It is a known fact that Aboriginal and Torres Straight Islander populations don’t live as long as their western counterparts as shown by AMA Health Report Card (2011). ‘Closing the Gap’ (Calma 2008) is a campaign aimed at a national attempt to support and bring equity in health to our Aboriginal and Torres Straight Islander communities. In order to be successful in this we must identify the key issues causing this inequity and through public awareness and government campaigns such as ‘closing the gap’, we become closer to our goal of Aboriginal and Torres Straight Islanders reaching a full and greater life expectancy.
Health reform initiatives are used to promote health care within their communities and encourage Aboriginal and Torres Straight Islanders to be educated about their own health. As a nurse, in order to assist in this process, an understanding of family centred health care and the Aboriginal and Torres Straight Islander concept of family must be utilized. With these two nursing skills, the local health initiatives and government campaign’s, we are providing the best opportunity and support for Aboriginal and Torres Straight Islander communities to take control of their health and ultimately ‘close the gap’.
Key issues contributing to the ‘gap’ in health and life expectancy, as identified by AMA (2011), include; low income, limited education, low levels of employment, poor housing, affordability of health care, geographical access to health care and the acceptability of the health care practice to Aboriginal and Torres Straight Islander communities. Illawarra Aboriginal Medical Service (2013) is a local health reform initiative for Aboriginals and Torres straight Islanders that provides a culturally secure environment where they can access health care due to it’s geographical location, affordability and mostly acceptability.
Illawarra Aboriginal Medical Service (IAMS 2013) has two centers within the Illawarra making it geographically accessible. The center is entirely aimed towards the better health of Aboriginals and Torres Straight Islanders, ensuring all health care is affordable and providing as much assistance and support where it may be needed to help these communities improve their health. The main key issue identified by AMA (2011) that is addressed within the IAMS (2013), is the acceptability.
The two medical centers are entirely based on the care given to the Aboriginal and Torres Straight Islander communities, making them specialized and aware of cultural beliefs, customs and the correct communication techniques. The Illawarra Aboriginal Medical Services also employ Aboriginal and Torres Straight Islander members of the community as their staff providing a culturally secure environment and a greater concept of family centred care and the Aboriginal and Torres Straight Islander concept of family within their approach.
The AMA (2011) states that Indigenous health workers are significant in facilitating the journey of Aboriginal and Torres Straight Islanders to better health. This also provides opportunities to the Indigenous communities to gain employment, contributing to the resolution for issues of low income and low levels of employment, as identified in the AMA Report Card (2011). Centers such as these provide Aboriginal and Torres Straight Islander families a culturally secure, accessible and affordable method to be treated for their health issues in a more comfortable surrounding.
On a larger scale the Department of Health and Ageing run by the Australian Government have many programs and health reform initiates in place to assist in ‘closing the gap’ as identified by Calma (2008). Element three of the Indigenous Early Childhood Development National Partnership Annual Report (2011) have a goal of increasing the provision of maternal and child health services of Indigenous children and their mothers. To achieve this, the Child and Maternal Health Services component of their program includes $90. 3million to be used for New Directions Mothers and Babies Services (Department of Health and Ageing 2011).
This initiative increases access for Indigenous mothers and their children to; antenatal and postnatal care, education and assistance with breastfeeding, nutrition and parenting, monitoring of immunization status and infections, health checks and referrals for Indigenous children before starting school and monitoring developmental milestones. This initiative provides Indigenous communities with access to health care that promotes better health in the new generation of Aboriginal and Torres Straight Islander Australians, designed to assist with ‘closing the gap’ by raising a new generation with fewer health issues.
With this, we are able to address key issues identified by AMA (2011). The main key issue addressed by this initiative is access. Consultations are held with Aboriginal Health Forums to assist in the identification of priority areas for child and maternal health services. In their annual report, the Department of health and Ageing (2011) state that this ensures that access is given those most in need considering, geographic location, affordability and acceptance. The second key issue identified in the AMA Aboriginal and Torres Straight Islander Health Report Card (2011) addressed by this initiative is education.
The funding provided builds a solid base for providing much needed education to mothers about their babies and already existing children. In order for a program such as this to be successful, health professionals allocated to educating Aboriginals and Torres Straight islanders must be equipped and prepared to deal with the problems faced by cultural barriers as well as being experienced in a family centred care approach (Taylor & Guerin 2010). Family centred nursing care is an important factor in the health outcome of any given patient (Bamm & Rosenbaum 2008).
They also claim that there is no exact definition of family, instead, the meaning of family and their level of involvement in care provided, is determined by the patient themselves. The core concepts of successful family centred care are; respect and dignity, information sharing, participation, and collaboration (IFPCC 2013). These principles are the main constituents of effective family centred health care, and ultimately better health outcomes for the patient themselves (Mitchell, Chaboyer & Foster 2007). These concepts can be utilized, with a correct nursing approach, regardless of age, gender or cultural differences.
To provide the best family centred care to Indigenous Australians, nurses must utilize the main concepts above, but also have an understanding of the Indigenous concept of family. The Aboriginal and Torres Straight Islander population have strong family values, however, it differs from the usual nuclear concept of family in common ‘western’ society. Their family has an extended structure, and in order to provide adequate family centred care, this concept must be understood by health professionals on all levels, including nurses (NSW Department of Community Services 2009).
This concept of extended family and their Indigenous ‘community’ as their family means that children are not only the concern of their biological parents, but the entire community. Care of the children in indigenous communities is the responsibility of everyone. Family members can be blood-related, through marriage or through their community, such as elders. It is normal for a combination of mothers, fathers, uncles, aunties, cousins, brothers, sisters or elders to be involved into the care of the individual and these figures must be treated as their direct family even if not directly blood-related (NSW Department of Community Servies 2009).
In order to provide family centred care, to not only Indigenous but also all patients, a therapeutic relationship and foundation of trust should be developed (Baas 2012). The principles of family centred care should also be incorporated, especially respect of the Indigenous culture and maintaining their dignity. Respect and dignity, combined with trust and a therapeutic relationship within the Indigenous community, information sharing, participation and collaboration should follow once enough trust has been developed.
To gain the trust of Aboriginal and Torres Straight Islander patient’s and their family, firstly an understanding of their culture should be pertained. When needed, to be aware of such customs as ‘Men’s and Women’s business’, and to respect these practices within your care (Tantiprasut and Crawford 2003). This shows the patient and their family members, you respect them and their culture. Introducing yourself in a friendly and polite manner, including all family members present and always respecting cultural values is key to receiving respect back and developing trust.
Acknowledge and actively listen to the needs of the Indigenous people and also their community in a culturally appropriate manner. As described in the practice resource for working with Indigenous communities published by DOCS (2009) showing respect for their elders and community leaders and involving them in important decision making processes will also show that you respect them, their culture and that they can trust you and eventually your advice regarding health issues.
In order to successfully be accepted by the community, communication techniques need to be specialized to avoid offending any members of the family or misinterpreting their language. Gaining a basic knowledge of their community will assist in understanding the dominant family groups, language groups and preferred names. This ensures you don’t step out of your boundaries and remain respectful in your approach to their care. Including or consulting with Aboriginal health care workers regarding communication and Aboriginal-English would be beneficial to adequately understand their method of communication.
Understanding non-verbal methods of communication and being aware of your own non-verbal communication is highly appropriate when consulting with Indigenous communities. Always speaking with respect, clearly, and avoiding jargon will deliver the best results when building a relationship within the tribes (NSW Department of Community Services 2009). Remaining open minded when consulting with Aboriginal and Torres Straight Islander communities in aspects of communication and family relations will avoid incorrect assumptions. It is also high important to play an active role within the community and their events.
According to NSW Department of Community Services (2009) within Indigenous communities’ word of mouth is a powerful tool, once an outsider is known as someone who listens actively and can be trusted, the community will be eager to work collaboratively and participate in your health approach (NSW Department of Community Services 2009). When the principles of family centred care; trust, dignity, collaboration and participation, have all been achieved and a therapeutic relationship within the community has developed, the community will listen to your health advice.
When introducing a health concept to the Aboriginal and Torres Straight Islander families it is important to engage them actively into your care (NSW Department of Community Services 2008). Using appropriate communication techniques to explain health issues and the reasons they need to be addressed provides them with education and knowledge regarding why interventions need to be implemented. Allowing them to discuss their options and decide as a community is also important, forcing them to uptake medical help could be seen as disrespectful.
Allowing time to answer all questions and concerns from various members of the family in a manner they can understand identifies that you are actively listening and honestly concerned for their health. Demaio and Dysdale 2012 show that continuity of involvement in their community, and providing a continuous support network will only further build their trust in your advice. The ‘gap’ in health and life expectancy between Indigenous Australians and ‘westernised’ Australians is a concerning issue within the country (Calma 2008).
Health reform initiatives are funded by the government and local organisations to provide accessible, affordable and culturally safe health care to our Aboriginal and Torres Straight Islander communities. These initiatives are designed to address the key issues identified in the AMA Report Card (2011) regarding barriers to health care. Approaching Aboriginal and Torres Straight Islander family communities utilizing the family health care principles and with a knowledge of their concept of community family and understanding of their culture increases positive outcomes in their health education and furthermore assisting to ‘close the gap’.
Courtney from Study Moose
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