Culturally Safe Healthcare for Indigenous Australians: A Case Study

This essay discusses the challenges faced by indigenous Australians in accessing culturally safe healthcare. It presents a case study of a 14-year-old indigenous female healthcare service user suffering from Acute Rheumatic Heart disease and the application of culturally safe care on her. The essay highlights the importance of incorporating the Culturally Safe nursing model in healthcare practices.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student
Name of the University
Author note

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A culturally safe healthcare environment is full of challenges, assault, as well as
refutation of the individuality of the care receivers of healthcarservice. When it comes to
indigenous people across the world, several negative experiences of them associated with the
contemporary healthcare system has been recorded. Culturally safe healthcare is referred to a
concept, which had emerged in the late 1980s as a framework for developing a suitable
healthcare service for culturally diverse populace. According to researcher, culturally safe
healthcare refers an environment that secures social, spiritual, and emotional safety of the
consumers of healthcare service (The Health of Aboriginal Children and Young People in
Western Australia., 2015). The chief reasons behind the mentioned issues are the fact that in
majority of cases, healthcare service providers tends to diminish, disempowered as well as
demean the cultural identity and well being of an indigenous service users. In this essay, the
analysis and discussion of methods for application of culturally safe care on the client has been
performed with cultural competency. The thesis statement of this essay is ‘Culturally Safe’
nursing care framework is the most effective framework for treating indigenous healthcare
service users prioritising their social, cultural and emotional needs. The research parameters that
will be used in this essay are Biomedical Treatment Framework and the Culturally Safe Trans-
cultural nursing framework.
In this paragraph, the method of selection of client from a particular cultural group will be
discussed. Being a healthcare service provider of a popular healthcare home located in Australia,
I am currently working with the aboriginal residents of Australia. During my service period, I
noticed that health inequity exists among the Aboriginal Australians. In accordance to the
professional code of conduct of nursing care statement number four, every nurse should provide
care with dignity while respecting culture, values and beliefs of the patients during the care

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providing process (NMBA, 2008). One of the chief reasons behind the mentioned inequity is the
cultural barriers that exist between the healthcare service providers and the healthcare service
users. The culture and lifestyle of aboriginal Australians are highly different from that of the
non-indigenous Australians. Poverty, lack of education, unhygienic lifestyle along with
excessive consumption of tobacco has given birth to several healthcare issues suffered by the
Aboriginal people. In this situation the adults are suffering significantly from healthcare issues
like diabetes, obesity and various lung and cardiovascular diseases. On the other hand, the
aboriginal children are majorly found to be suffering from Asthma, Chronic health conditions,
Rheumatic Heart disease, disabilities and oral health issues because of their poverty and lack of
education. During my practice, I come across a 14 years old indigenous female healthcare
service user who is suffering from Acute Rheumatic Heart disease. The mentioned diseases is
caused by the by Group A Streptococcus (GAS) bacteria and the mentioned bacteria are found to
affect children more compared to Adults. According to survey, more than 68 percent of the
Aboriginal children and adolescents are found to be suffering from bacteria diseases caused by
the by group A Streptococcus bacteria (Rothstein, Heazlewood & Fraser, 2018). During the 20th
century GAS diseases had greatly decreased the Aboriginal population. Hence it is highly
important to eradicate the disuse from the Aboriginal community. During the Admission of
Ms.X , I found that she is unwilling to get admitted in the healthcare home cultural barrier and
competence being two of the major reason. Hence, I have chosen Ms. X from the Australian
aboriginal community for the discussion on cultural safety healthcare.
In this paragraph, the healthcare issue that has the potential to impose impact on Ms.X has been
discussed. According to researchers one of the chief reasons behind diseases caused by Group A
Streptococcus Bacteria is unhygienic lifestyle (Parker, & Milroy, 2014). Considering the fact that

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like a majority of Aboriginal Children, Ms. X also leads a highly unhealthy life style, she bears
the risk of suffering from superficial infection, invasive disease, the autoimmune squeal of acute
rheumatic fever (ARF) and acute post-streptococcal glomerulonephritis (APSGN) (Kingsley et
al., 2013).
Another healthcare issue that may often found in the children of Aboriginal community is ear
disease. According to survey, more than 38 percent of the Australians children of age range 2 to
14 years old are fund to be suffering from various bacterial infections and fevers due to their lack
of knowledge in hygiene cleanliness and healthy lifestyle (May, Bowen, & Carapetis, 2018). The
aboriginal parents face lack of knowledge and guidance about the healthy lifestyle while having
some misbelieves and social stigma that leads children and young people to be more likely to be
hospitalised due to lack of transport, healthcare service distribution because of their geographical
position compared to the non-indigenous children. The chief reason behind this is lack of safety
measure in home as well as workplace is poor income level, lack of efficient healthcare access,
poorly facilitated rural clinics giving rise to incidents unhealthy food, unhygienic water
consumption, fire, burns, and scalds. Considering the fact, that Ms X is also habituated in the
above mentioned lifestyle, cultural and social influences she also suffers from the risk of getting
severely injured or chronic bacterial bronco or cardiac diseases.
Miss X has a pathophysiological report for having streptococcal Pharyngitis and Impetigo from
the last one or two years, which was nearly untreated because of the negligence of the parents
and other guardians. Pharyngitis is a disease caused by various bacterial infections, which is
caused by group A Streptococcus bacteria. On the other hand, a typical bacterial skin infection
named Impetigo is caused by either Staphylococcal or Streptococcus bacteria (Ball, Bindler &
Cowen, 2013). Any of these bacterial diseases can spread by the physical contact, nasal

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discharge and saliva from another infected person. However, all of these bacterial diseases can
be treated with antibiotics. ARF/RHD or Acute Rheumatic Heart is a Rheumatic Heart disease
mainly caused by long term untreated or undertreated bacterial infection. However, regular
intake of antibiotics and other supportive medication process without having any break can solve
these issues entirely. However, she has failed to receive some antibiotics that allow the bacteria
to spread across the defence mechanism of her body (Coyne, 2015). As an expected outcome,
she was experiencing sore throat from last 2 to 3 weeks while also experiencing migratory joint
pains including acute joint pain in her knees, elbows, ankles and shoulders. Along with that, she
also had the body temperature of 38 degree Celsius that is noticeably higher than normal
temperature. All of these symptoms are directing referring the overwhelmed infection of the
bacteria that gradually has lead to ARF/RHD. In this situation regular oral or injected antibiotics
intake can improve the condition. At the same, it also needs complete bed rest and adequate
healthy diet, emotional as well as metal support. As it affects the cardiac tissues, ignorance of
this type of condition can be lethal (Gibbs, 2013).
To analyse the needs of the patient the theory of various nursing frameworks with the procedure
of implementation with effective cultural competence in nursing practice is chiefly important. As
per the NMBA or Nursing and Midwifery Board of Australia, some standard nursing models
regulate the affectivity of regular healthcare practice. In traditional nursing framework, the major
focus of a medical professional is described as the health and wellbeing of the patient that
increase the cultural competence of nursing practice. On the other hand, some modern and
advanced alternate nursing practice argues about the traditional theories and operational
framework in nursing practices. One of the most common theoretical models that are used to
develop the standard nursing framework is Biomedical Care of nursing (Jackson et al., 2013).

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This theoretical model emphasises the physical and psychological wellbeing of the patient while
showing dignity to the patient’s culture, social background as well as perspective and attachment
pattern. The standard roles and responsibility framework provided by NMBA follows most of
this conventional nursing theory which includes taking care of patients pain threshold while
treating and diagnosis, keeping the patient under continuous monitoring, regular diagnosis of
patient physical as well as metal health, preservation of healthy and Hygienic environment
around the patient and other major nursing activities. On the other hand, another major nursing
theory argues against this traditional nursing conceptual framework. The foundation of
Culturally Safe or Transcultural nursing theory has made on the cultural understanding between
the healthcare provider and the patient. According to the NMBA nursing framework, preserving
the patient’s personal and cultural identity is equally important while keeping the patient
physically and psychologically balanced and healthy.
As per my personal experience with the help of person cantered care approach, the traditional
nursing framework can be altered with appropriate attributes that can be very healthful to
maintain the cross-cultural healthcare system and nursing models. In this case, the 14 years old
girl needs more emotional and psychological health along with the understanding of her physical
condition and needs (Kumar & Tandon, 2013). However, in this type of case the traditional
nursing practice fails to recognise the entire needs of the patient as well as the optimum process
of implementing the nursing framework. For this girl, she needs regular physical check-up and
medication. At the same time, the absence of the intervention of elder siblings, parents and other
entities from similar cultural environment leads the emotional condition to be more agitated.
Shoeing respect to her cultural and sociological perspective can avoid the consequences due to
the absence of her parent, which can cause additional hindrance in curing process.

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To understand the needs and requirements of the patient understanding of the psychological,
social and other eternal factors is highly important with theoretical interventions. Considering the
poverty level and inaccessibility to the healthcare service within aboriginal populace, the overall
psychological upbringing of a child from both consciously and unconsciously, receives strong
influence from the external factors like parents, society, peers and others. Lack of education, lack
of conciseness about health factors and hygiene, have a massive impact on the expansion of a
person inside his or her background process. Being a patient of child healthcare system, this girl
needs more emotional and psychological support by involving her parents, social components
and culturally attached beings along with the physical treatment (Ralston et al., 2014). The
inadequate interaction with the child with her parents can has a high impact on psychological,
social, emotional and perceptual well being. The lack of communication with the child can also
lead to misconception of her parents about the existing healthcare service. The girl and her parent
can also face some psychological tension because of lack of emotional attachment with
caregivers and nurse. All of this situation can hinder the overall process of patient’s care and
treatment needed for ARH. In this part of healthcare services, I need more in-depth knowledge
about the cultural background of the client along with their believe system and interpretational
perception. Struggling to find out most competent procedure without identifying the social,
cultural and emotional needs of the client cannot cure the patient in a stipulated timeline (Zühlke
et al., 2014). Detail understanding about her friend zone, cultural ethics, environment, social
aspect and other factors is highly require to incorporate the Culturally safe theoretical framework
in the nursing practice. Person Centred Care or PCC is one of the alternate healthcare service
approaches, which allows the caregiver to focus on the client’s emotional and socio-cultural
needs. In the traditional guideline of NMBA nursing framework prioritising the patient’s

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personal, emotional, social cultural viewpoint. Therefore, as a learner of the healthcare system
and appropriate guideline, I should also find out the appropriate alternative healthcare practice
like person cantered care or family cantered care that can allow me to incorporate the Culturally
Safe nursing model (Ross, Barr & Stevens, 2013).
In conclusive part, it can be said that culturally safe healthcare is referred to a concept
framework for stipulation of suitable healthcare services for ethnically varied population. With
this regards, a culturally safe healthcare environment is devoid of challenges, assault, as well as
denial of the identity of the healthcare service users. One of the chief reasons behind the
healthcare inequity in Aboriginal Australians is the cultural barriers that exist between the
healthcare service providers and the healthcare service users. While adults are found to be
suffering from healthcare issues like diabetes, obesity and a good range of lung and
cardiovascular diseases because of their poverty level, lack of education, geographical condition,
inaccessibility to the healthcare system. At the same time, aboriginal children are majorly found
to be suffering from Asthma, Chronic health conditions, Rheumatic Heart disease, disabilities
and oral health issues. From the above description, it can be said that, Culturally Safe or
Transcultural nursing framework is the most effective culturally safe framework for treating
indigenous healthcare service users. The inadequate interaction with the child with her parents
can has a high impact on psychological, social, emotional and perceptual well being. At the same
time, according to the NMBA nursing framework, preserving the patient’s personal, social and
cultural identity is equally important while keeping the patient physically and psychologically
balanced and healthy. At the same time, being a patient of child healthcare system, Miss X needs
more emotional and psychological support along with the physical treatment.

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Reference List
Ball, J. W., Bindler, R. C., & Cowen, K. J. (2013). Child health nursing. Prentice Hall. Ritrived
from:http://w3.salemstate.edu/~dhills/docs/Lorraines_Lectures/GIGUNutr/Microsoft
%20PowerPoint%20-%20nutrition%20final%20copy%20[Compatibility%20Mode].pdf
Coyne, I. (2015). Families and health‐care professionals' perspectives and expectations of
family‐centred care: hidden expectations and unclear roles. Health expectations, 18(5),
796-808. Retrieved from: https://doi.org/10.1111/hex.12104
Gibbs, J. C. (2013). Moral development and reality: Beyond the theories of Kohlberg, Hoffman,
and Haidt. Oxford University Press. Received from: https://books.google.co.in/books?
hl=en&lr=&id=56RpAgAAQBAJ&oi=fnd&pg=PP1&dq=Gibbs,+J.+C.+(2013).
+Moral+development+and+reality:+Beyond+the+theories+of+Kohlberg,+Hoffman,
+and+Haidt.
+Oxford+University+Press.&ots=lHDNXXzuIR&sig=p4fWjaEDRtH6YR7ChmE10vhs9
40
Jackson, G. L., Powers, B. J., Chatterjee, R., Bettger, J. P., Kemper, A. R., Hasselblad, V., ... &
Gray, R. (2013). The patient-centered medical home: a systematic review. Annals of
internal medicine, 158(3), 169-178. Retrieved from:
http://annals.org/data/journals/aim/926316/0000605-201302050-00006.pdf
Kingsley, J., Townsend, M., Henderson-Wilson, C., & Bolam, B. (2013). Developing an
exploratory framework linking Australian Aboriginal peoples’ connection to country and
concepts of wellbeing. International journal of environmental research and public
health, 10(2), 678-698. Retrieved from: http://www.mdpi.com/1660-4601/10/2/678/htm

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Kumar, R. K., & Tandon, R. (2013). Rheumatic fever & rheumatic heart disease: The last 50
years. The Indian journal of medical research, 137(4), 643. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724245/
May, P., Bowen, A., & Carapetis, J. (2018). The inequitable burden of group A streptococcal
diseases in Indigenous Australians. Retrieved from
https://www.mja.com.au/journal/2016/205/5/inequitable-burden-group-streptococcal-
diseases-indigenous-australians
Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an
overview. Working together: Aboriginal and Torres Strait Islander mental health and
wellbeing principles and practice, 2, 25-38. Retrived from:
https://www.researchgate.net/profile/Roz_Walker/publication/259715124_Working_Tog
ether_Aboriginal_and_Torres_Strait_Islander_Mental_Health_and_Wellbeing_Principles
_and_Practice/links/59c3abb20f7e9b21a82fd663/Working-Together-Aboriginal-and-
Torres-Strait-Islander-Mental-Health-and-Wellbeing-Principles-and-
Practice.pdf#page=54
Ralston, S. L., Lieberthal, A. S., Meissner, H. C., Alverson, B. K., Baley, J. E., Gadomski, A.
M., ... & Phelan, K. J. (2014). Clinical practice guideline: the diagnosis, management,
and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502. Retrieved from:
http://pediatrics.aappublications.org/content/134/5/e1474.short
Ross, K., Barr, J., & Stevens, J. (2013). Mandatory continuing professional development
requirements: what does this mean for Australian nurses. BMC nursing, 12(1), 9.
Retrieved from: https://doi.org/10.1186/1472-6955-12-9

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Rothstein, J., Heazlewood, R., & Fraser, M. (2018). Health of Aboriginal and Torres Strait
Islander children in remote Far North Queensland: findings of the Paediatric Outreach
Service. Retrieved from https://www.mja.com.au/journal/2007/186/10/health-aboriginal-
and-torres-strait-islander-children-remote-far-north
The Health of Aboriginal Children and Young People in Western Australia. (2015). Retrieved
from https://www.ccyp.wa.gov.au/media/1315/policy-brief-wmf-aboriginal-child-health-
january-2015.pdf
Zühlke, L., Engel, M. E., Karthikeyan, G., Rangarajan, S., Mackie, P., Cupido, B., ... & Francis,
V. (2014). Characteristics, complications, and gaps in evidence-based interventions in
rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY
study). European heart journal, 36(18), 1115-1122. Retrieved from:
https://doi.org/10.1093/eurheartj/ehu449