Promoting Family Centred Nursing for Aboriginal and Torres Strait Islander People in Australia

This article discusses the health challenges faced by Aboriginal and Torres Strait Islander people in Australia, including poor living conditions, poor health, poor feeding habits, inadequate access to infrastructure, low education, intimate partner violence, sexual abuse of children, smoking, and drug abuse. It also highlights the role of nurses in providing family-centered care support.

PROMOTING FAMILY CENTRED NURSING
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Introduction
The old definition to Aboriginal and Torres Strait Islander is original Australians. According to
Federal Government definitions, one can only be aboriginal if the community in which he or she
lives identifies them as aboriginal, one with aboriginal descent as well or one who recognizes as
an Aboriginal person, Broome, R., (2010). Data from the United Nations Permanent Forum on
Indigenous Issues, state approximately 370 million people are spread across 70 countries of the
world, with each retaining different cultures, economic and political characteristics and
uniqueness in traditions.Their cultural believes and practices determine Peoples' health and
values they place in their feeding,Broome, R., (2010), (Gooding et al., 2011,Vol. 35, No. 1, pp.
20-28).
Aboriginal people have been surviving many challenges such as drought and famine, and floods.
There is scientific proof that there exist extreme climate in areas where they live(d) due to
periods of arid climate change in regions of Warratyi, in South Australia dating from 50,000
years ago. These people survived wherebig animals would become extinct because of harsh
climate change, (Young and Doohan, 2011).
The standard weights in boys according to (FP Library) from birth to 1 year up to 18 years are; 1
year has an average of 10kg, age 2 years 13kgs, age 3 years 15kgs, age 4 years 17kgs, age 5
years 19kgs, age 6 years 21kgs, age 7 years 23kgs, etc. in this regard, David has a complication
since he only has 14.5kgs at age 4 years, instead of 17kgs for a healthy child. It should be noted
that weight gain after birth doubles by 4-5 months of age, triples in 1 year and quadruples by two
years where annual increase ages 2-9 years. At four years the height of David is standard as at

birth an average child height is 50cm, which doubles after four years. 97cm for David may not
be a big problem or a complication, Schultz,(2012).
There is a need for family caregivers to do thorough preparation to meet the needs of their new
responsibilities, such as physical care, psychological care and social and spiritual support. The
type of care given to patients will differ in accordance to their ailments. Some patients are too
physically vulnerable if discharged, e.g., patients with hematological cancer. Their immune
system is low making them too susceptible to lethal infections. Nutritional failure and too much
dehydration is a risk that they are likely to experience as a result of losing appetite and ability to
eat. There is a great need of patient's emotional support revolving around the recurrence,
readmission, or death, (Young and Doohan, 2011).
It has to be also noted that, family caregivers have also suffered emotionally arising a need for
education and support of family caregivers needs to address both how to solve the patients' needs
and maintain caregivers' well-being. In case of discharge, a telephone must be available to
monitor the symptoms management education provided.
It is said that aboriginal’s health and well-being in Australia is less healthy than the rest of other
Australian populace. Kidney dialysis was the leading cause of those admitted in Australian
hospitals from Aboriginal group in 2010-2011, (Davis et al., 2012, pp.2005-2011).However, the
leading causes of these health problems amongst aboriginals in Australia are 11 most
considerable preventable contributions such as tobacco, alcohol, illicit drugs, high body mass,
lack of exercises, low fruit and vegetable intake, high blood pressure, high cholesterol, unsafe
sex, child sexual abuse and intimate partner violence. They seek medical services more often
than non-aboriginals Australians. Aboriginals’health expenditure was approximated to be around

$4.6 billion. This represented 3.7% of Australian total recurrent health budget. This time there
are about 2.5% of aboriginals and Torres Strait Islander in Australia. Each indigenous’ health
expenditure is estimated at $7,995, 1.4 times greater than $5,437 spent in those non-indigenous.
Australian government spent 91.4% to fund indigenous health care in comparison to non-
indigenous who it spent 68.1%, (Ens et al., 2012,pp.100-107).
However, they moved from place to place where they believed to be favorable local environment
were created by the spirit of their ancestors. Recent past of Aboriginal people have influenced
their health in a negative way such as racism, discrimination, forced removal of children, loss of
identity, language, culture, and land. This is to say, health-wise Aboriginal people are
discriminated as evident in the 1860s where they have been discriminated on health issues,
schools, travel restriction, and education opportunities, (McDonald et al., 2009, p.346 ).
On the same year, mental health was in an alarming rate especially psychological distress
amongst indigenous, a double comparison with non-indigenous Austrians, (Dwyer et al.,
2009,p.viii), (Caron and Liu, 2010). A study of 2007 concluded that there are four main
preventable habits causing indigenous mental health included alcoholism, which takes the lead,
illicit drugs the second, sexual abuse among children and intimate violence. There was a 15%
gap of 10-year life expectancy gap betweennon-indigenous and indigenous caused mental health
disorders, (Dwyer et al., 2009,p.viii), (Caron and Liu, 2010), (Phillips et al., 2014).
The table below represents infant mortality rate of live births in Australia in 2006/08
Indigenous Australians No-indigenous Australians
Region Life Children Mortality Rate Region Life births Children Mortality

births rate
All Mal
e
Femal
e
All male Fem
ale
New
South
West
1000 7.7 New
South
West
1000 4.3
Northern
Territory
1000 13.6 15 12 Northern
Territory
1000 3.8 4.4 3.3
Table 1.1representation of children mortality rate, Australia
The mortality rate in children differs depending on regions of Australia as evident in the table
above. In this regard, male die more than females in both groups and regions. From 1998 to close
of 2013, a big drop in child death rate of about 31% and considerable gap narrowed by 35% in
the local community has been estimated, (O’Leary et al., pp.e770-e778).
Many factors are said to contribute poor health in Aboriginal and Torres Strait Islander than in
other Australians, and they include lack of education, inadequate health care knowledge, high
lack of employment, poor housing as well as poor access to infrastructure compared to non-
indigenous Australian. For 5 years alone between 2009/13, 621 children of locals died at 0-4
years, out of which 502(81%) infants deaths. This is 1.9 times than non-indigenous rate. Risk
behaviors such as smoking, alcohol, poor nutrition during pregnancy are the significant causes of
child mortality as well as other causes as preterm births and poor maternal health, (Davis et al.,
2012, pp.2005-2011).

They suffer significant health concerns, social, economic disadvantage, and shortened life
expectancy compared with non-aboriginal Australians. These are caused by unresolved issues of
land rights, self-determination, and identity poor economic development, due to historical
trauma, Altman,(2009).It has been thought before anything else healing from the past trauma of
the indigenous families before any other anything else can be addressed. They have a higher
feeling of disconnection and helplessness, loss, powerlessness, grief among locals, (Berry et al.,
2010).
Nurses have the role to play in family-centered care as the patient, and their families are
emotionally attached, and this can be too challenging, Harrison(2010, 25(5), pp.335-343.). There
is a need for nurses' intervention in health care provision to reduce confusion and emotional
attachment effects to the services they offer to the patients and their families. The following are
the nurses’ role in the provision of family-centered care support.
Carrying out medical analysis and treatment, evaluating, and managing a wide variety of severe
and chronic diseases is also a good practice.
Finding out patient’s medical histories and carrying outpatient’s examinations
Requesting diagnostic imaging
Carrying out diagnostic studies, e.g., lab tests)
Doing physical therapy, occupational therapy, and other rehabilitation treatments
Giving drugs for chronic diseases (extent of prescriptive authority varies by state regulation)
Offering parental care and family planning services

Doing Counseling services and education to patients concerningtheir health issues such as, self-
care skills, and treatment options in coordination with the occupational therapist and other
healthcare providers is also very useful.
Free communication between healthcare professionals and Australian indigenous people has
been made difficult by the negative impact of racial and economic discrimination with many
others past government policies disadvantaging Aboriginals and Torres Strait Islanders, Altman
and Hinkson(2010, 25(5), pp.335-343). Nurses should be cautious when dealing with this group
by establishing rapport through politely introducing themselves and giving stories of your
personal life. Also, there is a need for a nurse explaining why they would want to ask specific
questions. Also, nurses should be able to use non-verbal communication carefully as they may be
wrongly interpreted.
When nurses are communicating with the indigenous people, they should apply indirect
questioning mostly preferred by the Aboriginals and Torres Strait Islanders culture. This can be
achieved through active listening to avoid selective hearing, repeat through paraphrasing to
summarize what the person was saying to show concern, use of plain words, avoid telling a
person to repeat themselves as well as preventing long questions that need comprehension. When
making a decision try to know whether there is another person from the family who need to be
consulted due to kinship family structures and relationship when managing health.
The nurse would be concerned with the reason why Davidis light-weighted and skinny. The
possibilities of David underweight could be as a result of the genetic makeup of his parents.
Looking at Angela's body size the nurse could conclude of whether David's weight had a
relationship with her genetic make-up. It is not obvious that the genetic make-up would be the

course but a further potential explanation can be sought from the experts. David could be having
an eating disorder caused by mental disease hence making his body nutrient deficiency, Parker,
2010, 198(1), pp.3-7), (Parker and Milroy, 2014, pp.25-38.), (Berry et al., 2011). This would be
important if the nurse inquired from Angela of David’s eating habit, or refer David to a
psychologist or psychiatrist for further examination. From the case study, Angela was smoking
cigarette before David was born and this could be the cause why David health and weight was
not progressive or normal. Maternal smoking reduces child’s birth-weight by 150-250 g. This
has resulted in children who are small-for-date.
As a nurse, you need to make Angela access counseling services for her to know how she can
quit smoking she is addicted to stop harming her in-born children. Ensuring that she goes
through this process will help her understand the health risk of smoking to herself and the people
she loves (Jang et al., 2012, 12(1), p.145).Poor pregnancy due to smoking accounts for 20% of
children with low birth weights in the United States, 5% of stillbirths, and 8% of preterm deaths.
He or she should take advantage of Angela's unique quitting motivation by encouraging them
that quitting reduces the health risk of in-born child and review them the critical benefit of
postpartum to her and her child.
Conclusion
Aboriginals and Torres Strait Islanders are the original occupants of Australia and contribute
2.8% of Australian populace according to Australia bureau of statistics results released in 2016.
The population of Australian's Aboriginals and Torres Strait Islanders are concentrated in the
northern territory. This group has approximately over 170 million people of their kind distributed
in over 70 countries of the world and is associated with racial, economic and social

discrimination by both the government and the non-indigenous people. They are characterized by
poor living conditions, poor health poor feeding habits, inadequate access to infrastructure, low
education, intimate partner violence, sexual abuse of children, smoking and drug abuse.
They suffer inferiority complex and nurses are to be careful when dealing with them on health
matters. They need to be handled with a lot of care as past experiences of government policies
restricting them over some human rights affects them psychologically even today.
Today Aboriginals and Torres Strait Islanders are the leading in health expenditure with each
indigenous’ health expenditure estimated at $7,995, which is 1.4 times greater than $5,437 spent
in those non-indigenous. Australian government spent 91.4% to fund indigenous health care in
comparison to non-indigenous who it spent 68.1%.

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