8
XXXXXXXXXXAssignment Title: Reflective Essay
Unit code and Title: NCS2202 Culture and Health
Lecturer: XXXXXXXXXXKate Buchanan
Student Name: Devangi K.
Student Number: XXXXXXXXXX
Date of Submission: 29/04/2019
Word Count: XXXXXXXXXX
Table of Contents
Reflective Essay 1
References XXXXXXXXXX7
Culturally safe care reduces health disparities and promotes equality (Australian Institute of Health and Welfare [AIHW], XXXXXXXXXXThe nursing workforce must be aware of the culturally diverse context to improve the health outcomes of the patients and enhance health equity (Garneau & Pepin, XXXXXXXXXXThe Code of Conduct for nurses outlines to provide culturally safe and respectful practice by understanding the context in relation to age, gender, sexual orientation, socio-economic status, cultural beliefs, race and ethnicity (Nursing and Midwifery Board of Australia [NMBA], XXXXXXXXXXThe knowledge about these principles helps to understand that the concept of health and illness vary for different people and cultural aspects are a part of holistic care of the person (Adames, Chavez-Duenas, Fuentes, Salas, & Perez-Chavez, XXXXXXXXXXThis reflective essay will describe the cultural influences on the health of the Aboriginal and To
es Strait Islander people. This will be described by utilising the theoretical frameworks to identify the various factors that contribute to their health and wellbeing and how nursing practice can be modified to promote culturally safe care to the Aboriginal and To
es Strait Islander people. The impact of the access to services, geographical locations, cultural aspects and traditions all will be complied together to obtain a holistic view to develop a care plan for the people from Aboriginal and To
es Strait Islander (ATSI).
The ATSI people live in different regions of Australia and have their own language, cultural traditions and historical background (AIHW, XXXXXXXXXXA big proportion of the indigenous population lives in remote areas (19%) and very remote areas of Australia (45%) which has a direct impact on their health (AIHW, XXXXXXXXXXThe social determinants, health risk factors and access to the health services are responsible for the lower life expectancy of the Aboriginals than the other Australians (AIHW, XXXXXXXXXXDue to these factors, the diseases that are more common in this group are respiratory diseases (31%), cardiovascular disease (13%), diabetes (11%), chronic kidney disease (1.8%), mental health problems (11 %) and cancer (1%) (AIHW, 2015).
Among the diseases mentioned above, the focus in this essay will be on 69-year-old Aboriginal male from the remote area who suffers from stage 4 chronic kidney disease (CKD). The two main risk factors that contribute to the higher prevalence of chronic kidney disease in Aboriginals are diabetes, hypertension age, gender, smoking history, and late refe
al (Australia Bureau of Statistics [ABS], XXXXXXXXXXMr H (pseudonym) has hyperglycaemia and has respiratory issues due to the habit of smoking. The onset of disease was at the age of 45 and the como
id conditions have led it to progress to stage 4. I have been a health professional (as a pharmacist) in my home country and have seen cases of chronic kidney disease, but this was the first time for me to address the patient with an entirely different cultural background.
Cultural practices and beliefs of an individual have a direct influence on the health outcomes. Therefore, it is essential to understand the cultural background of the person. The culture defines a person’s perception of disease condition, influences the outcomes of the choices of the treatment options and directly affects the wellbeing of the person. Moran, XXXXXXXXXXdescribed cultural knowing’s framework in his book which included four interconnected learning interactions: knowing about, knowing how, knowing why and knowing oneself to understand the cultural experience.
The knowing about includes the various data, facts, practices and perspectives in the culture. So, I would gather information about Mr H’s practices, perspectives, products and language of the culture. Effective communication is the cornerstone to achieve better health outcomes for the patient by their active participation (Shahid, Durey, Bessarab, Aoun, & Thompson, XXXXXXXXXXSometimes the difference in tones and colloquialisms may change the meaning altogether and can be misleading (Queensland Health, XXXXXXXXXXKnowing how describes the ability to act according to the given culture by adopting their behaviours. In Mr H’s culture elders are treated with the utmost respect as they are considered pivotal members of the family (Australian Institute of Family Studies [AIFS], XXXXXXXXXXAlso, in their community direct eye contact is considered as a sign of disrespect and rudeness (Queensland Health, XXXXXXXXXXI would provide respect, speak humbly with minimal eye contact and ask questions in proper language. Knowing why would justify why certain practices and perspectives are followed by Mr H and the values, beliefs and attitude that are linked to his culture from etic (outside) and emic (inside) view. Finally, knowing oneself interprets my own values, opinions, feelings and thoughts that can intervene in making decisions. While conducting the cultural assessment, I would make sure to be open-minded, consider the value, beliefs and practices of my patient to provide person-centred care. The standards of practice describe nurses to conduct the assessment that is holistic as well as culturally appropriate (NMBA, 2016).
The social determinants of health framework analyses social, economic, political ecological and cultural factors that influence the health of the individual or the population (Chehall & Senior, XXXXXXXXXXThese determinants include distribution of power, goods, services, access to health care, education, income, culture and race, social inclusion and exclusion, early life and addiction (May, Carey, & Cu
y, XXXXXXXXXXSocial determinants are the major contributing factor which accounts for more than 1/3rd (34%) for the health gap between ATSI people and the other Australian population (AIHW, 2018).
The socioeconomic ladder defines that higher the socioeconomic position, better the health in the early age due to more access to the health services (AIHW, XXXXXXXXXXMr H has been in the labour workforce and came from a family background with the income below the poverty line. His early life has been affected with a low level of education due to the up
inging in the remote area with least access to the services. The genetic study of Aboriginal suggests that there is a nephron deficit due to the low birth weight (Hoy, Mott & McDonald, XXXXXXXXXXThis implies that these markers could have contributed to the development of the disease due to genetics and lifestyle of Mr H’s family. Although genetic factors cannot be altered, the significance of proper diet should be explained. There is a significant mortality gap between the indigenous and non-indigenous population of Australian and poor nutrition contributes to this gap due to geographical, environmental, social and economic disadvantage (Schem
i et al., XXXXXXXXXXI would gather information regarding the diet followed by Mr H and would ask him his perception of certain foods in his culture. Evidence suggests that the diet of the ATSI group of people was omnivorous and the culture continues to have a higher intake of raw meat in their diet (Lee & Ride, XXXXXXXXXXAlso, it has been found that the fatty foods are associated with development of cardiovascular disease but it has impact on renal disease due lack of the blood supply to the kidneys (Lee & Ride, XXXXXXXXXXIt would be explained to Mr H that dietary changes are mandatory to support the kidney function and reduce the obesity; therefore incorporation of a dietician to make a diet plan for a healthy lifestyle.
The cultural difference makes it challenging to provide health services to different minority groups. The Aboriginal population has distrust on the western healthcare system due to past traumatic experiences of colonisation and power imbalances (Rix, Barclay, Stirling, Tong, & Wilson, XXXXXXXXXXTherefore, I would build trust and rapport with Mr H by avoiding any kind of bias, being respectful towards his culture and maintain confidentiality. The code of conduct specifies nurses to treat all the patients from the different cultural background without any discrimination and avoiding any kind of bias or racism (NMBA, 2018).
The access to health services acts as a major contributor to improve the health outcomes of an individual (Davy, Harfield, McArthur, Munn, & Brown, XXXXXXXXXXRix et al., 2015 reported that Aboriginal people from remote areas missed appointments which are essential in the treatment of chronic kidney disease, due to lack of proper transport services and economic issues. Similar conditions were faced by Mr H which resulted in the progression of his disease along with late refe
al. The people from the remote area could become emotionally stressed due to the cultural shock, isolation or fear of disconnecting from the community (Queensland Health, 2016), as in the case of Mr H who belongs to the remote area, I would make sure that his fears and concerns are addressed by advocating for him. Disconnecting from social support makes them uncomfortable and affects their regular follow up process. So, for Mr H, I would frame the care plan based on his preferences of number of visits per week to the hospital, time of the treatment suitable for him, availability of the transport services and flexibility in the treatment options with option of home visits (McKercher, Jose, Grace, Clayton, & Walter, 2017).
The chronic kidney disease is associated with smoking as it leads to na
owing of the artery and thereby destroys the blood vessels and damaging the kidneys (Nakamura et al., 2015) Lower income, marginalisation, lack of awareness all of these contribute towards increased substance abuse (AIHW, XXXXXXXXXXIn the case of Mr H, cultural up
inging, lower income and level of education has been the reason for developing the habit of smoking. Therefore, patient education and involvement of the family to be a supportive hand to quit smoking without affecting his cultural beliefs would be included in the care plan for Mr H. Kinship has been of utmost importance in the indigenous society, therefore it is mandatory to involve the family members as treatment have an impact on