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Bridget Farmer is 37 years old and identifies as an Aboriginal woman. She has four children aged 14, 12, 8 and 1 year old. Her partner, Thomas, 37 years old, works as a fly in/fly out miner in WA. He is away for six weeks at a time, and then has two weeks at home each block.
The family lives in a small country town, one hour away from the closest regional town. Bridget does not have any immediate family nearby. They initially moved there for Thomas’ work and bought a home with a mortgage, however the mine nearby closed and so Thomas had to take the interstate job. Bridget can only work on a casual basis because she has to care for the children when Thomas is away. It has been a quiet time at her work, so she has only been getting one day a week. Money is tight, so Bridget and Thomas budget carefully.
Recently while Thomas was away at work in WA, their 1 year old child was hospitalised with croup. He had to be transferred to the regional hospital an hour away, which meant Bridget had to take all the children with her. Unfortunately, there was no hospital accommodation for families, so during the day, the children spent the time on the ward with her. At night time, Bridget had to stay on the ward with the baby, as he would scream whenever she left his bedside. The children slept in the car, as Bridget couldn’t find affordable accommodation and didn’t know what else to do. Staff notified the Department of Community Services (DOCS) and now Bridget feels like she’s a criminal. She feels that they have discriminated against her because she is Aboriginal, and no one came to talk to her about what was happening. She feels helpless and frightened that they may take her children away from her.
Bridget has returned home and has come to see you at the medical centre. She is feeling stressed and anxious, the baby is still recovering and not quite back to normal, very clingy and requiring her constant attention. The other children are back at school, but she feels bad that they had to miss almost a week of school and thinks that might give DOCS more reason to take them away. She tells you she has always been a good mother and would never have done anything like this but she did not know what else to do. Staff at the hospital were too busy to take time with her and she is angry they did not come to her to ask what was happening. Since returning home she has not been able to work because the baby has been so unwell, and she is worried about paying the bills.
Figure 1: The SDH Assessment Circle (McMurray and Clendon, 2015 pp 55)
1. List three social determinants of health that affect Bridget and her family and explain how you would plan her care based on these:
Social determinants of health include the resources that are used for performing daily activities. These social determinants of health contain components such as access to education, employment, economy and healthcare (Hahn et al., 2018). Discrimination and inequalities acts as social determinants that lead to severe disadvantage and social disputes.
The social determinant of health that affect Bridget and her family are:
Constraints of services
Lack of resources such as hospital accommodation
Discrimination on the basis of culture
The care plan for Bridget will include components of resource allocation, and availability of enough leaves so that she can care for her children. Bridget is worried about the bills hence helping her with financial resources in the care plan can be empowering to her. Further, informing Bridget about employment services that provide maternity leaves to ladies can be effective for Bridget. Further, Bridget believe that she is discriminated on the basis of culture as she is an aboriginal so showing respect and empathy toward her can be effective.
2. What services could Bridget have been referred to while her baby was hospitalised in the regional hospital?
Bridget could have referred to financial support services and family accommodation services while her baby was hospitalized. A range of assistance is available in Australia for people that cannot manage hospital expenses. These services include social workers such as patient liaison officer and no-interest loan schemes. The patient liaison officer can provide financial counselling to Bridget (Victoria State Government, 2020). They could have informed Bridget about out-of- hospital support services. The no-interest loan schemes and income protection insurance can help Bridget. According to the Income protection insurance the policyholders can get income benefits if they are not able to work temporarily due to any illness or burden. Bridget is facing difficulty in working with four kids so the income protection insurance can be beneficial for her. An accommodation liaison officer in the hospital can provide help related to accommodation (Victoria State Government, 2020).
3. Discuss three external factors that affect Bridget and her family.
External factors that affect Bridget and her family are:
Aboriginal culture, lack of employment opportunities in town and lack of awareness related to support services.
Culture is one of the major factors that bring up issues such as discrimination, inequality and exploitation. According to Bridget she was discriminated on the basis of her culture as she was not informed about any concern before reporting to the department of community services. The Aboriginal people have faced a traumatic history. Policies such as stolen generation took children away from their families which still have an impact over them (Ganter, 2018). Bridget was scared that her children will be stolen from her which was concerning for her.
Thomas and Bridget both were facing employment-based crisis. Due to lack of employment opportunities Thomas had to work interstate and Bridget was working with few leaves. This impacted their family. According to lack of employment opportunities is a serious concern that reduce family relationships and health.
Lack of awareness related to support services made Bridget vulnerable to discrimination. Had she known about the accommodation services then she would have not let the children sleep in care.
4. As the Enrolled Practice nurse at the local medical centre, discuss the community resources you can recommend to help Bridget, now they are back at home.
According to Service Australia (2020), each jurisdiction in Australia has a no-fault worker’s compensation policy. Informing Bridget about the no-fault worker compensation legislation can help her get money for paying the bills. Further supporting her with employment related services such as lifeline, beyondblue and Sane can be effective for Bridget. This can not only motivate to care for her family but can also provide financial relief. Employment services can provide access to job and it can thus empower people. Since it is difficult for Bridget to manage both the children and the finances so informing her about services such as JobSeeker Payment can be effective. The JobSeeker Payment provide income support to people between the age group of 21 to pension age (Service Australia, 2020). Moreover, services such as Jobactive can connect Bridget to a number of employers and then she can work according to her comfort.
5. Discuss three internal factors that may affect Bridget and her family.
The internal factors that impact Bridget and her family include lack of financial stability, traumatic Aboriginal history and interstate distance with Thomas.
Thomas was working interstate which increased burden over Bridget. Increased burden often bring complications and it can impact a family in terms of stability and safety. Distance between family members lead to responsibility mismanagement and it can make it difficult for a single person to handle complete household burden. Since the mile was closed in the town so Thomas had to work interstate. This left Bridget alone and she was feeling it difficult to manage both children and finances.
Bridget was facing significant financial issues. She was not getting enough leaves from work and she was afraid of failing to pay bills. According to Berlin, Martoccio and Jones Harden (2018), lack of financial stability often impact a family and it harden living for them. Financial burden thus acts as the major external factor that impact Bridget and her family. Lack of job safety often impact the mental health of a person.
Bridget belong to the Aboriginal group of society. The Aboriginal people are marginalized since ages and they have a traumatic history. They are vulnerable to discrimination and this can thus impact their mental health.
6. You are forming a nursing care plan for Bridget, list three actual or potential problems that you have identified from the scenario.
a. Actual problem: increased stress
Potential problem: Anxiety
b. Actual problem: post-partum depression
Potential problem: depression in later life
c. Actual problem: lack of finances
Potential problem: burnout
7. From the list of problems you have made, identify three different multidisciplinary team members you could refer Bridget to.
The problem of anxiety can be referred to a mental health nurse. A mental health nurse can make an assessment of the mental health of Bridget and provide interventions that best suits her health (Hayes et al., 2019).
The second problem of post-partum depression is very common among female after child birth. Stress of handling job and children can often become stressful for the women and this can decrease their ability of healthy living. The post-partum health of Bridget will be recommended to a midwifery nurse.
Third issue for Bridget is lack of support and opportunities. This has induced fatigue in her. A financial liaison officer in the multidisciplinary team can inform her about the insurance policies that can help her with her problems. Having an insurance for the health of children can help her save a lot of money and maintain health and safety of her children.
8. Bridget has asked you about private health insurance, as the older child has been told she will need corrective treatment for her teeth and will need braces. Explain to Bridget what you know about private health insurance and where she can find further information:
The healthcare system of Australia highly follows the private insurance-based healthcare. The private health insurance cover all the healthcare cost for the patient. This insurance can be used to claim the sum of money which is also known as benefit from the health fund. The money helps to cover the treatment cost for the patient. In Australia, Medicare is the free public healthcare system that helps several patients gain affordable and achievable healthcare. The average cost of a private health insurance is based upon the health aspects it covers. However, Walsh et al. (2017) have stated that the average private insurance-based healthcare cost is around AU$2,000 per year. It can include an extra sum of only AU $850 for better healthcare coverage. The best fund name for adding extra coverage of dental is Australian Unity because it provides the funds of 46.20%. The AXA is a global healthcare service provider that provide private healthcare insurance to Australian citizens.
9. Refer to the models of health and wellness discussed in Koutoukidis, G., Stainton, K., & Hughson, J. (2017). Tabbner's Nursing Care: theory and practice (7th ed.). Elsevier Health Sciences, pp79-80:
Define one of the models in your own words
How could you apply this model to Bridget’s better understand care requirements, including social and emotional wellbeing, and her health beliefs and practices?
The holistic model of health and wellness does not focus on a single illness or disease but it focusses on health and wellbeing of the complete person. The holistic model of health is an approach of life. It focusses on complete wellbeing of the person through connection between the body, spirit and mind (Koutoukidis, Stainton & Hughson, 2017). The five areas of holistic care involve intellectual, physical, spiritual, emotional and social needs. These factors enable a healthy person to live a happy and healthy life.
The holistic model of care can be applied to health and wellbeing of Bridget. It can develop greater understanding of Bridget in terms of her social, spiritual, emotional, intellectual and physical health. The holistic model of care requires actions from multidisciplinary teams that provide specialized treatment to the patients. The emotional health of Bridget can be improved by proper support and encouragement. Her spiritual health can be maintained by helping her overcome the traumatic history. The physical health can be improved by a registered nurse and the mental health can be improved by a mental health nurse.
10. Research and name a rural town in NSW and identify what community resources are available for Aboriginal and Torres Strait Islanders in this town.
Bourke is a rural town located in NSW. Bourke’s history is equally traumatizing in comparison to the Indigenous people as the traditional land owners were disrespected. According to statistics of 2018, the total population of Bourke is 1,824 people among which 38% people are Aboriginal and Torres Strait Islanders. Bourke have a number of community resources for the Indigenous people (Ulm et al., 2019). These resources include schools for primary, preschool and high school children. The resources also include proper transportation with proper maintenance or roads and flyovers. Bourke have Mitchell highway and Bourke Airport for making healthcare assessable to everyone. The community resources in Bourke are focused on agricultural practices and development of Aboriginal people.
Berlin, L. J., Martoccio, T. L., & Jones Harden, B. (2018). Improving early head start’s impacts on parenting through attachment-based intervention: A randomized controlled trial. Developmental psychology, 54(12), 2316
Ganter, R. (2018). The Contest for Aboriginal Souls: European Missionary Agendas in Australia. Australia: ANU Press.
Hahn, R. A., Truman, B. I., & Williams, D. R. (2018). Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM-Population Health, 4, 17-24.
Hayes, C., Palmer, V., Hamilton, B., Simons, C., & Hopwood, M. (2019). What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review. International Journal of Mental Health Nursing, 28(3), 671-686.
Koutoukidis, G., Stainton, K., & Hughson, J. (2017). Tabbner's Nursing Care: theory and practice (7th ed.). Elsevier Health Sciences, pp79-80
Service Australia. (2020). Looking for work. Retrieved from https://www.servicesaustralia.gov.au/individuals/subjects/looking-work
Ulm, S., McNiven, I. J., Aird, S. J., & Lambrides, A. B. (2019). Sustainable harvesting of Conomurex luhuanus and Rochia nilotica by Indigenous Australians on the Great Barrier Reef over the past 2000 years. Journal of Archaeological Science: Reports, 28, 102017.
Victoria State Government. (2020). Hospital stay- financial support and family accommodation. Retrieved from https://www.betterhealth.vic.gov.au/health/ServicesAndSupport/support-and-accommodation-for-families
Walsh, M., Bell, K. M., Chong, B., Creed, E., Brett, G. R., Pope, K. & Day, T. (2017). Diagnostic and cost utility of whole exome sequencing in peripheral neuropathy. Annals of Clinical and Translational Neurology, 4(5), 318-325
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