australians and cancer. In Cancer Forum(Vol. 37, No. 1, pp. 27-30). Cancer Council Australia.

Holland, C. (2014). Close the Gap: progress and priorities report 2014. Retrieved from: https://apo.org.au/node/38110

Ilton, M. K., Walsh, W. F., Brown, A. D. H., Tideman, P. A., Zeitz, C. J., & Wilson, J. (2014). A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population. A consensus statement from the National Heart Foundation of Australia. The Medical journal of Australia, 200(11), 639-643.  doi: 10.5694/mja12.11175 

Johnston, L., Doyle, J., Morgan, B., Atkinson-Briggs, S., Firebrace, B., Marika, M., ... & Rowley, K. (2013). A review of programs that targeted environmental determinants of Aboriginal and Torres Strait Islander health. International journal of environmental research and public health, 10(8), 3518-3542. Retrieved from: https://www.mdpi.com/1660-4601/10/8/3518/htm

Kingsley, J., Townsend, M., Henderson-Wilson, C., & Bolam, B. (2013). Developing an exploratory framework linking Australian Aboriginal peoples’ connection to country and concepts of wellbeing. International journal of environmental research and public health, 10(2), 678-698. Retrieved from: https://www.mdpi.com/1660-4601/10/2/678/htm

Kingsley, J., Townsend, M., Henderson-Wilson, C., & Bolam, B. (2013). Developing an exploratory framework linking Australian Aboriginal peoples’ connection to country and concepts of wellbeing. International journal of environmental research and public health, 10(2), 678-698. doi:10.3390/ijerph10020678

Lawrence, D., Hancock, K. J., & Kisely, S. (2013). The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. Bmj, 346, f2539. Retrieved from: https://doi.org/10.1136/bmj.f2539

Lin, I. B., O'Sullivan, P. B., Coffin, J. A., Mak, D. B., Toussaint, S., & Straker, L. M. (2013). Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ open, 3(4), e002654. Retrieved from: https://bmjopen.bmj.com/content/3/4/e002654.short

McCalman, J., Tsey, K., Bainbridge, R., Rowley, K., Percival, N., O’Donoghue, L., ... & Judd, J. (2014). The characteristics, implementation and effects of Aboriginal and Torres Strait Islander health promotion tools: a systematic literature search. BMC Public Health, 14(1), 712. Retrieved from: https://doi.org/10.1186/1471-2458-14-712

Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet, 25-38. Retrieved from: https://www.researchgate.net/profile/Roz_Walker/publication/259715124_Working_Together_Aboriginal_and_Torres_Strait_Islander_Mental_Health_and_Wellbeing_Principles_and_Practice/links/59c3abb20f7e9b21a82fd663/Working-Together-Aboriginal-and-Torres-Strait-Islander-Mental-Health-and-Wellbeing-Principles-and-Practice.pdf#page=54

Parker, S., McKinnon, L., & Kruske, S. (2014). ‘Choice, culture and confidence’: key findings from the 2012 having a baby in Queensland Aboriginal and Torres Strait Islander survey. BMC health services research, 14(1), 196.

Radford, K., Mack, H. A., Robertson, H., Draper, B., Chalkley, S., Daylight, G., ... & Broe, G. A. (2014). The Koori growing old well study: investigating aging and dementia in Urban Aboriginal Australians. International psychogeriatrics, 26(6), 1033-1043. Retrieved from: https://doi.org/10.1017/S1041610213002561

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