The status of Indigenous Australian people’s health is worse in comparison to the non-Indigenous people (Waterworth et al., 2015). For instance, the expected lives of Indigenous females and males are respectively 9.5 and 10.6 years lesser than their counterpart Australians and for all the age groups under 65 years, the age-specific mortality rate in Indigenous people is at least double of that in the non-Indigenous population (Waterworth et al., 2015). The health experiences of Australian Aboriginal as well as Torres Strait Islander peoples had been degrading because of both historical and socio-economic sufferings. Starting from the blatant denial of their existence as humans during 1770-1992 by Terra Nullius, which was British colonisation; Indigenous Australians have suffered a lot (Australians Together, 2020a).
From 1788 until today, their lands are often taken over by the colonial powers without entering into any negotiations. Resistance wars were fought by between 1788 and 1930s Indigenous Australians against colonisers seeking their homelands, way of life and families. These wars have been omitted from the history, leaving most Indigenous Australians without the knowledge of their history and with the reinforced stereotype of being incompetent and lazy because they did not fight for their country (Australians Together, 2020a).
Furthermore, the most devastating experiences of Indigenous Australians include the massacres between the 1780s and 1920s, and the stolen generations between 1910 and 1970 (Australians Together, 2020b). Stolen generations refer to the forceful confiscation of Indigenous Australian children from their families under government policies. This primarily happened because of the white people superiority to the black people (Australians Together, 2020b). Twenty-six per cent of the Indigenous Australian children residing in households of stolen generations rated their health as poor (Nature, 2019).
Other socio-economic factors responsible for the deterioration of Indigenous Australian’s health status include their exploited use for labour in non-Indigenous homes during the period the 1840s to 1970s and their social marginalisation at the same time (Australians Together, 2020b). Indigenous Australians remain among the most socially-excluded population in Australia and based on their past discriminatory and prejudiced experience, they have prominent resentment and mistrust for the authorities. Psychological agony associated with these factors affects the health of Indigenous Australians in a complex way.
Moreover, the longing of Indigenous Australians to retain their cultural distinctiveness also affects their health behaviour. In addition to this, strong kinship and social interactions intensified by obligations due to culture seem to disrupt the positive health status in Indigenous Australian peoples (Waterworth et al., 2015). Coming across all the sufferings of Indigenous peoples and their daunting sufferings was very saddening for me, and this made me realise the importance of effective health promotion for them.
Ethical principles or strategies set out the behavioural guidelines and expectations for any profession (NMBA, 2018). In the field of nursing, these principles are applied to all the practice areas, with the presumption that all the nurses will use professional judgement while implementing them, to deliver the best outcomes possible. The code of ethics shall be used to deliver safe practices and as a reservoir for activities aiming to enhance professional culture in the health system (NMBA, 2018). The key principles in the ethical code of nursing include justice, autonomy, stewardship, beneficence and non-malfeasance (International Organisation of Multiple Sclerosis Nurses, n.d.).
The ethical principle of justice asserts that all the decisions taken by a nurse practitioner should have the element of fairness i.e. the fair distribution of latest treatments and limited resources and fairness in the decisions that benefit or burden (Saint Joseph’s University, n.d.). It also states that nurses should be fair while providing care and that care should be justly and equitably provided among any group of patients being taken care of (Registered Nursing.org, 2020).
The principle of beneficence states that healthcare practitioners should do all they can to provide benefit to the concerned patient in every situation (Registered Nursing.org, 2020). Every course of treatment and procedure recommended should be undertaken with the intention of providing the best to the patient. For ensuring beneficence, proper development and maintenance of a high level of knowledge and skill should be done by the healthcare providers. They should make sure to be trained in the best and the latest medical practices and must take into consideration that what is beneficial for a patient may not be good for another patient (Saint Joseph’s University, n.d.).
In the medical profession, autonomy refers to a patient’s innate right to have his own opinion, belief and perspective. Furthermore, the patients have the right to accept or reject any course of treatment and the nurse should only encourage or advice the patients to make a choice, without coercing or judging him (Registered Nursing.org, 2020). Whether or not the healthcare provider believes that the patient’s choice is in his best interest, any attempt done to coerce or persuade a patient is the violation of the principle of autonomy (Saint Joseph’s University, n.d.).
Considering the demolished state of Aboriginals and Torres Strait Islanders people’s health experiences, the United Nations declared comprehensive rights under the human right framework for Indigenous populations, starting from 2007, which evolved from the different pre-existing international laws (Australian Human Rights Commission, n.d.). These laws primarily concerned with providing equal opportunities such as education, health facilities and employment to the Indigenous populations worldwide. Code of ethics played a major role during this period, as healthcare practitioners ensured that the laws related to the betterment of Indigenous health were properly applied, following the proper ethical principles.
As a nursing student, I have understood the significant role of following the code of ethics because it ensures the proper professional functioning in any organisation or field. Similarly, if proper care of the principles is taken while working with the Australian Indigenous people, respectful and harmonious partnerships can be made. Since the Indigenous Australian populations have developed mistrust and resentfulness for non-Indigenous people and the authorities based on their historical experiences of discrimination, inferiority and racism, certain challenges are present in making these partnerships with them. The concepts of Indigenous cultural safety and cultural competence will have to be taken care of to achieve this goal.
Cultural safety refers to an environment useful for people who want to be able to reflect on their own beliefs, ethics and values. Such an environment provides no challenge, denial or assault to the person’s identity about who he is and what he needs (Thorpe, 2018). It is about shared meaning, respect, experience and knowledge of learning and listening together, with dignity. On the other hand, cultural competence is defined as the capability of participating ethically and effectively in professional as well as personal intercultural settings. This needs one to be aware of his cultural significance along with the world’s views and implications to make reasoned, reflective and respectful choices, including the ability to collaborate and imagine across cultural boundaries (Thorpe, 2018).
Moreover, I will ensure to not discriminate any patient based their cultural or racial differences as cultural safety and cultural competence can be attained only if the aforementioned ethical principles of autonomy, beneficence and justice are followed attentively, giving equal importance to the beliefs, values, and decisions of people from every culture, including the Aboriginals and Torres Strait Islanders.
Australian Human Rights Commission. (n.d.). UN declaration on the rights of Indigenous peoples. Retrieved from https://humanrights.gov.au/our-work/un-declaration-rights-indigenous-peoples-1
Australians Together. (2020a). The stolen generations. Retrieved from https://australianstogether.org.au/discover/australian-history/stolen-generations
Australians Together. (2020b). What about history? Retrieved from https://australianstogether.org.au/discover/australian-history/get-over-it/
International Organisation of Multiple Sclerosis Nurses. (n.d.). Code of ethics. Retrieved from http://iomsn.org/policies-procedures/code-of-ethics/
NMBA. (2018). Professional standards. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Nature. (2019). Trauma of Australia’s Indigenous ‘Stolen Generations’ is still affecting children today. Retrieved from https://www.nature.com/articles/d41586-019-01948-3
Registered Nursing.org. (2020). Ethical practice: NCLEX-RN. Retrieved from https://www.registerednursing.org/nclex/ethical-practice/
Saint Joseph’s University. (n.d.). How the four principles of healthcare ethics improve patient care. Retrieved from https://online.sju.edu/graduate/masters-health-administration/resources/articles/four-principles-of-health-care-ethics-improve-patient-care
Thorpe, K. (2018). Ethics, Indigenous cultural safety and the archives. Archifacts, 2, 33-47. Retrieved from https://opus.lib.uts.edu.au/handle/10453/138992
Waterworth, P., Pescud, M., Braham, R., Dimmoc, J. & Rosenberg, M. (2015). Factors influencing the health behaviour of Indigenous Australians: Perspectives from support people. PLoS ONE, 10(11), e0142323. https://doi.org/.10.1371/journal.pone.0142323
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