1NURSING STEP 1 (500 words) a)Aboriginals and Torres Strait Islanders long-since faced discrimination in the country, and the racial disparity has been said to account for the differences in healthcare between the Aboriginals and Torres Strait Islanders. Personal racism accounts for the discrimination by an individual, guided by personal thoughts of racism, conscious and unconscious. Thisimpactsinterpersonalrelationships,and oftendisguised asa personal opinion. This is usually directed at individuals (Slaughter-Acey et al., 2019). The definition of Institutional Racism according to Macpherson can be described as the unequal or inappropriate service provided to a group of people or population based on their culture, ethnicity or colour of their skin. This unequal treatment can be apparent via their behaviour, ignorance, stereotyping and other factors that ultimately leadtodiscrimination.Thisputthatgroupofpeopleinseriousdisadvantage (Holdaway & O'Neill, 2006). A study untaken in Victoria shows significant racism experienced by Aboriginal and Torres Strait Islander adults, both systemic and interpersonal (Markwick et al., 2019). b)The concept of being a 'white Australian' has always had its unjust implications in all sectors, and healthcare is no different. Many Aboriginals and Torres Strait Islanders have reported being receiving worse healthcare than that of their white counterparts. ManypregnantAboriginalsandTorresStraitIslanderwomenspokeoftheir experience with racism and reported to have received less attention. A pregnant aboriginal woman reported that midwives would often treat them different from the white pregnant women in the same room, for example checking on her for no particular reason, while many black women were ignored. They also faced demeaning comments, distrust, talking down and downright mistreatment from the midwives, as recollected by many new fathers from the maternity ward (Jennings, Bond & Hill,
2NURSING 2018).InastudyconductedwithAboriginalwomen,itwasobservedthat institutional racism is one of the leading causes of poor mental health in Aboriginal Australians (Macedo et al., 2019). c)Cultural competency can be described as the ability of healthcare providers such as nurses to administer high-quality care to all individuals, irrespective of their race. It also includes administering healthcare while being aware and respectful of their culture.On the otherhand, culturalsafetycanbe describedasestablishinga physically, culturally, socially accepting environment for people from any ethnicity and race. While both is very important, an intensive review of the literature tends to lean in favour of cultural safety rather than cultural competence. Cultural competence involvesknowingaboutcultureandthebasicaspectsofit,andapproaching individuals while being aware of their culture. However, cultural safety involves not just knowing about the patient's culture, but rather establishing a healthcare setting that is inclusive and respectful towards patients from all ethnicities and race and aims to provide the best quality healthcare to all patients. It has been preferred by many because it has better potential to achieve equality in terms of healthcare (Curtis et al., 2019). Hence the healthcare professionals must work towards making the healthcare settings culturally safe for everyone so that patients are not deterred from seeking the best quality healthcare. STEP 2 (100 words) From reading Chapter 1 (Sherwood &Geia, 2014) I learned about the poor health of the Aboriginal and Torres Strait Islanders and the current issues they tend to face. Since the event of colonisation, they have been dismissed as irrelevant, and their issues are not taken seriously. This chapter, as conveyed by the Aboriginal Registered nurses, describes how the colonial policies lead to the ill-health of the Aboriginals and Torres Strait Islanders and the
3NURSING emergence of the healthcare gap. Currently, the leading cause of morbidity in Aboriginals is cardiovascular disease, followed by cancer, injury, and self-harm. Reading this chapter enlightened me with the specifics of the health issues faced by the Indigenous Australians and what changes need to be implemented to 'close the gap.' STEP 3 (400 words) Institutional or systemic racism has long since tarnished the history of Australia, ever since the British colonisation. This racism is majorly directedagainst the Indigenous Australians. The Aboriginals and Torres Strait Islanders have long been discriminated against in all sectors, including public health sectors, judicial sectors, and others. In terms of Australia's history, 1967 was the first year when the Aboriginals and the Torres Strait Islanders were counted as citizens. The white Australia mind-set was still pretty much prevalent. Before that, they were downright ignored as citizens. The Aboriginals and Torres Strait Islanders were riddled with diseases since the time colonisation itself. They lost their land and livelihood, and several introduced diseases spread. However, little was provided in terms of medical assistance. In 1837, under the policy for protection for Aboriginal populations, 'protectors' were appointed who had the right to move the Aboriginals from here to there between government settlements. Till the 1930s, the prevailing attitude was that Aboriginals were inferior to the white race (naccho.org.au., 2020).. The Aboriginal Protection Act of 1869 in the colony of Victoria, gave the government rights to move the Aboriginal population where ever they liked, and also enabled them to take away any Aboriginal children below the age of sixteen. This put a significant barrier in the lives and education of the Aboriginal children and gave rise to the 'stolen generation.' These policies and practices played a significant part in creating what is now known as the 'health gap' (Sherwood &Geia, 2014). The health gap contributes to the death of Indigenous
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4NURSING Australians every year (Aida.org.au., 2020). Such policies were dismantled not before the 1960s. It was not till 1972 that grants were permitted for Aboriginal health initiatives. At this point, funding for the health services controlled by Aboriginals was granted (naccho.org.au., 2020). The Aboriginals suffered not only physically, but as well as socially, emotionally, and psychologically after the colonisation. As of 2012, the gap in live expectancy between the non-Indigenous and Indigenous Australians is around ten years. The first primary health care center for the Aboriginals rose not before 1971 due to the inability of general healthcare services unable to meet the requirements (Harfield et al., 2018). This sort of systemic racism has been faced by Aboriginals and Torres Strait Islanders not only in healthcare but also in the case of education as well as in employment till the present times. Even now, the Indigenous students face inequality in higher education institutes as there is a lack of education about inequality and Racism (Hollinsworth, 2016). They also tend to face psychological issues such as depression. Overall, racism has proven to be an important factor in the poor health of Aboriginals (Priest et al., 2011). STEP 4 (300 words) Cultural safety in the context of healthcare can be described as the implementation of a safe, unbiased, and respectful healthcare environment for people of any race, ethnicity, or colour. In a country like Australia, where a significant health gap exists between the non- IndigenousAustraliansandAboriginalsandTorresStraitIslanders,thisisofutmost importance. Culturally safe nursing care entails that the nurses and midwives be aware of themselves as well as the patients, and the disparities in languages and culture must be intertwined. The belief systems of the Aboriginals and Torres Strait Islanders are much different than that of non-Indigenous Australians, and the nurses must remember to remain respectful towards the beliefs and culture of the Aboriginals and Torres Strait Islanders. It has
5NURSING been seen that lack of culturally safe healthcare environments lead to the Aboriginals and Torres Strait Islanders not seeking the healthcare that they need (Daly, Speedy & Jackson, 2017). This form of cultural safety is essential in healthcare systems. It has been said that the hospitals are 'Institutionally racist' and there is inadequate funding to take care of the issues like the language and culture barrier (Henry, Houston & Mooney, 2004). Cultural safety and critical consciousness must be taught in the health practitioners of Australia as it has been seen that being culturally aware has proven to improve the equal treatment and consideration in healthcare settings. Cultural safety ensures that no discrimination occurs in terms of healthcare (Curtis et al., 2019). Being aware of other cultures and learning to respect them will ensure that the nurses overcome their personal misgivings and discriminatory thoughts while caring for the patients, thus abolishing personal racism. If the healthcare staff ensures cultural safety in the workplace, eventually systemic racism will be abolished. Steps have been taken to ensure a discrimination-free healthcare setting. STEP 5 (500 words) Reporting From the above writings and information, I was enlightened about the struggles faced by the Aboriginals and Torres Strait Islanders in all public sectors, mainly the healthcare sector.Ilearnedaboutthediscriminationfacedbythemwhileseekingtreatment, employment, or education. I also gathered information about the history of the Aboriginals and Torres Strait Islanders and the health gap that exists between them and the non- Indigenous Australians. Finally, I became aware of how cultural safety practices can be used to create a healthcare setting that provides the best patient care to everyone irrespective of their culture and ethnicity.
6NURSING Responding As a non-Indigenous Australian nurse, I always knew the statistics of the issue, for example, the differences in life expectancy and poor health of the Aboriginals and Torres Strait Islanders; however, I was never aware of such a deep-rooted issue. Now that I realise how the concept of white privilege is toxic and still surrounds us till date. Most of us are ignorant of the struggles faced by the Aboriginals and Torres Strait Islanders, simply because we do not delve deep enough into the ideas, or try to relate them to our surroundings. I learnedaboutpersonalandinstitutionalracismandrealisedhowtheseimpactedthe Indigenous population. It was enlightening and upsetting at the same time. Relating Now that I learned the concepts and became more observant of my surroundings, I realised how the non-Indigenous population like me have do not have to face certain hurdles like the Aboriginals and Torres Strait Islanders. I realised how they are still apprehensive of seeking healthcare due to the inequality and underlying racism that exists among the healthcare workers. I only really knew about how they do not seek healthcare or do immunisation follow-ups (Philips et al., 2019), but never before I understood the reasons so clearly. Reasoning While the policies discriminating against the Aboriginals and Torres Strait Islanders have been abolished, I understand why they might still be apprehensive of the government institutions. The older Aboriginal adults, who experienced discrimination, are right to be defensive or feel like they are still being discriminated against (Markwick et al., 2019). Another issue that might be responsible for this is the underlying discrimination and ignorance among non-Indigenous people for the Aboriginals. For example, many white
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7NURSING nurses and midwives tend to discriminate against the patients based on their skin colour as well as their background (Wren Serbin & Donnelly, 2016). From this, I have realised that I can help my patients by being aware of their issues, as well as respecting their culture. It is necessary that I learn and understand how this works, and be aware to equally care for all my patients, irrespective of their ethnicity and race. Reconstructing From what I learned, I can conclude that this issue can be helped if we all become a little bit more aware and change our approaches in our personal and professional life. I will be sure to implement this knowledge in my practice and also teach others about the ways we can build a culturally safe environment. I will learn more about the Aboriginal culture, practices, and beliefs in order to care for my patients in a holistic way.
8NURSING Reference Aida.org.au.(2020).Retrieved27March2020,from https://www.aida.org.au/wp-content/uploads/2017/08/Racism-in-Australias-health- system-AIDA-policy-statement_v1.pdf. Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & 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), 174. https://doi.org/10.1186/s12939-019-1082-3 Daly, J., Speedy, S., & Jackson, D. (2017).Contexts of nursing: An introduction. Elsevier Health Sciences. Harfield, S. G., Davy, C., McArthur, A., Munn, Z., Brown, A., & Brown, N. (2018). CharacteristicsofIndigenousprimaryhealthcareservicedeliverymodels:a systematicscopingreview.Globalizationandhealth,14(1),12. https://doi.org/10.1186/s12992-018-0332-2 Henry, B. R., Houston, S., & Mooney, G. H. (2004). Institutional Racism in Australian healthcare: a plea for decency.Medical Journal of Australia,180(10), 517-520. Holdaway, S., & O'Neill, M. (2006). Institutional Racism after Macpherson: an analysis of policeviews.Policing&society,16(4),349-369. https://doi.org/10.1080/10439460600967885 Hollinsworth, D. (2016). Unsettling Australian settler supremacy: combating resistance in universityAboriginalstudies.Raceethnicityandeducation,19(2),412-432. https://doi.org/10.1080/13613324.2014.911166
9NURSING Jennings, W., Bond, C., & Hill, P. S. (2018). The power of talk and power in talk: a systematicreviewofIndigenousnarrativesofculturallysafehealthcare communication.AustralianJournalofPrimaryHealth,24(2),109-115. https://doi.org/10.1071/PY17082 Macedo, D. M., Smithers, L. G., Roberts, R. M., & Jamieson, L. M. (2019). Racism, stress, andsenseofpersonalcontrolamongAboriginalAustralianpregnant women.Australian Psychologist. 10.1111/ap.12435 Markwick, A., Ansari, Z., Clinch, D., & McNeil, J. (2019). Experiences of Racism among Aboriginal and Torres Strait Islander adults living in the Australian state of Victoria: a cross-sectionalpopulation-basedstudy.BMCpublichealth,19(1),309. https://doi.org/10.1186/s12889-019-6614-7 Markwick, A., Ansari, Z., Clinch, D., & McNeil, J. (2019). Perceived racism may partially explain the gap in health between aboriginal and non-Aboriginal Victorians: a cross- sectionalpopulationbasedstudy.SSM-populationhealth,7,100310. 10.1016/j.ssmph.2018.10.010 naccho.org.au.(2020).Retrieved27March2020,from https://www.naccho.org.au/about/aboriginal-health/https://www.naccho.org.au/ about/aboriginal-health/. Philips, L., Young, J., Williams, L. A., Cooke, M., & Rickard, C. M. (2019). Opportunistic immunisinginthepaediatricemergencydepartment:Arepatientsdue vaccines?.Australasianemergencycare,22(1),28-33. https://doi.org/10.1016/j.auec.2018.12.002
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10NURSING Priest, N., Paradies, Y., Stewart, P., & Luke, J. (2011). Racism and health among urban Aboriginal young people.BMC Public Health,11(1), 568. 10.1186/1471-2458-11- 568 Sherwood, J., &Geia, L.K. (2014). A history of health services for Aboriginal and Torres Strait Islander people. In O. Best & B. Fredericks (Eds.), YatdjuliginAboriginal and TorresStraitIslandernursingandmidwifery (pp.7-30).PortMelbourne,VIC: Cambridge University Press. Slaughter-Acey, J. C., Talley, L. M., Stevenson, H. C., & Misra, D. P. (2019). Personal versus group experiences of racism and risk of delivering a small-for-gestational age infant in African American women: a life course perspective.Journal of Urban Health,96(2), 181-192. 10.1007/s11524-018-0291-1 Wren Serbin, J., & Donnelly, E. (2016). The impact of racism and midwifery's lack of racial diversity: a literature review.Journal of midwifery & women's health,61(6), 694-706. https://doi.org/10.1111/jmwh.12572