How Equity and Access Issues affect Aboriginal and Strait Islander People in Chronic Disease

How Equity and Access Issues affect Aboriginal and Strait Islander People in Chronic Disease

Part A: Summary of Journal Articles

HealthInfoNet (2017).

The above source summarizes the health status and issues facing the Australian Aboriginal and Strait Islander people from their estimated population, births and deaths, common health problems, health risk and protective factors. More importantly, the paper gives significant focus to the chronic diseases and their respective burdens on the aforementioned population with a bias on the social determinants of health extending to access and equity. There is a detailed discussion of cardiovascular disorders (CVD), kidney problems and diabetes. It was apparent that cardiovascular disorders affect about 13% of Aboriginal and Strait Islander people accounting for 6% of the reported hospitalizations in 2014-2015. The inequality in the effect of CVDs was evident on the finding that the Aboriginal and Strait Islander people living in remote areas were more likely to report such cases more than those in the cities. Additionally, the indigenous population was 1.2 more times more affected than the non-indigenous persons. On diabetes, 13% of the population was affected with higher prevalence rates in the remote areas. The death rate associated with the disease was 5 times higher than for non-indigenous people. On kidney disease, End-Stage Renal Disease (ESRD) affects Aboriginal and Strait Islander people almost seven times as much as the non-indigenous population. 

The above summary demonstrates glaring inequalities between Aboriginal and Strait Islander people in relation to kidney disease, CVDs and diabetes with non-indigenous populations. This suggests the effect of socio-cultural factors on the access and equity of healthcare. In terms of equity, the article indicates most of the Aboriginal and Strait Islander people are impoverished and may not afford treatment for CVDs and other chronic diseases.  Elsewhere, the available medical facilities are largely culturally inappropriate and do not consider factors like language barrier. In some cases, the facilities are blind towards the specific needs of the indigenous population orchestrated by their cultural standing. On the issue of access, it is apparent that those in remote areas are disproportionately affected due to lack of medical facilities in their area. The existing health facilities are both inadequate and ill-equipped to handle chronic diseases.

Aspin et al. (2012)

The article explored strategic approaches towards the enhanced service delivery to the Aboriginal and Strait Islander people for chronic diseases. It takes note of the widely documented health inequalities associated with the above population and focuses on diabetes, chronic heart failure and chronic obstructive pulmonary disease. A qualitative research design was adopted with a sample of 16 patients and 3 family carers, transcribing interviews for content analysis. 

The results indicated several access issues related to the care of Aboriginal and Strait Islander people with chronic disease. First, there was poor access to culturally appropriate healthcare services and cultural support systems. The respondents indicated confusion and being overwhelmed by the burden of chronic illness while also identifying cultural and traditional knowledge as the frameworks of understanding their experiences. The present non-indigenous healthcare facilities operated in exception to such hence rendering the services provided as culturally inappropriate. According to their experiences, they needed bolstering from well connected family networks and by feeling of belongingness to the Aboriginal community. Therefore, there were general inadequacies of culturally appropriate health services and the requisite cultural support networks. On the latter, they were specific in the fact that the elders played a crucial role in increasing the awareness of chronic illnesses in the community. On equity, it was mentioned that economic hardships prevented the aboriginal people from accessing primary care that they so desperately needed in the face of chronic illness.

The study proposed that the integration of the wealth of traditional knowledge among the Aboriginal and Strait Islander people in the care and support programs related to chronic illness. This would address their complex needs and overcome the challenges of access and equity in the non-indigenous health services. 

Part Two: Case Scenario

Introduction

There are several equity and access issues facing Mr. Kay. First, he is economically disadvantaged meaning that he is unable to afford equal healthcare quality to the rest of the patients with his condition. This became worse after he lost his job and became reliant on his eldest daughter. Additionally, he is now exposed to further risk factors due to lack of proper shelter and comfort. However, he had access to cultural and family support from his daughter and her family. It was also apparent that he lacked access to proper primary care facilities with respect to third stage kidney disease and management of hypertension. The issues of access and equity in this case can be summed as follows:

  • Economical disadvantage hindering access to quality care
  • Exposure to risk factors such as pressure ulcers due to lack of proper shelter and comfort- a health inequality.
  • Access to family and cultural support from his daughter and her family – positive factor.
  • Lack of access to quality primary care for kidney disease and hypertension.

Intervention 1: Patient Centered Care

Patient entered care is a clinical approach that involves the persons consuming the health services in the planning, development and monitoring of care in order to meet the health goals. It goes beyond just providing them with information but rather taking into account their unique situations and their families, values and lifestyles thus making them part of the development of solutions (Reynolds, 2009). In the past, the healthcare system acted in what they deemed to be the best interest of the patient and their role was reduced to only adjusting to what was dictated upon them by healthcare professionals. However, in the proposed patient-centered care, the patient is respected, their input valued, their values considered and emotional support offered. Other facets of patient centered care include involving their family and friends, coordinating and integrating care as well as providing education, communication and information (Kralik & van Loon, 2011). All these factors have one effect- increasing the patient’s feeling of involvement in their own care.

The first rationale for instituting patient centered care for Mr. Kay is to increase his capacity to take care of himself and take care of the risk factors he is exposed to. The patient suffers from hypertension and stage 3 kidney disease, both of which require a high capacity of self care (Kralik & van Loon, 2011). Mr. Kay needs to understand the severity of the health problems that face him as he is clearly oblivious of the same. For instance, the RN had to contact the Aboriginal Health Service in Geraldton to extract his medical history. He is also exposed to health risks that require mitigation due to his lack of proper shelter. Homelessness leads to poor health status and putting Mr. Kay at the center of his treatment is the only way to mitigate the effects (Bailie & Wayte, 2006). This may include reducing chances of re-infection and inflammation in the affected area and the risks of developing pressure ulcers from his uncomfortable beddings. Thereby, patient centered care will empower him to take care of himself and also reduce the effects of the several risk factors he faces.

Elsewhere, patient centered care integrates family support that he so dearly needs. The patient desires to be close to his family that has expressed desire to accommodate him within their home. This will offer the cultural and family support desired at the particular point and also work towards improving on the conditions he lives in. The healthcare team should coordinate with his daughter to determine the best design for his comfort at home to help in recovery from the surgery and exploit if the fold up sofa is the best option. By living with his family and being consulted on how best to proceed with his treatment, Mr. Kay will feel fully involved in the management of his health problems (Kralik & van Loon, 2011).

Intervention 2:  Cross Cultural Nursing

The inculcation of cross cultural nursing entails sensitivity to the patient’s beliefs, lifestyle and general way of life. This is an important intervention in the context of dealing with indigenous communities that source healthcare from non-indigenous facilities (Suhonen, Saarikoski & Leino-Kilpi, 2009). This is the case of Mr. Kay who has moved from his indigenous home in Geraldton to a less remote area that lacks services specific to his cultural grounding. As a result, there is need for cross cultural nursing to help him feel culturally safe within the new settings. This encompasses forming proper communication models including the use of a translator as necessary (Kralik & van Loon, 2011). Other factors include appreciating the environment he lives in and his preferences in regard to family and attitudes towards certain forms of medication.

The rationale for cross cultural nursing is first the desire to provide quality care in the context of the chronic diseases he was battling with. Hypertension and stage 3 kidney failure are major health problems that require proper communication and coordination of care. The health professionals must understand his cultural attitudes and interpretation of the health problems and integrate the same in their care plan (Andrews & Boyle, 2002). Additionally, they should appreciate the role of his family and their importance in his recovery. The patient currently enjoys close relationship with his eldest daughter, a cultural facet that they must leverage on to maximize on positive health outcomes. The treatment of chronic diseases in indigenous communities involves multiple cultural considerations that suffice in this case.

Cross cultural nursing also mitigates economic disadvantages that face the patient. Having lost his job and now a dependent, Mr. Kay requires fiscal reliefs from the management of his healthcare problems. Apart from being barely able financially, he is also lives in conditions that discourage a speedy recovery. The shelter and beddings he relies on are likely to aggravate wounds and lead to re-infection. However, through proper communication and seeking solutions within his cultural setting, Mr. Kay may be able to mitigate the impact of these inequalities (Andrews & Boyle, 2002). For instance, creating a strong bond with his family and Aboriginal roots may reduce any psychological effects. Elsewhere, financial support and shelter can be arranged through advocacy within the limits of his cultural setting. 

References

Andrews, M. M., & Boyle, J. S. (2002). Transcultural concepts in nursing care. Journal of Transcultural Nursing13(3), 178-180.

Aspin, C., Brown, N., Jowsey, T., Yen, L., & Leeder, S. (2012). Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC health services research12(1), 143.

Bailie, R. S., & Wayte, K. J. (2006). Housing and health in Indigenous communities: Key issues for housing and health improvement in remote Aboriginal and Torres Strait Islander communities. Australian Journal of Rural Health14(5), 178-183.

HealthInfoNet, A. I. (2017). Summary of Aboriginal and Torres Strait Islander health. NSW229 (31), 3-0.

Kralik, D., & van Loon, A. (Eds.). (2011). Community Nursing in Australia. John Wiley & Sons.

Reynolds, A. (2009). Patient-centered care. Radiologic Technology81(2), 133-147.

Suhonen, R., Saarikoski, M., & Leino-Kilpi, H. (2009). Cross-cultural nursing research. International Journal of Nursing Studies46(4), 593-602.

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