Case Study: Nursing Management of Rheumatic Heart Disease (RHD)

This nursing case study focuses on a patient, Shakira, suffering from Rheumatic Heart Disease (RHD) and explores the impact of social determinants such as unemployment and social isolation on her healthcare access and outcomes. The study emphasizes the importance of cultural awareness and sensitivity in nursing care, particularly for Aboriginal populations, highlighting the need for understanding cultural beliefs and values. It discusses the Aboriginal and Torres Strait Islander Act 2005, the impact of colonization on Aboriginal health, and the role of community representatives in establishing effective communication. The case study also addresses language barriers and the significance of creating a culturally safe environment. It identifies indicators of culturally unsafe practices and emphasizes the importance of healthcare professionals acknowledging the indigenous culture and history. The document includes references to relevant research and legislation.

1Running head: NURSING
Nursing
Name of student:
Name of university:
Author note:

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1.
In the present case study, Shakira is suffering from Rheumatic heart disease (RHD)
which refers to the condition of damaged heart valves due to episodes of acute rheumatic
fever (ARF). ARF leads to inflammation of the heart, as a result of which the normal blood
flow is restricted. The complications arising due to this condition include endocarditis and
stroke (Rothenbühler et al., 2014). Social determinants of health influence an individual’s
health outcome, and for Shakira the two significant social determinants are unemployment
and social isolation. These two factors have led to inadequate access to healthcare. Living in
an isolated rural area and the poor economic condition has restricted the sufficient access to
healthcare that could have a prevented the occurrence of RHD. Unemployment has a negative
impact on the decision making process around care provided to an individual. In the present
case, Shakira’s mother’s poor economic condition has led to an improper care approach
towards Shakira (Roberts et al., 2015). As per reports, aboriginal individuals suffer more
chances of developing RHD than the nonindigenous population, and this chance is 64 times
greater (rhdaustralia.org.au, 2017).
2.
a. Cultural awareness refers to the capability of a healthcare professional in being aware and
knowledgeable about the cultural beliefs, values and traditions of other individuals that are
distinctly different. A nurse needs to carry out research to become aware of the cultural
background of Shakira and have a successful interaction (Holland, 2017).
b. Cultural sensitivity refers to the ability of a healthcare professional to perceive the cultural
similarities and dissimilarities between two different individuals in a positive approach
without disrespecting the other individual. A nurse needs to acknowledge the cultural beliefs

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and values of Shakira and not underestimate them while communicating with her (Norton &
Marks-Maran, 2014).
3.1.
The Aboriginal and Torres Strait Islander Act 2005 had been established to promote
the level of self-sufficiency and independence of the Aboriginal and Torres Strait Islander
population. The Act had been significant for focusing on the development of economic as
well as the cultural status of this population through different programs (Willis et al., 2016).
3.2.
a. The impact of colonisation on the health outcomes of the Aboriginal population is
noteworthy. The reduced life expectancy of the population and the high rate of prevalence of
a number of health conditions can be linked to the suffering and turmoil experienced by this
population as a result of the colonisation. Due to the colonisation, there have been chaos and
disturbances that have ultimately led to disputes and poor economic growth. Development
and growth in different domains have been restricted to a considerable extent. The
Aboriginals have therefore suffered physical and mental health concerns arising from loss,
abuse and anguish. Disconnection from the mainland and non-indigenous population have
added to the issues (Griffiths et al., 2016).
4.
a. Consultation with community representatives would be a key approach to be taken on the
enrolled nurse’s part in establishing an effective communication and building rapport that is
culturally safe and appropriate. A community representative would be in a better position to
understand the ethnic and cultural beliefs and systems of the aboriginal patient. A
consultation with the representative would ensure that his advice is taken while

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communicating with the aboriginal individual. The representative would be helpful in guiding
the manner in which the cultural beliefs are to be respected and acknowledged while
communicating. In this way, the preferences of the patient would be included in his care plan
(Willis et al., 2016).
5.
Since Shakira and her family live in a remote rural area belonging to mostly
indigenous population, chances are there that there might be a language barrier between the
nurse and them. For avoiding any issues while consulting for Shakira and engaging in
effective communication, it is required to have an interpreter who can foster the verbal
communication. The second method that would be suitable for effective communication is
understanding the level of education of the concerned individuals. Lower education level
influences poor knowledge of healthcare. This is to be acknowledged, and communication is
to rest upon this factor (Daly et al., 2017).
6.
c. Displaying Aboriginal or Torres Strait Islander art and posters that are visible from the
entrance to the building would ensure that Shakira and her family feel comfortable since such
an approach would indicate a culturally safe and sensitive environment. Shakira and her
family would feel that their cultural is being valued and respected by the care givers (Norton
& Marks-Maran, 2014).
7.
a. I have the knowledge that indigenous culture and history play an important role in shaping
the interaction they have with their counterparts. The culture and the value system that they
uphold are responsible for creating a disconnection between the indigenous and non-

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indigenous population. The nonindigenous population does not perceive the perceptions of
the indigenous population in a positive manner and thus isolate them from the mainstream
population. As a result of this, the later have been socially excluded and live in remote rural
areas, further aggravating the concern of insufficient communication between the two groups
(Holland, 2017).
8.
b. Insufficient use of healthcare services is the first indicator of culturally unsafe practice. In
such situation, the individual might not be provided with adequate care resources. The second
indicator would be situations in which the health care professional would not acknowledge
the concerns of the indigenous patient in relation to any health complication (Ray, 2016).

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References
Burden of Disease. (2017). Rheumatic Heart Disease Australia. Retrieved 19 October 2017,
from https://www.rhdaustralia.org.au/burden-disease
Daly, J., Speedy, S., & Jackson, D. (2017). Contexts of nursing: An introduction. Elsevier
Health Sciences.
Griffiths, K., Coleman, C., Lee, V., & Madden, R. (2016). How colonisation determines
social justice and Indigenous health—a review of the literature. Journal of
Population Research, 33(1), 9-30.
Holland, K. (2017). Cultural awareness in nursing and health care: an introductory text.
CRC Press.
Norton, D., & Marks-Maran, D. (2014). Developing cultural sensitivity and awareness in
nursing overseas. Nursing Standard, 28(44), 39-43.
Ray, M. A. (2016). Transcultural caring dynamics in nursing and health care. FA Davis.
Roberts, K. V., Maguire, G. P., Brown, A., Atkinson, D. N., Remenyi, B., Wheaton, G., ... &
Carapetis, J. (2015). Rheumatic heart disease in Indigenous children in northern
Australia: differences in prevalence and the challenges of screening. The Medical
Journal of Australia, 203(5), 221.
Rothenbühler, M., O'Sullivan, C. J., Stortecky, S., Stefanini, G. G., Spitzer, E., Estill, J., ... &
Pilgrim, T. (2014). Active surveillance for rheumatic heart disease in endemic
regions: a systematic review and meta-analysis of prevalence among children and
adolescents. The Lancet Global Health, 2(12), e717-e726.

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Willis, E., Reynolds, L., & Keleher, H. (Eds.). (2016). Understanding the Australian health
care system. Elsevier Health Sciences.