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Pam: Inequity In Its Healthcare System

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Discuss about the Pam for Inequity in its Healthcare System.




Australia is a large country that is made up of people from diverse cultural, racial, ethnic, religious, and social backgrounds. The plural nature of the Australian society has made the country to face a persistent problem of inequality and inequity in its healthcare system. For instance, there has been a big disparity between the health status of the indigenous and non-indigenous communities across the country. The case of Pam, a 39-year old Aboriginal patient demonstrates how challenging it is for the healthcare providers to deliver satisfactory services to the indigenous patients (Momani & Berry, 2017). After her diagnosis with a primary cervical cancer and metastatic disease, it has reached a time when Pam should be provided with a holistic palliative care. The healthcare providers serving the patient should deliver a culturally-competent care to her. This can enable her, alongside her family members, to be provided with the services to address the physical, psychological, and spiritual needs.


Approaches or Cultural Aspects to Culturally Competent Health Care Delivery for Indigenous Australians

Use of the Services of Aboriginal Liaison Officer (ALO)

The aboriginal’s attitude, culture and perception are reluctant towards modern health techniques. The nurse does not share in this culture. There is therefore need for the nurse to assess and understand Pam’s values, beliefs, attitude and perceptions for the knowhow of provision of better treatment. ALO will help the nurse in determining the best approach towards treatment of Pam with regard to culturally accepted language and contact as this will impact on communication. The ALO increases connectivity between the two leading to more trust and openness (McKenna, Fernbacher, Furness & Hannon, 2015). This will help in making Pam comfortable and freely willing to express herself, ensuring that her culture with regard to health is understood and health needs met (Daws, et al., 2014).

The ALO will also help in interpretation and ensuring that both Pam and the nurse get the right message with regard to communication. The nurse must be able to formulate and express the message and Pam too must be able to process the message and effectively respond back and vice versa. Since the nurse is not familiar with Pam’s language, she requires one who will help her understand what Pam will be expressing both verbally and none verbally ((Daws, et al., 2014). If the wrong nonverbal communication is used then this will impact on the response; for example a non verbal communication which could have meant pain can be interpreted as dislike in the interaction.  ALO will help also help in provision of counseling services to Pam as well as help her integrates into the health care system (Katzenellenbogen, Miller, Somerford, McEvoy & Bessarab, 2015).

Patient Involvement in the Treatment Process

Good Relationship between the Pam and the nurse is fundamental for effective therapeutic process. It is important that Pam feels to be part and parcel of the treatment process. This is important for her knowledge of her health status as well as appreciation of kind of treatment being provided and the stages. Involvement of Pam will also reinforce adherence and response of Pam towards treatment as well as ensure she and her family gets responsible about her health care (Shay & Lafata, 2015). This will in turn ensures sustainable search for further health care as Pam understands well the treatment process and so is the health care outcomes.

Good relationship begins with appropriate involvement in which the nurse should not appear to be all knowing and imposing; all rather, it should be a mutual relationship with Pam at the centre of care and in position of decision making. Pam should be involved not only because of what she will say or do to influence a decision, but also by virtue of what she thinks and feel about her roles, efforts and contributions to decision making and her relationship with the nurse (Renzaho, Romios , Crock & Sønderlund, 2013). Further involvement of Pam by the nurse may be in ways of allocating her sufficient time to express her ideas, discussion with her on treatment options available based on her beliefs and values, empowering her with health care information as well as encourage her to share out on her knowledge and giving her responsibility with regard to her health (Joseph-Williams, Elwyn & Edwards, 2014).


Therapeutic Communication

Therapeutic communication is the interactive process both verbal and non-verbal between the nurse and the patient through whom they will be able to connect and interrelate. It is through proper therapeutic communication that the nurse will be able to establish trust with Pam and eliminate any barrier of interaction. During Medication, similar eye level contact between Pam and the nurse will communicate equality in decision making (Schwind, McCay, Metersky & Martin, 2016). Similarly, using a simple, clear and direct language is important for Pam to understand what is taking place. The nurse should ensure that Pam is not kept in the dark regarding what is happening to her, the kind of reactions and sensations she might feel in the course of treatment and in the case where there is no clear data, the nurse should be willing to indicate this to Pam and what help she can provide (Braithwaite & Schrodt, 2014).

It is also important that the nurse recognizes efforts made by Pam for example improvement in her feeding habits, notices changes in her body and help her understand by clarifying the situation. This therefore means that the nurse need to respect and empathize with Pam even in regard to her feelings, perception of the situation, fears and reactions towards treatment to help in providing appropriate response .The nurse also needs to adopt a tolerant attitude and accommodate Pam especially with the regard that she is an Aboriginal with values and beliefs that might be different from hers and that might also not be receptive to modern medicine (Jongen, McCalman, Bainbridge & Tsey, 2014). Critical listening will be basic in therapeutic communication. The nurse needs to be sensitive to both verbal and non-verbal responses by Pam and noting whether they are in agreement so as to ensure that she responds appropriately (Braithwaite & Schrodt, 2014).


Reasons why Pam may Want to Return to Her Community at this End-Stage of Her Life

Pam has been getting palliative care because of her primary cervical cancer and metastatic condition. These diseases had deteriorated her condition to the extent that the only option she had was to be admitted at a palliative care facility (Doolan, Najman, Henderson, Cherney, Plotnikova, Ward, Kemp, Dev & Smirnov, 2015). However, before her discharge from the palliative care facility, Pam expressed concern that she wanted to be taken back to her community before she died. Pam made this request because it meant something to her. She held the view that it would play a significant role in her life (Jongen, McCalman, Bainbridge & Tsey, 2014).

The first reason why Pam requested the palliative care providers to take her back to her community is because it would enable her to get better care. As an Aboriginal, Pam believes that he condition can improve if she gets medical services in the midst of her people. Aboriginals are people who believe in traditional medicine that, in her opinion, is only available in her community (Grant, Parry & Guerin, 2013). Therefore, by going back to the village, Pam would receive all the bush medication that would help in treating her condition.  if she gets the bush medicine that she wanted, she might manage to improve her condition by reducing the suffering that she has been going through (Doolan, Najman, Henderson, Cherney, Plotnikova, Ward, Kemp, Dev & Smirnov, 2015).

Besides, Pam wanted to die at home. Aboriginals are conservative people who still hold certain views regarding end-of-life care. One of these views is that an Aboriginal should be given a dignified death in the midst of his people (Kelaher, Sabanovic, La Brooy, Lock, Lusher & Brown, 2014). Therefore, by going back to her community, Pam would die in the presence of her community and family members. Aboriginals hold the view that it can be fulfilling for an individual to die in the company of his close family members (Donato & Segal, 2013). Some death wishes should be shared with the family members. It is for this reason that she was uncomfortable to die at the hospice because it would delink her from the family and community in entirety (Kelaher, Sabanovic, La Brooy, Lock, Lusher & Brown, 2014).


Discharge Information to Present to Pam and Her Family

Pam is having a serious health challenge that needs to be addressed using culturally-safe approach. As a palliative patient, Pam needs to be served with culturally-competent practitioners who have a deeper understanding of the health challenges facing the Aboriginals and other indigenous communities in the country (Bylund, Peterson & Cameron, 2012). At the palliative care, Pam deserves to be given a high quality end-of-life care to enable her deal with the life-threatening condition he has been braving. However, during her discharge from the palliative care facility, Pam should be provided with the following information:

First, the healthcare provider should inform Pam that she should seek for medical services at the palliative care facility in her community. The patient should be told that her discharge does not imply that she has recovered. Instead, she should go ahead to seek for further end-of-life care at the palliative facility because it is necessary for her life (Parker & Milroy, 2014). She has reached a time when her condition should be closely monitored by palliative care providers. If this happens, the patient will still manage to deal with her condition and get all the necessary support that she deserves. It is only palliative care providers who have appropriate skills to use in assessing the patient, examining his condition, and providing the holistic services that she requires (Almutairi, McCarthy & Gardner, 2014).

Secondly, the patient should be provided with therapeutic services that she can rely on to manage her condition. When counseling her, the practitioner should provide her with truthful information regarding her condition and how it can be managed without causing further harms.  Since palliative care should be provided to the patient and the family members, the practitioner should extend the therapy to Pam’s family members (Momani & Berry, 2017). Just like Pam, the family members should be counseled and encouraged to be strong at this time of difficulty. The family members should be informed that they should not tire from supporting Pam because she is at a critical time when she in a dire need of their support. If properly informed, the family members will feel inspired and motivated to nurse, Pam and provide her with the necessary support that she needs (Russell, 2013).

Finally, the practitioners should inform the patient and her family members that they should cooperative with the healthcare providers who are responsible for providing end-of-life care to Pam (Kelaher, Sabanovic, La Brooy, Lock, Lusher & Brown, 2014). They should be informed that end-of-life-care is provided by a team of professionals including palliative nurses, physicians, social workers, priests, and bereavement counselors. Each of these experts has an important role to play in the delivery of palliative care services to the patient and her family members. Therefore, to receive holistic care, they should be encouraged to collaborate and foster a good relationship with them. It is necessary to do so because palliative care extends even after the death of the patient because his family members still need to be bereaved and comforted in case a death occurs (Thompson, Fahs & Kell, 2016).          


Pam is a patient who is nursing life-threatening illnesses. The healthcare providers should provide her with palliative services that can enable her to improve the quality of her life and adequately prepare her for her eventual death. The patient needs to be adequately supported so as to address the physical, psychological, and spiritual needs of the patients and her family members as well. However, as an Aboriginal, the healthcare providers should apply the principles of culturally-competent care to enable them appeal to the patient and win her confidence in the services rendered. To accomplish this, the palliative care providers should embrace a therapeutic communication strategy, accept the patient’s cultural views, and incorporate the contribution of the patient in the treatment process.



Almutairi, A.F., McCarthy, A. & Gardner, G.E., (2014). Understanding Cultural Competence in a Multicultural Nursing Workforce Registered Nurses’ Experience in Saudi Arabia.

Journal of Transcultural Nursing, p.1043659614523992.

Bylund, C.L., Peterson, E.B. & Cameron, K.A. (2012). A practitioner's guide to interpersonal communication theory: An overview and exploration of selected theories. Patient education and counseling, 87(3), pp.261-267.

Daws, K., et al., (2014). Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care. Australian Health Review, 38(5), 552-556.

Donato, R. & Segal, L., (2013). Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?. Australian Health Review, 37(2), pp.232-238.

Doolan, I., Najman, J., Henderson, S., Cherney, A., Plotnikova, M., Ward, J., Kemp, R., Dev, A.

& Smirnov, A. (2015). A retrospective comparison study of Aboriginal and Torres Strait

Islander injecting drug users and their contact with youth detention and/or prison. Australian Indigenous Health Bulletin, 15(4).

Grant, J., Parry, Y., & Guerin, P. (2013). An investigation of culturally competent terminology in healthcare policy finds ambiguity and lack of definition. Australian and New Zealand journal of public health, 37(3), 250-256.

Jongen, C., McCalman, J., Bainbridge, R. & Tsey, K. (2014). Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings. BMC pregnancy and childbirth, 14(1), p.1.

Joseph-Williams, N., Elwyn, G., & Edwards, A. (2014). Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient education and counseling, 94(3), 291-309.

Katzenellenbogen, J. M., Miller, L. J., Somerford, P., McEvoy, S., & Bessarab, D. (2015).

Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia. Australian Health Review, 39(4), 429-436.

Kelaher, M., Sabanovic, H., La Brooy, C., Lock, M., Lusher, D., & Brown, L. (2014). Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia. Social Science & Medicine, 123, 278-286.

McKenna, B., Fernbacher, S., Furness, T., & Hannon, M. (2015). “Cultural brokerage” and beyond: piloting the role of an urban Aboriginal Mental Health Liaison Officer. BMC public health, 15(1), 881.

Renzaho, A.M.N., Romios, P., Crock, C., & Sønderlund, A.L. (2013). The effectiveness of cultural competence programs in ethnic minority patient-centered health care—a systematic review of the literature. International Journal for Quality in Health Care, 25(3), pp.261-269.

Russell, L.M., (2013). Reports indicate that changes are needed to close the gap for Indigenous health. Med J Aust, 199(11), pp.1-2.

Schwind, J. K., McCay, E., Metersky, K., & Martin, J. (2016). Development and Implementation of an Advanced Therapeutic Communication Course: An Interprofessional Collaboration.

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Shay, L. A., & Lafata, J. E. (2015). Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision Making, 35(1), 114-131.

Thompson, C., Fahs, B., & Kell, C. (2016). A Nurse-Led Collaborative Linking Medical Center with Community Partners Transforms Patient Care and Reduces Readmissions. Heart & Lung: The Journal of Acute and Critical Care, 45(4), 381. 


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