Disability, Disadvantage, Vulnerability and Stigma

Image retrieved from craighill.net

Within Australia, a new scheme (National Disability Insurance Scheme (NDIS)) was implemented in 2013 to provide individualised support to eligible people with permanent  and significant disabilities, extending to their family and carers. The scheme aims to administer funding for essential care, support, services, therapy, equipment and aids. It was suggested by Guzy & Petrie (2014), that the scheme will aid in creation of improved links between the community and the individual with disability, and ensuring quality and best practice from service providers which will focus on person centered approach, community engagement and independent living.

Image retrieved from adaptivedealer.wordpress.com

While researching further, I discovered an article by Wylie, McAlister, Davidson & Marshall (2013) that discussed the issue of inequity in service provision for Indigenous Australians with communication disabilities.

The Department Of Health (DOH) (2011), defines disability as any restriction or lack of ability to perform an activity in the manner considered to be normal. A disability can be described as being physical or mental disorder of the body, disorders of cognitive ability or malfunction/malformation or disfigurement of body part, and possibly disease causing organisms or illness (Heidke, 2015).

Image retrieved from futureliving.org.au

My nursing journey so far, has incorporated contact and care with working with patients whom identify with a disability. As Guzy & Petrie (2014), suggest, people with disabilities experience poorer health, have unequal access to health care and often unmet health care needs.


Leanne Walsh provided feedback from the carer perspective, stating the there is a lack of communication around disabilities and always be respectful are the most important things to remember (Walsh, 2015).

Image retrieved from ctlgbtlaw.wordpress.com

Furthermore, I have learned that people with disabilities are part of the world's diversity (Heidke, 2015). This includes disadvantaged and vulnerable groups which are at risk of something, ageism which is stereotyping and discrimination of a person based on age, stigmatised groups which are health and illness conditions associated with stigma usually negative characteristics, and sexualism and mental health.

As a student nurse entering into the health profession, it is importance to have understanding of difficulties that individuals with a disability encounter when accessing equitable health care. The journal article by Whiteley, Kurtz and Cash (2016), discusses inequalities of treatment for patients with disabilities and research suggests education for nurses about barriers, discrimination and experienced stigma associated with individuals with developmental disabilities.

Image retrieved from medicalcareersite.com

References

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Heike, P. (2015). NURS12002-Inclusive Practice: Study guide. Rockhampton, Qld: CQUniversity Australia

Walsh, L. (2015). Interview with Leanne: child with cerebral palsy. Retrieved from http://moodle.cqu.edu.au

Health Literacy



Image retrieved from www.safetyandquality.com.au

Health Literacy is a combination of cognitive skills and social skills that determine motivation and ability for a person to gain access to, understand and use information for promotion of and maintenance of good health. (Heidke, 2015).



Image retrieved from www.safetyandquality.com.au

Additionally, health literacy is impacted by social determinants of health. The social determinants as listed by (World Health Organisation [WHO], 2016) are the conditions in which people are born, grow, work, live, and age, including environmental forces which shape the conditions of daily life. These factors may have positive or negative influences and impact on health outcomes according to Brown & Edwards (2012).

 Throughout my reading of health literacy, I have learnt there are a number of groups at risk of low health literacy and as Heidke (2015) has discussed, they are often related to social determinants of health. Groups identified to be more at risk include older adults, people with compromised health and or low economic status, language and disabilities. A recent interview with a vision impaired consumer (Peter, 2016) identified how a consumer's perspective of someone who identifies with a disability may be affected by social determinants and how it has influenced his lifestyle. Peter discusses how his disability, transport, age, environment and especially technology all contribute to his health.

An opinion that Peter discusses in relation to nursing staff and how he feels from the consumer perspective, is current nurses lack a certain 'care factor' compared to 'older nursing days'.



Image retrieved from allposters.com

As a current nursing student, I can learn from how Peter feels from the consumer perspective of a patient with limited health literacy. An article by Sand-Jecklin, Murray, Summers and Watson, (2010), discusses the importance of nursing students needing to be able to assess patients for health literacy limitations, also to intervene to support the patient in gaining understanding of important health information.





Image retrieved from stvincentcharity.com

The article strengthened the importance of having health promotion strategies to address health literacy. Guzy & Petrie (2014) identified the Ottowa Charter for Health Promotion which has five core strategies which can be viewed in more detail at Ottowa Charter (WHO), 1986.

Image Retrieved from http://www.who.int

Some of the health  promotion strategies I have endeavoured to lean are summarised by Guzy & Petrie (2014, p. 28), which are medical, behavioural, educational, empowerment and social change approach. Each of these strategies are generated from the Ottawa Charter. Oldfield (2005), suggests there are four characteristics associated with health literacy. These skills are reading, comprehension, numeracy and communication. Studies identified in Heidke (2015), found the internet an important source of health information, however, people with high educational levels may not necessarily have high literacy levels, and most people from lower socioeconomic geographic locations had less access. It supports the fact that empowerment was an important factor in health education (Heidke, 2015).

Image retrieved from www.safetyandquality.com.au

References

Brown, D., & Edwards, H. (2012). Lewis's medical-surgical nursing (3rd ed., pp. 50-51). Chatswood, N.S.W.: Elsevier Australia.

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Heike, P. (2015). NURS12002-Inclusive Practice: Study guide. Rockhampton, Qld: CQUniversity Australia.

Oldfield, S. (2005). The concept of health literacy within the older adult population. Holistic Nursing Practice, 23 (4), 204-212.

Peter (2016). Interview with Peter; Vision Impairment. [Echo360] NHLT12002: Inclusive Practice - NHLT12002_2153. Retrieved from https://moodle.cqu.edu.au/blocks/echo360_echocenter/echocenter_frame.php?id=2455

Sand-Jecklin, K., Murray, B., Summers, B., Watson, J. (2010). Educating Nursing Students about Health Literacy: From the Classroom to the Patient Bedside. OJIN: The Online Journal of Issues in Nursing, 15 (3).

World Health Organisation (WHO), (2016). Health Promotion. The Ottawa Charter for Health Promotion. Retrieved from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

Equity and Diversity in the Workplace

Image retrieved from mdecg.com

Organisations have policies and guidelines for legal and ethical obligations for staff, students and volunteers. According to World Health Organisation (WHO), 2016, equity is best defined as the absence of avoidable or remedial differences among people. Simply put, it aims to address equal opportunities. Whereas diversity includes issues related to ethnicity, age, religion, politics, gender, ability, sexual orientation and identity and geographic position (Guzy & Petrie, 2014, p. 78).

Image retrieved from nurseinterupted.wordpress.com

Having a diverse workforce helps an organisation in being responsive to cultural needs through varied perspectives gained by multicultural competence staff. Workplaces that support and enlist significant cultural events for staff, clients and volunteers will help prevent cultural shock and promote workplace satisfaction which leads to better consumer outcomes (NSW Department of Community Services, 2009).

When cultural diversity and equity within a workplace are lacking, evidence suggests higher staff turnover and culture shock are contributing factors for poor attitudes and practices toward multicultural colleagues. Concordance can be a useful tool to implement within health workplaces according to Guzy& Petrie, (2014), to facilitate successful outcomes.

Image retrieved from www.hwa.gov.au

In addition to resourceful tools such as LEADS (Australian Health Leadership Framework, 2013), which can be utilised within an inclusive workplace, contributing educational journal articles identify that supportive transition plans for foreign (nursing) staff can assist in addressing culture shock as health care disciplines are predominately dominated by immigrants.

Image retrieved from www.smallbuisness.com.au

I have gained the understanding from readings and lectures that for effective cultural diverse workplaces to have harmonious existence, everyone must be accountable and take responsibility to prevent high staff turn over and poor retention of multicultural staffing. Regardless of faith, gender, ethnicity and sexualism, as best summarised by Heidke (2015), every individual has the right to feel valued and self worth. I believe this to be an important equality ethic within the workplace, especially as a student nurse entering a culturally diverse profession.

References

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Heike, P. (2015). NURS12002-Inclusive Practice: Study guide. Rockhampton, Qld: CQUniversity Australia

NSW Department Of Community Services, (2009). Working With Aboriginal People and Communities. Ashfield NSW 2131: Aboriginal Services Branch in consultation with the Aboriginal Reference Group, pp.36-38. Retrieved from http://www.carersaustralia.com.au/storage/2011Working%20with%20Aboriginal%20People%20and%20Communities.pdf

World Health Orgainisation [WHO], (2016). Health Systems. Equity. Retrieved from http://www.who.int/healthsystems/topics/equity/en/

 

Cultural Competence & Care in Communities

Culturally competent health care within communities aims to eliminate disparities in health status among people from diverse cultural backgrounds. As suggested by Guzy & Petrie (2014, p. 81) cultural competence is by means of acquiring culturally appropriate information and knowledge then applying it within health care delivery. The process of developing cultural competence according to Brown & Edwards (2014, p. 24) requires cultural awareness, knowledge, sills, cultural encounter and desire.

Image retrieved from http://clas.uiowa.edu/nrcfcp/areas-expertise/cultural-competence 

Community contexts including ethnicity and lifestyle are examples of community settings. By being accepted into the community, nurses can assist in creating better health practices. This is a crucial foundation for a student nurse to have an understanding of and with a career goal of community based nursing, I am especially interested and keen to endeavour to learn more about care in communities.

Image retrieved from legacy.communitydoor.org.au

Within the community, barriers and enablers encountered include sub-cultures (groups that have values and norms distinct from majority [Miller-Keane (2003)]), homelessness, illicit drug users, conscientious objection to immunisation, chronic health conditions and rural and remote settings.

Image retrieved from thelibertarianrepublic.com

A recent article by Gurjeet & Hurriyet (2012) identified barriers affecting cultural competent care for  CALD (Culturally and Linguistically Diverse) communities within Australia. Barriers identified included low health literacy, impaired language skills, lack of interpreters within communities, insufficient confidence in their own abilities/skills, and traveling distances required to access health, especially in rural and remote areas.

Image retrieved from nursezone.com

Nurses play a pivotal role in bridging the gap for sub cultural groups within the community. Including people from diverse backgrounds in the decision making process, is an important strategy when delivering cultural health care services (Heidke, 2015). Additionally, nursing practitioners utilise effective tools such as the Gibbs Reflection Tool (Gibbs, 1998) which if used in context within cultural diverse care clients with complex needs, can improve knowledge, skills and ability to meet demands in a culturally diverse health care setting.

Image retrieved from pearsonportfolio.co.uk

References

Brown, D., & Edwards, H. (2013). Lewis's medical-surgical nursing (3rd ed.). Chatswood, N.S.W.: Elsevier Australia.

Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Oxford: Oxford Polytechnic Further Education Unit.

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Miller - K.  (2003). Encyclopedia & Dictionary of Medicine, Nursing, & Allied Health Seventh Edition.  Retrieved January 16 2016 from http://medical-dictionary.thefreedictionary.com/subculture

O'Mara, B., Gill, G., Babacan, H., & Donahoo, D. (2011). Digital technology, diabetes and culturally and linguistically diverse communities: A case study with elderly women from the Vietnamese community. Health Education Journal, 71(4), 491-504. http://dx.doi.org/10.1177/0017896911407054

 

Multiculturalism and Health

Australia is made up of various cultural backgrounds including overseas born people which have migrated to Australia for a better life. It has become a highly diverse society which embraces multiculturalism (Guzys and Petrie, 2014). An accurate understanding of multiculturalism I found was best described by Guszys and Petrie (2014), stating ‘multiculturalism is a philosophy guiding policy and practice in the management of the consequences of cultural diversity, in the interests of the individual and society as a whole.’ Simply put, it is a response to reality of cultural diversity which aims to foster social justice and economic efficiency within Australia.

Image retrieved from http://www.moreland.vic.gov.au

Immigrants entering Australia are faced with language barriers and cultural practice challenges that can impact access to health services and participate within community (Heidke, 2015). Australia’s history of immigration has shaped the composition, size, and cultural population. It is one of the most ethnically diverse countries in the world (Julian, 2009). As summarised by Heidke (2015), immigrants may be healthy initially, but can develop chronic conditions over time same as Australian populations.

Image retrieved from migrationblog.border.gov.au

This can be contributed to barriers that exist within the culturally and linguistically diverse populations that migrants are exposed to.  Queensland Government published information pertaining to barriers identified by culturally and linguistically diverse communities, found at http://www.qld.gov.au/web/community-engagement/guides-factsheets/cald-communities/introduction/barriers.html  

                     Image retrieved from www.slideshare.net

When providing culturally competent care, these barriers and challenges can be detrimental when providing heath care for overseas born people. As I researched further, I found an article by (Griffith, Mellor, Green and Renzaho, 2014) which  suggests culturally competent prevention programmes should consider design and delivery specific to immigrant clientele. This is an example of a health related issues within migrant populations, that I may encounter within a nursing career.

Image retrieved from googleimages.com

Additionally, Gill and Babacan (2012) documented how Australian employers value diversity, and recognise the benefit of diversity within the workplace.  In conjunction with effective collaboration with client, family and cultural health workers, this is an example of how to establishing a therapeutic relationship between the patient and I could assist me in meeting their needs (Heidke, 2015).

When responding to changing cultural patterns of health, the Australian Government is committed to deliver services responsive to the diverse community. Issues that immigrants may experience include separation of family, language barriers, employment and housing issues, different cultural practices impacting on ability to participate in society and limited health literacy knowledge. These barriers as described by Heidke (2015) affect access to healthcare, and as I have learnt throughout this course, such barriers will exist and having cultural literacy and competency will aid me in achieving cultural competency and gain greater understanding of multiculturalism in the health care workplace.

Image retrieved from Mildura Regional City Council

References

Gill, G. K., & Babacan, H. (2012). Developing a cultural responsiveness framework in healthcare systems: an Australian example. Diversity & Equality In Health & Care, 9(1), 45-55.

Griffith, M., Mellor, D., Green, J., & Renzaho, A. M. (2014). Migration-related influences on obesity among sub- Saharan African migrant adolescents in Melbourne, Australia. Nutrition& Dietetics, 71(4), 252-257.

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Heike, P. (2015). NURS12002-Inclusive Practice: Study guide. Rockhampton, Qld: CQUniversity Australia

Jordan, J., Buchbinder, R., & Osborne, R. (2010). Conceptualising health literacy from the patient perspective. Patient Education And Counseling, 79(1), 36-42. http://dx.doi.org/10.1016/j.pec.2009.10.001

Cutlural Health Practices and Beliefs

Image retireved from promoteprevent.org

Cultural Health Practices and Beliefs incorporates the importance of cultural background and how it affects an individuals understanding of health, in relation to culturally sensitive issues relating to faith and ways to address them (Lecture Notes, CQU, 2015). As a student nurse, I believe it imperative that health care practitioners from culturally diverse backgrounds can bring additional skills within the work environment which can facilitate cultural competence (Guzys & Petrie, 2013). Cultural practices and beliefs include faith, dietary considerations, spirituality and preferences in medical procedures with strict guidelines according to cultural and religious beliefs.  

Cultural healing practices are the primary therapeutic interventions which are more commonly known as Complementary and Alternative Medicines (CAM). Sandi Worsley (2015) discussed interventions that are based around four basic concepts. These concepts are best defined by Heidke (2015) are  Holism, Humanism, Balance and Spirituality. Additionally, resourceful information from an online journal article on these concepts can be found at http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/AlternativeComplementaryModalities.html

 

Image retrieved from http://hubpages.com/education/Complementary-Alternative-Medicine-Therapies-cam-meaning-difference

The Code of Ethics by NMBA (2008), Statement 3.3 outlines the diversity of people in the community and nurses recognise and accept cultural diversity (NMBA, 2008). Nursing staff must work within areas of expertise and be aware of professional boundaries and remain non judgmental and respectful of cultural aspects regarding traditional medicines (Worsley, 2015).

In Australia, the practice of traditional indigenous medicine is at risk of being lost (Wood, 2010). Traditional forms of healing and bush medicines were the only source of primary health care, and according to Wood (2010), it is unclear what traditional medical practices remain, and how it sits alongside a biomedical approach to health. Western and traditional therapies date back thousands of years which were verbal and handwritten records (Berman, Kozier & Erb, p. 378, 2012).  

 

Image retrieved from http://australiasurvival.proboards.com/thread/80

A recent study identified the importance of understanding and acknowledging cultural factors, that are a prerequisite to determining where and how to intervene to improve health (Riggs et al., 2014).

Additionally, further cultural elements that I would be expected to be aware of according to Brown and Edwards (2013), are communication, family and kinship ties, personal space, nutrition and physical contact (touch). It is equally important which model staff will utilise for developing cultural competence. Models include ETHNIC, LEARN, BATHE, and GREET (Guzys & Petrie, P. 85, 2013). Having a sound understanding of these models would support my journey as a student in being culturally appropriate and aware of patients that I may encounter in my career as a registered nurse.

References

Berman, A., Kozier, B., & Erb, G. (2012). Kozier and Erb's fundamentals of nursing (2nd ed., pp. 377-393). Frenchs Forest, N.S.W.: Pearson.

Brown, D., & Edwards, H. (2013). Lewis's medical-surgical nursing (3rd ed.). Chatswood, N.S.W.: Elsevier Australia

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Heike, P. (2015). Cultural Health Practices and Beliefs. Retrieved from CQUniversity e-courses, NURS12002 Inclusive Practice, http://moodle.cqu.edu.au

Heike, P. (2015). NURS12002-Inclusive Practice: Study guide. Rockhampton, Qld: CQUniversity Australia

Nursing & Midwifery Board of Australia (NMBA). (2008). Code of ethics for nurses in Australia. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx#codesofethics

Riggs, E., Gibbs, L., Kilpatrick, N., Gussy, M., van Gemert, C., Ali, S., & Waters, E. (2014). Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia. Ethnicity & Health, 20(3), 241-257. http://dx.doi.org/10.1080/13557858.2014.907391

Wood, C. (2010). A History of Healing Therapies: Western, Eastern, and Alternative Approaches. Choice Reviews Online, 48(02), 219-230. http://dx.doi.org/10.5860/choice.48.02.219

Worsly, S. (2015). Complementary and Alternative Medicine [Blackboard Collaborate Session]. Retrieved from https://moodle.cqu.edu.au/blocks/echo360_echocenter/echocenter_frame.php?id=2455