Analytical paper on the health issues of the Aboriginal people - Nursing Assessment Answers

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The analytical paper builds on your work during the semester where you have reflected on and explored health issues that are faced by Aboriginal and Torres Strait Islander people within our society and our health systems. You have also been given multiple readings throughout this course that use a patient journey mapping style developed through the Managing Two Worlds Together (MTWT) project. These readings and case study examples will help guide you as you write your analytical paper. You are required to identify a person of Aboriginal and/or Torres Strait Islander origin during one of your placements over the semester and map and analyse their patient journey using the following templates in the MTWT workbook (create your own tables in a Word doc rather than using the PDF)

1. A narrative account of the journey (telling the story)
2. Dimensions of health table
3. Underlying factors table
4. Multiple perspectives in chronological mapping table

In addition, please

1. Summarise the important aspects for this patient, discuss any issues that arose for this patient and how you could respond to them. Task 2.8 and 2.9 may assist with this.
2. Identify five things that you could consider or initiate as a part of your nursing practice to improve care for Aboriginal and Torres Strait Islander people from urban, rural and remote settings. Task 3.2 may assist with this.
3. Include an Introduction and Conclusion to complete your assignment.

Introduction

The Aboriginal and the Torres Islanders are the native inhabitants of Australia. However, they are a marginalized community who lacks basic necessity, such as access to formal education and healthcare services. This makes them an underprivileged population in the country. Research has shown that kidney failure and renal problems are a frequent phenomenon among the Aboriginals in the age bracket of 40-60 years (Lim, Johnson, & Mcdonald, 2005). The high rates of kidney or renal problems among this age bracket are complex and it is associated with many factors such as obesity and higher rates of diabetes; premature births among the Aboriginals; increased vulnerability to damage of the kidneys; high blood pressure; constant infections; poor access to good and quality food as well as limited education and substandard housing. Therefore, renal disease or kidney failure is a condition born of dispossession and poverty. Statistics has established that the chances of an Aboriginal person succumbing to the condition are more than 17 times that of persons of non-Aboriginal tribe (Hoy, 2014). The situation is compounded by the fact that the Aboriginal are also prone to certain conditions like heart disease and diabetes. These two, together with renal disease has resulted in early deaths, especially for the Aboriginal adults. This led to several studies being conducted among the native Aboriginals to determine the risk factors and possible address them (Hoy, 2014). The studies are not yet conclusive, but there is sufficient information that gives clues as to why renal disease is a common phenomenon among this native Australians. This paper seeks to give an analytical perspective of an Aboriginal patient who has been diagnosed with renal condition with emphasis on health issues among the larger Aboriginal community. It gives a detailed narrative account of the journey of the patient in relation to health dimensions, underlying factors, and multiple perspective in a chronological order.

Telling a story

The story is about James, a patient who had renal condition (www.creativespirits.info) James is an Aboriginal who had a life that is more or less varied. He started as a patrolman in his native state, but eventually took up a job as a primary school teacher within the government of Australia education system. He changed his career from patrolman to teaching when he started having problems with his physical health. About a year ago, James noticed that he was getting tired all the time, despite having done no serious work during the day. Initially, he was diagnosed with diabetes some years back and he was on continuous medication of insulin injection (Collier, 2013). In fact, in recent months he started using an insulin pump. However, the feeling of tiredness was a new phenomenon. When this feeling started occurring, James attributed it to the demanding nature of his job. The feeling persisted and James sought a physician’s advice. Immediately after observing James, the physician sent him for laboratory investigations and tests at a local health care facility. James was later admitted to the healthcare facility for what he described as endoscopy investigation since the physician had the feeling that James was suffering from intestinal problems. Tests were conducted and as it later emerged, the standard blood tests revealed that James had high levels of calcium. Eventually James was informed that he had Acute kidney problem/ failure. The test results showed that the immune system of James had started attacking his kidneys rather than fight body infection. The process was described as autoimmunity. It is a common trigger of renal disease. The nurse counselled James. In addition, James got emotional support from family members and the community. At the local hospital most of the employees were of the Aboriginal tribe and the patient felt as being part and parcel of the hospital community with the belief that his social well-being properly catered for. However, as time progressed, James developed a complex renal condition that could not be properly treated at the local hospital due lack of modern treatment facilities. He was transferred to the City hospital. At the city hospital, James felt that the cultural, personal and spiritual considerations would not be properly addressed by the medical staff who mostly hail from the different tribe as the patient. Most of the caregivers were foreigners to the culture of the Aboriginals. Moreover, the proximity of the city hospital would make it difficult for the entire community and the immediate family members of the patient to fully commit to the social welfare of one of their own. The family requested that he be transferred back to the local hospital. At the local hospital, the cultural, personal and spiritual considerations were addressed by the medical staff who mostly hail from the same Aboriginal tribe as the patient. The patient was comfortable with the hospital environment, got support from the local community, reduced travel costs to the hospital, and the patient was near family members. Since James had low income and therefore limited financial resources, city hospital was unsuitable for him (Samuel, et al., 2012). This is because James had limited financial resources to meet costs such as treatment, medications, transportation and health care. It is worth to note that at the local hospital, there was an ease of communication between the health care workers since they were mainly Aboriginals and spoke the same language. James continued with Renal medication and after sometimes, he was discharged from the hospital and only checked in twice a week for medical follow-ups. The patient resumed normal duties of fending for the family. He went back to his former school where he continued with teaching. Table 1: Dimensions of health table (Kelly, et al., 2015) p.g 29

Health Dimensions	Situations
	Local community	Regional/ city hospital
Emotional and social well-being	The patient got emotional support from family members and the community. At the local hospital most of the employees were of the Aboriginal tribe and the patient felt as being part and parcel of the hospital community with the belief that his social well-being properly catered for.	The patient felt that he was unlikely to get emotional support of the city hospital for the family would be unable to travel to the city hospital frequently because of the high cost of travel. The aspect of social well-being would also be missing since the patient felt that he would be in a foreign environment.
Community and family commitments	The entire community and the immediate family members of the patient were committed in checking the welfare of the patient.	The proximity of the city hospital would make it difficult for the entire community and the immediate family members of the patient to fully commit to the social welfare of one of their own.
Personal, cultural and spiritual considerations	At the local hospital, the cultural, personal and spiritual considerations were addressed by the medical staff who mostly hail from the same Aboriginal tribe as the patient.	At the city hospital, the cultural, personal and spiritual considerations would not be properly addressed by the medical staff who mostly hail from the different tribe as the patient. Most of the caregivers were foreigners to the culture of the Aboriginals.
Biological and physical considerations	Biological and physical considerations did not seem to take a center stage at the local hospital.	Due to high levels of well-trained medical personnel, biological and physical considerations would be given priority as an integral part of healthcare service delivery.

Table 2: Underlying factors table (Kelly, et al., 2015) p.g 33

Underlying factors
			Rural and remote/urban Environmental considerations, support networks, travel to hospital and proximity of the family	The patient was comfortable with the hospital environment, got support from the local community, reduced travel costs to the hospital, and the patient was near family members	The patient was uncomfortable with the city hospital environment, there was a lack of support from the local community, there was increased travel costs, and the patient was to be far from the family members
Impact of injury or illness Complex or chronic conditions, being moderately injured or acutely ill	The patient had a complex renal condition that could not be properly treated at the local hospital due lack of modern treatment facilities	The city hospital had modern facilities for the treatment of the complex renal condition
Communication and language Difficulty or ease of communication between staff and patients; access to dentures, interpreters and hearing devices	There was ease of communication in the local hospital for the health care employees at the facility were Aboriginals and spoke the same language. However, there was limited access to dentures, interpreters and hearing devices	There was difficulty in communication in the city hospital since the health care employees at the facility were from different tribes and spoke the different language. However, there was unlimited access to dentures, interpreters and hearing devices
Financial resources and earnings Ability to meet costs such as treatment, medications, transportation and health care. Caring duties and inability to work	The Aboriginal patient had low income and therefore limited financial resources. Consequently the ability to meet costs such as treatment, medications, transportation and health care was limited. However, the patient’s local community took over the responsibility of caring duties for the patient would not work anymore. After sometimes, the patient was discharged from the hospital and only checked in twice a week for medical follow-ups. The patient resumed normal duties of fending for the family	Since the Aboriginal patient had low income and therefore limited financial resources, city hospital was unsuitable for him. This is because the patient lacks the financial resources to meet costs such as treatment, medications, transportation and health care. In addition, the local community was unable to travel to the city to provide care services to the patient. Moreover, the patient would not be able to work completely. He remained in hospital until he got completely well again.
Cultural safety Aboriginal and Torres Islanders experience within a healthcare system (Shah & Reeves, 2012)	Since the healthcare staff at the local hospital were mostly Aboriginals, the patient felt that his cultural safety was well protected and would connect easily with the caregivers since he felt that his cultural safety was well protected as well as valued.	The healthcare staff at the city hospital were mostly non-Aboriginals. Therefore, the patient had the feeling that his cultural safety would be at threat and unprotected. In addition, the patient was of the view that he might not connect well with the foreign medical staff.

Table 3: Multiple perspectives to chronological mapping (Kelly, et al., 2015) p.g 35

Perspective	History of patient	Referral/ diagnosis	Travel	In healthcare/ hospital	Transfer/ discharge	Follow-up	Comments
Patient’s journey	Age of the patient is 57years. The patient has been diabetic for 10 years (www.creativespirits.info).	Diagnosed with chronic kidney disease in the year 2015	He had to travel all the way to Sydney renal unit for laboratory test from Melbourne	Sydney Renal Unit	Transferred to Cape Hospital and Health services	The renal specialist at Sydney Renal Unit would call the caregivers at Cape Hospital and Health services to make follow-ups of the patient progress (www.creativespirits.info).	This was a convenient and perfect arrangement
Patient’s commitment, priorities and concerns	The patient adhered to the routine medication of diabetes (Dunning, 2013)	He was diagnosed with diabetes in a local private clinic	He has not travelled to any hospital, but has been taking his regular medication from the local private clinic	Private clinic in central Australia	Never been transferred to any hospital for diabetic related illness	Follow-up has been routinely conducted by the Private clinic in central Australia.	Further consultation should be done on any other diabetes-related illness
Timeline	Diagnosed with diabetes in 2005	Diagnosed with renal disease in 2015	Travelled for 6 months to Sydney for a laboratory check-up and treatment of and renal disease in 2015	Hospitalized for 3 months at the Sydney Renal Unit	Transferred to Cape Hospital and Health services in August 2015 and has been receiving treatment from the hospital since then.	The kidney specialist at Sydney Renal Unit make visits to Cape Hospital and Health services after every 2 months	The kidney Specialist should visit the patient on a monthly basis
Career/ family journey	The patient is a patrolman and involved in monitoring illegal activities at the Northwestern Australia. He is married with two children	No other family member that has been diagnosed with renal condition	The family rarely travels from the ancestral land. They prefer going to the forest for purposes of hunting wild animals and gathering fruits.	No other family member who has been admitted into a health facility	Not applicable	Not applicable	The family members should go for medical checkups to find out their health status and if the renal disease is inherited
Services/ healthcare priorities	The family prefers taking concoctions and herbal medicine for therapy	No herbalist has diagnosed renal condition among the family members	The patient his family normally travels to the forest to seek healthcare services from the medicine man	No other family member who has been admitted into a health facility	Not applicable	The medicine man occasionally makes visit to check on the patient	More focus should be put on conventional medication
Another specific aspect	The patient and the family consume a lot of sugary foods	This may have triggered the diabetic condition in the patient	They should travel to local healthcare facilities to get advice on nutrition and dieting.	Not applicable	Not applicable	The caregivers at the local hospitals should follow-up on the way the patient consumes food at home	Nutritional training would be appropriate for the patient and the family
Services/ healthcare gaps	Only one small dispensary available in the locality	Specialized medical equipment still lacking	Poor accessibility of the forested areas due to poor road networks	Not applicable	Fatal renal conditions should be referred to the city for specialized health care	Renal specialist to make a follow-up on their patients’ well-being and response to medication	This will ensure that healthcare services are accessible to everyone
Responses to the gaps	At least two other modern healthcare facilities should be constructed in the area	Medical equipment for renal, cardiac, cancer and other ailments should be fixed at the local hospital	Tarmac roads should be constructed to reach out to the Aboriginal community living in the forest	Not applicable	Awareness campaign among the Aboriginal should be conducted on the importance of specialized treatment	The patients should be enlightened on the importance of cooperating with the caregivers. They should also not miss the appointments with the physicians	This will ensure that healthcare services are accessible to everyone

Summary of the important aspects of the patient Based on my analysis, the important aspect of this patient I came to unearth is that the patient had been already ill with other conditions such as diabetes and high blood pressure which compounded the chronic kidney disease that was diagnosed in the year 2015. My response to this scenario was for the patient to go for further medical check-up to make sure that there is no other hidden condition that he may be oblivious of. Secondly, the patient was so attached to the customs and values of the Aboriginal tribe and would not wish to be attended by non-aboriginal health professionals (Samuel, et al., 2012). To me this was certainly absurd since it is the medication or drug that can make the patient get well but not the individual caregiver. Thirdly is the aspect of communication. The patient being a typical Aboriginals prefers being attended by healthcare workers who understand the language better and can fluently communicate with using the language (Collier, 2013). I find this being weird if not challenging. This is because in medical school there are official languages such as English, German, Chinese or any other that is used to train the healthcare worker but not the local dialect. In addition, the language does not give therapy by the individual healthcare professional is the one who does that (Douglas, 2013). Therefore, the patient and the entire Aboriginal community should accept non-aboriginal caregivers and also allow them to conduct their duties with interference (Truasheim, 2014). It is worth to note that the Aboriginals prefer care services of medicine men other than the conventional medicine (Clucas, et al., 2015). In my case I realize this patient also prefer taking concoctions and herbs rather than taking conventional drugs. To me, I perceive this habit of using herbs and concoctions as totally outdated unless the patient is fully aware of the chemical formulae of these herbs. The implication is that such concoctions’ and herbs should go through thorough laboratory analysis and quality checks to determine their effectiveness to treat ailments (Brown, et al., 2015). The possibility of preferring herbal medicine may be associated with the lack of well-equipped health care facility that is present in the region, resulting into the Aboriginals seeking the services of the medicine man in the forest (Davis, et al., 2012). Finally, I realized that the patient religiously adhered to medication as directed. This was a positive step toward recovery. Notably, he confessed to me that the way he adhered to taking conventional drugs is the same way he would have adhered to taking herbal medicine (Clarke & Boyle, 2014). I don’t know if the herbal medicine would work in a renal condition, but what I know is that the conventional drugs have been tested and proven to work. This to me was really awesome and quite encouraging to me as a nursing professional. As far as I know most patients with renal conditions tend to default medication.

Identify five things

Personal The two things I would consider as part of my nursing practice in order to improve health care for for the aboriginal people from rural, urban and remote areas may include scripting and hourly round (NRHA, 2005). Scripting will ensure that my communication with the aboriginal patient is made easier. It will involve having a regular training and discussion with the patient so that the patient will know what to expect from me as a nurse and what I expect from her/him as a patient. For example, as required by the hospital management, I will identify and introduce myself to a new patient in relation to my professional credential as well as giving an elaborate explanation of the treatment regimen. Scripting is a way of handling issues like lost results and delayed procedures. As a nurse, it will assist me in handling challenging and difficult circumstances like managing angry Aboriginal patients. Secondly, I will be making hourly rounds to ensure that patients admitted at the hospital are satisfied. Usually Aboriginal patients as well as any other patient feel better and excited when they expect someone to be checking on them or visit them on an hourly basis. If I will be committed, I will request my nursing assistant or my fellow colleague to step in for me. This will ensure that the patients are attended to all the time and their joy and happiness is maintained. It is therapeutic when a patient feels happy and it marks the first step in the journey to recovery. Patients are likely to behave positively and accommodating. This positive response will give me an opportunity of offering quality nursing services without any hindrance. The likelihood of luring other Aboriginal patients with renal conditions for health care services shall improve because of this personal contact on an hourly basis with the patient. Professional One thing I would consider as part of my nursing practice in order to improve health care for for the aboriginal people from rural, urban and remote areas is patient education. I will create time for educating the Aboriginal patient. Mine is a noble profession and I believe that am pulled in a thousand and one different ways, making me be obligated to give patient education concerning their conditions as well as health status. It would be imperative for me to give detailed information about the illness and hour to manage it (NRHA, 2005). Moreover, the time that a nurse spend with the patient means a lot to them. Usually, the patient is overwhelmed and sometimes feel intimidated to take in information given to them by the physicians or doctors during a post - procedure or initial diagnosis. Therefore, the patients will always look up to a nurse for translation or easy understanding of the complicated news. Service One thing I would consider as part of my nursing practice in order to improve health care for for the aboriginal people from rural, urban and remote areas in terms of service is demonstrating caring. Nurses are the most trusted professionals globally, according to Gallup polls. It is a well known fact that patients relate well to the nurses since the physicians and the doctors are a little intimidating to normal ordinary patients. It is worth to note that when patients feel that they are genuinely cared for, there is customer satisfaction and the recovery process proceeds on very smoothly. Usually many nurses have the instincts demonstrating caring for all patients without any discrimination. Being a professional nurse, I have developed this culture of demonstrating culture that I will definitely use in my service to the marginalized Aboriginal patients. This I will do by sitting down the patients, bringing an extra blanket to a patient or holding their hands when they need support. Systems Level One thing I would consider as part of my nursing practice in order to improve health care for for the aboriginal people from rural, urban and remote areas in terms of system level is being involved in the Nurse-led initiatives. As a senior nurse in an administrative position, I will engage my junior nurses working under me in all programs intended to improve service delivery. Usually at community level, the programs driven and managed by nurses get maximum support from the locals (NRHA, 2005). In addition, nurses are likely to engage more in such programs to ensure patient satisfaction. The nurses will come up with new ideas that is likely to improve on the health care system. The nurses will also be accountable for failure or success of such nurse-driven initiatives. As a nurse, I will feel more empowered with autonomy over my nursing practice that will significantly improve quality of service delivery. As a senior nurse, I will empower the staffing committee of the nose to make key decisions on patient safety.

Conclusion

In terms of health dimension, the patient got emotional support from family members and the community. This was a little bit easier because the patient was referred back to the local hospital where his family and friends would visit him regularly. In relation to the underlying factors, the local hospital even though located in a remote area was able to provide the patient with a comfortable hospital environment where he got support from the local community and family members as well as reduced travel costs to the hospital. The analysis of multiple perspective in chronological order shows that the patient was 57 years of age and therefore susceptible renal condition, especially if he was not working out and taking junk food. It is worth to note that the patient’s family had no history of the disease and therefore the possibility of having inherited the condition from the parents is totally out of the question. Of significance is the preference of the patient to use herbal medicine for treatment rather than conventional medicine. However, in this case study the patient stuck to conventional medicine. The five key things that I will consider as part of my nursing practice in order to improve health care for for the aboriginal people from rural, urban and remote areas can be classified under broad categories like personal, professional, service and system levels as discussed in this paper.