University of Sunshine Coast: AOM and Cultural Safety Poster

This digital poster presents a case study analysis focusing on Acute Otitis Media (AOM) and cultural safety within the context of Indigenous health, specifically addressing Aboriginal and Torres Strait Islander populations. The poster begins with an introduction highlighting the prevalence of AOM in Indigenous communities, emphasizing the multi-factorial risk factors such as social determinants and the impact on health outcomes, including hearing loss and language acquisition. The case study centers on a 9-month-old Indigenous child, Lowanna, who is experiencing AOM. The poster then delves into the pathophysiology of AOM, detailing common bacterial causes like Streptococcus pneumoniae and the role of Eustachian tube dysfunction. Nursing interventions are discussed, including pain management, antibiotic therapy (Amoxilin as a first-line treatment), and the importance of cultural safety in providing care. The poster emphasizes the need for culturally appropriate care, including building trust with parents, acknowledging their concerns, and the potential benefits of Indigenous nurses. The conclusion reiterates the significance of AOM in Indigenous infants and the importance of addressing social determinants to improve health outcomes. The poster provides references to support the information presented, adhering to USC Harvard referencing style. The poster also includes the case study details, relevant history, and the application of cultural safety principles in nursing practice.

Acute Otitis Media and Cultural Safety- Author (name) and student ID
Introduction
Indigenous people suffer from various specific health issues and experience
higher mortality rate when compared to other non-Indigenous people. Again,
Indigenous people are more likely to experience poorer health and disability
which leads to lower life expectancy. Children of Aboriginal people also suffer
from health disorders including many infectious diseases and various social
health determinants are responsible for such issues (Coleman et al. 2018). In
this poster, the case study of an Indigenous Queenslander child will be
considered where he is suffering from acute otitis media (AOT) disease. Here,
the details of the child will be provided along with a proper literature support
related to the pathophysiology and nursing interventions. The cultural safety
considered in this case will also be illustrated in the poster.
Case study scenario
• Name: Lowanna
• Age: 9 months
• Lowanna lives with her parents and 2 other school going elder brothers.
• Her mother previously worked in a departmental store but left the work
when Lowanna was born. Her father works in a farm.
• According to her mother, Lowanna is fussing and pulling her left ear for
the past 2 day.
• She is not having any fever or lethargy.
• The only relevant previous history is a previous AOM at the age of 5
days only, and then she was treated with an unknown antibiotic for ten
days. However, she had not undergone any surgery ever.
• Currently she has a runny nose with clear discharge and lungs are also
clear. No allergy issues were found.
Cultural Safety in Nursing
Maintaining the cultural safety is an important means of providing care to the
Indigenous people of Australia. Nurses are expected to provide a culturally appropriate
care to all the individuals in a respectful way. It is also linked to the principles of Treaty
of Waitangi which suggest maintaining cultural safety in care. It is also clear from the
closing the gap report of 2018, Aboriginal and Torres Strait Islanders still experience
poorer health outcome than other non-Indigenous Australians (Fang et al. 2016).
Inequities are the result of colonization process and the many discriminatory policies
that Indigenous people are still experiencing while receiving care. According to NMBA
standards of nursing, nurses should introduce a culturally safe health system that can
address the cultural expectation of the patients. The principles of cultural safety in the
new Code of Conduct for nurses provide guidance about how to establish culturally
safe practice. In this case also, while providing care to the child, nurses should build a
positive relationship to the parents so that they feel comfortable in sharing their issues
to the nurse. Embedding a nurse from Indigenous people can also be an option to
provide cultural safety (Gill et al. 2017). Also, to assist in every stage of the treatment
as per the closing the gap policy, nurses can implement culturally competent care.
Nurses can also be culturally competent by active and attentive listening,
acknowledging all the concerns of the patients and their families.
Conclusion
Acute Otitis Media is a common disease among
infants and in the Indigenous people of Australia it
is more likely to be found due to many social
determinants. This poster illustrated a case-study
with such issue along with the pathophysiology and
positive treatment option. It also thoroughly
discussed the nursing interventions as well as the
steps to provide culturally safe care.
Topic information
Acute Otitis Media (AOM) is generally a spectrum of pathologies that involve infection or inflammation in the middle ear. It can become acute
to chronic disease which is clinically characterized by a fluid in the middle ear. According to researches, AOM is highly prevalent in the
Indigenous people of Australia, particularly when compared to non-indigenous people. The reasons for the prevalence of AOM in Indigenous
populations are multi-factorial (Jones et al. 2018). The risk factors include various social determinants such as poverty, inadequate housing,
exposure to environmental tobacco smoke, overcrowding and others. Such issues cause hearing loss and difficulties in language acquisition as
well as learning. AOM, the middle ear inflammation is generally caused by a bacteria or virus that ini9tially colonize the nasopharynx. It also
accesses the middle ear space through the Eustachian tube. Dysfunction of Eustachian tube causes upper respiratory tract infection which
results in mucosal infection as well. The most common bacterial organism that can cause AOM is Streptococcus pneumonia followed by non-
typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat). The children under the age of five years are the major carrier of
these bacteria which transmits via human-human contact, hand contamination, spread of nasal secretion and others (Thornton et al. 2017).
The only medications that can be effective for acute otitis media are the use of antibiotics. In order to improve the compliance antibiotics can
be administered once or twice daily as per the suggestion of the physician. Amoxilin has excellent middle ear penetration, with an adequate
oral dose, this medicine is more likely to be effective than any other. In some cases, other antimicrobials should be considered as first-line
when non-response to Amoxilin is found (Venekamp et al. 2015).
Nursing Interventions and Drug Therapy
When the issue is diagnosed, the primary task is to control pain and to target the infection
with proper antibiotics. The initial nursing intervention should be to assess information from
the patient and the frequency of the pain using the pain rating scale. Preverbal infants
generally pull or rub the affected ear and roll their head. Heart rate, blood pressure and fever
may discomfort the patient and hence, monitoring and recording the vital signs is also
essential nursing intervention. Nurses should encourage the mother to provide liquid to soft
food as movement of the Eustachian tube may further cause pain. It is important to put a
pillow behind the head of the patient so that the pressure from fluid is reduced (Hole et al.
2015). Nurses can also instruct the parents to hold and comfort the patent and in this regard
the mother can use warm-heating pad or an ice pack application as heat reduces discomfort
promoting vasodilation. Also, cold compress might decrease pain and edema. At the end, it is
highly necessary to monitor the child that if any side effect of medication is occurring.
References
Coleman, A., Wood, A., Bialasiewicz, S., Ware, R.S., Marsh, R.L. and Cervin, A., 2018. The unsolved problem of otitis media in indigenous populations: a systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media. Microbiome, 6(1), p.199.
Fang, M.L., Sixsmith, J., Sinclair, S. and Horst, G., 2016. A knowledge synthesis of culturally-and spiritually-sensitive end-of-life care: findings from a scoping review. BMC geriatrics, 16(1), p.107.
Gill, F.J., Kendrick, T., Davies, H. and Greenwood, M., 2017. A two phase study to revise the Australian Practice Standards for Specialist Critical Care Nurses. Australian Critical Care, 30(3), pp.173-181.
Hole, R.D., Evans, M., Berg, L.D., Bottorff, J.L., Dingwall, C., Alexis, C., Nyberg, J. and Smith, M.L., 2015. Visibility and voice: Aboriginal people experience culturally safe and unsafe health care. Qualitative health research, 25(12), pp.1662-1674.
Jones, C., Sharma, M., Harkus, S., McMahon, C., Taumoepeau, M., Demuth, K., Mattock, K., Rosas, L., Wing, R., Pawar, S. and Hampshire, A., 2018. A program to respond to otitis media in remote Australian Aboriginal communities: a qualitative investigation of parent perspectives. BMC pediatrics, 18(1), p.99.
Thornton, R.B., Kirkham, L.A.S., Corscadden, K.J., Wiertsema, S.P., Fuery, A., Jones, B.J., Coates, H.L., Vijayasekaran, S., Zhang, G., Keil, A. and Richmond, P.C., 2017. Australian Aboriginal children with otitis media have reduced antibody titers to specific nontypeable haemophilus influenzae vaccine antigens. Clin. Vaccine Immunol., 24(4), pp.e00556-16.
Van Dyke, M.K., Pirçon, J.Y., Cohen, R., Madhi, S.A., Rosenblüt, A., Parra, M.M., Al-Mazrou, K., Grevers, G., Lopez, P., Naranjo, L. and Pumarola, F., 2017. Etiology of acute otitis media in children less than 5 years of age: a pooled analysis of 10 similarly designed observational studies. The Pediatric infectious disease journal, 36(3), p.274.
Venekamp, R. P., Sanders, S. L., Glasziou, P. P., Del Mar, C. B., & Rovers, M. M. (2015). Antibiotics for acute otitis media in children. Cochrane database of systematic reviews, (6).