Australian Healthcare System

Question One

Part A: Culturally unsafe practices in the case scenario include an inappropriate power differential, lack of sharing, and failure to ethnocultural recognition. Cultural safety is the power differential framework where healthcare providers reflect on the power differences between patients and themselves, to facilitate the appropriate healthcare for all, including indigenous people (Curtis et al., 2019).  In the case scenario, there is an inappropriate power distribution between the nurse and the Aboriginal mother, which is a culturally unsafe practice. Firstly, the nurse quarrels with the patient in public. Secondly, she asserts that the patient must have an excuse for all missed appointments and lateness. Lastly, she prejudices that the patient is ignorant of the appointments by asking, “Don’t you know how busy we are?”

In culturally safe healthcare practice, power shifts such that the patient has an ultimate say in their healthcare process. According to Yeung (2016), the patient-practitioner relationship is based on the knowledge of the patient’s holistic conditions, which makes them powerful contributors to their treatment. In that case, it is culturally unsafe for the nurse to quarrel with the patient.

Yeung explains that culturally safe practice is based on sharing (2016). Nevertheless, the nurse questions the patient’s efforts to attend the appointments in a crowded place, which is a lack of respect. Lastly, a culturally safe practice recognizes re cultural factors that affect patients. However, the nurse seems to misunderstand the hustle experienced by the Aboriginal mother to come for the appointment. The nurse is not aware or does not consider that the patient comes from a remote area and that she does not have sufficient healthcare funds. According to Yeung, a culturally safe practice recognizes and appreciates the cultural identity of patients (2016). Therefore, it is culturally unsafe for the nurse to quarrel and disrespect the patient, doubt her commitment, and overlook her cultural implications.

Part B: The nurse may improve their communication skills by respecting the situations of the patient, respecting their choices in a less provocative method. That is, an ethically respectful communicator is self-aware of the implications of colonialism, racism, and discrimination (Schill & Caxaj, 2019). Therefore, the nurse may develop skills to address patients in an ethnically respectful manner, making sure not to provoke their cultural situations such as colour or poverty level.

Understanding the ethnic affiliation of a patient helps the practitioner to reflect on the possibilities that make patents behave in a particular manner. That way, the nurse may talk to Aboriginal patients politely, since their situation incapacitates them from attending the appointment regularly. Besides, the nurse ought to address patients as individuals in a private room to foster respect (Dickert & Kass, 2009). Hence, patients are positioned better to explain their situations, for culturally competent healthcare. Besides, the patient has the foreground power differential, and their choices ought to be respected (Curtis et al., 2019). Lastly, nurses have a duty to serve patients as they are, to improve their health conditions (Whyte, 2012). Hence, the nurse should learn to communicate professionally, without blaming or provocation to the patients.

Question Two

The Aboriginal and the Torres Strait Islander people are likely to fear or avoidance of mainstream health services in Australia due to culturally unsafe practices and government policies. Concerning culturally unsafe practices, a study studies have found that many Aboriginals are discriminated against due to race, language, level of education, and cultural beliefs (Aspin, Brown, Jowsey, Yen & Leeder, 2012). The discrimination is predominantly the aftermath of colonization policies that alienated the Aboriginal and the Torres Strait Islander people from the white society (Waterworth, Pescud, Braham, Dimmock & Rosenberg, 2015). Also, some legislatures such as the Aborigines Protection Amending Act 1915 (1915 – 1969) and the Aborigines Act 1905 (1906 – 1964) have adversely impacted access to mainstream healthcare by indigenous people. The acts restricted the indigenous people from accessing education, some healthcare services, socialization, and forceful alienated children from parents into a work system. Some aftermath of the restrictions is social inequality, ethnic mistrust, and racism in the mainstream healthcare sector, which is populated with whites (Smith, 2004). Notably, the three aftermaths are culturally Insafe situations, which cause avoidance of the mainstream health service.

Government policies such as the Aborigines Protection Amending Act 1915 (1915 – 1969) and the Aborigines Act 1905 (1906 – 1964) have adversely impacted access to mainstream healthcare by indigenous people.

Besides, the alienation policies created an ill educational foundation for the Aboriginal and the Torres Strait Islander people. Until the year 2000, the education for the indigenous people in Australia was not a government priority (Ministerial Council on Education, Employment, Training and Youth Affairs, 2000). According to reports from the office of the prime minister and the cabinet, the rate of attendance to school for indigenous students has increased in recent years though it is still low compared to attendance for non-indigenous students (Australian Government, 2018). Therefore, the former generations of indigenous people do not have adequate literacy to communicate with practitioners in the mainstream healthcare sector, which is among the factors that aggravate discrimination (Aspin, Brown, Jowsey, Yen & Leeder, 2012). That is, colonial alienation led to illiteracy that has caused discrimination.

Lastly, there is adequate government support for traditional medicine. Both traditional and mainstream healthcare is integrated into the Aboriginal Medical Service (Oliver, 2013). According to Baba, Brolan & Hill (2014), the mainstream healthcare system in Australia has many inherent barriers for Aboriginal s and the Torres Strait Islander, but the AMS serves as the culturally appropriate alternative to the mainstream healthcare system. A study has found that the Aboriginal s are most likely to seek AMS services than the mainstream healthcare services since they feel more culturally appreciated in the former than the later (Baba, Brolan & Hill, 2014). Hence, indigenous people prefer AMS to mainstream health services.

Question Three

The essential components of culturally safe, accessible, and acceptable primary health services (PHS) for Aboriginal and Torres Strait Islander Peoples include cultural appropriateness, community participation, accessibility, holistic care, affordability, and culture. In a study, culture was found to play a central role in PHS for indigenous people (Harfield et al., 2018). Such a system appreciates patients’ cultural practices, values, customs, and belief systems (Benoit, Carroll & Chaudhry, 2003). In that, the PHS appreciates the community involvement in healthcare delivery, foregrounding the inclusion of all community members into their healthcare service delivery. Besides, the PHS must build trust with the community. One way to achieve that is by the hiring of competent healthcare Aboriginal practitioners. That way, the Aboriginal practitioners understand the concerns of the indigenous people better and are likely to implement the PHS effectively over the AMS framework.

The PHS adopts the philosophies of AMS, where culturally appropriate healthcare issues are addressed by a skilled workforce (Harfield et al., 2018). Besides, in Aboriginal Medical Primary Healthcare System, cultural appropriateness such as ensuring equity in healthcare provision, social justice, and cultural respect (Murphy & Best, 2012). Hence, more Aboriginal patients are likely to seek PHS. In addition, an accessible PHS is affordable. According to the NACCHO report, primary healthcare is critical since it is a preventive strategy against man communicable and non-communicable diseases. The accessibility of primary healthcare is affected by the cost incurred by a patient in the PHS. High costs are likely to discourage patients from seeking services, hence inaccessible, and vice versa. Besides, the geolocation of healthcare facilities should be accessible (Yeung, 2016). That is, a comprehensive PHS is based on an extensive network of healthcare facilities, which are readily accessible by patients. For instance, they reduce the cost of access through transport (Harfield, McArthur, Munn & Brown, 2016). Hence, a culturally acceptable, accessible, and acceptable is affordable, accessible, culturally appropriate, allows community participation, holistic care, and honours a patient’s culture.

References

Aspin, C., Brown, N., Jowsey, T., Yen, L., & Leeder, S. (2012). Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC Health Services Research, 12(1). doi: 10.1186/1472-6963-12-143

Baba, J., Brolan, C., & Hill, P. (2014). Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities. International Journal For Equity In Health, 13(1), 56. doi: 10.1186/1475-9276-13-56

Benoit, C., Carroll, D., & Chaudhry, M. (2003). In search of a Healing Place: Aboriginal women in Vancouver’s Downtown Eastside. Social Science & Medicine, 56(4), 821-833. doi: 10.1016/s0277-9536(02)00081-3

Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal For Equity In Health, 18(1). doi: 10.1186/s12939-019-1082-3