• Subject Name : Nursing

Indigenous Population

The health care system has always been biased toward the indigenous population that has increased their risk to encounter different disorder due to lack of facilities. The tough history of the indigenous population has increased their vulnerability for the different disorder that is also increased by traditional lifestyle belief (Horrill et al., 2018). The health care professional is expected to improve the practice concerning the indigenous population by considering cultural, social and historical. There is a need to improve the equity in the healthcare that will help to improve the health care procedure for the indigenous population (Browne et al., 2016). Reflective practise is considered to be important skills in nursing practise as it helps the nurse to learn from their past experiences. Reflecting over the past practice helps the nurse to identify the gap in clinical practise that need to be addressed in future working practice (Helyer, 2015). The reflective is going to utilize the Gibbs reflective mode to present the three scenarios that are linked to the social determinant of health. The reflective essay will include historical, social and cultural factors that directly impact the health of the individual. 

One of the incidents that I want to reflect on is related to one of the clients who is 88-year-old, I recently helped to improve the mental wellbeing. The client was admitted to the emergency ward complaining about the anxiety issue that has increased his complication. I was the in-charge nurse at that time so went to attend him to identify the issue concerning the health status. When I was attending the patient I realised that he belong to different cultural background thus there is need to improve cultural competency in the care. During the conversation and evaluating his medical history was realised that he belongs to the stolen generation by his residential location that has directly negatively impacted the mental wellbeing of the patient. He explained that he is facing anxiety issue from past many years but now things are getting complicated thus he needs assistance. I tried to utilize my cultural competent communication in the care to improve his comfort and helped him to reduce his complication by consulting with the therapist.

This incident made me devastated as I was able to understand that the tragic historical and social aspect which directly impacted the mental wellbeing of the stolen generation. I was also surprised that the pain and suffering of the population were so much that it has deteriorated mental peace and increase the chances to encounter mental illness. The incident was very painful as I was able to evaluate the difficult situation that the stolen generation has faced that increased the vulnerability for the mental disorders. I was also happy that my cultural competent communication skills are helpful to assist the culturally different patient to improve the quality of care.

The study presented by George et al., (2019) describes that there are different social determinants that directly impacted over the adverse health issue that includes racism, the priority of strong cultural identity population, different cultural belief and different values. The incident helped me to understand the life experience of the suffering of the indigenous population and the impact of the difficult historical experience over their health wellbeing. I utilized my reflective skills to improve the care process by incorporating the cultural competency in the care that improved the patient.

The colonization has directly impacted the indigenous population’s lifestyle that has negatively impacted the mental as well as physical wellbeing. The dispossession is one of the major issues faced by the indigenous population that has directly impacted the mental wellbeing of the individual (Axelsson et al., 2016). The tragic colonisation has also led to the formation of the stolen generation that includes a population that is isolated from their families. The stolen generation and the family have faced serious damage as they are forcefully isolated from the family that lead to mental issues (The Lancet Public Health, 2018). 

The incident has helped me to realise that cultural competency is important in the care process to improve the equity that will help to reduce the disparity in the health care sector concerning the Indigenous population. In future practice, I will try to improve the cultural competency that will help me to assist the patient concerning the cultural background. The study presented by Handtke et al., (2019) discussed that due to the increase of cultural aspect in the population with different linguistic health care system need to improve the cultural competency. The health care professionals are expected to provide the care concerning the client preferences.

Another incident that is directly related to the social-political aspect increased the complications for the indigenous population. The incident was related to one of the patients I attended and he was complaining of fatigue, increased urination and increased diet. After the assessment, it was revealed that patient is suffering from diabetes that needs to be urgently addressed. While explaining the situation to the patient, I realised that he was not able to understand the disorder and precaution he has to take in daily routine. Then utilized my therapeutic communication skills to help the patient to understand what are some risk factor that he needs to avoid and how can he improve his lifestyle to reduce complication associated with diabetes. I discussed this incident with one of the colleagues belong to different cultural background and she explained that Indigenous population has been associated with low social and political power that directly impacted over the educational background of the generation.

The incident was indeed a learning experience that due to decrease authority and power Indigenous population has been also deprived of the basic education that is important to sustain life. I was sad after realising the feeling of the patient when he was not able to understand about his health status and related precautions. I was splintered after realising that due to the colonization the non-indigenous population have allotted all the power and authority that decreases the social and political power of the Indigenous population.

The colonisation not only increased the risk for the healthcare-related disparity that increase complication for the patient but it has also increase the chances of social injustice that lead to poor education of the Indigenous population. The forced reallocation and decrease political power has increased the vulnerability of the Indigenous population to be deprived of the education (Griffiths et al., 2016). The incident was an eye-opener concerning the social and political injustice faced by the Indigenous population that lead to decrease excess toward education. The incident was helpful to understand the importance of the rapport with the client to help them by providing the best assistance concerning the health status. 

After the incident, I was aware of the inequality in the different sectors that directly lead to the decrease position of the Indigenous population (Lee, 2017). The colonisation can lead to the unequal distribution of the power, land, wealth, income and status. The policies are also framed being biased toward the non-indigenous population that increase the inequalities in every sector. Deprivation from the education has directly decreased the understanding of the Indigenous population and this directly leads to health care-related disparity (Waterworth et al., 2015). Therapeutic communication is considered to be important while assisting the low health literacy patient so that communication can be improved to improve patient understanding. Therapeutic communications help the health care professional to improve the rapport with the patient that is necessary to help the patient to understand concerning the disorder and related aspect (Amoah et al., 2019). I will try to improve my therapeutic communication in future practice that can be utilized to improve patient knowledge concerning health status. Therapeutic communication will help me to connect with the patient that is necessary for quality care.

The increasing diversity of the population increases the different cultural practise and values that are followed by the population. The reflection is about one of the incidents that help me to understand the importance of cultural factors for the indigenous population. When I was instructed to help a patient in the department facing issue with breathing and she was very comfortable concerning the ward environment. She was not comfortable with the ward environment due to her bad health care experience that has increased his stress concerning health care services. After the patient medical history evaluation and patient assessment, it was revealed that she has encountered with exacerbation of asthma that needs urgent attention. Then I was immediately instructed to provide the patient with albuterol to assist the patient in the need but when I visited the patient to administer the medication she denied. After having a conversation with the patient I realised that due to different cultural values and practise she is refusing the medication. Then I discussed with the client to understand her choices so that patient-centric care can be delivered to the patient by increasing patient participation.

The incident was depressing because I can feel the stress and issue the patient is feeling due to the discrimination of the health care services due to her different cultural belief and values. The incident helped me to understand that health care professionals are expected to maintain the equity in the care as they act directly impact the mental, emotional as well as physical wellbeing of the patient. I was also amazed at how I was able to handle the situation by utilizing my interpersonal skills that are important to provide patient-centric care.

Indigenous population have their different cultural identity concerning their cultural belief and values that are important to maintain the cultural competency. The disparity in health care also generated due to the different cultural values thus they experience irrelevant behaviour of the healthcare workforce (Shepherd et al., 2017). This incident was important for my clinical practise as it is important to improve the health care service that is culturally sensitive. The incident has helped me to understand that different cultural values and belief of the patient should be respected and care should be following the patient preferences.

The difference in the cultural belief and values increase the chances of discrimination faced by the Indigenous population in health care. The poor behaviour of the health care professionals directly impacts the mental and emotional wellbeing of the patient. Discrimination leads to the inequality of the resources that are necessary to assist the patient (Wylie & McConkey, 2018). Person-centred care is considered to be important to deliver quality care to the patient concerning the patient perspective. The patient participation in the care helps the care process to be more personalised that directly help to decrease the recovery time of the patient (Santana et al., 2018).

The essay has helped to understand the different factor that has a direct impact over the disparity in the health care sector concerning the Indigenous population. The indigenous population has faced disparity in every section due to lack of power and participation in the decision-making process. The historical factors that lead to health care issue to the Indigenous population are the effect of colonization lead to a stolen generation that is facing the mental issue. Cultural competency is important to improve the health care service concerning the Indigenous population the social and political factors that directly increase the chances of health care issue for the indigenous population is lack of power that lead to lack of education. The decrease in health literacy is one of the serious issues as due to this patient face issue while understanding the disorder and related aspect. Therapeutic communication can help the nurse to improve the rapport with the patient that is important to improve their understanding. The third cultural factor that directly impacts the Health-related issue concerning the Indigenous population is different of cultural belief and values that lead to the disparity in the services. The person-centred approach helps health care professionals to improve patient participation in the care that is important to improve the quality of care.

References for Cultural Proficiency Framework

Amoah, V. M. K., Anokye, R., Boakye, D. S., Acheampong, E., Budu-Ainooson, A., Okyere, E., & Afriyie, J. O. (2019). A qualitative assessment of perceived barriers to effective therapeutic communication among nurses and patients. BMC Nursing, 18(4), 1-8. DOI:10.1186/s12912-019-0328-0 

Axelsson, P., Kukutai, T., & Kippen, R. (2016). The field of Indigenous health and the role of colonisation and history. Journal of Population Research, 33(1), 1–7. DOI: 10.1007/s12546-016-9163-2.

Browne, A. J., Varcoe, C., Lavoie, J., Smye, V., Wong, S. T., Krause, M., & Fridkin, A. (2016). Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study. BMC Health Services Research, 16(544), 1-17. DOI: 10.1186/s12913-016-1707-9 

George, E., Mackean, T., Baum, F., & Fisher, M. (2019). Social determinants of Indigenous health and indigenous rights in policy: A scoping review and analysis of problem representation. International Indigenous Policy Journal, 10, 1-25. DOI: 10.18584/iipj.2019.10.2.4.

Griffiths, K., Coleman, C., Lee, V., & Madden, R. (2016). How colonisation determines social justice and Indigenous health—a review of the literature. Journal of Population Research, 33(1), 9–30. DOI: 10.1007/s12546-016-9164-1

Handtke, O., Schilgen, B., & Mösko, M. (2019). Culturally competent healthcare – A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision. PLOS ONE, 14(7), e0219971. DOI:10.1371/journal.pone.0219971 

Helyer, R. (2015). Learning through reflection: The critical role of reflection in work-based learning (WBL). Journal of Work-Applied Management, 7(1), 15–27. DOI: 10.1108/jwam-10-2015-003 

Horrill, T., McMillan, D. E., Schultz, A., & Thompson, G. (2018). Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives. Nursing Inquiry25(3), 1-9. DOI: 10.1111/nin.12237

Lee, V. S. (2017). Political determinants and Aboriginal and Torres Strait Islander women: Don’t leave your integrity at the political gate. Journal of Public Health Policy, 38(3), 387–393. DOI: 10.1057/s41271-017-0075-y 

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person-centred care: A conceptual framework. Health expectations: An International Journal of Public Participation in Health Care and Health Policy21(2), 429–440. DOI: 10.1111/hex.12640

Shepherd, S. M., Delgado, R. H., Sherwood, J., & Paradies, Y. (2017). The impact of indigenous cultural identity and cultural engagement on violent offending. BMC Public Health18(1), 50. DOI: 10.1186/s12889-017-4603-2

Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019). The challenge of cultural competence in the workplace: Perspectives of healthcare providers. BMC Health Services Research, 19(135), 1-11. DOI: 10.1186/s12913-019-3959-7 

The Lancet Public Health. (2018). Australia’s Stolen Generations: sorry is not enough. The Lancet Public Health, 3(9), e407. DOI: 10.1016/s2468-2667(18)30165-8 

Waterworth, P., Pescud, M., Braham, R., Dimmock, J., & Rosenberg, M. (2015). Factors influencing the health behaviour of Indigenous Australians: Perspectives from support people. PloS One10(11), 1-17. DOI: 10.1371/journal.pone.0142323

Wylie, L., & McConkey, S. (2018). Insiders’ insight: Dscrimination against indigenous peoples through the eyes of health care professionals. Journal of Racial and Ethnic Health Disparities. DOI: 10.1007/s40615-018-0495-9

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