HNN217: Community Nursing - Torres Strait Islander Peoples -Assessment Answer

Community Nursing Assignment

Case Scenario

The purpose of this assessment task is to give you the opportunity to examine the role of the community nurse in increasing accessibility to health care for Aboriginal and Torres Strait Islander peoples.

Assignment Task

Explore the nurse’s role in addressing the impact of the social determinants of health on accessibility to health care for Aboriginal and Torres Strait Islander peoples.

According to the culture of Aboriginal and Torres Strait Islander, health is not just physical well-being of an individual. They have a holistic perspective for health. They relate health to the social, emotional and cultural well-being of the community as well along with the physical well-being. The population of Aboriginal and Torres Strait Islander in Australia was estimated in 2014 to be around 713,600 (Burns et al., 2014). 75% of this population resides in developed major cities and regional areas. These regions are highly equipped with all the mainstream health services. However, the access and use of these health services for indigenous is still often quite low.

The health inequalities between Aboriginal and Torres Strait Islander people and non-Aboriginal and Torres Strait Islander people has been recognized to be the largest among the world by the World Health Organization (WHO) (Marmot et al., 2008). The life expectancy of people of Aboriginal and Torres Strait Islander, born in 2010–2012, was observed to 10.6 years less for males and 9.5 years less for females in comparison to their other non-indigenous counterparts (Collins & Kalisch). 70% of the health gap can be attributed to non-communicable diseases, followed by 23% by heart disease, 12% because of diabetes and mental disorders each and finally 9% is contributed by chronic respiratory diseases (Vos, Barker, Stanley, & Lopez, 2007).

The overall health and development of individual depends upon a number of factors over time, place and life style of living. Though genetic and biological factors along with environmental conditions have a great impact on the health of the people and are responsible for many physical and mental health problems, recently much emphasis is also being led on the social factors which are also equally responsible in determining the health outcomes. These factors are now popularly known as the social determinants of health (Zubrick et al., 2014). These social determinants of health constitute a widely distributed range of factors, starting from the social status of families and communities they live in and their life’s psychosocial conditions. These factors further extend to other aspects of life like education, housing and employment options, income earned, poverty, access to community resources, institutional racism, and various demographic and geographical factors.

Many theoretical frameworks have been proposed over the time to explain the relationship between health and their social determinants. They state that lower social status and recognition can lead to stressed conditions and force the individual towards the use of alcohol and smoking. They soon start losing control over their practices and this leads them to poor health. On the other hand, some of the studies relate the broader economic and political influences with poor health conditions. For example, poor financial conditions can limit the use of health care services by these Aboriginal people even if they have an access to them. However, all these determinants are interlinked and do not occur in isolation from others (Zubrick et al., 2014).

The framework modeled by the WHO’s Commission on Social Determinants of Health (WHO CSDH) is a perfect example to illustrate that the conditions which prevail in daily life and the environment of society surrounding an individual are important health determinants (Marmot et al., 2008). It implicates that social inequalities also result in inequalities in physical as well as mental health (Marmot, 2011).

The acts of racism are acknowledged as major determinants of health for these indigenous populations in Australia. Recent data generated using a nationwide study data states that about 27% of 15 years old children of Aboriginal and Torres Strait Island have experienced the events of racism in the last 12 months. Racism has been shown to affect the health of an individual in many ways. These commonly include a self-induced limitation in access to factors like education and employment, which can positively contribute towards maintaining good healthy conditions in the society. It also affects the self-efficacy and self-esteem of the individual thereby exposing them to stress, substance use and self-harm. It also leads to harmful effects on cultural identity. So the disadvantages experienced by the Aboriginal Australians can be associated to historical and contemporary racism, colonization and coercion. Thus, redressing racism has become a national priority for Australia (Priest, Paradies, Gunthorpe, Cairney, & Sayers, 2011).

A number of studies further connect the problem of poor health of Aboriginal Australians to their remote living. Individuals or communities living in remote areas have been shown to have higher rates of risky health behaviors, these induces activities like smoking, limited access to health services, and worse health when compared to people occupying the metropolitan areas. In 2011, only one-third of the total Indigenous Australian population was estimated to be living in urban areas (34.8%). Only 1.7% of non-Indigenous Australian population was found living in remote or very remote areas, while one-fifth of Indigenous Australians live at remote locations, around 7.7% Indigenous Australians live in remote and 13.7% live in extreme remote areas (AIHW, 2014).

WHO CSDH believes that these factors forming the social determinants of health for Aboriginal and Indigenous people can be modifiable and controlled so as to reduce the ill impact on health and the prevailing conditions can be improved to endorse the people with positive physical and mental health and improved wellbeing.

In attempt to close the gap between Aboriginal and Torres Strait Islander peoples living in urban, rural and remote areas, Australian government has initiated many community controlled primary health care services. The services cater to the very specific needs of these communities and include a varied range of health related service providers, from both health and social welfare areas. Skilled nurses and midwives play a major role in determining the success of such initiatives. They not only provide these aboriginal people with the basic primary care in remotely located rural areas but also constitute the group of health professionals who directly interact with these people when admitted for the acute care. Though nurses always adopt a holistic approach to deliver their best in term of advice and care for the admitted patients, but there is also a need understand and respect the local traditions of the aboriginal islanders. They must practice cultural humility and try not to forcefully impose their own beliefs and values. Health does not only associate with physical wellness but also embraces emotional, intellectual, and spiritual well-being. They all together are the different quadrants of a medicine wheel. They should understand the social determinants of health, local history of the people residing there, their traditional beliefs, traditional medicinal and healing practices and inadequate access to food and other resources. They have to work in close collaboration with multidisciplinary teams including Aboriginal health workers, doctors, nutritionists, counselors and drug and alcohol workers, etc. (Macaulay, 2009). The nurses need to develop more professional maturity. Many programs have been initiated to promote education and recruitment among aboriginal people. The non-aboriginal nurses need to treat the marginalized and disempowered coworkers equally as a single community. Although they are making all the effort to reconcile themselves with the original inhabitants of Australia, but still a lot needs to be done. The way laws are being made to return the land to Aboriginal people under the Native Title, the field of nursing also needs to waver off some of its powers and privileges that were taken away from the Aboriginal people. This is a necessary step towards supporting the Aboriginal health workers and communities for starting their journey towards self-determination. Instead of treating the Aboriginal health workers as second-level nurses, the Australian nurses must acknowledge the skills and knowledge possessed by these health workers and try to establish a sound relationships with people constituting this group of health care providers. Thus nurses will have to take the very first step in this initiative of reconciliation, by formally conceding the unique role played by Aboriginal health workers in providing much required health care services to the people of their communities. They must provide moral and practical support to these workers by providing them assistance in utilizing resources and acquiring much out of the given technical training and educational opportunities (Jackson, Brady, & Stein, 1999). They must be sensitive to cross-cultural care. Simple measures can be taken to put these patients at ease. Some of these include maintain less eye contact, taking less and that too in lower tone, not asking too many direct questions if the patient is not willing to answer. They are generally not comfortable in talking to others if they perceive them as more powerful and knowledgeable. Experience of individual from such communities not only affects their closely associated family members alone but also the entire community. Language might be another hindrance, an interpreter may be appointed in case aboriginal patients operate in using second language. Working so closely with aboriginal patients can make the nurses understand the key issues in linked to the patients’ health and can contribute their greatest knowledge, to gain insights and suggest some practical recommendations to improve the prevailing conditions (Macaulay, 2009).

Thus redressing inequalities in social aspects to deal with the physical, social and emotional wellbeing of these Australian Aboriginal people has become a crucial national priority for Australia. Combating racism along with providing equal opportunities for all as a determinant of health is a critical aspect of such an endeavor. Further research can be done to explicate various risk and protective factors towards the health related issues associated Aboriginal and Torres Strait Islander. Such knowledge and information can then be used to develop appropriate and effective interventions to combat these inequalities to further improve the Aboriginal health outcomes. Nurses among the health care providers can be prepared through proper training and guidance for successful implementation of the developed interventions.