Reflecting on Cultural Competency in Indigenous Nursing: A Report

This essay explores the historical context of healthcare disparities faced by Indigenous Australians, focusing on the impact of discriminatory laws and policies, such as the Aboriginal Protection and Restriction of the Sale of Opium Act 1897, and their lasting effects. The essay uses Cassie's story as a case study to illustrate the forced displacement and control experienced by Indigenous communities. It then examines the importance of cultural competency in nursing, highlighting how healthcare professionals can improve interactions with Indigenous patients by understanding their historical mistrust of government institutions, addressing issues of perceived racism, and respecting cultural practices. The essay emphasizes the need for nurses to learn about Indigenous cultures and communicate with empathy to provide better healthcare outcomes, including strategies for improving patient satisfaction and addressing vaccine hesitancy. Finally, it concludes that training healthcare professionals in cultural competency is a crucial step toward bridging the healthcare gap for Indigenous Australians.

Running head:INDIGENOUS NURSING
Name of the Student
Name of the University
Author Note

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Introduction
Ever since a long time, Indigenous Australians have faced severe discrimination in
terms of healthcare, livelihood, and other basic human rights. Multiple surveys and studies
have found that they have drastically lower life expectancy than that of their non-Indigenous
counterparts. The gap in life expectancy between both the groups is as high as 10.6 years for
males and 9.5 years for that of women. They suffer from diseases around 2.5 times more than
that of non-Indigenous Australians (Mazel, 2018 p.2). There have been several laws and
government policies aiming towards the overall improvement of the Aboriginals and Torres
Strait Islanders. Still, many of them have been vastly unsuccessful or resulted in dominating
them further rather than giving them equal rights. Throughout the course of history, many
laws were passed, resulting in significant discrimination. This included but was not limited to
the fact that the Indigenous Australians were not considered to be the citizens of Australia.
They had no rights over their lands, and the government could remove any Indigenous
children under the age of 16 from their parents, termed popularly as the 'stolen generation'
(Bth.humanrights.gov.au., 2020). This essay aims to report on certain laws that historically
impacted the Indigenous Australians, and reflect on the ways that cultural competency can be
useful while providing healthcare to the Indigenous population.
Reporting
Amongst the many laws that discriminated against the Indigenous Australians and
their basic human rights, the Aboriginal Protection and Restriction of the Sale of Opium Act
1897 must be mentioned. This act was referred to as supposedly the act to provide better'
protection to the Aboriginal population' and reducing the sale of opium as well (Australian
Institute of Aboriginal and Torres Strait Islander Studies, 2020). Indigenous Australians
suffered from largely opioid abuse-related diseases, and this was considered to be a solution

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to that. However, this directly gave government the rights control the lives and livelihood of
the Aboriginal population. This law was replaced by Aboriginals Preservation and Protection
Act as well as the Torres Strait Islanders Act in the year 1939. This act paved the way for
Protectors in each district to control possible aspects of aboriginal life. This continued up
until the 1970s. This included controlling where they worked and lived, wages, land
ownership as well as removing children from the families by force. This period is described
as the period of 'living under the act' by Aboriginals and Torres Strait Islanders
(Qhrc.qld.gov.au., 2020).
Throughout history, there have been many accounts of the effects of these acts on
Indigenous Australians. From the given piece of writings, it can be easily understood that
Cassie and her family, along with other Aboriginal families of their mob, are being forced to
move to the other part of the town. Cassie's narration also mentions that it is not the first time
that she and her community has been moved. She words explicitly state that the 'white people'
and 'council fellas' tend to just give them a couple of weeks' notice before "herding us up and
moving us on." This suggested that the people of the community heavily related to the time
they had no rights under the act, and they were forced to move even if they strongly protested
against it. It also said that Cassie was afraid of moving away from her mother, suggesting that
she thought it was a very strong possibility that she will be separated from her family.
Cassie's story was not the only one; there are countless recollection and stories
regarding how the Indigenous Australians were treated. It has been said that they were treated
the same way by the European settlers as they would wild animals. An old newspaper
described the events of Aboriginal children forcibly taken away from their families, as well
as the Indigenous women being carried away. The act of 1939 allowed the government
officials to move the Indigenous population by force to one reserve from another, as
happened in Cassie's story (Humanrights.gov.au., 2020).

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From the National Aboriginal Health Strategy Working Party (Australia), we know
that health to the Indigenous population refers to the overall emotional, social as well as
cultural wellbeing of the community, rather than physical wellbeing. Quoting the same-
"Health" to Aboriginal (and Torres Strait Islander) peoples is a matter of determining
all aspects of their life, including control over their physical environment of dignity, of
community self-esteem, and of justice. It is not merely a matter of the provision of doctors,
hospitals, medicines or the absence of disease and incapacity."
-National Aboriginal Health Strategy Working Party (Australia). (1989)
So it is no surprise that this sort of control over their lives had a severe impact on their
physical wellbeing, but also their dignity and psychology (Mazel, 2018 p. 10).
Relating
Keeping in mind the previous scenario, I can understand why Indigenous Australians
may have certain reservations with government facilities and non-Indigenous nurses. As a
non-Indigenous Australian nurse, I cannot say that I understood their issues on a personal
level, I could relate to and understand their apprehension of government institutions and
Caucasians. I understood why many of my Aboriginal and Torres Strait Islander patients
decide to opt for early discharge despite it being against medical advice (Bryce et al., 2016 p.
740). There have been multiple times when Aboriginal patients have claimed that we do not
understand their disease or that we are misdiagnosing them. There have also been instances
where clear abnormalities were normalised by the families. A study shows that chronic wet
cough in Aboriginal children is often normalised by their families, and they do not consider it
a problem. In reality, this type of cough usually signifies underlying issues such as respiratory
illness (D'Sylva et al., 2019 p. 833-843).

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Often, they are sceptical with the treatment plans we provide. Once, I had an
experience with an elderly aboriginal lady who did not comply with any of the medications
she was provided, claiming that she did not trust the medications and her family compelled
her to come to us. It was seen that the older Aboriginals and Torres Strait Islanders reported
of facing more perceived racism than that of their younger counterparts. So much of this
racism may be simply perceived. They usually feel the need to report unfairness and racism.
So it is possible that they still have a tendency to avoid perceived racism (Temple, Kelaher &
Paradies, 2019 p.39). It has also been seen that Aboriginal children have a higher chance of
contracting a vaccine-preventable disease than that of non-Indigenous children. This is
because Indigenous parents do not vaccinate their children as often. This may be due to
mistrust towards government-mandated vaccines (Hendry et al., 2018 p. 24).
Reasoning
In context of we learned, it can definitely be understood that the unpleasant history
and laws still impact how much the Indigenous populations benefit from the current
healthcare systems. From Cassie's story, it was very clear that both her aunt and her mother
had problems relating to blood sugar. Also, statistics show the prevalence of diseases to be
higher in Indigenous Australians than that of their non-Indigenous, and they also have a clear
disparity regarding healthcare. So steps must be taken to ensure that the Aboriginals and
Torres Strait Islanders seek the required healthcare when they need so and that they are
administered the best possible care. For this, the nurses must become culturally competent in
relation to Indigenous Australian culture. Cultural competency of health professionals has
proven to be a very important factor in providing healthcare to the population from different
ethnic and cultural groups. This has a clear effect on the knowledge and skills of the
healthcare practitioner. Higher cultural competency has been reported to result in better
patient quality and a higher quality of care overall. Cultural competency training has been

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given in many places, and it mostly focuses on increasing the knowledge of healthcare
professionals about different cultures, practices, and traditions (Jongen, McCalman &
Bainbridge, 2018 p.2). This enables the healthcare professional to communicate with the
patient in a more effective way as the nurse will already know which topics may be sensitive
for the person and approach with caution. The nurse will also know how to build a rapport
with the patient. It has been seen that people tend to listen to someone willing to understand
them. This will also show the patients that the healthcare professional respects their traditions
and beliefs. If healthcare professionals are culturally competent, they will be aware of the
possible problems the person might face. Thus in some cases, that may make the diagnosis
and treatment easier. This will increase their quality of care (Jongen, McCalman &
Bainbridge, 2017 p. 1).
In the case of the Aboriginals and Torres Strait Islanders, it must be remembered that
they already distrust the facilities, especially the elderly Indigenous population. So the nurses
must learn about their cultures and their struggles in order to connect with them fully. If a
person respects and tries to understand their struggles, it may be likely that they will respond
more warmly to the nurses. It has been seen that cultural competence is a very effective
nursing intervention, and along with having better patient outcomes, it also provided with
improved patient satisfaction (Govere & Govere, 2016 p.402).
Reconstructing
Cultural competence is very important in nursing practice as patients from other
ethnicities often feel like they are being overlooked. Being culturally competent can help
them feel that the nurse caring for them is aware of their culture and, in turn, respect them.
This will reduce the distress they may face otherwise (White et al., 2019 p. 2). Personally, in
my practice, I come across any Indigenous Australians whom I must care for with the best of

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my abilities. So being culturally competent is very important for me. For this, I must learn
more about the Aboriginal and Torres Strait Islander cultures. I must communicate with the
patients in such a way that they understand that I very much respect their culture, and I
respect the struggles and hardships that they face daily. However, it must not seem like I am
pitying them or even trying to fool them. I must be empathetic towards them and
communicate effectively (McDermott, 2019 p. 255).
Apart from learning about their culture on my own, I must talk to Aboriginal patients
and express my interest in learning about their culture. This way, it is usually possible to
learn about the culture more in-depth. For example, once I came across a patient who was in
palliative care, and I learned about Aboriginal cultural practices and traditions for the end of
life. I learned that they did not believe that death was the end. They did not like talking about
death or even naming the disease. Many of them felt coerced when the nurses forced them to
talk about their disease. So, I have learned to communicate with them more in a general
manner than continuously asking questions about the disease (Nslhd.health.nsw.gov.au.,
2020). This usually helped them become more relaxed. Hence by increasing my interaction
with the Aboriginal and Torres Strait Islander patients under my care as well as doing my
own research, I have aimed to make myself culturally competent.
Conclusion
From the above essay, we can conclude that even though the older laws are abolished,
the Aboriginals and Torres Strait Islanders still face certain disparity regarding healthcare
services. They are often sceptical of the treatment provided at the government facilities and
by Caucasian healthcare professionals due to their unpleasant history with the coercing and
controlling laws. Hence they are often apprehensive of seeking help when they need it. The
best way to combat this problem is to train healthcare professionals to become culturally

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competent. This will help them relate to the Aboriginal and Torres Strait Islanders. By
becoming culturally competent, one becomes aware of the different traditions and learns how
to better communicate with a patient from a different ethnicity. This practice will, in turn,
result in better patient outcomes and improved quality of care for the Indigenous Australian
population. Hence, the disparity of healthcare between Indigenous and non-Indigenous
populations can be abolished, and the best quality of healthcare can be provided to both
groups.

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Reference
Australian Institute of Aboriginal and Torres Strait Islander Studies. (2020). Queensland.
Australian Institute of Aboriginal and Torres Strait Islander Studies. Retrieved 23
March 2020, from https://aiatsis.gov.au/collections/collections-online/digitised-
collections/remove-and-protect/queensland.
Bryce, V., Crick, C., Kitchener, T., Cowburn, G., Richardson, L., Stanford, E., & Wang, W.
(2016). Clinical Follow-Up of Aboriginal and Torres Strait Islander Patients that
Discharge Against Medical Advice to Minimise Risk. Heart, Lung and
Circulation, 25, S313.
Bth.humanrights.gov.au. (2020). Historical Context - The Stolen Generations | Bringing
Them Home. Bth.humanrights.gov.au. Retrieved 23 March 2020, from
https://bth.humanrights.gov.au/significance/historical-context-the-stolen-generations.
D'Sylva, P., Walker, R., Lane, M., Chang, A. B., & Schultz, A. (2019). Chronic wet cough in
Aboriginal children: it's not just a cough. Journal of paediatrics and child
health, 55(7), 833-843.
Govere, L., & Govere, E. M. (2016). How effective is cultural competence training of
healthcare providers on improving patient satisfaction of minority groups? A
systematic review of literature. Worldviews on Evidence‐Based Nursing, 13(6), 402-
410.
Hendry, A. J., Beard, F. H., Dey, A., Meijer, D., Campbell‐Lloyd, S., Clark, K. K., ... &
Sheppeard, V. (2018). Closing the vaccination coverage gap in New South Wales: the
Aboriginal Immunisation Healthcare Worker Program. Medical Journal of
Australia, 209(1), 24-28.

9INDIGENOUS NURSING
Humanrights.gov.au. (2020). Bringing them Home - Chapter 5 | Australian Human Rights
Commission. Retrieved 23 March 2020, from https://www.humanrights.gov.au/our-
work/bringing-them-home-chapter-5.
Jongen, C. S., McCalman, J., & Bainbridge, R. G. (2017). The implementation and evaluation
of health promotion services and programs to improve cultural competency: a
systematic scoping review. Frontiers in public health, 5, 24.
Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency
interventions: a systematic scoping review. BMC health services research, 18(1), 232.
Mazel, O. (2018). Indigenous health and human rights: a reflection on law and
culture. International journal of environmental research and public health, 15(4),
789.
McDermott, D. (2019). "Big Sister" Wisdom: How might non-Indigenous speech-language
pathologists genuinely, and effectively, engage with Indigenous
Australia?. International journal of speech-language pathology, 21(3), 252-262.
National Aboriginal Health Strategy Working Party (Australia). (1989). A national
Aboriginal health strategy. NAHS Working Party.
Nslhd.health.nsw.gov.au. (2020). Retrieved 23 March 2020, from
https://www.nslhd.health.nsw.gov.au/Services/Directory/Documents/Death%20and
%20Dying%20in%20Aboriginal%20and%20Torres%20Strait%20Islander
%20Culture_Sorry%20Business.pdf.
Qhrc.qld.gov.au. (2020). Retrieved 23 March 2020, from
http://www.qhrc.qld.gov.au/__data/assets/pdf_file/0013/10606/Aboriginal-timeline-
FINAL-updated-25-July-2018.pdf.

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Temple, J. B., Kelaher, M., & Paradies, Y. (2019). Prevalence and context of racism
experienced by older Aboriginal and Torres Strait Islanders. Australasian journal on
ageing, 38(1), 39-46.
White, J., Plompen, T., Tao, L., Micallef, E., & Haines, T. (2019). What is needed in
culturally competent healthcare systems? A qualitative exploration of culturally
diverse patients and professional interpreters in an Australian healthcare setting. BMC
public health, 19(1), 1096.