Community Care: Nursing Management of Cystic Fibrosis in Australia

This report explores the role of a community registered nurse in managing cystic fibrosis in a 7-year-old Aboriginal girl named Milly, focusing on the Mingenew rural community in Australia. It emphasizes the importance of culturally competent care, addressing Milly's and her family's needs, and incorporating bioethical principles. The report details the clinical signs and symptoms of cystic fibrosis, highlighting the nurse's role in educating Milly and her parents about self-management skills, including breathing exercises, nutritional control, and proper sleep. It outlines specific, measurable, achievable, relevant, and time-bound (SMART) goals for nursing management, such as developing self-management skills, fostering shared responsibility, coordinating care with other healthcare professionals, preparing for transitions, and involving a skilled workforce. Furthermore, the report discusses the Patient Assisted Travel Scheme and the Pharmaceutical Benefits Scheme as essential resources for supporting Milly's family, particularly given their low socioeconomic background and relocation to a rural area, and the nurse's role in providing information and facilitating access to these schemes to improve child-centered care.

Running Head: COMMUNITY CARE
COMMUNITY CARE
Name of the Student
Name of the University
Authors Note

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Introduction
Obesity, hypertension, cardiovascular and cardiorespiratory disorders,
hyperlipidaemia, chronic renal diseases and the mental health conditions like stress and
anxiety also led to incidences and prevalence in the increased rate depression and advancing
cases of Alzheimer’s and dementia in the public populations of Australia (Segal et al., 2018).
It is very important and also very vital and cardinal to understand that in the community
settings where the indigenous Australian people such as Aboriginal and the Torres Strait
islander people lives and in the community where the South Sea islander people lives, the
public health in these community areas are worse as compared to the overall health and
wellbeing in the urbanised areas of Australia. In childhood, the presentation and development
of the respiratory conditions like cystic fibrosis can be very critical especially when the
parents are unaware of how to manage the cystic fibrosis conditions in their child and
increased dependency of the children on their carers and especially their parents complicate
the matter further (Hall et al., 2017). In this study, the role and functioning of a nurse in the
management of cystic fibrosis in the child from aboriginal community and the importance of
developing the self-care skills in the management of cystic fibrosis in relation to The Cystic
Fibrosis organisation of Australia’s “Moving on up” self-management program for children
living with the disease has been explored (Forrest, Butt & Namachivayam, 2017).
Role of the community nurse regarding self-management of child
expectation, family expectation
As a community registered nurse partnering in care with Milly who is a 7 year old
aboriginal girl living with cystic fibrosis and her parents, it is firstly very important to address
the dignity, esteem and privacy and cultural care needs of Milly and her family. Milly has just
moved with her family to Mingenew which is a rural area and again, as she and her parents

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might have an acculturation problem which might complication thee clinical of the child with
cystic fibrosis to a great extent. As a nurse, first it is very important to understand that the
bioethical principles of thee nursing such as beneficence, maleficence, totality and integrity,
autonomy has to be applied and incorporated in the caring for the child, Milly and the other
roles of the nurse includes providing an informed care to subjeects and her parents in this
case scenario. As a community registered nurse, while it is very vital to address the case
clinically – it is also important to teach the self-management skills to the subject and when
the subject is too dependent, the family centred nursing practice must be intervened with.
Dense mucous formation blocking the lungs and the various regions of the gastrointestinal
system results in signs and symptoms such as persistent cough (with dense mucous),
recurrent affections with sinusitis, recurrent lung infections, inflammation of the nasal
passages and stuffy nose, exercise intolerance, wheezing are the clinical signs and symptoms
in the child with cystic fibrosis that were revealed from the nursing assessment. The role of
the nurse is to deliver a culturally competent nursing care to the child with cystic fibrosis and
her family. Increasing the knowledge and awareness of the parents of the child about cystic
fibrosis condition (Hiscock et al., 2018) and thee effective way of self-management and home
management as per the ‘Moving on up’ program, is a very critical way of delivery a
community competent care to the child with cystic fibrosis. As the care surrounds around the
child, it is important for the nurse to incorporate adequate rest periods and play activities for
the child in addition to education in the nursing care of cystic fibrosis (Aoun et al., 2018).
Educating and teaching Milly and her parents about the self-management skills such as
breathing exercises, nutritional control (to manage the digestive and excretory symptoms),
proper sleep and relaxation for management of fatigue is vital (Mitchell et al., 2018).
SMART goals

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There are certain specific, measurable, achievable, relevant and time bound goals that
are important in the community nursing management of this cystic fibrosis case and it is
highly important that the various aspects of these health and social care goals of the child and
her family are addressed in an imperative manner. It is highly critical that the nursing goals
must be able to address the child care needs with cystic fibrosis by the development of young
person- and family centred care, development of shared responsibility, development of
coordinated care creating a readiness for transfer and through the application and
incorporation of the skilled workforce into the care delivery program. The community
registered nurse has to play a very critical role in the development of the goals with respect to
management of Milly’s cystic fibrosis. As knowledge and education is a problem in the
indigenous community, the first goal of the nurse is to develop the self-management skills
(such as self-care, proper sleeping, relaxation and recreation techniques, emotional
management, breathing exercises, adequate play and rest periods, hygiene and the same
pertaining to the nutritional support) pertaining to the management of the disease cystic
fibrosis which is a chronic condition in the child and it is very important to teach the family
of the subject that is the parents of the child about the self-management skills in order to
address the health and social needs of the child (McLean et al., 2019). The goal has to be
achieved in a month. The second goal of community practitioner nurse is to develop a team
with the parents of the child that demonstrates the importance of shared responsibility
towards the overall health and wellbeing of the child with cystic fibrosis. The same can be
achieved in about a week of beginning the nursing care of the child with cystic fibrosis
(Hendrickx et al., 2018). The parents of the child are responsible for caring for the child at
home on a day to day basis and it is very important they are taught the parental and child care
skills so that the community registered nurse who is the clinician in this case can collaborate
with the parents of the child in order to deliver a child centred collaborative care. The third

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goal is to provide a coordinated care that means addressing the patients’ preferences and the
needs of the subject through the delivery of an appropriate, safe and high quality clinical car
to the subject. In this case as the subject Milly has cystic fibrosis, based on the signs and the
symptoms – the community registered nurse should be able to coordinate with a respiratory
therapist, a nutritionist in order to address the needs of the subject (Adams et al., 2019). It is
important to understand that the child and the parents of the child are from an indigenous
background and the family of Milly have just relocated to a rural community, in order to
deliver a proper clinical care, a community worker can be collaborated with in order to
address the rights of the child effectively. This can be achieved in the first two weeks of
clinical car. The fourth goal is to develop a readiness for transfer (Grossman & Barolsky,
2019). Transition from one stage of child’s life to another stage of the life through the major
life events like change of schooling and promotion in the academic standards are to be taken
into consideration and it is important that in this case as the child has changed the living area
to a new place – it is important for the community nurse to address the cultural, social and the
transitional needs of the child and her family and this can be achieved in three weeks. The
last goal is to involve a skilled workforce in management of the cystic fibrosis of Milly and it
is important that an interdisciplinary care must be provided to the subject. Duration needed is
four weeks.
How to assist
i. Patient Assisted Travel Scheme
It is very critical to understand that the indigenous community dwelling people of
Australia such as the Aboriginal and the Torres Strait islander people do not have
accessibility to quality health care services and primary health care services that distorts the

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social determinants of health with respect to the health care of the community. Similarly in
this case scenario, Milly and her parents has moved from an indigenous community scenario
(where they belong from) to a rural area and in both the areas there is a lack of primary and
community in addition to institution based health care and this required Milly and her parents
travelling from a rural setting to a place where there is quality health care institution that
needs expense as well. This increases the cost and the expenditure that is difficult to be
beared by Milly’s parents as they already belong from a low socioeconomic background,
being a part and members from the aboriginal community of Australia (Braithwaite et al.,
2018). It is very much vital that under these circumstances – a community car is delivered to
the subject in order to reduce the cost of care and make it bearable by the family and the
community nurse must take up the responsibilities in order to deliver a quality care to the
patient. This is where the Patient Assisted Travel Scheme that is formulated by the legislative
framework of Australia to support the expenses of people travelling from rural and
indigenous communities to other areas that is at least 100 kilometres and more distance away
and the nurse in this framework and situation, can inform the patient’s family with the
information related to the car and then collaborate with the local workers and community
workers to deliver a more proper and apt clinical care to Milly and her family (Grossman &
Barolsky, 2019). This is important that the interdisciplinary professionals must be
collaborated with, by the community nurse and in order to do this – the subject and her family
should travel to the nearby primary or quality health care institution to receive a proper level
of multidisciplinary care and the Patient Assisted Travel Scheme can surely help the subject
and her family with the expense of travelling and also accommodation as well (Radford et al.,
2016). The health information technology is needed to know more about the scheme and the
community nurse can surely assist the family of Milly with the required knowledge and

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information perating to the health travel expenses scheme in order to better the level of
delivered child centred care.
ii. Pharmaceutical Benefits Scheme
It is very critical to understand the in community setting, the social determinants of
health such as lack of employability, low socioeconomic status, lack of education, knowledge
and awareness of the health conditions, lack to accessibility to proper health care and primary
quality care services and increased psychosocial addictions to alcohol and other drugs
aggravates the community health or health of the individual in the community further.
Pollution and other environmental factors in addition to the various genetic modulation
arising from modulation and mutation of the genes due to internal and external triggers lead
to various diseases in the public health framework of the country as well. It is to be noted and
very critically understood that the various aspect of the community health differs markedly
from the health and well-being of the public in the urban settings of Australia (Bilson et al.,
2017). Certain diseases poses one of the most complex psychosocial and physical health
threats in the public health scenario and it is the public health status that becomes and forms
the most important situation that are to be addressed by the public health policies led by the
government legislative framework. It is highly important or rather vital to understand that the
government insurance policies pertaining to health and the health care services led and
delivered by the health care institutions in tandem with the needs of the community and only
after accessing the needs of the population, the health service delivery has to be planned and
strategized following which the multidisciplinary patient centred and community centred care
to the target population is delivered. Expenses of the medications and the expenses of the
health care services delivered depends on the quality of the care service and it is very
important that the clients of the health care institutions must be able to afford it as well in

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order to make the client centred clinical and community care delivery – a successful one but
with the people from low socioeconomic status such as the community living indigenous
people and in this case study , Milly and her family comes from an indigenous community
background which makes the quality pharmacological control of cystic fibrosis in Milly a
cost expensive one. Thus, pharmaceutical benefits scheme that is delivered by the Australian
government in collaboration with Medicare would surely assist the community nurse plan a
potential nursing care for Milly and her parents. The medication benefits would help the
family receive a proper clinical care in terms of medications. (Breen et al., 2018).
iii.Telehealth
It is important to understand that the various types of the patient centred care in a
proper and apt clinical care setup such as a multidisciplinary or an interdisciplinary care
institution is at times expensive given the cost inclusion of the technologies, biomedical and
the instrumentation services that is delivered in a high quality clinical care setting to the
patients and it becomes very difficult for the communities and the families of low
socioeconomic backgrounds find it difficult to receive these high end medical and nursing
care services from and in these institutions. In addition it is important to understand that the
service fees of the health care clinicians such as surgeons and the medicine practioners, the
allied health care workers and the nurses often increase the charges of health servicing in the
health care institutions and it is very cardinal that the multiple clinical disciplines that provide
a patient centred, multidisciplinary services to the patients makes the cost of the clinical
services in conjunction with the use and application of biomedical technologies – even more
expensive and again it is more than difficult for the community living people such as the
Aboriginal and Torres strait islander people as well as South Sea islander people. In this case
as well, in the cystic fibrosis management of the subject, the same above mentioned
socioeconomic analysis applies. Thus with the advent of technologies – it is very critical to

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use and incorporate the appropriate use of health information technology in easing and
bridging the delivery of care and this is where the use of Telehealth has come into practice
and has drastically changed the way of delivering a clinical care to the patients who cannot
access a proper institutional health care service out of financial reasons or due to distance and
this is important, that in this case scenario of Milly – the same can be accessed through a
computer in the community centre and the nurse can collaborate with a local community
worker in order to help the family of Milly access a Telehealth service with the use and
application of communication technologies, like mobile devices and computers and this can
be considered as cheap option or rather a cost effective option for the people who cannot
afford the institutional services in a clinical scenario and many services that that is delivered
via Telehealth are focussed at improving the self-care skills of the individuals and this is in
relation with the ‘Moving On Up’ program in community settings (del Pozo de Bolger,
Dunstan & Kaltner, 2018).
Conclusion
Hence it can be concluded saying that It is to be critically noted that the
cardiorespiratory diseases such as asthma, chronic obstructive pulmonary disease affect the
health and wellbeing of the children and the adults alike and these clinical situation pertaining
to its management and to the prevention of these conditions are even aggravated in the
community settings and the social determinants of health also play a critical role in the
presentation, pathophysiological development and deterioration and progression of the
disease signs and symptoms. The clinical management as well as the self-care skills are very
important in the management of chronic diseases in a community settings.

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