Cultural Safety, Person-Centred Care, and Dementia in Australia

This essay provides an analysis of dementia care within the Australian healthcare system. It begins by defining dementia and outlining its prevalence, particularly among Indigenous Australians. The essay then explores various types of healthcare delivery, with a focus on primary care and community services, and identifies suitable models for dementia patients, including palliative and long-term care. It emphasizes the importance of person-centered care. The discussion further delves into the social determinants of health, particularly poverty and its impact on dementia patients, and highlights gender disparities and lack of employment opportunities. The essay then addresses cultural safety and patient-centered care approaches, referencing the NMBA Code of Conduct and ICN Code of Ethics for nurses. The analysis emphasizes the need for culturally sensitive and equitable healthcare practices, especially concerning the mental health of Aboriginals and Torres Strait Islanders, while also touching upon the role of the healthcare system in addressing discrimination, and ensuring the delivery of safe and effective care.

Running Head: NURSING
0
Professional practice and cultural safety
5/21/2019

NURSING
1
Contents
1.Introduction........................................................................................................................................2
2. Mental healthcare delivery................................................................................................................2
2.1 Types of Health-care delivery......................................................................................................2
2.2 Types of healthcare delivery in Dementia and their underpinning values....................................3
2.3. Social determinants of Health: Poverty (dementia).....................................................................4
2.4 Cultural Safety and Patient centred care approach: Apply Codes and Standards.........................5
3. Conclusion.........................................................................................................................................8
References.............................................................................................................................................9

NURSING
2
1.Introduction
The essay brings about the discussion on the assessment of the patients or individuals
affected by the mental health issues within a particular age group in Australia. It has been
found that more than 200 classified type of mental health disorders exists, which includes
depression, bipolar disorder, anxiety disorder, dementia, schizophrenia, and others. These
disorders or illness affects thinking, mood, and behaviour. Here, the discussion in the essay
will be based on the mental health problem ‘dementia’ that is considered as the ‘second’
leading cause of death amongst Australians. From the statistics, it has been found that the
number of deaths in female is higher, i.e. 11.3% which is more than males.
The prevalence of dementia is found 2-5 times higher amongst the Aboriginal and
Torres Strait Islanders, than others i.e. indigenous Australians. Moreover, from the survey
conducted in the recent years, it has been found that three in ten people over age of 85years,
and approximately one in ten people over 65 encounter the problem of dementia. Dementia
mainly affects the health of people in the later years of life, and third leading cause of
disability in the country. Thus, the essay will provide the facts and information relevant with
the dementia, and related aspects (Dewing & Dijk, 2016). In addition, the discussion will
mention the type of health care delivery systems, and determining the most suitable system
for mental health problems in Australia. In the later part, the aspects of social determinants
of health and the concept and application of cultural safety and person-centred care will be
discussed.
2. Mental healthcare delivery
2.1 Types of Health-care delivery
Health care services in Australia is operated, governed, and are given funds by the
government of the Australia along with the state & territory governments. Dementia is not a
particular disease rather it describes a group of symptoms that are related to the loss of
memory, or other thinking skills. The decline in memory and thinking skills leading to
individual’s inability to perform activities of daily life. The first and most common sign or
symptom of dementia include memory problems, difficulty-remembering events, confusion
and impaired concentration (Rozsa, Ford & Flicker, 2016).

NURSING
3
The health care system of Australia is recognised as one of the most effective
healthcare system, which aims to provide safe, quality, and affordable care to the patient. The
promotion and prevention of an individual’s health from illness and mental health has been
focused upon by the Australian health care institutions and organisations. Australia’s health
2016 is the AIHW’s 15th biennial report that provides the statistical information about health
and welfare of Australia. As per the report, of AIWH, it has been found that more than
400,000 people are surviving with Dementia. The information, and facts revealed, from the
report has stated that the incidence rate of dementia is found at 55% in women more than
men (Wu et al., 2017).
One of the major types of health care delivery in the Australian health care system
includes ‘primary health care’. In Australia, primary healthcare is typically the first criteria
through which individuals interact with the health system established in the country. In the
country, majority of the health services are delivered through the primary care, including the
treatment of many psychological or mental disorders. Therefore, in this discussion ‘primary
care and community services’ are emphasized in reference to the given mental health
problem ‘dementia’. Primary care services or primary care involves the healthcare provided
to the individuals, based on the needs and preferences of the patients and their family.
However, primary care includes a range of providers and services across different sectors
(public, private and non-governmental) for mental health illness (Mihrshahi, Dobson &
Mishra, 2015).
2.2 Types of healthcare delivery in Dementia and their underpinning values
Mental health care service in Australia determines the action of health and welfare
system for health needs of the people in the country. It includes activities and key aspects of
Australia’s health care and social care services that people access to improve health. In
Australia, 10.2% of the people have received medicare specific mental health services.
Despite the importance of the health care delivery from the primary care, it has been found
that ‘dementia’ remains a challenge in the primary care. Specialised care includes providing
treatment within holistic care model, underpinning nursing practice to educate patients of
dementia (Fleming et al., 2016).
A nurse may advise them to undertake participation in exercise, eliminating stress,
and focusing on positive aspects to lead a healthy and happy life. Therefore, it can be stated
that management, and prevention of the poor health of the older people, especially women in

NURSING
4
Australia also involve a model of care (Russ et al., 2016). To define the care model, it can be
defined as best practice, provided to patients as they progress to different stages of chronic
health condition. However, there is no common model of care as symptoms of dementia can
be perceived in respect to different causes or illness including, Alzheimer’s disease, stroke,
severe head injury and others. Consequently, the mental health problem, i.e. dementia
affects different people in varied ways and thus involves a holistic and person centred
approach (Edvardsson, Watt & Pearce, 2017).
Two types of health care delivery in context to HCS within Australia, for patients
affected by dementia include ‘palliative care’ and ‘long-term continuing care services’.
Palliative care means to the care, which helps people live their life comfortably, in context to
their life-limiting illness (Griffiths et al., 2015). Diagnosis of dementia can occur some years
after onset of symptoms, and the approach of person-centred care has been found significant
(Dementia Australia, 2018).
A person with moderate dementia may require palliative care, and it is most suitable
to the patients with advanced dementia. As per the national survey in 2014, Australian people
(men and women) can access palliative care services within their care settings; however, they
struggle to get access to the end of life care. Medicare is another health care delivery is
universal funded healthcare under the HCS of Australia, which primarily provides health
services to people in Australia. It is beneficial especially, to the patients in the initial stages of
dementia (Thyrian et al., 2017).
Besides, this the underlying values, or principles in consideration to the two
healthcare delivery include health and safety from the process of treatment for dementia
patients. These values are achieved through the aspect of practising effective or
transformational leadership within healthcare institutions. Hence, it has been analysed from
the above discussion that approximately 70% of the aboriginals and Torres Islanders and
other people have received treatment from primary care services (NSQHS Standards, 2018).
2.3. Social determinants of Health: Poverty (dementia)
The term social determinants of health can be defined as the conditions under which a
person live, learn, work and grow that includes health care service. The social determinants
consist of education, income levels, unemployment, job-insecurity, inadequate access to

NURSING
5
food and healthcare services. However, WHO (World Health Organisation) has recognised
income, wealth influence, support from the society as the major factors that promotes the
health and prevent illness. In addition, the research has stated that people living with mental
problem like dementia in Australia do not get equal access to the resources, thereby leading
to poverty. Therefore, Australia has been identified amongst the top five unequal societies or
country around the globe (Knaak, Mantler & Szeto, 2017).
In this context, gender disparities and lack of employment opportunities are the
structural determinants affecting the mental health and leading to mental illness such as
dementia. Australian women belong to the low socio-economic status, which expose them to
greater risk of poor health and mental health problem like dementia (Galimberti et al., 2015).
This leads to an impact on their thinking capacity and their concentration, which risk their
behaviour within family and society at different ages. Henceforth, dementia is not considered
as mental illness, and does not affect the overall mental health of the individual.
. In context to the mental issue dementia, factors such as age, sex, and reduced levels
of involvement in the family decisions constitute as major social determinants of dementia
(Garg, Boynton-Jarrett & Dworkin, 2016).
In Australia, the population mainly in Aboriginals people are facing the problem of
lack of mental care services, and lack of employment opportunities. Furthermore,
unemployment leads to poor mental health outcomes, which either causes disability or
weakens an individual’s thinking capacity, and causing mental health issues. It increases the
risk to other problems such as sexual violence, and health problems such as Post Traumatic
disorders (PTSD). Thus, mental health of an individual is mainly influenced by the economic
or financial condition, determining overall wellbeing in longer period (Rickwood, Mazzer &
Telford, 2015).
2.4 Cultural Safety and Patient centred care approach: Apply Codes and
Standards
In context to illness, and care provided to patients, it can be stated that systems that
emphasize on collaborating care with patient delivers effective healthcare services. Nursing

NURSING
6
in Australia mainly incorporates the cultural safety (CS) person-centred care (PCC) in their
practices as mentioned in the Code of conduct. Patient-centred or person-centred care has
been considered significant approach to healthcare delivery. The approach involves the
elements, patient engagement, and empowerment of the patient to engage in self-care. Here,
patients are treated as partners to attain outcomes, and ensure wellbeing (Kirmayer,
Bennegadi & Kastrup, 2016).
The approach of patient centred care involves the aspect of compliance with the
standards or code of conduct, for nurse specialists in the healthcare settings in Australia.
NMBA, i.e. Nursing and Midwifery Board of Australia published Code of Conduct for the
nurses and midwives. In accordance to this code, all the nurses will be taken into effect on
March 1, 2018 (Nursing and Midwifery Board of Australia, 2018).
Now, the discussion will lead onto the assessment of the experience of the consumer
or patient in respect to the discrimination in the healthcare, as discrimination is related in
terms of racism, sexism, and others related to gender disparity. The mental health stigma
affects people and their wellbeing in a number of ways. In Australia, aboriginals face
discrimination includes lack of access to effective treatment or other health facilities for
people suffering from mental health problems such as dementia within healthcare (Rossom et
al., 2016).
NMBA (Nursing and Midwifery Board of Australia), states the standards of practice
and behaviour of nurses within healthcare, and includes code of conduct, code of ethics, and
standards of practice. Nurses or midwives must comply with their duty of asking the patients
about their mental health history, in a systematic manner. This state maintaining proper
documentation of the medications taken by the patient in the past. Nurses must practice
safely and collaboratively, ensuring integrity in their profession. To attain this, nurse must
develop effective therapeutic relationship with patients to help them attain change in their
health condition (Griffiths et al., 2015). Moreover, it has understood that mental illness also
affects an individual’s physical health, and therefore, nurses must take care of the patient’s
health affected by dementia. Psychological therapies of counselling, taking care of the
patient with the help of multi-disciplinary team within healthcare (Nursing and Midwifery
Board of Australia, 2018).

NURSING
7
In context to the healthcare of the patients affected by mental illness, the strategy of
Mental + discrimination + health + care has been found suitable for the issue of dementia.
Four elements of the ICN code of Ethics for nurses are relevant to the management and
prevention of illness in the Australian healthcare system. These elements consist of the
nursing staff and people, and the medical profession (Dewing & Dijk, 2016).
Nurse must work with high commitment to deliver competent health service to the
patients suffering from mental health illness, such as dementia. In addition, they should not
discriminate people in terms of services and the treatment processes. Discrimination affects
the individuals in every aspect, as people living with dementia in Australia are often
disengaged from the workforce, and neglected in the aspect of community participation.
Therefore, health care professionals and nurse must comply with the cultural standards and
ensure providing care following the person-centred approach to treatment (Olfson, Druss and
Marcus, 2015).
Compliance to the code of conduct for providing effective treatment to patients is
essential, for nurses in the healthcare. These include efficacy of the anti-depressant drugs and
other medications, psychotherapies, in-house care, as per the mental health need of the
patients of dementia (NSQHS Standards, 2018).
Effectiveness in attaining the cultural safety will lead to a positive experience of the
patient receiving care; therefore, health professionals must be given training to undertake
their responsibility. The aspect of cultural safety and standards, and compliance to the ethics,
and other code of conduct will determine positive attitude of the patient towards their illness.
Hence, it would lead to empowerment of both, healthcare professionals and patients,
undertaking the process of treatment and ensuring recovery from illness (Fox et al., 2016).

NURSING
8
3. Conclusion
To conclude the above discussion it has been analysed that dementia is considered
one of the major factors causing death in the country. It affects different people in different
ways, at varied ages leading to many signs and symptoms. The issue and impact of the mental
health illness in the country is based on genders, which means more than 50% of the women
are influenced by mental health problems. Therefore, dementia has been illustrated well in
the essay with the aspects such as treatment, use of patient-centred approach, and the
description of health delivery systems. In addition, the discussion has stated the meaning and
significance of cultural safety and standards applicable in the Australian healthcare system.
Code of conduct and value of ethics in the Australian health institutions has been also
focused to assess the effectiveness of services leading to positive health outcomes in context
to dementia.

NURSING
9
References
Dementia Australia. (2018). Palliative care and Dementia. Retrieved from:
https://www.dementia.org.au/files/documents/Dementia-Policy-Statement-2018.pdf
Dewing, J. & Dijk, S. (2016). What is the current state of care for older people with dementia
in general hospitals? A literature review. Dementia, 15(1), 106-124.
Edvardsson, D., Watt, E. & Pearce, F. (2017). Patient experiences of caring and person‐
centeredness are associated with perceived nursing care quality. Journal of advanced
nursing, 73(1), 217-227.
Fleming, R., Goodenough, B., Low, L. F., Chenoweth, L. & Brodaty, H. (2016). The
relationship between the quality of the built environment and the quality of life of
people with dementia in residential care. Dementia, 15(4), 663-680.
Fox, C., Hilton, A., Laidlaw, K., Thyrian, J. R., Maidment, I. & Smithard, D. G. (2016). 23
Role of Specialist Care in Dementia. Mental Health and Older People: A Guide for
Primary Care Practitioners, 267.
Galimberti, D., Dell’Osso, B., Altamura, A. C. & Scarpini, E. (2015). Psychiatric symptoms
in frontotemporal dementia: epidemiology, phenotypes, and differential
diagnosis. Biological psychiatry, 78(10), 684-692.
Garg, A., Boynton-Jarrett, R. & Dworkin, P. H. (2016). Avoiding the unintended
consequences of screening for social determinants of health. Jama, 316(8), 813-814.
Griffiths, P., Bridges, J., Sheldon, H. & Thompson, R. (2015). The role of the dementia
specialist nurse in acute care: a scoping review. Journal of clinical nursing, 24(9-10),
1394-1405.
Kirmayer, L. J., Bennegadi, R. & Kastrup, M. C. (2016). Cultural awareness and
responsiveness in person-centred psychiatry. In Person centred psychiatry (pp. 77-
95). Cham: Springer.

NURSING
10
Knaak, S., Mantler, E. & Szeto, A. (2017). Mental illness-related stigma in healthcare:
Barriers to access, and care and evidence-based solutions. In Healthcare management
forum (Vol. 30, No. 2, pp. 111-116). Sage: Los Angeles.
Mihrshahi, S., Dobson, A. J. & Mishra, G. D. (2015). Fruit and vegetable consumption and
prevalence and incidence of depressive symptoms in mid-age women: results from the
Australian longitudinal study on women’s health. European journal of clinical
nutrition, 69(5), 585.
NSQHS Standards. (2018). Partnering with patients in their own care. Retrieved from:
https://www.nationalstandards.safetyandquality.gov.au/2.-partnering-consumers/
partnering-patients-their-own-care
Nursing and Midwifery Board of Australia. (2018). Professional Standards. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/
Professional-standards.aspx
Nursing and Midwifery Board of Australia. (2018). New codes of conduct for nurses and
midwives published. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/news/2017-09-28-new-codes-of-
conduct.aspx
Olfson, M., Druss, B.G. and Marcus, S.C. (2015). Trends in mental health care among
children and adolescents. New England Journal of Medicine, 372(21), 2029-2038.
Rickwood, D. J., Mazzer, K. R. & Telford, N. R. (2015). Social influences on seeking help
from mental health services, in-person and online, during adolescence and young
adulthood. BMC psychiatry, 15(1), 40.
Robinson, L., Tang, E. and Taylor, J.P. (2015) Dementia: timely diagnosis and early
intervention. Bmj, 350, 3029.
Rozsa, M., Ford, A. & Flicker, L. (2016). Assessing people with dementia: the role of the
aged care assessment team and memory clinics. Internal medicine journal, 46(9),
1081-1088.
Russ, T. C., Murianni, L., Icaza, G., Slachevsky, A. & Starr, J. M. (2016). Geographical
variation in dementia mortality in Italy, New Zealand, and Chile: The impact of

NURSING
11
latitude, Vitamin D, and air pollution. Dementia and geriatric cognitive
disorders, 42(1-2), 31-41.
Thyrian, J. R., Hertel, J., Wucherer, D., Eichler, T., Michalowsky, B., Dreier-Wolfgramm, A.
& Hoffmann, W. (2017). Effectiveness and safety of dementia care management in
primary care: A randomized clinical trial. JAMA psychiatry, 74(10), 996-1004.
Wu, Y. T., Beiser, A. S., Breteler, M. M., Fratiglioni, L., Helmer, C., Hendrie, H. C. &
Matthews, F. E. (2017). The changing prevalence and incidence of dementia over
time—current evidence. Nature Reviews Neurology, 13(6), 327.