HNN 217 Community Nursing Practice Discrimination

The Aboriginal and Torres Strait Islander people are native Australians. It is believed that they were the first ones to move out of Africa about 50,000 years ago. The health of the Aboriginal and Torres Strait Islander people has poor health status when compared with the other Australians (Gee et al., 2014). There is a vast inequality gap between the indigenous and non-indigenous inhabitants of Australia. The native inhabitants do not have an equal opportunity to the healthcare services as the immigrant or the foreign inhabitants (Sherwood & Geia, 2014). Thus, the natives are eventually less healthy than others (Donato & Segal, 2013). The socio-economic differences that they face place them at risk of more significant exposure to different environmental and behavioural health risk factors. To reduce this inequality gap very little has been done. This study is based on the strategies that nurses can apply to ensure socially inclusive healthcare service, and to create greater healthcare equality for Aboriginal and Torres Strait Islander people.

The health determinants factors are those that contribute to one’s state of health. The elements can be socio-economical, biological, behavioural, psychological and social. Access to quality healthcare services is one of the crucial factors of health determinants (“Social determinants and the health of Indigenous peoples in Australia – a human rights-based approach | Australian Human Rights Commission”, 2019). The Aboriginal and Torres Strait Islander inhabitants do not get access to proper education too; lack of it also results in their poor health status besides the above factors. The primary approach for health equity is to address social determinants, which are discrimination and income. The health care services should be accessible to all without any prejudice; this is the fundamental right of every people. The nurses should be trained so that they do not discriminate people based on their ethnicity and social status; they should be prepared to go any place for the health care services. They should be socially inclusive and not exclusive (Yanicki, Kushner & Reutter, 2014). Being socially inclusive, the nurses can improve the health of the native inhabitants of Australia by giving them proper medication and teach them about health and hygiene through community-based educational programs, which helps one to identify and rectify the health issues. The community nurses teach preventive measures by giving them information about the disease or health issue prevailing in a community, about avoidance of common practices to prevent specific health issues, either verbally or written in the form of a flier. Thus, the nurses can be an essential link in a health equity program for the Aboriginal and Torres Strait Islander people.

The nurses have a massive impact on the health of the native inhabitants, firstly due to their significant contribution to primary health care. The enforcement of population-based preventive measures benefits mostly the indigenous population. The preventive measures are based on evidence such as screenings. The preventive measures are regular exercise and weight management, healthy eating, avoiding drugs and smoking, low or moderate alcohol consumption. The nurses help one by counselling them and giving precautionary medications as a means of preventive measures. Secondly, nurses are in the acute care system, which is mostly the first contact with the health service for the indigenous people. Lastly, yet most importantly, the nurses are the only health service providers in the remote regions where the indigenous people inhabit, acting as the mediator of the health system.

The nurses for the mentioned reasons have a few critical roles and responsibilities. Firstly, they act as a disease prevention specialist. The community health nurses focus on prevention of disease for both long and short terms. Their work is to control and prevent the spread of different infectious diseases like flu. They help the mothers of the newly born to keep their babies healthy and thus, decrease the mortality rate of the infants. They also identify the gaps in the services and help to fill them. Secondly, they cross the boundaries of culture, literacy and language boundaries to give the children and adults of the native inhabitants’ access to proper health care services so that they can shape their health and well-being. They provide prenatal care and give expecting mothers education on maternal nutrition and development of the child. Thirdly, they act as the advocate for the indigenous inhabitants on the local, state and federal level so that they can have access to better healthcare services; remove health inequality also protects the funds of the public health programs. Lastly, the nurses act as a community educator. They educate the people about health and hygiene by giving materials in a format, which is clear and understandable. They advise the inhabitants to give up wrong habits like smoking and drinking, to improve their health status. They give information for creating healthy choices and healthy living to the communities, families and individuals. They, in school also teach sex education. It can be said that they give focus on preventive healthcare by community health education.

The Aboriginal and Torres Strait Islander inhabitants can speak in many different languages, other than English, which is a second language for them. The nurses should listen and interpret their reply patiently, or they should know their language or an interpreter with them. The community health nurses, who provide education and health care to the native inhabitants who live in the remote regions should not only know their language and have patience but also should have communication skills of oral, interpersonal and written, to inform them about health and healthy lifestyles and motivate them for the same. The nurses should know the language of the natives and interact with them. The nurses should be competent enough to interact with the natives both in oral and written communications so that the message of health and hygiene is clear to them (Hart & Mareno, 2014). They should build inter-personal relation with the inhabitants so that they can know them better by understanding their past and opinions and help them to improve their health.

The nurses also should inculcate in them the ability to solve various problems of the people; this is an essential factor of socially inclusive nursing (Kim & Choi, 2014). The ability to solve a problem helps them examine and judge a situation critically, which determine one’s ability to relate to a case effectively. The nurses should not only be able to give healthcare services but should have the capability of thinking critically. They should have the ability to examine the information by thinking and judging critically and analytically. This ability is a vital trait for the nurses, which is self-disciplined and self-guided. Critically thinking develops by being inquisitive (Kaddoura, 2013). When they are focussed and disciplined, they acquire this ability. It helps them in many ways while dealing with the native inhabitants in the remote regions of Australia. Critical thinking helps the nurse to get excellent outcomes from the patients. This ability is also helpful for many challenging situations, which they might face during their services.

The Aboriginal and the Torres Strait Islander people are of different cultures; thus, culture barrier is a critical factor regarding inequity in access to the healthcare services. The natives have a set of values and beliefs which they had followed from many generations regarding health and cure of diseases (“Connections to Value and Belief – Supporting Carers (SNAICC)”, 2019). They do not incline, rather a belief in the healthcare services and follow their tradition in medication, which requires one to have knowledge of flora, fauna and land in detail (Freeman et al., 2014). They do not give much importance to an individual’s health instead provides significance to the community as a whole. Studies suggest that fear of death, the desire to follow traditional healing, shame, several spiritual issues and beliefs like cancer is contagious disease affects the decisions of the natives surrounding accessing of the healthcare services. These factors are the reason why there is a disparity of healthcare services between the indigenous and non-indigenous inhabitants of Australia (Li, 2017).

Different health-promoting interventions have been taken for the benefits of Aboriginal and Torres Strait Islander peoples (Donato & Segal, 2013). The Australian government on 1st July 2014 have established the Indigenous Australians’ Health Program (IAHP), which consists of four funding streams- Child and Maternal Health Programs, Primary healthcare, stronger futures in the Northern Territory and different programs for the Aboriginal and Torres Strait Islander Chronic Disease Fund. The aim of IAHP is to give the indigenous people access to healthcare services, which are highly effective, culturally appropriate and comprehensive in any part of Australia (“Department of Health | The Indigenous Australians’ Health Programme”, 2019). The nurses can apply the strategy of community engagement to improve their health. It requires the collaboration, partnership and empowerment of the native citizens (Durey et al., 2016). It means that the natives not participate but are also a part of the healthcare services. They are effectively engaged for providing the services so that the services are culturally appropriate; also, a relationship is built between the service providers and the natives.

Thus, to conclude it can be said that the disparity in the healthcare services between the indigenous and the non-indigenous people of Australia is due to the difference in the culture, beliefs, education and socio-economic aspects. The indigenous people of Australia due to not only discrimination and marginalisation but also to their beliefs, values and culture do not have sufficient access to the healthcare services and have poor health and high mortality rates than the non-indigenous inhabitants. Different governmental programs, educating the natives and motivating the nurse and the other healthcare personnel to serve the native people can help to mitigate the inequality to access to healthcare services.

References

Connections to Value and Belief – Supporting Carers (SNAICC). (2019). Retrieved from https://www.supportingcarers.snaicc.org.au/connecting-to-culture/connections-to-value-and-belief/

Department of Health | The Indigenous Australians’ Health Programme. (2019). Retrieved from https://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-programme-lp

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), 232. doi: 10.1071/ah12186

Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., & Bessarab, D. (2016). Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Services Research, 16(1). doi: 10.1186/s12913-016-1497-0

Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S., & Francis, T. (2014). Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand Journal of Public Health, 38(4), 355-361. doi.org/10.1111/1753-6405.12231

Gee, G., Dudgeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, 2, 55-68.

Hart, P. L., & Mareno, N. (2014). Cultural challenges and barriers through the voices of nurses. Journal of clinical nursing, 23(15-16), 2223-2233. doi.org/10.1111/jocn.12500

Kaddoura, M. (2013). The Effect of Preceptor Behavior on the Critical Thinking Skills of New Graduate Nurses in the Intensive Care Unit. The Journal Of Continuing Education In Nursing, 44(11), 488-495. doi: 10.3928/00220124-20130816-21

Kim, K., & Choi, J. (2014). The Relationship between Problem Solving Ability, Professional Self Concept, and Critical Thinking Disposition of Nursing Students. International Journal Of Bio-Science And Bio-Technology, 6(5), 131-142. doi: 10.14257/ijbsbt.2014.6.5.13

Li, J. (2017). Cultural barriers lead to inequitable healthcare access for Aboriginal Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207-210. doi: 10.1016/j.cnre.2017.10.009

Sherwood, J., & Geia, L. K. (2014). Historical and current perspectives on the health of Aboriginal and Torres Strait Islander people. Yatdjuligin: Aboriginal and Torres Strait Islander nursing and midwifery care, 7.

Social determinants and the health of Indigenous peoples in Australia – a human rights based approach | Australian Human Rights Commission. (2019). Retrieved from https://www.humanrights.gov.au/news/speeches/social-determinants-and-health-indigenous-peoples-australia-human-rights-based

Yanicki, S. M., Kushner, K. E., & Reutter, L. (2015). Social inclusion/exclusion as matters of social (in) justice: a call for nursing action. Nursing inquiry, 22(2), 121-133. doi.org/10.1111/nin.12076