Nursing Case Study Healthcare Input Context

Question: 1. Identify the concepts of helping and caring in nursing practice across the lifespan. 2. Discuss the theory and practice of an effective therapeutic nurse-patient relationship. 3. Discuss the impact of cultural diversity on health and illness behaviour. 4. Identify the meaning of effective therapeutic communication in nursing including working. with people from diverse cultural backgrounds and age groups. 5. Explore the issues of cultural safety and cultural competence within nursing practice. 6. Plan for the promotion and maintenance of the health of individuals, families, groups and communities, with particular emphasis on the needs of vulnerable populations. Answer: Introduction Health care framework in Australia has incorporated a number of standards and policies for improving the living standards of people in Australia. However, a significant gap within the health care statistics and the provision of health care facilities has been observed in the Australian heath care system. It has been revealed from a number of previous literatures that the mortality and morbidity rate is significantly higher in Australian aboriginals compared to the non-indigenous people. The major contributory factors of the poor health outcomes of the Australian aboriginals include their lack of education and poor life style (Bailie, 2012). In addition, other studies also have highlighted the inaccessibility to the health care system. Other factors include socio-economic status, power of society leaders as well as discrimination and financial instability. To ensure their health and well-being, the health care sector must focus on keeping them in their ancestral habitat, where their w ell-being can be promoted. From a holistic perspective, health promotion needs all the aspect of life including physical, mental, emotional as well as the social wellbeing. As these people have their own tradition and culture, their wellbeing can be promoted in an environment, where they can live with satisfaction. In this essay, the focus would be the life struggle and health issues of the yolngu brothers named Warrack and Mandu. These two brothers belong to an aboriginal family living the northeastern Arnhem Land in the Northern Territory. Warrack has been playing the role of a leader in their yolngu community and was trying to retain their traditions within their future generations. On the other hand, Mandu is a young man, who did not want to be in the community, as he felt boring and started to find things interesting in urban area, such as Melbourne. The essay will emphasize on their health and social issues and will discuss about the ways they can combat with these issues. Background The Yolngu are groups of 40-50 people, living in the Northeast Arnhem Land. Before the arrival of missionaries in 1942, Yolngu population lived a peaceful life in their ancestral habitat. According to the given scenario Yolngu people, in older days, people used to get no sickness at all, it is because, the aboriginal food is balanced (Calma, 2011). The young people did not live at one place all the time, rather they moved from place to place. At their habitat, the natural foods helped them to be fit and healthy. They have been taken away from their native habitat, put into the yard, and said to live in the yard. It has been revealed that, the indigenous people are 40 times more likely to experience and die due to diabetes, a disease that had no existence before the arrival of Europeans. Their freedom has been snatched from them, which is one of the main reasons behind their poor health outcomes. In the European community, the Yolngu people are not able to cope with the new rule of li ving(Cooper, 2011). To adapt in the new community, they need education and assistance to combat with the new situations, but, unfortunately, there is no one for their assistance. Their traditional systems, laws and governance has been undermined by the Europeans rules. Many indigenous Australians are the victims of human rights violation. Others experience systematic discrimination and social exclusion from political and economic power. There are several cases, where the aboriginal populations are dispossessed of their traditional habitats and forced to leave their survival resources. Their traditional languages are threatened with extinction; it is very common phenomenon that an aboriginal people are excluded from any social activity due to linguistic issues. They need respect; they need to explore their human rights like the other non-indigenous people (Burbank, 2011). The health issue of these aboriginal populations should be assessed with more concentration to reduce the health issue related gaps. The European laws and rules has been forced the Yolngu to practice with their perspectives. Yolngu has been ignored, neglected and rejected from political and social viewpoints. A 30 years in-depth research on the lowered health outcomes of the Yolngu people has revealed that, to reduce the negative health outcomes of the Australian aboriginal people, their native community must be given back the control of their own lives (O, 2009). The new policies and practices have not been consulted with the aboriginals, in many cases, they wanted to be involved, but they did not get involvement. Therefore, the nursing intervention for their positive health outcomes must involve them as the major part of their health related intervention. Education is one of the most important parts, which is needed for improving them way of living and to increase their coping ability in the new community. This long and difficult history has left its scars on this native population, which has a negative impact upon the community members economic, social and psychological life. These non-physiological factors are known as the social determinants of health (SDH). In addition to the above determinants, the indigenous health is also affected by the language and culture. The cultural safety and security is another major factor that affects the lifestyle of aboriginal people. The cultural safety and security helps to enhance cultural awareness within the community members (Mallett, 2011). In this essay is focused around two Yolngu brothers, who have grown up in their traditional and ethnic culture. They have four others siblings. The essay is mainly focused on the cultural discrimination and lack of cultural safety of the Yolngu population. The community has been forced to leave their native land and put them in place, where their minimum needs of living is not meeting. Therefore, through th e understanding of the trans-generational trauma, endured by the community, a community nurse can be aware of complex interactions, contributing to the social determinants of health. This understanding will help the nursing staff to implement a holistic and person-centered care approach in the community, while ensuring their cultural safety. Case study of Warrack and Mandu The case study represented the struggle of two Yolngu brothers, Warrack and Mandu. Warrack plays the role of leader in his community. He tries to retain the traditional and ethnic culture in the community. He believes in education, but he also attempts to distribute his traditional education and knowledge in his fellow generation to keep alive the native Yolngu tradition. Recently, the government officers have informed the community that much of the community has taken over for mining and they are no longer allowed for hunting, which was their primary activity of life. Some of the community people got some work in mining industry, but they got the habit of smoking and alcoholism from the industrial environment. These people encouraged other community workers in drug abuse. The result is lowered health outcomes of the community members (Markwick, 2015). The government has provided the opportunity to get medical assistance from the Aboriginal health service in Yirrkala once in a fortni ght, instead of their traditional doctor. Nursing intervention strategies As a nurse in Aboriginal health service in Yirrkala, my primary concern would be to identify their needs; it would be a holistic assessment, for identifying their psychological, physiological, emotional as well as social needs. The initial step would be to take initiative of giving their native habitat back to them because it would be beneficial for by reducing the negative health outcomes of the Yolngu people (Priest, 2012). Establishing a therapeutic relationship with the community is the initial step to address the causes and impact of ill health in the Yolngu community. Establishing a therapeutic relationship with individual community members would help to build a trust on the western therapeutic procedures. For this, communicating with them with respect and dignity is very important. The yolngu people are deprived of their rights, as a human being. Thus, the initial step would be to ensure that they are respected, their feelings, perception and culture is valued. Research has shown that the aboriginals were not consulted about any western policies made for them (Priest, 2012). Thus, consultation with them about their needs, their conflicts and their complex needs can help to improve the quality of therapeutic relationship. The nurses have to communicate with them in their way, by involving in their lifestyle, thereby showing respect to Yolngu culture. In this case, the elders can be consulted first, who can then transfer the message to the rest of the community. For this, interpreter services can be taken. This service helps to reduce linguistic barrier. However, it will be effective, when a nurse have linguistic competency and without taking the help from an interpreter a therapeutic relationship is established. It enhances the trust and cooperatively of the relationship, as well as enhances the chance of interventions success. The establishment of therapeutic relationship with the aboriginals will help to enhance trust on the western treatment, which in turn help them to improve their health outcomes and lifestyle. Conducting a survey is the next step in the intervention plan. It would include close and individual consultation and survey about their problems, their actual needs and the causes behind their poor health status. Interacting individually with the community members would enhance trust; help them to forget about the negligence they have experienced (Reutter, 2010). It would also help nurses to be familiar with the community people and understand their like, dislikes, beliefs and values based on which the intervention plans can be made. Conducting a survey within the aboriginal community will help the nurses to assess the health and other issues experienced by the community; these will have a positive impact upon the aboriginal community by perfectly identifying their health issues and undertaking appropriate medical intervention to resolve these issues. Health promotion is another way to address the health needs and impact of poor health on aboriginals life. They are disadvantaged people; this community does not have much awareness about their social determinant of health. Through health promotions in these people, can make them aware of the facts that contribute into their poor health. As a result, they would be more cooperative with the health care team in developing their care plans for improving the health status (Greenwood, 2012). In this health promotion, the elders in Yolngu community can play a vital role in dispersing awareness within the community. It can reduce the rate of smoking and other drug abuse. Health promotion would include a wide range of positive impact upon the poor health status of the aboriginal community. It is because, through health promotions, the members of the community would be aware of aspects, which can improve their health outcomes, for example, they would be aware of the negative impact of alcohol and tobacco smoking. As a result, the young people would attempt to quit alcohol consumption or smoking. Linking the traditional therapy with the modern nursing interventions is one of the ways to encourage Yolngu people for participating in the western health care system. The Yolngu people are culturally responsive in nature. They believe in their traditional medication, thus involving the traditional therapy with the western health care pattern would improve their satisfaction, which is a major factor that improves the signs of depression, anxiety and the overall mental status (Browne, 2012). An overall mental and emotional well-being would enhance the success rate of the nursing interventions. However, the main success factor of aboriginals improved health is to prioritizing their needs, rights and visualizing the world from their perspective, in spite instructing them about how to live, like white people. It would also have a positive impact upon the physical as well as emotional well being of the Yolngu community. It has been revealed that Yolngu people has a faith on their traditi onal medicines, thus linking their traditional medicines with the modern treatments would help to enhance their adherence with the therapeutic procedures, thereby enhancing their positive health outcomes. Elders in Yolngu Elders have a major role in reducing the rate of ill health in the Yolngu. Here, in the case scenario, the elder word is referred to the people of certain age group, who have enough traditional knowledge about the cultural and ethnicity of a community. In case of Warrack and Mandus case study, the elder people refers to the people like Warrack, who have grown up into the native community habitat and fresh environment, without disturbance of the white people, i.e. Europeans. These elderly people have a major role in the enhancing health related awareness within the young Yolngu generation. One common trait in the aboriginal elders is a deep spirituality, which promotes each aspect of their lives and teaching. They struggle to represent their tradition by living based on their in-depth ingrained principles, values, norms and teaching. However, elders are not defined by their age; rather they are characterized by their earned respect in the community through their harmony, wisdom and ba lance of their actions in their teachings (Jamieson, 2012). Though the role of elders differs from community to community, they follow common principle of safeguarding the community and play the role of leaders. The Yolngu elders are committed to share their earned traditional knowledge, guidance and to teach others about respecting the natural world and their native ethnicity. In yolngu community of the case study, Warrack is an elder, who is being respected in his community as an important, traditional and initiated elder as well as leader. His education started with traditional passed on clan, cultural and environmental knowledge from his elders. With his wife, Warrack teach some traditional knowledge to their kids, when they are not in the school. Thus, he beliefs in nourishing the traditional knowledge, while adopting new and essential educational elements from current culture. Thus, he has all the characteristics necessary for being an Elder. Role of elders in health intervention In the health care initiative, one of the major factors would be to return their ethnic and traditional identity. For this, the people who has been practiced smoking and others abusive behaviors, when they came across the Europeans in the mining industry; should be redirected towards their ethnic and healthy life (Aspin, 2012). The elderly can help to promote their ethnic culture in the community through a health promotion. With the help of their traditional and ethnic knowledge, the elder people might be able to control the young generation to cease smoking and alcohol abuse. In addition, the elder people play the role of leaders, who has better understanding and can protect the community from the external influences. The nursing staffs or health care team can explore the aboriginal world by viewing of health and wellness and can assess the contemporary and emerging trends in the health issues for aboriginal communities through the interaction with the Yolngu leaders and community representatives like Warrck. These people can help the nursing staffs to identify the overall needs of the community, with individual specific requirements. The elders can help the nursing staffs to be aware of their traditional features, which could be included in the nursing interventions for providing them an essence of their traditions in the current nursing interventions and other practices for their health and well-beings (Wilson, 2012). Elders can also assist the community members to understand the nursing interventions and being aware of the facts related to ill health contributors. Therefore, the elder people may act as the bridge between the urban nursing staffs and the community members to promote the communit y health. It will help the nurse to build a trustworthy therapeutic relationship with the yolngu community. In addition, elder people can contact to their traditional doctors and insist for working with the urban nursing staff. It will have a great positive impact upon their mental health. As the holistic care approaches are based on the overall health of the care users, the mental and emotional satisfaction is essential for improved health outcomes (Britt, 2013). A combined therapeutic approach of the modern health care and their traditional health care approach can enhance their mental and emotional satisfaction, thereby improving their health outcomes. In the aboriginal documentary film, our generation, it has been shown that there is a huge difference between the health care facilities, obtained by the remote and urban community people (Saban, 2010). In this context, the people living in remote settings face inaccessibility to the health care facilities. There are several significant differences within an urban and a remote setting of health care facilities. Difference between urban and rural settings The social determinant of health has a great impact upon the overall health of outcomes of a community. These determinants are dependent on the social, economic, physical and cultural environment of the habitat. Environmental In case of remote or rural settings people likely to have a good health, as they are nourished by the nature, rather than obtaining nourishment from the technical world like in the urban settings (Aspin, 2012). In spite of the fact, it has been seen that people living in more area has suffered more than the urban population in terms of health aids. Social There are several reasons, for example, in case of Warrack and Mandus case study, it has been seen that the mining industry offered some Yolngu men to work there; however, from there Yognlu people brought cigarettes, alcohol and other stuffs back to their community, which affecting the health of the entire community negatively. Economic Another major difference is the accessibility of the health care facilities. It has been seen that the communities like Yolngu community, does not get opportunity for higher education, which is very important for getting suitable jobs. Due to lack of educational qualifications, these rural residents are not getting skilled jobs. Their unemployment is the major reason behind their financial instability (Ford, 2012). The poor economic condition promotes their malnourishment, which in turn contributes into their poor health outcomes and mortality rate. Their financial background, dont let them access the urban health care facilities (Aspin, 2012). Physical In the case of Warrack and Mandus case study, it has been revealed that, government provided health care services by the community doctors and nurses, who visit them once in a fortnight. However, these people are not able to go to the urban hospital or urban health care facilities, due to the expense of going to the urban areas and experience the urban facilities. Thus, due to lack of treatment, the mortality and morbidity rate increases along with increased illness throughout the community. According to Bourke et al. (2012), more community services and health care facilities should be present in the rural community, for providing them continuous health care assistance. It can reduce the negative impact on health and rate of mortality and morbidity. Cultural In an urban area, the community members are educationally developed as compared to the rural community; it becomes easy for the health care staffs to implement medical procedures easily with users support. In rural community, their cultural responsiveness is lower towards the modern medical care than the urban population. Reason behind Aboriginals disadvantaged life in town Aboriginal people are disadvantaged in several ways, while living in town. Their situation can be demonstrated with the example of Warracks brother Mandu and the aboriginals documentary film Our generation. In the documentary, it has been shown that Yolngu community has been forced to live in an open yard, and their native land has been taken over by the Australian government (Saban, 2010). They are getting sicker day by day due to lack of their natural habitat, natural food and traditional medications (Wilson, 2012). They were trying to adopt the urban culture, but no assistance was provided them to adapt the new environment. It has been seen that, deprived of their natural resources of life, they are getting sicker day by day. Yolngu people are freely living community, who hunts from their native land and eats natural foods (Jorm, 2012). However, while living in town, it has been seen that, they are deprived of hunting and natural food, rather, they are brought to Yirrkala shop, wh ere they have to eat processed food, therefore, their diet has been changed and this has a significant impact upon their poor health. Cultural issues The cultural components are also there, contributing to their poor health. According to Warracks case, his children are getting urban education in school, but they have no free time to sit beside their parents and gather traditional knowledge. Warrack and other elders are afraid of the fact that, if this kind of situation carries on, their cultural and traditional knowledge would not be carried to their future generation. So both husband and wife start giving traditional knowledge which they do not get in school. In this case scenario, Mandu, who is the younger brother of Warrack, was bored to his life in community and wanted to experience urban lifestyle, thus he came to Melbourne. Initially, he got a job in national park and his life was going well. However, the cultural discrimination and biasness interrupted their normal life, he was accused for stealing money and other things from his workplace. Racial conflict highlighted Mandus position in urban society. Economic issues After leaving the first job, Mandu failed to find other job due to his low educational and academic qualification. Losing his job, Mandu was not financially stable to pay for his accommodation. Therefore, Mandus example clearly highlights the impact Aboriginals low education on their lifestyle (Browne, 2012). As he had no experience for skilled job, it was tough for Mandu to live in the city. Lack of cultural competency made him more vulnerable towards poor health. He was stressed for his future; as his English was not good, unskilled jobs were also not available for him in Melbourne. He even did not have enough money to buy a ticket for Yirrikala. Mandu is now living with a koorie family, by sharing a room with 4 teenage kids. In the documentary our generation, it has been shown that government has promised them to give their own houses, but now, 20-30 people are lives in a house, in an unhealthy environment (Saban, 2010). Medical research has shown that this overcrowded house enhan ces the chance of infection (Bleich, 2012). Economic issues The communities people are still waiting for their own house, build by government. The urban society has snatched their freedom, enhancing the rate of depression in the community people. Economically, the community has no stability or financial support. They are neither enough skilled to get a job in urban areas, nor they are getting financial support to help themselves (Flicker, 2012). In Warracks community, the community nurses and doctors come once in a fortnight. It might be due to the lack of funding from Australian government support regarding medical support to the aboriginal community. It shows lack of health assessment, leading to poor health status. Unemployment is one of the major social and economical reasons behind their poor health status of aboriginals. Their educational qualifications were not suitable to get a job in urban society. Thus, their poor economic status promoted their poor health status. Aboriginal people were not able to bare the expense of getting treatm ent from urban hospitals; on the other hand, the community health facilities lack modern tools of healthcare, thereby lowering their health outcomes. In addition, their traditional medication is also not available, which might help them to improve their health status. Like Mandu, the aboriginals are being discriminated in professional and political world, they are neglected by the government and other social powers. The social issue is poverty. Lack of employment, financial support and native habitat, poverty became the main issue in their lives. Due to poor diet and lack of natural food, malnourishment promoted their ill health. Other social issues include cigarette smoking, drug addiction and alcoholism. Even, it has also been reported that the rate of child sexual abuse is high in the aboriginal society than non-aboriginals (Adams, 2012). It is one of the major causes behind the poor mental health and increased rate of depression and cognitive impairment in the aboriginal society. In case of Mandu, the social discrimination has been observed significantly. When Mandu was severely ill, he became vulnerable for living in the city. He was taken to a place, where he got no respect and faced wired behavior. The result of these kinds of action was de pression and loss of cooperative behavior and communication skills (Bleich, 2012). This scenario highlights how the aboriginals, who wants to adapt the norms and lifestyle of western society are being dominated and disadvantaged, pulling them behind in spite of assisting them to go forward. In conclusion, it can be said that the aboriginal Australians are the vulnerable and ignored community in Australia, who are not getting their basic human rights, which is the main reason behind their ill health. In order to restore their health status, the nursing interventions should rely on prioritizing their social and economic needs. Therefore, it has been revealed that, there is a strong link between the aboriginals social, economic and physical health status. Homelands are the fundamental component of their lives, but the government does not understand their demand, which is negatively affecting their lives. Government attempted to improve the aboriginals health by urbanizing them into small towns after taking them out from their native ancestral homeland. It is highly disrespectful for governments to tell people that how they will live their lives. In this essay, the scenario of Warrack and Mandus community has highlighted their struggle, negligence and poor health outcomes f rom the view of social and economic conflict. Government has taken several steps for improving their health status, but their needs are not being prioritized. 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