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Nursing Essay: Equity in Healthcare Provision for Indigenous People in Victoria


Task: You task is to write a nursing essay addressing the following points: Critically analyze 1 historical and 1 current Australian (Victorian Specifically) policies and how this has impacted the social determinants of health for indigenous people, their culture and effect on mental health.
Discuss how a nurse can be a culturally safe and competent healthcare provider in providing support and education for indigenous client with mental health conditions. What specific issues might you consider?


The target group considered in this nursing essay is Indigenous people in Victoria from Aboriginal and Torres Strait Islanders. 2016 statistics show the population of Indigenous people in Victoria was 57,767. Women were 28,962 and men 28,805. The median age amongst the male was 22.4 years and females 23.2. On the other hand, non-Aboriginals had a median age of 36.2 years for males and 38.1 females. Life expectancy for male Aboriginal people between 2011-2015 has been 77.9 for women and 74.4 years for men. This has been improving gradually, but the difference in life expectancy between non-aboriginals and aboriginals is 7years("Health and wellbeing," n.d.). The gap is attributed to social determinants of access to healthcare. Scholars attribute the difference in health service provision and outcome to social determinants. These are conditions within which people are born, grow, live and work. The determinants are; socioeconomic status, education, neighborhood, and physical environment, employment, access to healthcare, and social support networks. Further research attributes the difference in health between the two groups to colonization, which resulted in the dispossession of land, political oppression, social marginalization, and acculturation. This paper will analyze two policies of historical and current times and their impact on the social determinants of health for the indigenous population, their culture, and their effect on mental health.

Dhumbanganjin Policy
To bridge the gap between non-indigenous and indigenous, sharing stories was developed in the Department of Health and Human Services. Initially, the idea was meant to reconcile the non-aboriginal and aboriginal in the department, but the impact has gone further than that("Dhumba-nganjin," n.d.). The policy Dhumbanganjin, which means sharing stories to promote reconciliation, was started in 2014. It involved sharing and listening to stories among each other in the department. Occasionally, original Aboriginals were invited for their stories to be heard.

The policy impacted in addressing mental health by building trust between non-aboriginals and Aboriginals by disseminating stereotypes. Additionally, it resulted in social networks forming that open up the marginalized community to opportunities in employment, education, and access to healthcare. In totality, the policy shaped the medical field by equipping staff with knowledge about the Aboriginal's which is vital in building cultural safety and competence.

Historically, the disparity between Aboriginals and non-aboriginals resulted from colonization, which resulted in the dispossession of land, racism, and marginalization("Aboriginal and Torres Strait Islander social justice," n.d.). The impact brew mistrust between the two factions; thus, talks were to help recreate trust that would, in turn, increase the number of aboriginals seeking healthcare rather than rely on traditional means.

Additionally, it intended to bring to life-varied stories that would change individual's perceptions of Aboriginal history and culture and the need to have an equitable Australia. The policy culminated in a book titled Dhumbanganjin, which contains a series of written stories about Aboriginals that address personal thoughts and experiences whose intention is to foster peace and create trust between Ab and non-Aboriginals.

BalitMurrup policy
A study by Vos et al. indicates that the health gap between the Indigenous and non-indigenous was at 9% for chronic respiratory disease, 10% for mental disorders, 12% diabetes, 23% cardiovascular diseases, and 70% non-communicable chronic diseases. One current policy to address the life expectancy gap between Non-aboriginals and aboriginals is BalitMurrup (Strong spirit). BalitMurrup is a ten-year(2017-2027)social and emotional wellbeing framework in the Victorian government for the Aboriginals. The framework was put together by The Aboriginal Social and Emotional Wellbeing Reference Group with the help of the Department of Health and Human Services and the community("Aboriginal health," n.d.). It is based upon three cornerstones; Recovery-oriented approach in prevention and intervention process, trauma-informed care, and integration of healing. According to the minister of mental health Martin Foley, the Victorian government is investing in three key initiatives to tackle mental health issues in the Aboriginal community; improving mental health initiative for people with moderate to severe mental conditions, the increasing Aboriginal workforce in the mental health field and trials in prevention of suicide cases. According to McGough et al. (2018), the policy considers that many Aboriginals face poor mental health outcomes due to; colonization, racism, marginalization, discrimination, and transgenerational trauma. Further, the policy incorporates traditional means in addressing mental health among the Aboriginals. The four domains in the framework advocate for improving accessibility of culturally responsive services, Incorporated and effective service delivery, support of resilience, healing and recovery from trauma, and building a skilled and empowered workforce. The program equally fosters Aboriginal youth mentoring programs with a budget of A$1.8 million meant to fund the mentoring activities. Estimates by the program show that the number of Aboriginals undergoing mental health problems will be halved in ten years. It is currently standing at 55%. Additionally, the number of kids in foster which is at 60%, will be reduced as most were found to be away from home due to family struggles, mental health problems in parents, and drug and alcohol abuse-related incidences. Therefore, wholesomely the program will work to create safer homes for the Aboriginal community.

Discuss how a nurse can be a culturally safe and competent healthcare provider in providing support and education for indigenous clients with mental health conditions. What specific issues might you consider?

Eliminating disparity in healthcare provision in communities with indigenous and minority groups requires an understanding of their culture. Researchers note that healthcare organizations and personnel have a duty to bridge the gap to attain equity in service delivery (Oglof et al., 2017). According toCAI (2016), indigenous communities find themselves in a disenfranchised position due to racism, discrimination, and economic disempowerment, which eventually impacts their access to healthcare determinants. In particular, countries, cultural safety, and competence are included in training programs and licensing of medical professionals. These points out the importance of medical professionals understanding their impact in ensuring equitable healthcare provision (Cave et al., 2019).

This part of the paper will discuss how a nurse can be culturally competent and safe in providing healthcare services to an indigenous client with a mental health condition.

A nurse can attain cultural safety and competence by first having cultural consciousness (Henderson et al., 2018). Cultural consciousness involves first understanding your own culture as a nurse then understanding the patient's culture. Being able to compromise on your cultural attributes and respecting the patient's culture leads to safety (Curtis et al., 2019). According to a study, cultural competence and safety can be attained through training programs and engagements with the minority culture. In this scenario, the Dhumbanganjin (Storytelling to promote reconciliation) will come in handy. From personal stories, a nurse can understand the Aboriginal's culture, thus developing mechanisms that they will utilize in dealing with mental disorder patients from the minority group. The second stage in achieving cultural safety is assessing and appraising the differences between the nurse's culture and the patient's culture (Doran et al., 2019). The difference in cultural domains will inform the nurse on what to compromise on to achieve equity. The Griffith University First Peoples Health Unit highlights five capabilities in attaining cultural safety; Respect, Communication, Safety and quality, Reflection, and Advocacy.

Respect involves recognizing Aboriginal and Torres Strait Islander community way of life-based on culture, diversity, and history (Calma et al., 2017). A nurse has to affirm and protect this attribute of Aboriginal culture by learning in healthcare studies. This information is critical in dealing with a patient with mental illness from the Aboriginal community, according to Kilian and Williamson (2018). The nurse will endeavor to offer medical care while respecting how they think and their way of life.

Nurses are the link between patients and a medical facility. Therefore, proper communication between the two parties is significant to improve diagnosis and ensure service delivery in due time. Good communication directly relates to trust between the two parties (Cave et al., 2019). Therefore, nurses should engage with patients in a culturally appropriate and sensitive manner to build trust with the patient and create a respectful relationship with the indigenous people (Hartley et al., 2020).

Additionally, the nurse should ensure to provide safe and quality care. After winning the patient's trust, it is responsible for applying practices that have been medically tested and proven (Yeung, 2016). In this case, the patient could be put under depressants or in rehab in a situation where the patient is grappling with drug and alcohol abuse.

Lastly, the nurse's cultural safety and competence involve advocacy. A nurse needs to understand that the healthcare system is responsible for improving the medical condition of the indigenous community (Parisa et al., 2016). Therefore, they should be lead advocacy campaigns for indigenous people to receive equitable healthcare and social justice.

I would consider understanding the indigenous people's history in regards to mental health. Research indicates that many of them suffer from past trauma due to racism and discrimination (Kilian and Williamson 2018). Therefore, my approach will be to comprehend how the past traumas intertwine with their way of life to develop solutions that will result in mental soundness (Scanlan et al., 2019). Statistics indicate most Indigenous people are not tolerant of alcohol, resulting in aggression, family feuds, and mental instability. I will focus on cultural attributes such as spirituality to foster correctional mechanisms for the mentally ill.

Conclusively, the healthcare system has a significant role in bridging the gap between indigenous and non-indigenous social justice and equitable healthcare. The difference of 10.5 years in life expectancy could be eliminated in a system focused on understanding the minority groups and formulating policies after bridging the gap. Two notable policies are Dhumbanganjin and BalitMurrup. Dhumbanganjin of 2014 was meant to encourage medical practitioners to understand the indigenous culture by listening to and telling personal experiences. The stories of times in the kitchen and during lunch breaks resulted in the transformation of attitudes and a deeper understanding of the Aboriginal culture.Cultural safety and competence are critical in rendering medical care. BalitMurrup meaning strong spirit is a current policy in Victoria. The policy is intended to improve the emotional and social wellbeing of an indigenous community in Victoria. The framework incorporates cultural components in addressing mental illness.

Aboriginal and Torres Strait Islander social justice. (n.d.). Australian Human Rights Commission. social-justice

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Carlin, E., Atkinson, D., &Marley, J. V. (2019). ‘Having a quiet word’: yarning with Aboriginal women in the Pilbara region of Western Australia about mental health and mental health screening during the perinatal period. International journal of environmental research and public health, 16(21), 4253.

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