HNN348 Rural & Remote Area - Nursing Case Study Assessment Answers

Nursing case study Assignment Help

Purpose of Assessment Task 3

The importance of the nurse’s role in caring for people in rural and remote areas cannot be underestimated. This assessment task provides you with the

opportunity to apply your knowledge of rural and remote areas and the issues

encountered by nurses in ensuring equity of health outcomes.

Case study

You are a Registered Nurse working in a community health service in far north

Queensland. Today you are visiting the remote community of Pormpuraaw, with a population of approximately 600 people. The majority of this population are indigenous persons and are part of the Thaayorre people.

Tommy is a 32-year-old Indigenous male who arrives at the clinic complaining of feeling unwell over the past 2-3 days. Tommy has a history of Rheumatic Heart Disease and is a smoker. You notice that his symptoms appear to be worsening so you consult with the Medical Officer who states that Tommy needs to be urgently transferred to Cairns Base Hospital for further review and management.

You are required to prepare Tommy for his medical evacuation to Cairns.

Tommy has only been to Cairns once before and he is not used to hospital

environments. He will be accompanied by his auntie Janelle who will be there as a support person.

Assignment Question

Using the case study above, explain the key health issues that confront Tommy and relate the discussion to the indigenous population in general. In addition, identify, prioritise and discuss relevant strategies for two (2) of these health issues that you as a registered nurse could implement that would improve Tommy’s situation. Provide rational for these decisions.

Introduction

Nursing in remote areas is a complicated endeavour and requires extreme care and concise strategies to make it successful. In 2014, the bureau of statistics estimated the indigenous population to be 713,600 people. Approximately 70% of them reside in the remote areas of the country. Nurses in working in these areas face multiple challenges in their daily work such as limited resource availability. Improving the health of the families residing in remote communities is therefore very important. As a result, nurses have to come up with strategies that will assist them ensure that the individuals residing in these areas have reliable and accessible healthcare (Australian Bureau of Statistics, 2014).

As a registered nurse working with Pormpuraaw residents, the nurse will have to come up with strategies to help the patients she encounters. Currently, she is dealing with Tommy, who is unwell and has a history of both being a smoker and having rheumatic heart disease and has been referred to Cairns for further review. The nurse is now tasked with preparing the patient for the upcoming evacuation to the referral hospital. In this case, she has to understand the health issues that the patient is confronted with and come up with strategies that would improve those issues (Queensland Health, 2010).

Key Health Issues

The patient in question is dealing heart disease and has a history of smoking. Indigenous populations have been known to be predisposed to both cardiovascular and respiratory issues. The government estimates that indigenous populations are 1.7% more likely to suffer from cardiovascular issues as compared to the other Australians. Patients such as Tommy, who reside in the remote areas, are faced with health issues that would expose them to unfavourable health outcomes (Australian Bureau of Statistics, 2012).

Tobacco use among the indigenous people is higher than the use among the rest of the population. This exposes them to various medical conditions such as cardiovascular and respiratory disorder. In 2013 for instance, the bureau of statistics estimated that 44% of indigenous people over the age of 15 were smokers. It further found that 46% of them were male. Tommy is a prime example of the smokers in these remote areas. As a smoker who is also suffering from Rheumatic heart disease, he is reducing his chances of recovering from this disease (Overview of Australian Indigenous health status, 2014)

The degree of Acceptability of health services in indigenous communities is detrimental on health services provision in these remote areas. The cultures of some indigenous communities, certain aspects of the health services are not culturally appropriate and therefore the members of such communities may not find health services as important. The research found that some indigenous communities refused to seek medical help due to cultural inappropriateness and lack of trust of medical services. In Tommy’s case, he may have come to the hospital as a last resort because his community doesn’t trust modern medicine or medical professionals (Dudgeon, Wright, & Coffin, 2010).

The perception of what constitutes health and wellbeing and how to maintain or damage it differs between the indigenous communities and the rest of the population. For instance, indigenous populations believe in a more holistic understanding of both health and wellbeing. They believe that the physical, mental cultural as well as spiritual wellbeing are all interlinked. In this kind of reasoning, ill health is seen as being caused by dysfunctions in either the cultural or spiritual health and will be treated with this in mind. Such communities may regard traditional healers and bush medicine higher than they would western medicine and will go to modern medicine as a last resort. In Tommy’s case for instance, he sought medical help after being unwell for a few days implying that he may have come to hospital as last resort (Stansfield & Browne, 2013).

According to Dwyer et al. (2011), indigenous patients will face miscommunication problems with the medical professionals. The ‘pseudo-intelligibility trap’ has been experiencing challenges where it is hard to explain the medical concepts to the patients. For instance, as a nurse, Tommy may not understand the complexity of the chronic disease he is suffering from and therefore may not understand that he should not smoke as this may exacerbate it. Communication issues may also occur where patients may perceive nurse’ behaviour as being patronising and rude when they are asked certain questions. For instance, some communities may perceive eye contact as a sign of the assertion of power.

Behavioural protocols among genders and other indigenous relationships cause issues between practitioners and the patients on several occasions. These communities have demarcated gender roles and have regulated behaviours and relationships between these genders. Some of these societies have kinship rules that require some relatives to avoid contact. If health services breach these norms, the indigenous patients may avoid seeking those services. This will affect access to medical help and will produce an undesirable outcome. In Tommy’s case, the nurse will need to take the gender rules of that community in consideration to avoid alienating him from accessing the help he requires. Therefore in including his Aunt in the journey to the hospital in Cairns, she will also need to ensure that she remains conscious of the cultural restrictions (Walker, 2011).

Access to quality health care is problematic in such areas. Remote areas like Pormpuraaw are unable to access centres that can provide adequate care and management for some diseases. This is a worrying issue because patients will critical conditions are likely to die if they are not transported to the institutions that provide advanced care on time. In Tommy’s case, for instance, he is unable to get specialised help at the local health centres due to inadequate facilities and is therefore referred to bigger hospitals where he can access the specialised services (Australian Bureau of Statistics, 2014).

According to Renhard et al. (2010) equity and fairness issues are prevalent among the indigenous people in the country. Issues like health inequalities have plagued the indigenous people across many decades. The feelings of displacement and discrimination have become embedded in the people in these areas and they often feel like they are constantly left out and forgotten by governments. Although strategies have been established by the government, they have not been fully implemented and this has made the inequalities become worse in progressive years. Issues like health and physical infrastructures such as water, sanitation as well as housing and food have contributed to the bad state of health amongst the indigenous people. For instance, the WHO argues that approximately 75% of the indigenous population lives in houses that are severely crowded. Their remote location also hinders transport of important medical supplies to the residents of these localities (World Health Report, 2010).

Lack of proper education in the remote areas has increased the risk of bad health outcomes among patients residing in the indigenous communities. When the patients do not understand the gravity of the health issues they are facing and how they can prevent those ailments, they are likely to make the conditions they are suffering from even worse. For instance, Tommy is suffering from a heart condition that could have been prevented if the Rheumatic fever he had suffered from previously had been addressed. In addition, smoking is known to be detrimental in patients who suffer from the heart disease he is suffering from. Since he doesn’t know this he keeps smoking and this is making the likelihood of a good health outcome for himself less likely (Bailie, 2013).

Strategies for Dealing with the Health Issues

The health issues that indigenous people are numerous. In spite of that, nurses can come up with strategies that can contribute to addressing those issues. Lack of adequate information is a major contributor to some of the health issues that the communities face. This can be combated by creating awareness among the people on the various diseases they could face and how they can prevent some of the diseases from recurring. In Tommy’s case, for instance, a nurse can give him information regarding the heart condition he faces and how to manage it. Such information will help the patient realise that smoking may be reducing his survival chances and may save his life as a result (Lalor et al. 2014).

Creating awareness among the people will also help solve the communication issues that occur between the patients and professionals. The nurse will explain to the medical terms to patients in a manner that they can understand. In Tommy’s case for instance, if he understands what leads to the communicable heart issue he suffers from, he will be in a position of avoiding the occurrence of this same disease among his future children. If the nurse implements the plan to educate the community, patients like Tommy will understand the importance of seeing medical personnel immediately they feel unwell and not wait for a couple of days like he had done previously (Reibel &Walker, 2010).

The nurse can create programs aimed at promoting healthy living among the indigenous people. This is because most diseases prevalent in this population segment can be avoided. Rheumatic heart disease can be avoided by developing programs aimed at encouraging the people to modify behaviour in form of reducing tobacco use and improving their sanitation. These programs are instrumental in educating the people and creating awareness about various issues that pertain to health. For these programs to be fully effective, they should be done with the assistance of the local people. This help in making the materials easy to understand by these people and also ensuring that they are culturally appropriate. The community members will also help the nurse come up with appropriate delivery mechanisms for the information they want to pass to the people (Durey, 2010).

Community involvement can also be used by the nurse to overcome some of the issues that are faced in these communities. When the community is involved in health services provision, the nurse will be able to build trust with the community. She will also be in a better position to understand the culture and build mutual respect with the community. According to NSW Ombudsman (2010), when implementing services that are culturally acceptable, community ownership is vital. This is because indigenous communities are empowered to make decisions that relate to the provision of health services that are appropriate. If this is implemented, the community will begin to look at modern medicine as the first option when one is ill as opposed to thinking of hospitals as the final resort when traditional medicine fails to work.

Community involvement also helps reduce miscommunication issues that occur due to cultural differences. For instance, some communities may have issues with body language where they may perceive eye contact as a show of authority. Once the nurse understands this, she will be in a position of changing her approach and will make patients more comfortable when being treated. Community involvement will also assist in improving the degree of acceptability of the services among the indigenous communities. When the nurse involves community members in decision making, she is able to understand the culture a bit more and will be in a position to decide the proper treatment plan that will provide good outcomes while at the same time ensure that the cultural beliefs of the community are taken into account (Trenerry, Franklin, & Paradies, 2010).

Employing indigenous people is an integral aspect of community involvement that the nurse can apply to fight the health issues she faces in the community. Indigenous people assist in bridging the culture gap that exists in service delivery because they serve as intermediaries between the community and the medical professionals. For instance, they provide assistance in translation, providing advocacy for the patients. They also provide a familiar face for patients who visit the medical centres and make them comfortable while seeking treatment. They are also instrumental in providing the medical staff with both sensitivity and competency training. If the nurse employs these indigenous people, understanding Tommy and his medical history and how she can help him after he receives treatment will be relatively easier (Williamson & Harrison, 2010).

If the nurse implements community involvement, they will understand the behaviour protocols that are expected for each gender. Some communities have rules that govern male-female interactions and these needs to be factored in when treating indigenous patients. If the nurse takes this into consideration, she will be able to offer Tommy proper care while ensuring that she avoids causing him any embarrassment (Carnie, Berry, Blinkhorn, & Hart, 2011).

Conclusion

The indigenous communities are an integral part of the vast population and need to be prioritised in the provision of healthcare. As a nurse working in such areas, understanding the core health issues you can expect while undertaking your duties is important as it assists one to formulate strategies that will help counter those issues. By recognising the communities as functional units that require respect and consideration, nurses are able to create a relationship with these communities. These relationships allow the nurses to do their jobs in a conducive environment and go a long way to ensuring favourable outcomes for all patients who they encounter.