Nrs428Vn Community And Public Health: Assessment Answers

You are an RN working at a community health centre that does home visits.

Patient Background:

Your new patient is Judy, a 57yr old Aboriginal woman with type 2 Diabetes who has been discharged home with a leg ulcer for daily dressings. She is a widow, currently living at home by herself. Judy has two siblings, Jack and Jennifer, who live close by, and who assist when they can. One of them may be present for the first visit.

The referral is from the local AMS.

The request is for the community nurses to provide home visits for the daily dressing to Judy’s leg ulcer, and the request was from the ALO, as AMS are not able to attend to this need.

Answer:

Closing the gap in Australia

Australia’s indigenous people that is the Aboriginal and the Torres Strait Islander experience disadvantages that put their lives at a high risk than the non-indigenous people.The lack of access to primary healthcare and lower standards of healthcare infrastructure which are as a result of being located in remote areas are the major risk factors contributing to poor health in Aboriginal and Torres Strait Islander people (Hoy 2009, p. 543).The high incidence of child mortality, low lifespan,low enrolment and retention in schools are the major consequences of these disadvantages. The reproductive health of Aboriginal and Torres Strait Islander is poorer than of the other Australians (Kildea, Kruske, Barclay and Tracy 2010).  Achieving Parity in health and life expectancy has been a national priority in Australia. The government together with other activists have developed the “closing the gap” campaign to work towards reducing the disadvantages experienced by the Aboriginal and Torres Strait Islanders in terms of healthcare.

Closing the gap

This is an action taken to reduce the disparities between the indigenous and non-indigenous Australians in terms of health, education, employment, living standards and involvement in community activities. The closing the gap policy which is a principle of action adopted by the Australia governments to reduce the Aboriginal and Torres Strait Islander disadvantages with the aim of increasing their life expectancy, reducing child mortality rate and the double burden of diseases, is currently running though with insignificant success. The policy was developed in 2008 after there were increased rates of chronic diseases, low life expectancy by ten years for both male and female of the indigenous group compared to the non-indigenous people (Ashmanet al 2016, p. 367). The high prevalence of suicidal cases due to mental disorders, poverty and substance abuse were factors that contributed to the formation of the policy (Armstrong et al 2017, p. 1241).

The aims and significance of the closing the gap policy

The policy aimed at improving the accessibility to better government services for these people, raising the standard of health services given, improve level of governance in their communities and promote economic and social participation wherever possible. The implementation of these policies targets the betterment of lives and equalization to achieve the set goal by 2030. The policy will help to improve health among the Aboriginal and Torres Strait Islander by reducing the incidences of diabetes, obesity and hypertension. It will reduce child mortality rate which is highly contributed by low birth weight (Diehm et al 2018, p.1129). It will also increase the rate of employment which will improve their living standard and hence will be able to seek proper medical services.

Challenges affecting changes in closing the gap

Closing the gap campaign has been faced with various challenges and hence affecting its success. Politics are the major barrier. The use of this campaign to win more votes during political campaigns and later not fulfilling the promises after one wins the position has negatively affected the progress. The funds allocated by the government to steer achievement of the closing the gap campaign is misused by the relevant officer and hence delaying success (Freeman et al 2016, p. E19). The continuous use of substances for example alcohol, cigarettes smoking and other drugs has increased the incidences of chronic diseases and hence hindering achievement of the goal (Wilson 2016). Language barrier has also contributed to low success of this strategy. As suggested by Robinson, employing Aboriginal women nurses will help to reduce the low birth weight, child mortality since they will educate the women in their native language (2018).

Impact of chronic diseases

Chronic diseases which highly affect the Aboriginal and the Torres Strait Islander people such as Diabetes affects families and the society at large. For instance, in Judy’s case, diabetes which is a chronic impairment of blood sugar regulation in the body, cause several complications in the body for example peripheral neuropathy which has caused a leg ulcer to her. This increases the cost of management of the disease which directly affects the family financial status (Islam, Rawal and Niessen 2015, p. 40).  Lack of proper management of this disease can affect organs such as kidney, liver, eyes and eventually causes death. The diseases also affect a person’s productivity since with the leg ulcer she cannot do jobs like may aggravate pain. This directly affects the economic status of a community due to reduced man power and hence leads to poverty.  However, the closing the gap strategy will help to reduce the impact of diabetes. The daily dressing of the ulcer will help to ensure that there is quick healing of he wound. The continuous home visit will also help Judy to learn on how to manage the condition through diet and use of the right medicine. This will ensure help to control the disease and hence delay further complications therefore improving her health status, the CTG will also bring health services closer to the people. This will increase their knowledge on health and also change their health behavior and eventually the community will experience reduced rate of diseases occurrence.

Importance of being registered in a CTG

Registration to the closing the gap program is beneficial since one will enjoy the interventions put in place to help better oneself. For instance, the Australia had put in place strategies of improving healthcare services, improving infrastructure, providing employment and education to the Aboriginal and Torres Strait Islanders people. In the case of Judy, she will receive quality medical services without having to visit the hospital. The quality improvement is patient centered (Scott 2017). This will improve Judy’s health. This will have a positive impact to her social determinants since it will better her health and hence long life to live. It will also help in engaging in economic activities which will increase her productivity and hence reducing economic burden to the family and society.

The AMS and ALO refereed Judy to a registered nurse for her to receive healthcare services at her home rather than going to the hospital. This is because her stay in hospital will aggravate the medical bill while the services she requires can be done from home. The Aboriginal Medical Service (AMS) is a body that comprise of health workers who provide free medical services to Aboriginal and Torres Strait Islander people. The Aboriginal Liaison Officer (ALO) is an officer who gives relevant information to a patient and the family about hospital services and linkages with other indigenous community resources. They also provide emotional, social and cultural support to the patient and the family. For instance, in Judy’s case, the healthcare service was provided by the AMS and through the ALO she was directed on the appropriate nurse to offer the recommended services. The AMS and ALO interact with the current health system to provide wholesome healthcare services to the Aboriginal and Torres Strait Islander people. This is by ensuring that the most disadvantaged group is able to acquire primary health care to enhance their lifespan and to reduce the cases of chronic diseases (Villarosa et al 2018, p.318).

Conclusively,closing the gap is a significant strategy for achieving equality in health in Australia for both indigenous and non-indigenous people. Reducing the disparities in healthcare services, life expectancy, reducing child mortality, promoting education and creation of employment will ensure that the disadvantaged groups that is Aboriginal and Torres Strait Islander receive quality healthcare service. Enrolment in the closing the gap program will highly contribute to improving health status of the Aboriginal and Torres Strait Islanders.The government therefore need to support and employ more Aboriginal Medical Service health workers and Aboriginal Liaison officers to achieve the set health goal of 2030.  Though the strategy has not yet made measurable step towards the achievement of this goal, continuous monitoring and having appropriate indicators of achievement will help to ensure the program does not fail but rather create unity among people and standardize the social determinants of Australia people.

References

Armstrong, G., Pirkis, J., Arabena, K., Currier, D., Spittal, M.J. and Jorm, A.F., 2017. Suicidal behaviour in Indigenous compared to non-Indigenous males in urban and regional Australia: prevalence data suggest disparities increase across age groups. Australian & New Zealand Journal of Psychiatry, 51(12), pp.1240-1248.

Ashman, A.M., Collins, C.E., Weatherall, L., Brown, L.J., Rollo, M.E., Clausen, D., Blackwell, C.C., Pringle, K.G., Attia, J., Smith, R. and Lumbers, E.R., 2016. A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study. Journal of developmental origins of health and disease, 7(4), pp.357-368.

Diehm, C.J., Lumbers, E.R., Weatherall, L., Keogh, L., Eades, S., Brown, A., Smith, R., Johnson, V., Pringle, K.G. and Rae, K.M., 2018. Assessment of fetal kidney growth and birth weight in an Indigenous Australian cohort. Frontiers in physiology, 8, p.1129.

Freeman, T., Baum, F.E., Jolley, G.M., Lawless, A., Edwards, T., Javanparast, S. and Ziersch, A., 2016. Service providers' views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation. The International journal of health planning and management, 31(1), pp. E1-E21.

Hoy, W.E., 2009. Closing the gap” by 2030: aspiration versus reality in Indigenous health. Med J Aust, 190(10), pp.542-4.

Islam, S.M.S., Rawal, L.B. and Niessen, L.W., 2015. Prevalence of depression and its associated factors in patients with type 2 diabetes: a cross-sectional study in Dhaka, Bangladesh. Asian journal of psychiatry, 17, pp.36-41.

Kildea, S., Kruske, S., Barclay, L. and Tracy, S., 2010. ‘Closing the Gap’: how maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Rural and Remote Health, 10(3).

Robinson, M., 2018. Aboriginal women yarning about experiences as undergraduate nursing students in Western Australian universities.

Scott, C., 2017. Closing the Gap. International Journal of Integrated Care, 17(5).

Villarosa, A.C., Villarosa, A.R., Salamonson, Y., Ramjan, L.M., Sousa, M.S., Srinivas, R., Jones, N. and George, A., 2018. The role of indigenous health workers in promoting oral health during pregnancy: a scoping review. BMC public health, 18(1), p.381.

Wilson, R.L., 2016. An Aboriginal perspective on'Closing the Gap'from the rural front line. Rural and remote health, 16(3693).