Nursing Assignment: Cultural Safety & Healthcare of First Nations People in Australia

Question

Task: Nursing Assignment Instructions: Part 1: The role of Aboriginal Community Controlled Health Organisations (ACCHOs): You are required to discuss the role Aboriginal Community Controlled Health Organisations (ACCHOs) play in reducing the health inequality experienced by Aboriginal and Torres Strait Islander Australians.

a) Equality vs Equity: Discuss the difference between the terms Equality and Equity and describe how Aboriginal Community Controlled Health Organisations are an example of addressing health inequity to reduce the health inequality experienced by First Nations people.

b) ACCHSs improving health and wellbeing:
“Aboriginal health means not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a wholeof life view and includes the cyclical concept of life-death-life.”

National Aboriginal Health Strategy Working Party (1989, p.ix). A National Aboriginal Health Strategy. Canberra: Australian Government Publishing Services. Discuss how the Aboriginal Community Controlled Health Organisation model of comprehensive primary health care reflects the above definition of health.

Part 2: The role of hospitals:
The NSQHS Standards provide a nationally consistent statement of the level of care consumers can expect from health service organisations regardless of where they live. The eight standards were developed to protect members of the public form harm and to enhance the quality of health services. Each standard consists of a set of action items. The second edition of the Standards, released in 2017, includes actions designed to ensure that healthcare is tailored to the unique needs of Aboriginal and Torres Strait Islander people.

In this part of the assignment you are required to discuss how the implementation of the NSQHS standards in hospitals can contribute to reducing the health inequality experienced by First Nations Australians.

Part 3: The role of individual nurses and midwives:
Aboriginal and Torres Strait Islander peoples experience poorer health outcomes than nonIndigenous peoples. Cultural safety is a proven way for nurses and midwives to contribute to better health outcomes and experiences for Aboriginal and/or Torres Strait Islander peoples.

Nursing & Midwifery Board of Australia, (2018) Fact Sheet: Code of conduct for nurses and Code of conduct for midwives https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ/
Fact-sheet-Code-of-conductfor-nurses-and-Code-of-conduct-for-midwives.aspx

In Part 3 you are required to discuss how individual nurses and midwives can deliver culturally safe care and contribute to reducing the health inequality experienced by Aboriginal and Torres Strait Islander Australians. Best (Best & Fredericks, 2018) describes 5 principles of cultural safety as follows:

1. Reflect on your own practice
2. Seek to minimise power differentials
3. Engage in discourse with the client
4. Undertake the process of decolonisation

5. Ensure that you do not diminish, demean or disempower through your actions
Choose two (2) of these principles of cultural safety. Describe strategies individual nurses and/or midwives can use to incorporate these principles into the care they provide and discuss how these strategies can improve patient outcomes for Indigenous Australians.

Answer

Nursing Assignment Part 1: Role of Aboriginal Community Controlled Health Organisations (ACCHOs)
A. Equality vs Equity
The words equality and equity can be used interchangeably, but they are pretty different. Equality is the belief that everyone should have the same resources and opportunities as one another; everyone should be treated in the same way regardless of their differences and backgrounds. Everyone should enjoy equal satisfaction with specific fundamental everyday needs and rights. Equality is human rights and the concept of fairness and social justice (Mason-Whitehead et al. 2008). An example of equity is giving the same treatments in the same situations and providing different treatments in different cases, giving other treatments to make people's opportunities the same (Rooddehghan et al. 2019). To achieve equity for First Nations people inequity first needs to be fixed. The Aboriginal Community Controlled Health Organisations (ACCHOs) are working to reduce health inequities that First Nations people are experiencing; they are addressing many health inequities through supporting factors of empowerment and self-determination (Campbell et al. 2018; Panaretto et al. 2014). They also offer culturally accessible, appropriate primary care and provide holistic health services and address the social determinants of health (Campbell et al. 2018). They provide educational resources for health professionals, different programs that promote health and wellbeing (Panaretto et al. 2014). ACCHOs have programs and services that increase the number of organizations and services that focus on the principles of empowering communities to achieve better outcomes.

B. ACCHSs improving health and wellbeing
Based on the community safety guidelines (ACCHOs), Victoria Aboriginal Health Service is offering equal opportunities on its phone consultation and front door screening. Moreover, the organization is providing support for emotional and social well-being, financial well-being along with alcohol or drug counseling (rehab) services (Victorian Aboriginal Health Service, VAHS, 2021). The Bendigo and District Aboriginal Co-operative (BDAC) has developed the ‘Aboriginal Children in Aboriginal Care Pilot Program’ to improve staff commitment and their dedications to assure health equality as well as well-being. Mallee District Aboriginal Services has also promised specialists and aided health services, preventative healthcare, and cost-effective health assessment for every Aboriginal and Torres Strait Islander person. As asserted by Brigg & Curth-Bibb (2017), as the Aboriginal community is having high health risk, hence, the organization has also provided 'Care Coordination and Supplementary Services Program’ with multi-disciplinary care to optimize wellness. ACCHOs like HEART OF COMMUNITY-Rumbalara Aboriginal Co-operative are also developing trust, maintaining high-profile leadership, and providing a client-based unbiased treatment plan for assuring spiritual mental, and physical wellbeing. Besides, Albury Wodonga Aboriginal Health Service is also offering a holistic approach and a wide range of care facilities (diabetes support, management of chronic conditions, and child health) for the Aboriginal population in Australia and NZ (Albury Wodonga Aboriginal Health Service, AWAHS, 2021). For improving health and well-being, ACCHOs have increased their support towards mental health, developed cooperation, emphasized caring economics, and promoted altruism as well. ACCHOs are kept on improving strategies on health education for promoting better health outcomes to Aboriginal children and adult people.

Part 2: The contribution of hospitals
Standard: Clinical Governance (Action 1.4)
Description of the strategies
Based on "Clinical Governance" (Action 1.4),leaders of healthcare sectors have the responsibility to maintain effective communication for ongoing improvement of quality services for Aboriginal people and assuring person-centered care. In addition, healthcare organizations need to implement patient-centered strategies and monitor the activities of the caregivers to meet the quality and safety priorities of the Aboriginal and Torres Strait Islander population. It is evidenced that healthcare systems used to close the gap in treatment by strengthening the engagement of Aboriginal and Torres Strait Islander people in health service planning. Quality Information Performance (QIP) used to maintin to get the updated information about the Aboriginal people and assure a culturally responsive care system (Dalton & Carter, 2018). Also, organizations must conduct Aboriginal-specific treatment programs and several health promotion programs to improve Aboriginal health in a culturally respectful manner.

Significance of implementation
As per the opinion of Green et al.(2021), incorporation of this action can commit coordinate response in terms of quality care and safety to the Aboriginal communities. Besides, it supports reducing unsafe practices towards Aboriginal people, assures monitoring progress as well as allocates essential resources to improve patients' experiences. Collaboration with clinicians and managers along with Aboriginal representatives support to improve the design in priority areas. As asserted by Richards et al.(2017), cultural awareness together with cultural competency can support to facilitate a welcoming atmosphere by recognizing the significance of cultural beliefs of the Aboriginal population in healthcare. Routinely monitor and measuring success can help to develop major projects or policies that influence the treatment protocol of Aboriginal communities. Improving workforce and local engagement can ensure a well-documented information system and review the effectiveness of care models for the Aboriginal and Torres Strait Islander population.

Standard: Partnering with Consumers (Action 2.13)
Description of the strategies
As per the "Partnering with Consumers" (Action 2.13), partnership with clients must be associated with planning, priority design, treatment delivery, and evaluation of patient attention. It is reported that healthcare sectors maintain a partnership with Aboriginal and Torres Strait Islander people to come across their health desires. For implementing this action, healthcare service providers must maintain ongoing and effective relationships with Aboriginal communities to understand their cultural beliefs along with determining health priorities. As commented by Farnbach (2018), healthcare organizations used to conduct consumer programs (such as consumers' motivation, understanding cultural diversity, and assuring significance of community involvement) and create a culturally safe atmosphere for this community. According to NSQHS Standards (Edition 2017), healthcare systems are used to set up schemes to record the health status of the Aboriginal population routinely and ensure them a comfortable interaction (Richards et al.2017).

Significance of implementation
As asserted by Harfield (2020), working in partnership with the Aboriginal population supports to development of access to quality treatment without bias behavior. Moreover, it can also bring about changes in treatment by gaining trust and understanding mutual benefit. A healthy relationship can be the most respectful effort used to impact minimizing disease burden among the Aboriginal population. Moreover, good communication and interaction may also result in sharing understanding and influence on the activities of the decision-making department of healthcare sectors. Implementation of this action support to minimize institutionalized racism and increase engagement with this population that enhances patients' outcome. Partnership help to improve health literacy and reduce clinical disparities among the Aboriginal communities. As asserted by Green et al.(2021), adopting this action can assure this community that they will receive an effective, efficient, and evidence-based equality treatment considering the variations in health challenges.

Part 3: The role of respective nurses and midwives
Principle 3: Engage in disclosure with the client
Description of the strategies
As mentioned by Gerlach et al. (2017), nurses and midwives must be responsive to the result of racialized as well as gender regulation. Moreover, nurses used to communicate with diverse groups and allow them to take active participation in migration projects or right-based progressive approaches. Nurses ought to develop a healthy relationship with clients through an open-minded and flexible attitude for avoiding various stereotypic barriers within healthcare sectors. As opined by Jennings, Bond & Hill (2018), Engage in disclosure with the client is a multi-layered procedure that requires participatory activity through consultation, priorities, and Indigenous aspiration. Nurses and midwives used to conduct ‘Loyalty Reward Program’, follow ‘Client-centric’ services, and keep Aboriginal clients within an orbit with precious expertise to provide clients a voice and maintain tailored interaction.

Significance of implementation
Engagement of the Aboriginal population in a healthcare setting can strengthen cultural safety by understanding clients’ needs as well as removing inequalities and racism (Jennings, Bond & Hill, 2018). Moreover, the involvement of clients can commit safety priorities and positive respectful experiences in healthcare sectors. Therapeutic communication and patient-nurse interaction support to get the treatment goal addition to palliative care in nursing practice towards Aboriginal people. Besides, client involvement can improve community governance healthcare structure, promote joint planning and meet mutual accountabilities to get long-term goals. Disclosures with Aboriginal clients can enhance partnership working, resolve chances of conflicts and intensify the concept of wellness. As commented by Gerlach et al. (2017), a discipline disclosure is a positivist approach that can assure broader engagement, reduce substantial harm and eliminate health threat.

Principle 4:Undertake the process of decolonization
Description of the strategies
Nurses in the different departments used to maintain various codes of conduct for establishing an effective professional relationship with the Aboriginal communities. As opined by Leung& Min(2020), nurses used to recommend evidence-based practice guidelines NMBA (Nursing and Midwifery Board of Australia) Standard for controlling sensitivity towards racial identity among the Aboriginal population. Nurses used to follow anti-racist, feminist in addition to decolonizing practices that influence colonial power, collaboration, and relationship. Moreover, to come across successful decolonization of Aboriginal communities, nurses used to follow strategies like Rediscovering and Recovery, Mourning, Dreaming, Commitment, and Action. These strategies are having distinct forms and clear sequences that should be attempted for refashioning the society by considering cultural safety (Sherwood& Mohamed,2020).

Significance of implementation
Continuing colonization over Aboriginal and Torres Strait Islander communities makes them knowledgeable about Aboriginal and International First Nations’ approaches and shifting the system into enhancing services. The ‘Rediscovery and Recovery’ strategy may support “getting up to speed” of healthcare facilities whereas ‘Mourning’ succor to meet sufficient satisfaction for long term. ‘Dreaming’ is also vital for decolonization as it can assure consultation through debate to allow the Aboriginal community to explore their cultures. As commented by Sherwood & Mohamed (2020), undertaking true decolonization can promise re-evolution of economic, social, political together with a judicial structure that influences health facilities of this population. ‘Commitment’ along with ‘Action’of nurses can support to increase and retain healthcare diversity with decolonization that deprives this community of self-determination as well as the formation of social structure.

Reference list
Albury Wodonga Aboriginal Health Service (AWAHS) (2021). awahs.com.au. Retrived on 17th June, 2021. Retrived from https://www.awahs.com.au/

Brigg, M., & Curth-Bibb, J. (2017). Recalibrating intercultural governance in Australian Indigenous organisations: the case of Aboriginal community controlled health. Australian Journal of Political Science, 52(2), 199-217. Retrived on 16th June, 2021. Retrived from https://www.tandfonline.com/doi/abs/10.1080/10361146.2017.1281379

Campbell, M. A., Hunt, J., Scrimgeour, D. J., Davey, M., & Jones, V. (2018). Contribution of Aboriginal Community-Controlled Health Services to improving Aboriginal health: an evidence review. Australian Health Review, 42(2), 218-226. Retrived on 16th June, 2021. Retrived from http://www.publish.csiro.au/ah/ah16149

Dalton, A., & Carter, R. (2018). Economic Evaluation of the Indigenous Australians’ Health Programme Phase I. Melbourne: Deakin University. Retrived on 15 th June, 2021. Retrived from https://www.ehealth.gov.au/internet/main/publishing.nsf/Content/E829D2AE47571554CA2581F4007535E9/ $File/Economic%20Evaluation%20of%20the%20Indigenous%20Australians%E2%80%99%20Health% 20Programme%20Phase%201%20Report.pdf

Farnbach, S. (2018). Conducting high-quality, culturally-appropriate primary healthcare research with Aboriginal and Torres Strait Islander peoples. Retrived on 18th June, 2021. Retrived from https://ses.library.usyd.edu.au/handle/2123/18850

Gerlach, A. J., Browne, A. J., & Greenwood, M. (2017). Engaging Indigenous families in a community?based Indigenous early childhood programme in B ritish C olumbia, C anada: A cultural safety perspective. Health & Social Care in the Community, 25(6), 1763-1773. Retrived on 17th June, 2021. Retrived from https://onlinelibrary.wiley.com/doi/abs/10.1111/hsc.12450

Green, M., Cunningham, J., Anderson, K., Griffiths, K., & Garvey, G. (2021). Measuring health care experiences that matter to Indigenous people in Australia with cancer: identifying critical gaps in existing tools. International journal for equity in health, 20(1), 1-10. Retrived on 18th June, 2021. Retrived from https://link.springer.com/article/10.1186/s12939-021-01433-2

Jennings, W., Bond, C., & Hill, P. S. (2018). The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal of Primary Health, 24(2), 109-115. Retrived on 17th June, 2021. Retrived from http://www.publish.csiro.au/PY/PY17082

Leung, L., & Min, J. (2020). Navigating allyship through Indigenization, decolonization, and reconciliation: Perspectives from non-Indigenous pharmacy educators. INNOVATIONS in Pharmacy, 11(1), 8-8. Retrived on 15th June, 2021. Retrived from https://pubs.lib.umn.edu/index.php/innovations/article/view/2300

Mason-Whitehead, E., McIntosh-Scott, A., Bryan, A., & Mason, T. (2008). Key Concepts in Nursing. SAGE Publications. Retrived on 18th June, 2021. Retrived from http://ebookcentral.proquest.com/lib/latrobe/detail.action?docID=635480

Panaretto, K. S., Wenitong, M., Button, S., & Ring, I. (2014 ). Aboriginal community controlled health services: leading the way in primary care. mja, 11. Retrived on 17th June, 2021. Retrived fromhttps://doi.org/doi: 10.5694/mja13.00005

Richards, M., Cruickshank, M., Cheng, A., Gandossi, S., Quoyle, C., Stuart, R., ... & Waters, M. J. (2017). Recommendations for the control of carbapenemase-producing Enterobacteriaceae (CPE): A guide for acute care health facilities: Australian Commission on Safety and Quality in Health Care. Infection, Disease & Health, 22(4), 159-186. Retrived on 16th June, 2021. Retrived from https://www.sciencedirect.com/science/article/pii/S2468045117301207

Rooddehghan, Z., ParsaYekta, Z., & Nasrabadi, A. N. (2019). Equity in nursing care: A grounded theory study. Nurs Ethics, 26(2), 598-610. Retrived on 18th June, 2021. Retrived from https://doi.org/10.1177/0969733017712079

Sherwood, J., & Mohamed, J. (2020). Racism a Social Determinant of Indigenous Health: Yarning About Cultural Safety and Cultural Competence Strategies to Improve Indigenous Health. In Cultural Competence and the Higher Education Sector (pp. 159-174).Springer, Singapore. Retrived on 17th June, 2021. Retrived from https://library.oapen.org/bitstream/handle/20.500.12657/39549/2020_Book_CulturalCompetenceAndTheHigher.pdf?sequence=1#page=164 Victorian Aboriginal Health Service (VAHS) (2021). vahs.org.au. Retrived on 18th June, 2021. Retrived from https://www.vahs.org.au/