NMIH205 Cultural Competence in Health Care | Health Risk Factors

Answer:

Introduction

Health care should be accessible to everyone regardless of their cultural practices and beliefs. According to the World Health Organization (2017), every citizen should have access to the best standard of health care possible. Cultural safety ensures that health care is tailored to meet the individual’s unique cultural needs. Unfortunately, this is not the case. Some of the cultural health needs that prevent the indigenous Australians from receiving health services include the need for holistic health care that takes to account the use of complementary medicine, the need to overcome the language barrier and the need to reduce health risk factors. Although the Australian government has taken measures to solve these barriers, the existing health care systems have not been tailored to fit the Aboriginal people. Still, registered nurses can effectively come in to fill these gaps.

Cultural Health Care Need 1: Holistic approach to healthcare including integration of complementary medicine

Culture plays a crucial part in determining an individual’s health choices. There is, therefore, a need to offer holistic health care services and to integrate complementary medicine into the system. The Aboriginal and Torres Strait people, for instance, still seek treatment from traditional healers and use traditional remedies. They believe that having a constant spiritual connection with their land plays an important role in their healing process. Subsequently, if a physician does not understand the intensity with which they regard tradition medicine, the indigenous Australians might opt to forcefully discharge themselves from the hospital (Queensland Health Aboriginal and Torres Strait Islander, 2014, pg. 12). On the other hand, if the physician understands them and is able to integrate complementary medicine into their care plan, they are more likely to embrace conventional therapies. Unfortunately, this does not often happen due to widespread discrimination across Australia, which has adversely affected health care access and outcomes (Waterworth et al., 2015, pg. 11).

Mistrust has also contributed to the failure of the indigenous Australian communities such as the Aboriginal and Torres Strait people to freely meet their cultural health care needs. During colonization, the indigenous Australians went through a lot of physical and emotional pain which left them traumatized. Studies have shown that traumatic historical events and current racism have prevented the indigenous people from trusting the non-indigenous people (Waterworth et al., 2015, pg. 13). This kind of mistrust makes it necessary to offer the indigenous Australians holistic health services, and if possible, to integrate complementary medicine into healthcare delivery. It is only then that they will fully accept conventional therapies. 

The Australian health care system has made a number of efforts to promote the accessibility of healthcare by the Aboriginals and Torres Islander people, including channeling more funds towards their health. However, it has not been able to successfully eradicate the inequity gap that exists between the indigenous and non-indigenous Australians. Although the system recognizes the need to offer holistic treatment to the indigenous communities, the mainstream clinics have cultural barriers. The health workers remain bias to conventional medicine and they do not offer health education in cultural concepts (Baba, Brolan and Hill, 2014, pg. 5). To solve this loophole, local health workers need to be actively involved in the process of conceptualizing and planning health care delivery to the Aboriginal and Torres Strait Islander people.

Nurses should make attempts at providing culturally capable patient care, which calls for knowledge about the cultures of the indigenous communities. The Queensland Health Aboriginal and Torres Strait Islander (2014, pg.5) suggests that for healthcare workers to get better health outcomes, they need to work with the patients’ beliefs and not ignore them. Better understanding between the nurses and patients can be further improved when the nurses appreciate the reason as to why the Aboriginal and Torres Strait people are hesitant to fully accept conventional medicine. Such a form of mutual understanding will motivate the nurses to practice complementary medicine alongside conventional therapies. Needless to say, interventions associated with culturally trained health workers have proven to have the best healthcare outcomes (Truong, Paradies, and Priest, 2014, pg.13).

Registered nurses could also recruit health workers from the local communities so as to promote culturally safe healthcare. The Aboriginal and Torres Strait patients are less anxious and more cooperative when they are attended to by an Aboriginal staff (Freeman et al., 2014, pg. 358). The Aboriginal health workers also promote cultural safety in healthcare delivery since they better understand their culture and can best relate with the patients. They also advocate for their people’s health care rights against cultural discrimination that has swept across the country.

Cultural Health Care Need 2: Overcoming language barrier

Health workers find it difficult to communicate with the indigenous Australians due to language barriers. The Aboriginal and Torres Strait people, for instance, seem to speak an English dialect that is slightly different from the usual. Those who speak in English tend not to be very clear. They also use a lot of non-verbal communication which the health worker should be keen to note. Some of the nonverbal communications used by the Aboriginal and Torres Strait people are sudden periods of silence in between conversations and avoiding eye contact as a sign of respect (Queensland Health Aboriginal and Torres Strait Islander, 2014, pg. 7).

Language barrier may further widen the gap that developed between the indigenous and non-indigenous Australians during colonization. Furthermore, communication between the patients and the health workers is not effective. Although language interpreters may come in to help the two parties communicate, this method is not very effective. Medical history and patient’s symptoms are best communicated directly from the patient to the health workers. It is likely that interpreters might leave out some information that could be vital for diagnosis and treatment.  Also, health workers cannot offer health education to the indigenous communities due to language barrier. They cannot advise the Aboriginal and Torres Strait patients regarding better health practices. Neither can they advise them on health risk aversion or early disease detection. As things are, the Aboriginal and Torres Strait people continue to live in health ignorance which significantly contributes to their low life expectancy. According to Hart, Moore, and Laverty (2017, pg. 11), a good education in itself can increase a person’s life expectancy by 10years.

 The Australian healthcare model, Flinder Rangers, has made attempts at training midwives on the culture of the indigenous people. However, language barrier still exists between the midwives and the local communities (Brown et al., 2015, pg.200). It is likely that the government has not set up adequate measures for the Finder rangers to counter language barrier. Still, it could be possible that the health workers are not keen to improve their communication skills during the program. The program should, therefore, be adjusted to be more competent and wholesome.

A good education not only improves patient outcomes but also improves preventive medicine. People who are more educated are aware of unhealthy lifestyle patterns and the advantages of maintaining good health. They are more likely to make better decisions about their health. However, the Australian Health healthcare system does not recognize the role of a high level of education in health care.  The high level of illiteracy among the Aboriginal and Torres Strait people has therefore hindered efforts to improve communication between patients and nurses (Dassel, Ralph, and Cass, 2017, pg. 5). The indigenous people are thus not able to embrace healthier lifestyles. Neither are they able to effectively communicate their symptoms to the nurses during history taking.

Registered nurses should make attempts at learning the language of the indigenous people (Queensland Health Aboriginal and Torres Strait Islander, 2014, pg. 7). They should learn gestures of respect among others, so as to create a good rapport between them and their patients. Such efforts can be made at the organizational level or at individual capacity. The results are very rewarding given that the nurses will be able to directly communicate with their patients. Acceptability of conventional medicine will also improve since misunderstandings, mistrust or fears will be cleared.

Indigenous local health-workers can assist in offering health services to the Aboriginal and Torres Strait people. Registered nurses should recruit more local healthcare workers to ensure that the language barrier gap is narrowed between the nurses and the Aboriginal and Torres Strait people. By going through the indigenous local health workers, nurses can easily offer primary health care services to the local communities (Freeman et al., 2014, pg. 358). The indigenous people are also likely to practice what they are taught by one of their own. Therefore, overcoming language barrier would improve the acceptability of conventional medicine and participation of the indigenous communities in health delivery.

Cultural Health Care Need 3: Reducing health risk factors

Indigenous communities develop diseases faster compared to their non-indigenous counterparts. This has created a gap in life expectancy between the two groups. The local communities thus tend to live for shorter periods for both males and females (Australian Institute of Health and Welfare, Life expectancy of Aboriginal and Torres Strait people, para. 1). This illustrates that it is vital to focus on the reasons behind the lower life expectancy among the Aboriginal and Torres Strait people. It would thus be efficient to tackle the challenges that they face pertaining to health and their limitations towards accessing health care services.

Social disruption among the Aboriginal and Torres Strait people has resulted in their indulgence in activities that are harmful to our health including cigarette smoking (Waterworth et al, 2015, p.1). Smoking and alcohol abuse increase individuals’ risks of developing cancer. Across Australia, the indigenous males are mostly affected by lung, colorectal and prostate cancer. More women from the local communities have been diagnosed with cancer (Moore et al., 2015, Findings). Other cancers that affect the indigenous women are breast, cervical, colorectal and lung cancer.

Besides being more predisposed to cancers, the Aboriginal and Torres Strait people are usually diagnosed late after the disease has progressed. For instance, many Aboriginal people are diagnosed with head and neck cancers that have already distantly metastasized (Gibberd et al., 2015, Results). Since their cancers are not detected early, there are high chances of treatment failure. It, therefore, makes sense that the survival rates for patients with cancer are lower in indigenous Australian communities than among the non-indigenous Australians (Condon et al., 2014, pg. 10).

The Australian health care system has not adequately embraced preventive health care services which are an effective strategy towards reducing health risk factors. Although there is an existing primary health care model, it has not been tailored for the indigenous people. The Audit and Feedback tool used for primary health care is feasible. However, the acceptability rate is low among the Aboriginal and Torres Strait people since they feel that the tool is not suited for them. The indigenous people cannot, therefore, enjoy adequate accessible prevetive medical services and health infrastructure as compared to their non-indigenous counterparts. Still, the rapid health gains made in Australia do not reflect the actual health outcomes among the Aboriginal and Torres Strait people. A study by the Australian Institute of Health and Welfare (2016, pg. 6) found that indigenous Australians still have a great disease burden.

Most of the Aboriginal and Torres Strait people fall sick due to poor environmental sanitation. Many of them are unemployed. Therefore, they have low stands of living which predisposes them to health risks. The Australian health system, however, has not sufficiently addressed the low socio-economical status of the Aboriginal and Torres Strait people. The funds being channeled towards improving the accessibility to health care services for the indigenous people should instead be used to promote the living standards of the indigenous people. According to Davy et al (2016, pg. 6), the indigenous people are unable to access healthcare advice since they lack basic infrastructure such as mobile phones, The Australian health care system should thus consider improving the infrastructure in areas where the indigenous people live.

A health worker’s personal perception about the chances of patient recovery indirectly affects health outcomes. Although substantial data support claims that the Aboriginal and Torres Strait people do not respond positively to therapy, nurses should embrace a positive ideology about them for better patient outcome (Wilson et al., 2016, pg.6). If the health workers are more hopeful for patient recovery, they are encouraged to give the patients the best possible care and treatment. However, if they let the statistical data cloud their mind; they are likely to have an already-perceived failure of treatment as soon as they are approached by an Aboriginal patient.

Registered nurses should also promote primary health care among the indigenous communities. Health education forums and workshops can help the Aboriginal and Torres Strait people to take better care after of their health. Once they know that some activities such as tobacco smoking are harmful to their health, they are likely to live healthier lifestyles. Local health workers from the indigenous communities should also be trained through a training-of-trainers model. This ensures that the dispensation of primary health care is faster and more effective.

Conclusion

Cultural safety improves coordination of care between healthcare workers and patients. Although the Australian health care system has tried to provide cultural safety to the Aboriginal and Torres Strait people, its approach does not include holistic health care, efforts to counter language barrier or to reduce the health risk factors among the indigenous people. This makes it necessary for registered nurses to make efforts at filling these gaps. Nurses with a positive attitude towards the Aboriginal people, are able to provide holistic, culturally safe health services.

Reference

Australian Institute of Health and Welfare.  (2016). Australian Burden of disease study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Retrieved from: https://www.aihw.gov.au/reports/burden-of-disease/australian-bod-study-2011-indigenous-australians/contents/summary

Australian Institute of Health and Welfare.  (2018).  Deaths in Australia. Retrieved from: https://www.aihw.gov.au/reports/life-expectancy-death/deaths/contents/life-expectancy

Baba, J.T ., Brolan, C.E.  & Hill, P.S.(2014). Aboriginal medical services cure more than one illness: a qualitative study of how indigenous services address the health impacts of discrimination in Brisbane communities. International Journal for Equity in Health, 13 (56). doi: https://doi.org/10.1186/1475-9276-13-56

Brown, A.E, Middleton,  P.F., Fereday, J.A. & Pincombe, J.I.  (2015). Cultural Safety and midwifery care for Aboriginal women  - A phenomenological study. Women at Birth, 29(2016), pp. 196 – 202. Retrieved from: https://www.womenandbirth.org/article/S1871-5192(15)00333-9/pdf

Condon, J.R., Zhang, X., Baade, P., Griffiths, K., Cunningham,  J., Roder, D.M., Coory, M., Jelfs, P.S. & Threlfal, T. (2o14). Cancer survival for Aboriginal and Torres Strait Islander Australians: a national study of survival rates and excess mortality. Population Health Metrics,  12 (1). doi: https://doi.org/10.1186/1478-7954-12-1

Dassel, J.L., Ralph, A.P. & Cass, A.  (2017). A systematic review of adherence in Indigenous Australians: an opportunity to improve chronic condition management. BMC Health Services Research, 17 (845). doi: https://doi.org/10.1186/s12939-016-0476-8

Davy, C., Harfield, S., McArthur, A., Munn , Z. & Brown, A. (2016). Access to primary health care services for indigenous people: A framework synthesis. International Journal for Equity in Health, 15 (163). doi: https://doi.org/10.1186/s12939-016-0450-5

Freeman, T., Edwards, T., Baum, F., Lawlwss 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) pp. 355 – 361. doi: https://onlinelibrary.wiley.com/doi/pdf/10.1111/1753-6405.12231

Gibberd, A., SupramaniamR., Dillon, A., Armstrong, B.K. & O’Connel, D.L. (2015). Are Aboriginal People more likely to be diagnosed with more advanced cancer? The Medical Journal of Australia,  202 (4), pp.195 -199. doi: 10.5694/mja14.00701 

Hart, M.B.,  Moore, M.J. & Laverty, M. (2017). Improving Indigenous Health Through Education. Perspective, 207 (1). doi: 10.5694/mja17.00319

Moore, S.P.,  Antoni, S., Cloquhoun, A., Haely, B., Ellison-Loschmann, L.E., Potter, J.D., Garvey, G. & Bray, F. (2015). Cancer incidence in indigenous people in Australia, New Zealand, Canada, and the U.S.A: a comparative population-based study. The Lancet, 16 (15), pp. 1483-1492. doi: https://doi.org/10.1016/S1470-2045(15)00232-6

Queensland Health Aboriginal and Torres Strait Islander . (2014).  Patient Care Guideline. Retrieved fromhttps://www.health.qld.gov.au/__data/assets/pdf_file/0022/157333/patient_care_guidelines.pdf

Truong, M., Paradies, Y. & Priest, N. (2014). Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Services Research., 14 (99) doi: https://doi.org/10.1186/1472-6963-14-99

Waterworth, P., Pescud,  M., Braham, R., Dimmock, J. & Rosenberg, M. (2015). Factors Influencing the Health Behaviour of Indigenous Australians: Perspectives from Support People. PLoS ONE , 10(11): e0142323. doi: https://doi.org/10.1371/journal.pone.0142323

Wilson, A. M., Kelly J., Magarey, A., Jones,  M. & Mackean, T. (2016). Working at the interface in Aboriginal and Torres Strait Islander health: focusing on the individual health professional and their organization as a means to address health equity. International Journal For Equity in Health, 15 (187). doi: https://doi.org/10.1186/s12939-016-0476-8