Essay on Culturally Safe Nursing Practice for Aboriginal Australians

This nursing essay examines culturally safe practice for Aboriginal and Torres Strait Islander populations in Australia. It begins by introducing the target group and highlighting health issues such as cardiovascular disease, diabetes, and kidney disease, which are prevalent among this population, particularly in remote areas. The essay then explores the social determinants of health (SDH) and the Etic and Emic views of culture as theoretical frameworks that contribute to health inequalities. The student discusses the importance of patient-centered care, effective communication, and the role of healthcare professionals in providing culturally competent care, specifically in managing T2DM. The essay emphasizes the need for health education, diet planning, and lifestyle modifications to improve health outcomes and reduce health disparities, aligning with the Australian health policy of closing the gap in Indigenous health.

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

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Introduction
According to Australian Institute of Health and Welfare [AIHW] (2016), the
population of Australian that is recognising themselves as aboriginals or the Torres Strait
Islanders are increasing. During 2011 to 2017, there is an increase in the 17% of the
aboriginals and the Torres Strait Islander population. Torres Strait Islanders must not be
confused with the aboriginal population of Australia. Torres Strait Islanders are indigenous
population residing in parts of Queensland. The following essay aims to highlight my own
perceptions and strategies of providing culturally safe practice to a client from Aboriginals
and Torres Strait Islander population. The essay will initiate with introduction of the target
group followed by health issues affecting the target group. At the end, the essay will discuss
theoretical frameworks to analyse the cultural factors and social determinants of health that
might affect my client from Aboriginal population. I will also discuss the resources and
practice that I will follow in order to procure culturally safe care. Overall the essay will
discuss the importance of culturally safe practice for improving health equality.
Selection of Client form the Cultural Group
According to Australian Institute of Health and Welfare [AIHW] (2016), the
population of Australian that is recognising themselves as aboriginals or the Torres Strait
Islanders are increasing. During 2011 to 2017, there is an increase in the 17% of the
aboriginals and the Torres Strait Islander population. Torres Strait Islanders must not be
confused with the aboriginal population of Australia. Torres Strait Islanders are indigenous
population residing in parts of Queensland. Markwick et al. (2014) are of the opinion that
there is a significant health inequality prevalent among the indigenous and the non-
indigenous population in Australia. In spite of the government’s constant in initiatives to
“close the gap”, the indigenous population in Australia like the aboriginals experiences poor

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health conditions and the main reason attributed for this poor socio-economic determinants of
health (SDH). According to the study conducted by Jamieson et al. (2016), the Aboriginals
adults who reside in remote regions of Australia are victims of the poor hygiene and
sanitation, lack of proper employment and denial of care. All these ill-treatment and poor
SDH are the reasons behind high rate of occurrence of chronic diseases among the
aboriginals, leading to health inequalities.
The prevailing health inequalities for the Aboriginal adults in the remote areas make
me feel for them. Thus during my nursing practice I will leave an extra room for attention in
providing care and treatment to the Aboriginals adult clients as I feel every human have
equal rights to lead to healthy life.
Health Issues and Impact of Chosen Client
Through the concepts and knowledge and gained through the course, I have identified
that the main health issues that impact the adult Aboriginal population residing in the remote
areas of Australia are cardiovascular disease, diabetes and kidney disease. According to the
reports published by AIHW (2015), the cardiovascular disease (CVD) burden among the
Aboriginal adults is 8 times higher in comparison to the non-aboriginal population residing in
Australia. AIHW (2015) also remotes the Aboriginals are more likely (18% probability) to
develop type 2 diabetes mellitus (T2DM) in the later part of their life than non-aboriginals.
The occurrence of the renal disease is 38% high among the Aboriginals (AIHW, 2015). The
detailed analysis of the health related quality of the life of the Aboriginals in the remote areas
of Australia highlighted that modifiable risk factors are the main reason behind the increased
probability of the occurrence of his non-communicable diseases. Mitrou et al. (2014) are of
the opinion that lack of employment or job not only restrict their financial independence to
access healthcare, but also increases a sense of depression. The depression is further

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aggravated as a result of social isolation and bullying. In order to cope with depression they
indulge in substance abuse (alcohol and smoking). Aboriginals are also marked with
unhealthy eating patterns and lack of physical activity leading to uncontrolled gain in weight
(Whelan & Wright, 2013). This unhealthy diet (less consumption of fruits and vegetables),
substance abuse, lack of physical activity along with poor mental health condition is the
reason behind the high rate of occurrence of renal disease, CVD and T2DM among
Aboriginals, leading towards health inequalities.
Arena et al. (2015) stated that proper diet, healthy life style (no smoking and drinking)
along with lack of physical activities is the modifiable risk factors behind the development of
non-communicable chronic diseases. I personally feel that giving medication and doing
health-checkups are not comprehensive in improving the health-related quality of life of the
older adults. As I can see that majority of the causes leading to the development of non-
communicable diseases among the Aboriginals are modifiable, process heath education and
generation of the health-related awareness will help to reduce the chance of getting affected
with this chronic diseases in the first chance. I Aboriginals residing in rural areas are unable
to enjoy culturally competent care due to lack of proper trained nurses in the rural areas. So in
order to increase their access to healthcare, we the healthcare professionals must come up
with patient-centred care plan targeted towards the clinical needs of the Aboriginals. My
thought process is mainly guided by the Australian health policy for the Aboriginals naming
closing the gap. According to this policy, in order to close the health related gap among the
indigenous population in Australia apart from increase in the healthcare access, the
improvement in the SDHs must be done along with proper heath education and procuring
care in a patient-centred manner. This will help to increase life-expectancy of the aboriginals
by reducing the rate of occurrence of the non-communicable diseases (Australian Human
Right Commissions, 2019).

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Theoretical Frameworks behind Health Inequalities among Aboriginals
I think, two best suited theoretical frameworks behind the prevailing health
inequalities among the Aboriginal adults in the remote areas of the Australia are Etic & Emic
views of culture and the SDH.
Etic & Emic views of culture
According to the cultural anthropology, ethic view of a culture is the perspective of an
outsider looking in. Like the majority of the non-indigenous population, nurture a biased
perspective towards the Aboriginal populations residing in Australia (Zhu & Bargiela-
Chiappini, 2013). Dandy, Durkin, Barber and Houghton (2015) reported that there are
stereotypes and prejudice towards the Australian Aboriginals. The majority of the non-
Aboriginals are of the opinion that the Aboriginals are drunk, intentionally indulge in
unhealthy lifestyle habits and feed on wrong food like white sugar and flour. People outside
the Aboriginal community also think that they are lazy and hence do not work. Their dark
skin, wide-nose, curly hair provokes development of negative body image towards them. This
generates a feeling that Aboriginals are involved in crimes, they are violent and are not
civilized to reside in urban areas. This misconception and prejudices are the reason behind
why the aboriginals experiences social bullying or there is an increase in the school dropouts,
denial of proper healthcare or gap in employment opportunities among the aboriginals. I think
this etic is the reason behind lack of financial support, education and healthy mental life
leading to development of non-communicable diseases, creating health inequality.
As per the Emic view, the intrinsic cultural distinctions or the insider's perspective of
culture is the reason behind immersion inside orthodox behaviour (Zhu & Bargiela-
Chiappini, 2013). Yuan, Ma, Ye and Piao (2016) highlighted that Aboriginals who reside in
the remote areas are not exposed to the denial advanced in the health care and they have a
strict conviction towards the use of the traditional medicines for the process of disease

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recovery. However, traditional medicines are not comprehensive behind the effective
treatment of the fatal disease like ischemic heart attack in CVD or cancer. This orthodox
behaviour redistricts them to avail healthcare access and thus creating healthcare inequalities.
Social Determinants of Health (SDH)
According to AIHW (2016) poor social determinants of health (SDH) has a
significant impact behind the health equalities or poor status of the health of the Aboriginals
residing in the rural areas of Australia. According to AIHW, good health is associated with
complex set of underlying factors that include the access to the healthcare service, health-
related behaviours, prevailing environmental factors and health endowment. All these factors
are randomly distributed in the society and is associated with the SDH. Broadly, SDH are the
circumstances under which a people grow, live work and the age. SDH is measured based on
the family income, personal education, employment, social support and social inclusion. For
Aboriginals and the Torres Strait Islanders SDH include family, cultural identity,
participation in the cultural activities and access to traditional lands. This limited definition
of the SDH for the Aboriginals in Australia is the reason behind the poor health status.
Moreover, AIHW (2016) also stated that Aboriginals residing in remote areas lacks poor
access of pre-pregnancy health care, nutritious food and social support. Such that the babies
are malnourished making them prone towards developing CVD, T2DM and renal
complications in the later stages of life. Lack of proper pregnancy care also leads to
postpartum death. The health behaviours of the Aboriginals are also poor and lack of proper
employment, financial and social support is the reason for the poor health behaviour and
increasing disease predisposition.
Thus, the theoretical perspective of the SDH and Etic & Emic highlight a strong
reason behind the argument that is highlighted behind my selection of the Aboriginal adults
in remote regions of Australia as my main target group for the care plan.

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Health Issue: T2DM and Culturally Safe Care
According to Inzucchi et al. (2015), T2DM is a lifestyle disease that has no definite
cure and medication management. However, effective regulation of the lifestyle habits like
diet, physical activities can help to reduce the severity of the disease. The Aboriginal adults
in Australia are obese, lack any significant physical activities, feed on unhealthy food and are
victims of high alcohol intake. All these factors make them vulnerable towards developing
T2DM. So in order to provide effective care plan for the Aboriginal adults, I will frame a
patient centred care plan for the effective T2DM management targeting the major modifiable
risk factors. However, According to the Nursing and Midwifery Board of Australia (2018) it
is the duty of the nursing professional to practice in the culturally competent manner while
maintaining a respectful relationship with the clients (Principle 3). This can be best executed
by the use of the effective communication skills (Kourkouta & Papathanasiou, 2014).
Effective communication skills will help me to develop therapeutic relationships and this in
turn will help me to know their exact health needs and thereby devising person centred care
plan. Kourkouta and Papathanasiou (2014) stated that therapeutic relationship with the client
helps the nurses to increase the participation in the care while making provision for the
informed decision making (Principle 2). I think involving my Aboriginal client and his or her
family members in the decision making process will help me to increase their health
awareness and knowledge and thus improving healthcare access.
From my personal experience, I have seen giving culturally competent care plan to the
Aboriginals in Australia under the application of the Transcultural nursing will help me to
take a minute step towards reducing the gap of the health inequalities. Apart from the
execution of the effective communication skills to known their exact problems, I will also
take help from the professional dietician in framing a person-centred diet plan by respecting
the cultural thoughts and spiritual believes of my Aboriginal client. This will help to increase

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diet adherence and at the same time will help them feel empowered within their own culture.
According to Diabetes Australia (2019) diet holds a principal part in the T2DM management,
low carbohydrate, sugar restricted and high protein diet helps to reduce the blood glucose
level.
Requirements for utilisation and distribution of resources
Cultural background of the patient has a huge impact on their approach in accessing
healthcare service. For example, pain has an inherent relation to culture. In Aboriginal
culture, pain is visualised as more stoic or a return punishment for return miss-deed. In non-
Aboriginal culture, the sense of pain is high. They are less tolerant towards pain (Galanti,
2014). So in this cultural clash management of pain can be done through culturally
competencies. T2DM patients at times suffer from peripheral pain due to peripheral diabetic
neuropathy (Khalil, 2013). In order to manage pain for my Aboriginal client, I will fuse
culturally competent care plan along with the use of the pain scale to denote the level of pain.
The score of the pain scale will help to give care accordingly.
Language also plays an important role in healthcare access. Aboriginal people
residing in the remote areas of Australia are not well-versed in English and they mainly
communicate in their native Aboriginal language. Engaging with patients with their own
language helps to promote better health outcomes (Flores, 2014). Thus in the educational
awareness program and under the healthcare settings I will recommended more Aboriginal
and Culturally and Linguistically Diverse (CALD) nurses. This will help me to increase the
participation of my Aboriginal adult client in the care plan and at the same time will help to
bring globalisation and diversification in the nursing workforce. Galanti (2014) stated that
diversification in the workforce will help to increase the cultural competency of the
healthcare service delivery.

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Conclusion
Thus from the above discussion, it can be concluded that, culturally safe practice
helps in improving healthcare access to the Aboriginal client. Under culturally safe practice
the presence of aboriginal and Torres Strait Islander nurse will help to ease the process
communication thus promoting patient participation in the care plan. Moreover, transcultural
nursing must be implemented so that cultural bias does not hamper the process of decision
making. Moreover, the spiritual and the cultural thoughts of the Aboriginal client must be
respected in order to procure care with dignity and cultural competence.

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References
Arena, R., Guazzi, M., Lianov, L., Whitsel, L., Berra, K., Lavie, C. J., ... & Myers, J. (2015).
Healthy lifestyle interventions to combat noncommunicable disease—a novel
nonhierarchical connectivity model for key stakeholders: a policy statement from the
American Heart Association, European Society of Cardiology, European Association
for Cardiovascular Prevention and Rehabilitation, and American College of
Preventive Medicine. European heart journal, 36(31), 2097-2109.
https://doi.org/10.1093/eurheartj/ehv207
Australian Human Right Commissions. (2019). Close the Gap: Indigenous Health Campaign.
Access date: 24th April 2019. Retrieved from: https://www.humanrights.gov.au/our-
work/aboriginal-and-torres-strait-islander-social-justice/projects/close-gap-
indigenous-health
Australian Institute of Health and Welfare (2015). Cardiovascular disease, diabetes and
chronic kidney disease—Australian facts: Aboriginal and Torres Strait Islander
people. Access date: 24th April 2019. Retrieved from:
https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/indigenous-
australians/contents/table-of-contents
Australian Institute of Health and Welfare (2016). Social determinants of Indigenous health.
Access date: 24th April 2019. Retrieved
from:https://www.aihw.gov.au/getmedia/d115fe0f-9452-4475-b31e-bf6e7d099693/
ah16-4-2-social-determinants-indigenous-health.pdf.aspx
Dandy, J., Durkin, K., Barber, B. L., & Houghton, S. (2015). Academic expectations of
Australian students from Aboriginal, Asian and Anglo backgrounds: Perspectives of

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NURSING
teachers, trainee-teachers and students. International Journal of Disability,
Development and Education, 62(1), 60-82.
https://doi.org/10.1080/1034912X.2014.984591
Diabetes Australia. (2019). Eating Well. Access date: 24th April 2019. Retrieved from:
https://www.diabetesaustralia.com.au/eating-well
Flores, G. (2014). Families facing language barriers in healthcare: when will policy catch up
with the demographics and evidence?. The Journal of pediatrics, 164(6), 1261-1264.
DOI: https://doi.org/10.1016/j.jpeds.2014.02.033
Galanti, G. A. (2014). Caring for patients from different cultures. University of Pennsylvania
Press.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... &
Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a
patient-centered approach: update to a position statement of the American Diabetes
Association and the European Association for the Study of Diabetes. Diabetes
care, 38(1), 140-149. https://doi.org/10.2337/dc14-2441
Jamieson, L. M., Elani, H. W., Mejia, G. C., Ju, X., Kawachi, I., Harper, S., ... & Kaufman, J.
S. (2016). Inequalities in indigenous oral health: findings from Australia, New
Zealand, and Canada. Journal of dental research, 95(12), 1375-1380.
https://doi.org/10.1177/0022034516658233
Khalil, H. (2013). Painful diabetic neuropathy management. International Journal of
Evidence‐Based Healthcare, 11(1), 77-79. https://doi.org/10.1111/1744-1609.12010

11
NURSING
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia
socio-medica, 26(1), 65. doi: 10.5455/msm.2014.26.65-67
Markwick, A., Ansari, Z., Sullivan, M., Parsons, L., & McNeil, J. (2014). Inequalities in the
social determinants of health of Aboriginal and Torres Strait Islander People: a cross-
sectional population-based study in the Australian state of Victoria. International
journal for equity in health, 13(1), 91. https://doi.org/10.1186/s12939-014-0091-5
Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E., & Zubrick, S. R.
(2014). Gaps in Indigenous disadvantage not closing: a census cohort study of social
determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC
Public Health, 14(1), 201. https://doi.org/10.1186/1471-2458-14-201
Nursing and Midwifery Board of Australia (2018). Professional code of Conduct. Access
date: 24th April 2019. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/news/2017-09-28-new-codes-of-
conduct.aspx
Whelan, S., & Wright, D. J. (2013). Health services use and lifestyle choices of Indigenous
and non-Indigenous Australians. Social science & medicine, 84, 1-12.
https://doi.org/10.1016/j.socscimed.2013.02.013
Yuan, H., Ma, Q., Ye, L., & Piao, G. (2016). The traditional medicine and modern medicine
from natural products. Molecules, 21(5), 559.
https://doi.org/10.3390/molecules21050559
Zhu, Y., & Bargiela-Chiappini, F. (2013). Balancing emic and etic: Situated learning and
ethnography of communication in cross-cultural management education. Academy of

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Management Learning & Education, 12(3), 380-395.
https://doi.org/10.5465/amle.2012.0221