INDH2107 Working With Aboriginal And Torres Strait Islander People

Introduction

Aboriginal and Torres Strait Islander People form the oldest living and surviving cultural groups in the world. Being the most disadvantaged group in Australia, they suffer from critically poor health which requires urgent attention at both state and national levels. Therefore, it is of utmost importance to work towards their better health (Best & Fredericks, 2014). In this paper, I aim to reflect on my learning based on the course titled ‘Working with Aboriginal and Torres Strait Islander People’ to inform my professional practice. A key understanding from this course involves the historical, social and political contexts of the Indigenous Australians in relation to their health.  However, this has empowered me with the necessary knowledge and skills to provide culturally safe care to my patients. I have also gained an understanding of the concept of identity from the view of Australia’s First Peoples.

Reflection

My journey in nursing studies at UQ begun with little knowledge about Aboriginal and Torres Strait Islander People. This is because of the fact that I was an international student. However, after engaging in this course, I have come to realize much of its similarity to my own culture and now find myself well-informed and well-equipped with the adequate knowledge and skills to provide optimal care to Australia’s First Peoples.  When I began this course, I was completely unaware of the shocking history of Indigenous Australians. The discovery of the atrocities inflicted on Indigenous Australians post-European contact was confronting for me. The process of colonization, dispossession, and introduction of foreign diseases, which resulted in the loss of a large population of Indigenous Australians filled me with commiseration (Best & Fredericks, 2014). This oppressive history has provided me with background knowledge regarding my patients and will enable me to deliver care more holistically to them. In addition, the knowledge about the history of the land on which I will be providing care is further a critical step in working towards the betterment of their health (Best & Fredericks, 2014).

 I also learned about the oppressive policies and acts issued by the Government. In particular, I found the literature on The Stolen Generation as most traumatizing which filled me with empathy (Best & Fredericks, 2014).  As a consequence of these racist and discriminatory policies, Indigenous Australians highly mistrust the government institutes. This mistrust leads to under-utilization of the health services resulting in negative health outcomes for Indigenous Australians (Durey et al., 2012). So as a nurse, I will tailor my care with the objective of developing trustworthy and respectful relationships for better health outcomes among Indigenous Australians. I will also remain sensitive to topics, such as The Stolen Generation. This knowledge has filled me with empathy and has moulded my judgments of Indigenous Australians optimistically which will affect my practice positively while delivering care to Indigenous Australians. By understanding the historical, political and social factors that affect the health of Indigenous Australians, I will be able to conduct a culturally safe practice. Delivering a culturally safe practice is one the nurses’ code of conduct which forms the legal requirement in all practice settings (Douglas et.al, 2014).

Prior to engaging in this course, I was unaware of the appropriate terminologies to be used while addressing and working with Indigenous Australians (Queensland Health, 2010). This could have led me to unintentionally offending my Indigenous Australian patients and hurting their sentiments. It could also be viewed as racism. This could make them feel unwelcome and would directly impact their engagement with me as a health professional which might result in their reluctance to access health services in future for diagnosis or treatment and hence leading to negative health outcomes (Durey et al., 2012).

I also learned about the principles of cultural safety which begin with self-reflection. I was really surprised to realize that the ways in which my cultural values, identity, assumptions, and attitudes could influence the care that I provide and at the same time, ‘diminish’, ‘demean’ or ‘disempower’ an individual (Eckermann et al., 2010). As a nurse, I can avoid this unsafe cultural practice by following a non-judgmental approach while handling the clients. Furthermore, I can avoid forming assumptions and stereotypical attitudes towards my Indigenous Australian patients by involving them rather than making assumptions where it’s not clear (Eckermann et al., 2010).

When I came across Power differential, another principle of cultural safety, I got quite confused with the term. However, as I dug deeper into it, I realized that I had practiced it unintentionally at various instances during my placement, where power resided with me whereas my patients played a passive role in their own care. Therefore, I can improve my practice by remaining mindful to actively minimize these power differentials between me and my patients, particularly Indigenous Australian patients (Best & Fredericks, 2014). I can achieve this by accepting and incorporating my patients’ values in their care which form the core of a person-centred care (Calisi, Boyko, Vendette, & Zagar, 2016). I can also achieve this by working with them at their pace and acknowledging their Indigenous practices (Best & Fredericks, 2014).

Before the commencement of this course, I was only culturally aware and could recognize the cultural differences that existed between me and my patients. However, I now consider myself as culturally safe since I can and will always strive to provide holistic care to my patients that is free of racism and bias while incorporating their values (Holland, 2017)

While undertaking this course, it shocked me that Indigenous workers could experience racism yet they are the traditional custodians of the land and should be highly respected (Best & Fredericks, 2014). Being on this land, I personally consider it as my duty to highly respect its traditional custodians. I, therefore, consider it as my responsibility to create a culturally safe and racism-free environment for them to work and will always challenge racist behaviours in accordance with the available hospital policies and the staff. By so doing, my practices will be in compliance with nurses’ code of conduct principle which urges the nurses to ignore racism and harassment and act to eliminate them.

I gained knowledge about identity which is another important concept for Indigenous Australians. It surprised me that identity forms a broad concept for Indigenous Australians similar to my culture, which not only incorporates them as beings but also closely relates to their family, community, land, culture, and history. Since it relates well to my culture and I have a similar mindset. I can better understand the indispensable role that family, community, and land play in the lives of Indigenous Australians. Hence, I can deliver care and cater to their health-related needs in a much better way. This practice complies with the standard which requires nurses to acknowledge the family and community’s role in Indigenous Australians cultures.

In addition, I was able to learn about the way Indigenous Australians identify themselves. Recalling my first-year experience, I had an Aboriginal patient who identified herself as ‘a Kaurna woman’. Though I was unable to comprehend it at that point, it seemed quite similar to the way I identify myself as ‘a Punjabi woman’. However, I am now aware that it indicated her nation, similar to the way it indicates my region. Based on these similarities, I consider it as my asset which I can use to better engage with Indigenous Australians. It will also help me to develop therapeutic relationships with my patients based on the sense of mutual trust and respect.  

Prior to commencing this course, I had the stereotypical notion of Indigenous Australians being dark-skinned. However, it was an eye-opener for me to become aware that it was a stereotype and one’s colour could not determine their ‘indigenous identity’. This clarification was essential for me since I could have unintentionally offended my Indigenous Australian patients by questioning their identity based on their colour. This could hurt their sentiments and create difficulty when engaging with the patients hence resulting in negative health outcomes. I will always remain cautious and sensitive to topics related to colour and identity and follow a non-judgemental approach. This holds compliance with Principle 3.1 which focuses on providing holistic and assumptions free care.

Initially, before studying this course, I often came across the notions of health inequity and social disadvantage among Indigenous Australians. I used to often wonder about its cause but due to the knowledge I acquired and gained from this course, I now have a sound awareness that it is an outcome of the colonial history and the current social determinants of health specifically relevant to Indigenous Australians. This knowledge of the specific social determinants will enable me to get a broader perspective of my patients’ background and provide them with more comprehensive care by recognizing and striving to eliminate the barriers that hinder them from accessing and utilizing the health services. It will also help me in providing psychosocial support and building a therapeutic relationship which acts as a major enabler for positive health outcomes. Moreover, by incorporating the positive determinants of health in my practice, positive health outcomes can be achieved. generally, by remaining mindful of these social determinants, I play a considerable part in diminishing the health inequities.

Despite the fact that as a health professional, I had come across the term ‘Closing The Gap’ during my placements, I could not understand the rationale behind the term ‘gap’. However, I have come to the realization that it refers to the health disparity between Indigenous and Non-Indigenous Australians. I gained knowledge regarding its targets and their progression. As a health professional, I consider it as my responsibility to work towards eliminating this health disparity by striving to achieve these targets. I can achieve this by providing culturally safe care to Indigenous Australian patients. I can act as an agent of change through a respectful and genuine partnership with them. In addition, since nurses serve as primary educators for their patients, I will try to collaborate health education at every point of patient contact and enable them to make healthy informed choices for themselves.

During this course, I was also acquainted with the concept of asset-based community development which I found very fascinating. It focuses on assets based on communities to achieve positive health outcomes. I strongly believe that as a nurse, the assets-based approach will be highly useful for me. Since nurses play a major role in health promotion at the individual levels and mass levels like participating in health promotion campaigns, I can incorporate this approach while interacting with the community in order to promote health for better patient outcomes.

Conclusion

In conclusion, learning about Aboriginal and Torres Strait Islander has not only enabled me to effectively deliver health care to various people of the community but it has also enabled me to develop more as an individual. I have been able to identify various ways in which I can actively participate in order to ensure that the indigenous Australians get the best health care services without fear of anything. I have also gained a lot of confidence in my profession. Moreover, it has given me insights on the various roles a nurse can play towards promoting health both locally and globally.

References

Best, O., & Fredericks, B. (2014). Yatdjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care: Cambridge University Press.

Calisi, R., Boyko, S., Vendette, A., & Zagar, A. (2016). What is Person-Centred Care? A Qualitative Inquiry into Oncology Staff and Patient and Family Experience of Person-Centred Care. Journal of Medical Imaging and Radiation Sciences, 47(4), 309-314. doi:https://doi.org/10.1016/j.jmir.2016.08.007

Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., … & Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109-121.

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. Nurs Inq, 19(2), 144-152. doi:10.1111/j.1440-1800.2011.00546.x

Eckermann, A.-K., Dowd, T., Chong, E., Nixon, L., Gray, R., & Johnson, S. (2010). Binan Goonj, Bridging Cultures in Aboriginal Health (3 ed.).

Holland, K. (2017). Cultural awareness in nursing and health care: an introductory text. Routledge.

Queensland Health. (2010). Aboriginal and Torres Strait Islander cultural capability. Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0031/147919/terminology.pdf