Community Nursing Practice Report: Indigenous Healthcare in Australia

This report delves into the critical issues of health disparities and access to healthcare faced by Aboriginal Australians, highlighting the role of community nursing practice in addressing these challenges. The report is divided into two parts, the first part examines the key findings of peer-reviewed journal articles related to Australian Aboriginal and Torres Strait Islander people’s health, specifically focusing on health equity and access to healthcare. It emphasizes the impact of racism, cultural barriers, and systemic discrimination on Aboriginal health outcomes, including higher rates of morbidity and mortality. The second part of the report describes and discusses evidence-based nursing interventions aimed at promoting health equity and access to care for Indigenous Australians. The report emphasizes the importance of cultural competence, patient-centered care, and effective communication to improve health outcomes. It highlights the need for culturally safe care, linguistic support, and the application of evidence-based practices to address health disparities and provide holistic, respectful care to Aboriginal patients. The report concludes with a call for increased education, training, and awareness among healthcare professionals to ensure equitable healthcare access and improve the health outcomes of the Aboriginal population.

Running head: COMMUNITY NURSING PRACTICE
COMMUNITY NURSING PRACTICE
Name of the Student
Name of the University
Author Note

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Part 1:
Health disparity is a common and significant issue identified globally and there is a
growing evidence how Aboriginal people experience healthcare inequalities due to racism and
ethnicity. Health care clinics are more towards supporting stereotypes that negatively influence
them to discriminate people by systematic racism. Australian Aboriginals have experienced
healthcare inequalities resulted in disengagement from care and delay in care. They are not given
priority compared to other patients (Mitrou et al., 2014). The Australian Aboriginals are more
susceptible to medical dismissal that eventually affects their health outcomes. Health disparities
and access to healthcare is known to have persisted globally irrespective of development and
income status. Researches have revealed that access to healthcare is not equal across populations,
including the ability to obtain the required services and the quality of care delivered.
Marginalized group with racial and ethnic minorities have received barriers to access and utilize
the healthcare services (Goodman et al., 2017).
Aboriginals experiences a significant health disparities that resulted in higher morbidity
and mortality rates and a restricted health care access compared to non-Aboriginal population. In
addition to that, the inequalities and discriminations are not evenly distributed within the
population. Evidences have shown that urban Aboriginal population experiences a higher rate of
disparities in health than those living on reserve. They experience a higher rate of homelessness,
diseases like tuberculosis, HIV/AIDS, diabetes and suicide and they are in an increasing risk of
substance abuse. They are more vulnerable towards health related harms (Goodman et al., 2017).
There are evidences that have shown the likelihood of Australian Aboriginals and Torres
Strait Islander peoples of Australia to suffer from health disadvantages both in terms of availing

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clinical services as well as getting priority in emergency situations. They received dismissed
health services due to health disparities that exists in the stereotypical nature and mentality of the
healthcare providers and clinicians. They are discriminated due to racism and ethnicity and
experiences a declined health services that results in higher morbidity and mortality rates. They
are unable to access the services due to racial discrimination, when compared to that of other
populations in Australia. There is a strong need of culturally competent health practitioners to
enable the Aboriginals to receive the required care and treatment associated with an improved
health outcome. The life expectancy of Aboriginals at birth is known to be around 11.5 years
lower for males and 9.7 years lower for females, when compared with non-Indigenous
Australians (Harrold et al., 2014).
There is always a gap between the Aboriginal and Non-Aboriginal Australians and it is
driven by diabetes, cardiovascular diseases and other related health issues. There are evidences
that proves that ethnicity and rurality both contribute to disparities in healthcare and the
population with ethnic minorities experiencing poorer access to healthcare. Though Australia
have an enormous health facilities but still, the existing quality standards and health safety are
not sufficient to ensure or promote culturally safe care for Australian Aboriginals to achieve
optimum care linked with an improved health outcome of the patients (Harrold et al., 2014). The
Aboriginal health care bodies argues that boosting of the likelihood of culturally safe care
contributes to the health outcomes of the Australian Aboriginals. It has been found in a survey
that Australian Aboriginals admitting to the emergency departments with acute coronary
syndromes were half as probable as non-Aboriginals to undergo angiography. It has also been
found that the Aboriginal Australians are less likely to get opportunity to be admitted in the
hospital and have procedures for a condition than non-Aboriginals (Randall et al., 2013).

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Cardiovascular diseases have been the leading cause of death among the Aboriginals. Cancer is
the second largest cause of death and the morality rate for some cancers have been raised up to
three times higher in the Australian Aboriginals than the non-Aboriginals. There is a rising need
to provide cultural competent care, especially in these two areas, to improve the health outcomes
of the Australian Aboriginals (Randall et al., 2013).
Part 2:
Although Australia facilitates high quality health care system. But there lies a
discrimination while treating the Australian Aboriginals (Mitrou et al., 2014). They experience
health disparities due to racism and cultural barriers. Cultural barriers refers to the obstacles an
individual faces including language, age, sex and culture difference that leads to an
unsatisfactory health outcome (Thackrah & Thompson, 2013). The strategy used to practice
evidence based care is the Continuous Quality Improvement (CQI), a management approach that
aims to increase the efficiency of organizational systems.
Proving cultural competent care:
The Australian Aboriginals are exposed to such racial discrimination and are unable to
access the healthcare system and quality care. Healthcare availability and accessibility requires a
strong cultural and linguistic support to let the population access healthcare services without
discrimination. Evidences have shown the urgent need of linguistic support to enable culturally
competent care by the healthcare providers (Nursingmidwiferyboard.gov.au, 2019). Language
barrier leads to unequal health outcomes among the aboriginal Australians and Torres Strait
Islanders. The nurses should be aware of the diverse culture, belief, faith, preferences,
understanding and value among the Indigenous people in Australia and deliver them quality care.

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Since, language is a vital component of culture, ineffective communication can lead to failure in
providing improved healthcare outcomes and provides little or no benefit to patients resulting
into more confusion and misunderstandings. Therefore, effectively communicating in a culturally
appropriate way can not only reduce any kind of ambiguity in treatment as well as result in
higher quality healthcare. Nurses should put emphasis to address the cultural differences of the
patients and treat them through effective communication (Nursingmidwiferyboard.gov.au, 2019).
Nurses should never be stereotypical and make assumptions or judgements about other
people or their beliefs. Instead, the nurses should keep the relationship within the therapeutic
communication and can ask questions about cultural practices in a professional manner
(Nursingmidwiferyboard.gov.au, 2019). Nurses should avoid stereotyping about their culture or
ethnic group based on physical features, race, country or their religion preferences. Stereotyping
leads to an oversimplified conception or belief about individuals. Nurses should be careful about
how they are identifying or labelling patients. It should always kept in mind that every individual
has the right to receive proper treatment and care irrespective of their race, ethnicity or culture
(Thackrah & Thompson, 2013). Healthcare providers must not facilitate discrimination based on
ethnicity, instead, provide quality care to the patients by respecting their views, preferences,
culture, ethnicity and values. The healthcare providers should provide holistic care to the
patients that is free of racism. They should facilitate access to quality and culturally safe care and
respectful for the Aboriginals.
Providing patient centred care:
Nurses should apply patient centred and evidence based practice in decision making and
also have a responsibility to deliver safe and quality care to the patient irrespective of their
cultural and ethnicity. The nurses should practice in accordance to the standards of the

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professionalism and evidence based practice that includes NMBA standards, codes and
guidelines and other regulatory standards (Nursingmidwiferyboard.gov.au, 2019). The nurses
should provide leadership to ensure safe delivery of care and they should be able to understand
their responsibility to protect people and ensure that the health staffs are aligning with the
obligations and guidelines. It falls under the responsibility of the nurses to document, monitor
and report concerns that they believe to be compromising the patient’s health
(Nursingmidwiferyboard.gov.au, 2019).
Nurses must take a patient centred approach towards providing care to the patient and
ensure improved health outcome. They should respect the patient values and preferences,
respect them and treat them with dignity. Nurses should provide a culturally safe environment
for their treatment and maintain an honest, respectful and professional relationships by adhering
to the obligations related to confidentiality and privacy (Olsen, Saunders & McGinnis, 2011).
Since, Australia is a linguistically and culturally diverse nation and Aborginals or Torres Strait
Islander people have been inhabited on the land as first people of Australia, the health of the
Aboriginals must be supported by proving holistic and patient centred care. There should not be
any discrimination based on their culture, instead, they should be treated with respect and dignity
irrespective of racism.
The nurses should apply Evidence Based Practice in delivering quality care to the patient
that eventually increases their health outcomes (Hibbard & Greene, 2013). The nurses should
have knowledge of their own culture, values, assumptions, beliefs and attitudes that influences
their communication with people and their families to deliver quality health care enabling them
to access health services. The intervention lies within the ability of nurse to respect the culture,
beliefs, ethnicity, sexualities and preferences of the patients and provide them treatment to

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ensure quality care that improves the health outcome of the patients by acknowledging their
socio economic and cultural background thereby giving them a bias free treatment. The nurses
should have a positive outlook and communicate with the patients considering their health issues
and enable them to access every healthcare facilities needed to improve their health outcome
(Nursingmidwiferyboard.gov.au, 2019).
The interventions strategies aims at improving patient health outcomes are not always
employed. There is a strong need to educate and train the healthcare professionals regarding the
evidence based practice and the importance of cultural competent care to increase health
outcomes of the Australian Aboriginal population. However, studies have revealed that it is not
possible to change the nature and mentality of health care professionals through trainings,
although education and trainings are conducted with the aim to provide quality care to the
patients (Clifford et al., 2015).

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References:
Clifford, A., McCalman, J., Bainbridge, R., & Tsey, K. (2015). Interventions to improve cultural
competency in health care for Indigenous peoples of Australia, New Zealand, Canada and
the USA: a systematic review. International Journal for Quality in Health Care, 27(2),
89-98.
Goodman, A., Fleming, K., Markwick, N., Morrison, T., Lagimodiere, L., Kerr, T., & Society,
W. A. H. R. (2017). “They treated me like crap and I know it was because I was Native”:
The healthcare experiences of Aboriginal peoples living in Vancouver's inner city. Social
Science & Medicine, 178, 87-94.
Harrold, T. C., Randall, D. A., Falster, M. O., Lujic, S., & Jorm, L. R. (2014). The contribution
of geography to disparities in preventable hospitalisations between indigenous and non-
indigenous Australians. PloS one, 9(5), e97892.
Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: better
health outcomes and care experiences; fewer data on costs. Health affairs, 32(2), 207-
214.
Ilton, M. K., Walsh, W. F., Brown, A. D. H., Tideman, P. A., Zeitz, C. J., & Wilson, J. (2014). A
framework for overcoming disparities in management of acute coronary syndromes in the
Australian Aboriginal and Torres Strait Islander population. A consensus statement from
the National Heart Foundation of Australia. The Medical journal of Australia, 200(11),
639-643.

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Laverty, M., McDermott, D. R., & Calma, T. (2017). Embedding cultural safety in Australia’s
main health care standards. The Medical Journal of Australia, 207(1), 15-16.
Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E., & Zubrick, S. R.
(2014). Gaps in Indigenous disadvantage not closing: a census cohort study of social
determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC
Public Health, 14(1), 201.
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia - Home.
Nursingmidwiferyboard.gov.au.
Olsen, L., Saunders, R. S., & McGinnis, J. M. (2011). Applying Evidence for Patient-Centered
Care: Standards and Expectations. In Patients Charting the Course: Citizen Engagement
and the Learning Health System: Workshop Summary. National Academies Press (US).
Randall, D. A., Lujic, S., Leyland, A. H., & Jorm, L. R. (2013). Statistical methods to enhance
reporting of Aboriginal Australians in routine hospital records using data linkage affect
estimates of health disparities. Australian and New Zealand journal of public health,
37(5), 442-449.
Thackrah, R. D., & Thompson, S. C. (2013). Refining the concept of cultural competence:
building on decades of progress. Medical Journal of Australia, 199(1), 35-38.