NUR131 Research Foundations for Health Practice Case Study 2 Sample
Assignment Details
This task will help you to identify culturally safe practice frameworks when nursing Aboriginal and Torres Strait Islander people. It aligns with the Nursing and Midwifery Board of Australia (NMBA) registered nurse standards for practice to respect all cultures and experiences of Aboriginal and Torres Strait Islander People. Ensuring a culturally safe and therapeutic relationship is paramount to establish mutual trust and respect.
Read the following Clinical Case Scenario and answer ALL of the following questions:
David is a 50-year-old Elder, Aboriginal man from a remote community in the Northern Territory. This is his first admission to hospital in his life and he has just been told about his diagnosis of end stage lung cancer. He has had minimal interaction with health services in the past and English is his third language. Other staff members have commented about his behaviour stating that he is ‘’not talking to anyone” and appears to be very upset.
David has a past medical history of type 2 Diabetes Mellitus and recently started vaping to try and quite his tobacco smoking. He does not drink alcohol, he loves fishing and enjoys spending time outdoors.
You have just received the following handover form the team leader:
This is David, he is 50 years old he just came today. His Oncologist Dr Sarah Matthews has just spoken with him, poor guy has end stage lung cancer. He is really quiet, but he was nodding his head when we asked him questions. He will need to start chemotherapy and radiation as soon as possible, we are just waiting for the oncology team’s confirmation.
Questions
1) Discuss the communication strategies that would be used to assess Davids clinical and emotional needs.
2) Identify the cultural needs of David and justify if this situation has been culturally safe.
3) From this situation, list (minimum of 3/maximum of 5) recommendations that you as the Nurse would implement to ensure that David’s experience in your Health Care Facility is culturally safe. Consider identifying any supportive services for Aboriginal people admitted to your local health care facility.
Assessment Requirements
Suggested procedure:
1. Review and familiarize yourself with the NUR133 Learnline Content
2. Read the Clinical Case Scenario and the questions
3. Consider the cultural needs of David
4. Research the literature
5. Answer the questions
Structure: Short answer assessment with headings.
Solution
Introduction
David is an Aboriginal man who has developed severe lung cancer and is hospitalized. In the hospital, staff are facing a challenge to communicate with him which has become a major barrier in the care plan. David is reluctant to express himself properly. English is his third language which is a prominent reason for him to stay quiet and just nod his head. He also has a history of type-2 diabetes mellitus. Chemotherapy and radiation are required to be started as soon as possible. Thus, an effective communication plan needs to be prepared based on his emotional and clinical needs. This will be beneficial for the patient to understand clinical guidelines effectively along with that the staff will be aware about cultural practices related to care.
Communication strategies to assess emotional and clinical needs
Establishing Trust
As David is currently reluctant to express his needs effectively, the communication strategy must be focused on establishing trust. In this regard, the promotion of reciprocal respect must be ensured while communicating with David to reduce anxiety and increase trust (Groot et al., 2020). In this regard, the cultural significance of nonverbal communication in Aboriginal communities must be demonstrated along with focusing on an unhurried and gentle interaction strategy. It must be ensured that he receives care from the same HCP to keep the trust intact. Apart from that, while providing health information to David and his family, cultural appropriateness must be maintained so that his trust in the practitioner can increase.
Overcoming Language Barriers
As English is the third language of David it can create significant barriers in understanding his emotional and cultural needs. Indigenous communication is focused on nonlexical aspects and few medical terms may have a proper translation in indigenous language due to the absence of equivalent words (Groot et al., 2020). Thus, it is important to arrange an interpreter for him who is fluent in his native language. Through this, David can be made more aware of his condition along with understanding treatment options effectively. Through this, his emotional needs can be better identified. Furthermore, an interpreter is to be appointed in order to understand the language of David. English is supposed to be the third language used by David. Authorities are to deliver the therapy and treatment in the first language used by David. A qualified language interpreter is to be appointed to interact with David in his primary language. This will ensure the flexibility of the treatment as well as confirmation that David is capable of receiving his diagnosis entirely or not. Any treatments, procedures or changing processes can be introduced to David first so that he may not be left with any uncertain thoughts behind. In addition, it will reduce any possible confusion, tension or feelings for university assignment help.
Patient Centred Communication
However, it is highly necessary to engage with David through interacting with simple and understandable gestures. In comprehending his diagnosis better, open-ended questions can be asked to him. This is a very important aspect of the communication strategy to learn more about the emotional and cultural needs of David. Healthcare professionals can build stronger trust with Aboriginal patients through active listening along with understanding critical factors in the care plan which are influenced by their culture (Bernardes et al., 2022). In this regard, the healthcare professionals must be attentive to the nonverbal cues while communicating with David such as his expression and body language. Furthermore, the communicator is to be patient in listening to David actively and make sure any single or important information may not be left behind in the conversation. It is necessary to make him feel easy to respond to every open-ended question. However, the interaction process may not be barrier-free while small interactions will defend David to express his thoughts effectively. This will be beneficial to understand his emotional condition and needs. Moreover, if with proper interventions he feels encouraged enough to express his feelings, patience and active listening will help him understand his emotional state in more depth.
Involving Family and Community
Culturally safe care can only be delivered by healthcare professionals through obtaining a proper understanding of cultural differences. In this regard, the environment of family and community members is necessary to understand the cultural needs of the patient (Kerrigan et al., 2020). This is also important as indigenous people tend to make collaborative decisions. However, in this regard, it also needs to be ensured that David is comfortable with the inclusion of community and family members. The main aim of including these people in the communication strategy is to provide necessary emotional support to David.
Cultural Sensitivity
Cultural sensitivity is defined as the ability to understand, recognise and appreciate the norms, values and cultural beliefs of a people (Thomas & Quinlan, 2023). In the case of aboriginal people, cultural sensitivity maintenance is a very necessary factor to explore. This is the process of developing interaction with people in their familiar way. Accordingly, it needs a medium such as a system or a person who helps in conducting the process of language generalisation. However, authorities, in case of have no idea about the primary language of a patient, are to be humble and acknowledge towards the patient with respect and good behaviour. It is to be ensured any nonverbal gestures or body language may not make the patient; like David, feel discomfort during the interaction.
Emotional Support
Emotional support is a very sensitive part of treatment to soothe the mind and thoughts of the patient. Counselling processes steadily improve the mental condition helping a person to win over the tendency of having mental saturation and frustration (Proctor et al., 2023). Accordingly, authorities are to gain knowledge of cultural sensitivity first. In this context, David’s mental condition is to be utilised after his diagnosis and isolation from his remote community.
Cultural needs of David
Language
David is an aboriginal man who belongs to the remote community of the northern part of Australia and has less proficiency in english. The Aboriginal man who lives in a remote area of the country often suffers from communication issues due to language differences. The Aboriginal people often use their native language which creates difficulties in understanding medical terminology. The absence of interpreters further worsened the situation (Louro & Collard, 2021). On asking any question David was just nodding his head. That reflects the difficulties in understanding and responding. Therefore, immediate language support is necessary to gain proper insights into David's complications. Inclusion of any bilingual staff can solve the problem to many extent.
Cultural respect
Aboriginal people like David suffer from multiple cultural problems at the time of their treatment and are very closely attached to its community and culture. There is a lack of cultural unity between the Aboriginals and the other civilised ethnicities (Kerrigan et al., 2020). The Aboriginal community often witnessed bullying and deprivation from the local society that restricted them from seeking help from the hospitals situated in the developed areas. Furthermore during the treatment detachment and relocation from the family members and traditional land can impact the mental health of David. Therefore the hospital authorities and nurses should be careful about providing emotional support to the patients and support them to overcome any negative past experiences.
Collective decision-making
Collective decision-making can help to provide support to the cultural needs of David. Collective decision-making can help in providing better treatment in the last stage of lung cancer. The involvement of the family in the decision-making procedures will help the nurses gain insights into the Aboriginal culture (Harris, 2020). The community is another successful strategy to improve treatment procedures. The engagement of the community helps to recognize the practices that will help the nurses and the health practitioner to make improved decisions.
Cultural mediation
Aboriginal communities are connected with strong cultural protocols. Unique protocols are found in different groups which include cultural beliefs, customs and taboos. Personal communication is to be driven by such elements as rapport, language, time, nonverbal communication, touch, silence and personal space. Developing friendly relationships with aboriginal people, and versatile language processing is to be driven towards them. According to the report, aboriginal people tend to agree with matters although they have not understood the factors yet. It is reported that often people from the community get victimised by cultural bullies and harassment that are destroying their interest in joining and participating in the revolutionary impact of healthcare (Dawson et al., 2021). Conceiving them and making them feel safe are crucial responsibilities of medical authorities.
Cultural safety of David
Communication assistance and cultural support is highly necessary for building connections with aboriginal people. The concept of cultural safety was first developed in New Zealand focusing on the urge to develop a feasible and effective environment for treatment. Accordingly, the foremost activity is to respect the cultural identity of David. There is a sheer need to provide respect and acknowledgement towards the people and their community. Moreover, inclusion is important to ensure that all the caring initiatives may be effective and helpful for the paint without hurting their beliefs and norms. Correspondingly, power balance differences within the healthcare institution are to be utilised effectively and authorities are suggested to examine how the imbalances can affect the quality of patient care (Harris, 2020). The autonomy of the patient, David, is to be supported and respected helping them to expertise their knowledge on their own. Self-awareness is an important term in which the caregivers are to be concerned. In this process, the professionals will detect their cultural beliefs and differentiation. Cultural safety turns out to be a lifelong commitment with the inclusion of determination and efficiency controlled by patient David himself, David. It is suggested to deliver adaptive care to customers. Communication is a very important factor to facilitate meaningfully to the patients.
Recommendation
Arranging a suitable Aboriginal Liaison Officer and interpreter
Culturally safe care can be provided to David by appointing a liaison officer. The officer can provide emotional and cultural support and advocacy for the patient. Through this, quality health outcomes have been ensured across the health workforce of Australia (Wilson et al., 2022). An ALO can effectively help the healthcare team understand preferences and cultural beliefs that are required to be respected in David’s care plan. An interpreter who has high proficiency in David’s first language will help in identifying his needs and enhance his experience during communication.
Respecting and integrating cultural practices
It is also recommended that the healthcare professionals significantly integrate and respect the cultural practices of David. In this regard, Lethborg et al., (2022), have recommended ethical approval from the community members. The AHLO will be responsible for clarifying the concerns and priorities of the patients. The plan must also include space for spiritual practices or cultural rituals to increase David’s comfort with the process. This will also be beneficial to create a culturally safe environment for him. The healthcare staff should also be made aware of these cultural aspects so that they can stay respectful of them.
Family involvement in the decision-making process
Another important recommendation is to involve David's family in the care plan. This will support the collaborative decision-making needs of the Indigenous community (Kerrigan et al., 2020). Any discussion and decision are required to be shared with the family members about the treatment procedures. The patient is required to be admitted for chemotherapy and radiation so the family members must be allowed to visit him during his stay. David also loves to spend time outside so it must also be incorporated in the plan by discussing with the family to ensure better recovery.
Creating comfortable environment and providing psychological and emotional support
In the primitive stage, the hospital culture and environment are to be prepared and organised which will make David comfortable in his treatment. Like David, all the aboriginal people deserve an effective environment to be treated. Several aspects such as privacy, accessing outdoor facilities, and safety for visitors are to be ensured simultaneously (Krys et al., 2023). David is suggested to be allowed to take quality care of his mental health and illness if required. This process is expected to be helpful for him to cope with his emotional stress as well as the diagnosis practices.
Conclusion
From the above discussion, it can be concluded that a culturally appropriate care plan must be prepared for David. Moreover, identifying the clinical and emotional needs of David, establishing trust, overcoming language barriers, involving family and active listening are necessary in the communication strategy. The cultural needs of the patient include cultural respect, collective decision-making and cultural mediation. Thus, it is recommended that the healthcare team arrange an Aboriginal liaison officer, respect his cultural practices and involve members of his family in the care process.
References
Bernardes, C. M., Houkamau, K., Lin, I., Taylor, M., Birch, S., Claus, A., ... & Pratt, G. (2022). Communication and access to healthcare: experiences of aboriginal and Torres Strait islander people managing pain in Queensland, Australia. Frontiers in Pain Research, 3, 1041968. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9763606/
Dawson, N. M., Coolsaet, B., Sterling, E. J., Loveridge, R., Gross-Camp, N. D., Wongbusarakum, S., ... & Rosado-May, F. J. (2021). The role of Indigenous peoples and local communities in effective and equitable conservation. Retrieved from: https://nru.uncst.go.ug/xmlui/bitstream/handle/123456789/6154/2021%20Dawson%20et%20al%20ES-2021-12625.pdf?sequence=1&isAllowed=y
Groot, G., Waldron, T., Barreno, L., Cochran, D., & Carr, T. (2020). Trust and world view in shared decision making with indigenous patients: a realist synthesis. Journal of evaluation in clinical practice, 26(2), 503-514. Retrieved from: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jep.13307
Harris, M. (2020). Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care. Social Science & Medicine, 260, 113183. Retrieved from: https://doi.org/10.1016/j.socscimed.2020.113183
Kerrigan, V., Lewis, N., Cass, A., Hefler, M., & Ralph, A. P. (2020). “How can I do more?” Cultural awareness training for hospital-based healthcare providers working with high Aboriginal caseload. BMC Medical Education, 20, 1-11. Retrieved from: https://link.springer.com/article/10.1186/s12909-020-02086-5
Krys, K., Haas, B. W., Igou, E. R., Kosiarczyk, A., Kocimska-Bortnowska, A., Kwiatkowska, A., ... & Bond, M. H. (2023). Introduction to a culturally sensitive measure of Well-Being: Combining life satisfaction and interdependent happiness across 49 different cultures. Journal of Happiness Studies, 24(2), 607-627. Retrieved form: https://link.springer.com/content/pdf/10.1007/s10902-022-00588-1.pdf
Lethborg, C., Halatanu, F., Mason, T., Posenelli, S., Cleak, H., & Braddy, L. (2022). Culturally informed, codesigned, supportive care for Aboriginal and Torres Strait Islander people with cancer and their families. Australian Social Work, 75(2), 165-179. Retrieved from: https://www.researchgate.net/profile/Carrie-Lethborg/publication/351630369_Culturally_Informed_Codesigned_Supportive_Care_for_Aboriginal_and_Torres_Strait_Islander_People_With_Cancer_and_Their_Families/links/6339821776e39959d68fe9ac/Culturally-Informed-Codesigned-Supportive-Care-for-Aboriginal-and-Torres-Strait-Islander-People-With-Cancer-and-Their-Families.pdf
Louro, C. R., & Collard, G. (2021). Australian Aboriginal English: linguistic and sociolinguistic perspectives. Language and Linguistics Compass, 15(5), e12415. Retrieved from: https://drive.google.com/file/d/1zqFnjBSe4pH7TVvZA5HGpqiHuCi4P8MW/view
Proctor, G., Cahill, J., Gore, S., Lees, J., & Shloim, N. (2023). A not-knowing, values-based and relational approach to counselling education. British Journal of Guidance & Counselling, 51(2), 310-321. Retrieved from: https://www.tandfonline.com/doi/pdf/10.1080/03069885.2021.1912289
Thomas, D. S., & Quinlan, K. M. (2023). Reimagining curricula: Effects of cultural (in) sensitivity of curricula on racially minoritised students’ engagement. Studies in Higher Education, 48(2), 283-298. Retrieved form: https://www.tandfonline.com/doi/pdf/10.1080/03075079.2022.2134332
Wilson, A., Mackean, T., Withall, L., Willis, E. M., Pearson, O., Hayes, C., ... & Baum, F. (2022). Protocols for an Aboriginal-led, multi-methods study of the role of Aboriginal and Torres Strait Islander health workers, practitioners and Liaison officers in quality acute health care. Journal of the Australian Indigenous HealthInfoNet, 3(1), 2. Retrieved from: https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=1006&context=aihjournal
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