Cultural safety for Aboriginal and Torres Strait Islander peoples requires addressing power imbalances in places and people in order to improve health outcomes and support the Torres Strait Islander and Aboriginal medical staff. Not only is the process dynamic, but it is also multidimensional. Ideally, there is a continuum of care that varies based on the context. In Australia, the procedure is critical since Torres Strait Islander people have greater illness burdens and socioeconomic disadvantages than non-indigenous Australians. For example, Aboriginal and Torres Strait Islander peoples face higher levels of prejudice and racism (Aspin et al. 2012 p.143). Professional responsiveness to culture can enhance strength, resilience, happiness, confidence, and identity that can lead to positive health outcomes among the people. Therefore, positive results in healthcare service delivery can be influenced by responsiveness to cultural differences as well as conscious and unconscious racism among the healthcare providers.
Cultural safety can also enable the medical students and doctors to stay and thrive well among the Aboriginal people and Torres Strait Islanders. The safety can be strengthened by prominent displays of artwork, flags and posters of the natives, respect in asking questions, and developing partnerships with the people, including them in governance, membership to indigenous organizations, developing and implementing reconciliation plans as well as creating employment strategies to benefit the Aboriginal and Torres Strait Islanders. Cultural competency entails emphasizing on attitudes, behaviours, and creating policies to enable professionals to work effectively in a situation where culture is diverse (Godwin et al. 2015 p.38). For a system to be culturally competent, it must acknowledge and incorporate the importance of culture, assess cultural relations and exhibit vigilance towards dynamics that cause cultural differences. As a matter of fact, cultural competence requires the caregivers to expand their cultural knowledge and adapt their services appropriately to meet the unique needs of different cultures within their area of operation.
Case Study
Name of the Patient:
Birth Date: 14/05/1968
Residence: Canberra (rural)
Gender: Female
Marital Status: Married
Family situation: Bad
Religion: Dreamtime
Employment: unemployed
Surgical History: None
Medications
Medical history: PRINIVIL TABLETS 25G (LISINOPRIL) 1 po qd
Last Refill: *30 x 2: Carl Savem MD (08/24/2017)
HUMULIN INJ 70/30 (INSULIN REG & ISOPHANE (HUMAN)) 20 units ac breakfast
Last Refill: *600 u x 0: Carl Savem MD (08/27/2010)
Allergies and Adverse reactions (!=Critical)
Service Due: FLU VAX, PNEUMOVAX, MICROALB URN
Date 4/20/2018
Provider: George Evans
History of Present Illness
Reason for visit: Routine follow-up
Main Complaint: Coughing and wheezing
Review of Systems
General: Denies malaise and weight loss and fatigue
Eyes; No blurring, discharge, irritation
Ear/Nose/Throat Ear pain, nasal obstruction, no so throat
Cardiovascular: Chest pain paroxysmal nocturnal dyspnoea
Prior condition before needing nursing intervention
Psychiatric: Indicates Depression, anxiety mental, disturbance, experiences sleeping difficulties, exhibit suicidal ideation
Allergy: Patient admits urticarial, and hay fever. Denies HIV risk behaviours.
Surgical needs: None
Topic Information
Most of the published research about the incidence of asthma among the Aboriginal people and Torres Strait Islanders focuses on studying the prevalence of asthma across different areas in Australia. According to the studies, More Aboriginal people than nonindigenous people report asthma as a health condition that is long-term. The ratio of 1:9. More specifically, 17% of the Aboriginal and Torres Strait Islanders and 2% respectively for non-indigenous communities. In Queensland, and in central Australia the prevalence was 3.3% among adults in 2001. Between 2004 and 2005,15% of the indigenous people were asthmatic. In 2010, the rate of death from respiratory diseases among indigenous people was 2.6 times higher than that of the non-indigenous people (MacRae et al.2012 p.27).
Between 2012 and 2013, approximately 18% of the Torres Strait Islander people reported having Asthma. Currently, 15% of Aboriginal people and Torres Strait Islander below 15 years and more than 22% of the adults aged 45 and above suffer from the condition. The incidence of the condition varies with age and place of residence. People that reside in less remote areas are more likely to suffer from Asthma compared to those that reside in remote areas according to Hall et al. (2017). A majority of the adults suffer coughs and wheeze while others have respiratory tract infection. Lung function is also poorer among the indigenous than the non-indigenous people. Asthma is more common in men than women.
Nursing Interventions
The patient can be treated by administering reliever inhalers containing beta2-agonist for a quick relief (Gatheral et al.2017.p.7). The therapy also incorporates the use of tropical inhaled corticosteroids to ease the breathing of the patient by reducing airway swelling to control the asthmatic symptoms (Loke et al. 2015). Thereafter, the patient can undergo specific allergen immunotherapy for the treatment of allergies. More specifically, allergen immunotherapy injections can be administered to the patient for treatment of allergic reactions. However, the treatment of immunotherapy should not be done in case the patient is having severe uncontrolled asthma to because it can lead to further complications.
Cultural Safety
Communication. It is important to allow the Aboriginal patient to take pride of her personal and group identity. It is crucial to give her a chance to speak proudly about her traditional song, language, story, dance, laws, and paintings in the course of treatment. It is also essential to explain all the potential medical procedures and medications that she might undergo while maintaining an approachable demeanour to create trust. More importantly, the physician must emphasize on verbal language when giving prescriptions for the medications, procedures, and directions (Chapman et al. 2014). When it is necessary to use written language, she must be able to understand it.
When speaking to the patient, it is important to refer to her as a member of aboriginal people as opposed to a member of aborigines. To act in a religiously-sensitive manner, the use a language that creates a sense of belonging to land, sea, people and the Aboriginal culture is recommended when communicating with the patient. Above all, because she is an elderly woman, I must display extreme respect.
Meals and Treatment. Being a member of the Aboriginal people, the patient is likely to be sensitive to food that she is served. Therefore, it is important to ask the patient about her meal preferences before giving her any food. The woman belongs to a community that is popular with traditional medicine. Because the patient might have used a traditional herb and plant for medication, I must ask her about it with respect before prescribing asthma drugs or conducting any medical procedure.
Attire. The Aboriginal people and Torres Strait Islanders clothe depending on medical constraints. It is crucial to avoid any rebuke for her clothing. For example, the patient should be given permission to wear amulets or totems before and after medical treatment if she prefers doing it
References
Aspin, C., Brown, N., Jowsey, T., Yen, L. and Leeder, S., 2012. Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC health services research, 12(1), p.143.
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-12-143
Chapman, R., Smith, T. and Martin, C., 2014. Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one Victorian Emergency Department. Contemporary nurse, 48(1), pp.48-58.
Gatheral, T.L., Rushton, A., Evans, D.J., Mulvaney, C.A., Halcovitch, N.R., Whiteley, G., Eccles, F.J. and Spencer, S., 2017. Personalised asthma action plans for adults with asthma. The Cochrane Library.
Goodwin, D., Sauni, P., Were, L., Kirkhart, K.E., Cram, F., Hill, M.F., Ell, F., Grudnoff, L., Limbrick, L., Cowie, B. and Cooper, B., 2015. Cultural fit: An important criterion for effective interventions and evaluation work. Evaluation Matters–He Take Tō Te Aromatawai, 1, pp.25-46.
Hall, K.K., Chang, A.B., Anderson, J., Dunbar, M., Arnold, D. and O'Grady, K.A.F., 2017. Characteristics and respiratory risk profile of children aged less than 5 years presenting to an urban, Aboriginal‐friendly, comprehensive primary health practice in Australia. Journal of Paediatrics and Child Health.
Loke, Y.K., Blanco, P., Thavarajah, M. and Wilson, A.M., 2015. Impact of inhaled corticosteroids on growth in children with asthma: systematic review and meta-analysis. PloS one, 10(7), p.e0133428.
MacRae A, Thomson N, Anomie, Burns J, Catto M, Gray C, Levitan L, McLoughlin N, Potter C, Ride K, Stumpers S, Trzesinski A, Urquhart B. Overview of Australian Indigenous health status, 2012. Retrieved from http://www.healthinfonet.ecu.edu.
au/overview_2013.pdf
