Community Nursing Practice 1: Aboriginal Health Assessment

This report examines community nursing practice within the Yamatji Aboriginal community in Australia, focusing on the prevalence of chronic diseases like diabetes and chronic kidney disease (CKD). It analyzes the impact of discrimination, socioeconomic factors, and lack of access to healthcare on Aboriginal health outcomes. The report highlights the need for culturally sensitive nursing interventions, including building trust with patients and showing respect for their cultural backgrounds. It discusses specific nursing strategies to address these issues, emphasizing the importance of competence, ethical conduct, and vigilance in patient care. The case of Mr. Kay, an Aboriginal man with CKD, is used to illustrate the application of these interventions and the significance of addressing social determinants of health. The report stresses the importance of understanding the unique challenges faced by Aboriginal communities and tailoring nursing practice to improve health outcomes and reduce health disparities. It also references studies and research regarding Aboriginal health and nursing practice.

Community Nursing Practice 1
Community Nursing Practice
Assessment Task 1
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Community Nursing Practice 2
Community Nursing Practice
The Yamatji community is the term that describes the prominent Aboriginal tribal section of
Australia. Predominantly, the Yamatji people inhabit the Murchison and Gascoyne regions of
Australia. Chronic diseases are commonly prevalent in the indigenous community of Yamtjis or
Aborginals. The following article studies the concept of community nursing practice for
treatment of Aborginals and the interventions that are required to build trust and efficiency of
nursing practice and treatment in the following sections:
1) Effects of discrimination against the Australian Aborginals and Torres
Strait Island people:
The studies by Reeve et al (2014) and Minges et al (2011) primarily focus on the determinants of
chronic illness (diabetes) in the indigenous populations of Australia. The social factors are
commonly surmised to be the discrimination and differential treatment along with a severe lack
of awareness amongst these people about health services. A study by Reeve et al, (2014), states
that Diabetes mellitus is a highly prevalent disease within indivudals of the Aborginal
community of Australia. In the Aborginals, this observation is of specific importance according
to the National Health Priority Area as recognised by Australian health organization [1]. The
prevalence of type 2 diabetes mellitus is higher in Aborginals as compared to non-Aborginal
communities worldwide and within Australia [2]. Type 2 diabetes mellitus is also commonly
recognized amongst the younger population. The occurrence of diabetes leads to an overall
compromise in the health and the quality of life amongst the Aborginals [3]. The common
aetiological and risk factors for diabetes mellitus include obesity, diet, sedentary lifestyle,
socioeconomic status, family history, ethnicity etc. The indigenous communities of Australia are
not primarily a part of the homogenous Australian population and thus belong to a lower

Community Nursing Practice 3
socioeconomic status [4]. In terms of the socioeconomic statuses and the prevalence of diabetes,
there is a marked connection between the social lifestyle factors of these individuals and the
prevalence of diabetes. The diversity in the socioeconomic status is an essential consideration in
the study of type 2 diabetes prevalence in the indigenous tribes of Australia. Research is evolving
around understanding the relevance and distribution of the disease within the indigenous
populations in Australia [4]. Joan Cunnigham, (2010), has reported the impact of various factors
prevalent amongst the indigenous community of Aborginals on the occurrence of type 2 diabetes
[4]. Joan states that socioeconomic factors such as age, gender, employment status, income of the
household, educational qualification, ownership of home are all factors that play an important
role in the occurrence of diabetes [4]. Most times, Aborginals belong to the lower socioeconomic
strata, lack education, and are often homeless. Joan has deduced that the occurrence of chronic
diseases such as diabetes is largely impacted by these social factors [4]. The findings of the study
indicate that the socioeconomic factors have a significant impact on diabetes occurrence but
cannot be considered sole predisposing factors to the disease [4]. Indigenous Australians present
a considerable gradient in the socioeconomic status with the non-indigenous groups [4].
However, there exists a considerable combination between the indigenous and non-indigenous
populations and the traditional factors are often not sufficient determiners for the complete
understanding of the patterns of diabetes occurrence amongst indigenous Australians. Several
cultural factors and social factors contribute to the pattern of diabetes occurrence in the
indigenous populations [4]. Familial history and genetic factors among other social and lifestyle
factors are combined predisposing factors [4]. Recent research has been studying the various
socioeconomic and lifestyle factors that contribute to the chronic disease prevalence amongst the
Aborginal populations of Australia. Whilst it is common belief that the patterns may be uniform

Community Nursing Practice 4
within the indigenous population, the patterns are non-uniform and unpredictable [4]. The gender
and social factors such as discrimination and racism, stress, grief legacy, family separation, loss,
dispossession, behavioural patterns are also recognised as contributors to the disease prevalence
[4]. Joan points out that the neurological, endocrinal, metabolic, and immunological factors are
predominant in the occurrence of diabetes [4]. This may additionally indicate that these
individuals may indicate that the Australian community health services have a racial disparity
amongst the individuals [4]. There is a differentiation in the services provided to the indigenous
populations and also between the individuals of the different socioeconomic groups [4].
In totality, the findings in the afore-mentioned studies clearly indicate a lack of distinct and
approachable nursing and health care provision to the indigenous population. They point out the
differential nursing service among other socio economic factors including education, income,
family, emotional and psychological states, stress, unemployment, and homelessness as primary
factors.
Chronic kidney disease (CKD):
In the study by Andrew White et al, (2010), it is stated that the prevalence of chronic kidney
diseases such as end stage renal disease is high amongst the indigenous populations of Australia
and New Zealand [4]. The risk factors are similar to most commonly occurring chronic diseases
and include obesity, socioeconomic factors, homelessness, education, and income of the family
amongst other emotional and qualitative factors.
In the case of Mr. Kay, a 48 year-old Amangu man of the Yamatji/Aborginal indigenous
community, there is the morbid condition of CKD. White et al (2010) observe that there is a
marked difference between the social and economic statuses of the indigenous people in

Community Nursing Practice 5
Australia and this poses a severe social disadvantage to individuals resulting in chronic diseases
[4]. Mr. Kay is a homeless individual and is unemployed after having dropped out of his job at
the iron ore. Socioeconomic status and income are primary factors in the occurrence of CKD in
the indigenous communities [4]. The gradient of severe social and economic statuses is marked
in the Australian Aborginal and other indigenous communities depending on the region of
inhabitancy. Mr. Kay resides in the Wathaurong country of the Victoria region in Western
Australia. White et al (2010) have indicated an existent correlation between the several pathways
that relate the social disadvantage of these communities to the occurrence of end stage kidney
disease and other chronic renal diseases. A few of the most common determinants include
scabies resulting from overcrowding, infections of the skin caused by streptococcal sources, and
social factors such as low income and related stress, lack of control on lifestyle, familial
separation, unemployment, sedentary lifestyle, smoking, alcohol, and poor diet. Since Mr. Kay is
an Amangu man of the Yamatji or Aborginal community, he is predominantly at a risk of
occurrence of CKD due to genetic factors as observed in the Australian statistical analysis. Males
of the indigenous Australian population are at a high risk of CKD and end stage kidney disease
occurrence. Several social factors are predisposing to the occurrence of CKD amongst
individuals. In the case of Mr. Kay, the factors having the highest to the least impact on the
morbidity of CKD are perhaps in the following order: i) Sedentary lifestyle and poor diet ii)
gender and race iii) high blood pressure iv) emotional separation from daughter v)
unemployment and lack of income leading to stress vi) homelessness. However, it is important to
note that these factors may be interconnected and may overlap in their contribution to the disease
occurrence. The social factors are all interlinked and connected. In Mr. Kay’s instance, since he
is unemployed, he has a considerably low income and is homeless. These factors lead to stress

Community Nursing Practice 6
and increase in blood pressure. Emotional factors such as familial separation and separation from
his daughter lead to emotional stress and psychological well-being is compromised. Research has
indicated that in most indigenous communities, family bond and togetherness are of much
importance to the health of the individuals. Additionally, there is a lack of exposure to medical
care due to lack of health services.
2) Nursing interventions in the case scenario:
For nurses, it is of crucial importance to establish a rapport and trusting equation with the
patients of indigenous backgrounds when they present with chronic illnesses in particular due to
these afore-mentioned factors. Murray and McCrone, (2014), note that trust is the elementary
aspect in most ‘patient-provider’ relationships and greatly ease the treatment process [7]. Breach
of trust leads to failure of treatment and obstacles are created between the health care providers
and the patients.
a) Nursing intervention for the promotion of trust:
Murray and McCrone state that there are three core qualities of the health care providers that
contribute to the promotion of trust between the patients and providers: a) competence of the
healthcare provider on the technical and interpersonal fronts b) ethical and moral conduct of the
provider c) vigilant nature of the provider. These core qualities need to be developed and
improvised amongst the healthcare professionals in order to promote the trust factor with the
patients. Especially in cases such as that of Mr. Kay, it is essential to build a rapport and trusting
relationship in order to provide a congenial psychological environment for healing. His
emotional distress needs to be reduced with the implication of trust and rapport with the
providers. In Mr. Kay’s instance, it is essential to use the qualitative nursing intervention using
the following aspects: i) transience and effort: maintaining the trajectory of general, innate trust

Community Nursing Practice 7
with constant negotiation ii) continuity: discontinued and repeated trustworthy behaviour at all
instances consistently iii) honing interpersonal skills: simple actions such as addressing the
person by name and enhancing communication method iv) display of competence: displaying
ample knowledge and confidence in technical competencies.
The treatment process is largely benefited by improvising the trust factor. Rutherford, (2014),
states that trust is an essential parameter in nursing and impacts positive outcomes of health and
treatment. Rutherford additionally notes that trust is a multidimensional factor and is complex in
its construct. The moral and ethical behaviours of nurses are important parameters for the
establishment of trust. Nurses need to acknowledge the building of meaningful relationships with
patients as an important consideration in the treatment process. It is essential for nurses to
display technical competence and ethical dependability as these build the primary foundation to
the treatment process.
b) Nursing intervention for displaying respect for his culture:
The nursing intervention that is apt in order to convey respect and acceptance of culture involves
the display of morality and vigilance. The primary intervention would be to refrain from
discriminatory and differential behaviour. Along with promotion of rapport, it is essential to
build a sense of understanding of culture [7]. Callous nursing behaviour is perceived as being
harmful to the patient’s moral integrity [8]. Moral and ethical fairness and a kind approach define
the most appropriate intervention methods to gain complete insight into risk behaviours of Mr.
Kay that can potentially derange the treatment [7, 8].
Mr. Kay needs to be able to confess his lifestyle, religious or personal beliefs that are probably
impacting the disease prevalence. Nurses can extract this information with patience, display of
technical competence, vigilance, and morality. Since patients of the indigenous communities do

Community Nursing Practice 8
not receive as much respect and are probably discriminated against in most community
healthcare facilities as a general practice, they tend to have a bias or scepticism towards
accepting health care service. Nurses play a vital role in educating them about the importance of
lifestyle, diet, and psychological health for the overall healing of the disease. The maintenance of
a healthy lifestyle whilst living with chronic illnesses, especially CKD or end stage kidney
disease, is of critical importance. Nurses need to be capable of building a trust relationship with
the patient in order to bring about awareness about these vital issues.

Community Nursing Practice 9
References:
1. Reeve, R., Church, J., Haas, M., Bradford, W., & Viney, R. 2014. Factors that drive the gap
in diabetes rates between Aboriginal and non-Aboriginal people in non-remote NSW.
Australian and New Zealand Journal of Public Health, 38(5):460-465
2. Minges, K.E., Zimmet, P., Magliano, D.J., Dunstan, D.W., Brown, A., & Shaw, J.E. 2011.
Diabetes research and clinical practice, 93: 139-149
3. White, A., William, W., Sureshkumur, P., & Singh G. 2010. The burden of kidney disease in
indigenous children of Australia and New Zealand, epidemiology, antecedent factors and
progression to chronic kidney disease. Journal of Paediatrics and Child Health, 46: 504-509
4. Cunningham, J. (2010). Socio-economic gradients in self-reported diabetes for indigenous and
non-indigenous Australians aged 18-64. Australian and New Zealand Journal of Public Health,
34(S1): S18-S24
5. Holmgren, J., Emami, A., Eriksson, L.E., & Eriksson, H. 2014. Intersectional perspectives on
family involvement in nursing home care: rethinking relatives’ position as a betweenship.
Nursing Inquiry, 21(3): 227-237
6. Donahue, N. 2009. Embracing diversity among students and patients. Teaching and Learning
in Nursing, 4: 119-121
7. Murray, B. and McCrone, S. 2015. An integrative review of promoting trust in the patient-
primary care provider relationship. Journal of Advanced Nursing, 71(1): 3-23
8. Rutherford, M.M. (2014). “The value of trust to nursing”. Nursing Economics. 32(6): 283-287