Aboriginals and Torres Strait Islanders are the two Indigenous population groups of Australia. They face a large extent of racism in all the sectors as economic, political, educational, social, and so on. Racism is the key determinant of Indigenous Australian health. These population groups are more affected because of lifestyle risk features and socio-economic status. Racism is of two types of institutional racism and systematic racism. Both have different meanings. In the "systematic racism" or "institutional racism", it refers to the way the ideas have been captured in everyday life. It involves the system of operation at a larger level than one-to-one interactions. The systems include policies, laws, and regulations that are used to operate the social system (Deacon‐Crouch, Skinner, Tucci & Skinner, 2018). The institutional racism is the type of racism which is prevalent in educational sites, employment mechanisms and accessibility to services. Whereas, in individual racism person’s actions and beliefsare considered to serve to perpetuate opression. It is based on the consciousness and unconsciousness of the community. Thev individual racism could be internal as well as external.
Whiteness is the main factor that is considered in the healthcare sector over Aboriginals and Torres Strait Islander population of Australia. It has advantaged the people of the white race in social acceptance. Whiteness in the system refers to the dominance and acceptance of structure and system of nursing that results in creating power in the culture and control that do not accept and respect differences. Nurses and patients in healthcare institutions are affected by the power of whiteness in culture. It is well explained in the various publications that the position of nursing is over the patients, acknowledging power as an initial step towards cultural safety. It has been also stated that imbalance bower has led to violence in culture and negative impacts on the health of patients (Kinchin & Doran, 2018).
Cultural safety is the otcome of services that is ensured by the nursing personnel and midwifery to comply with the standadised care and treatment. It enables that whosoever receives the service is getting up to the utmost level from healthycare providers. The cultural awareness is the beginning step for cultural safety. The cultural awareness is practiced by economic, political, social and emotional context. Then comes the cultural sensitivity, which takes experiences and backgrounds into consideration of Indigenous population. The next step is cultural competency. In this step, the knowledge, attitude and skills of the practitioners are considered around empowering clients. Sometimes, there is even linguistics need to address the social and cultural needs in healthcare syatem. Finally, is the cultural safety that is the systematic approach to understand the power of healthcare delivery system. The difference is that in cultural safety barriers are removed to service delivery including policy, procedures and practices. Whereas, cultural competency deals with referral knowledge, skills and attitudes of carers. It is being noticed that the health system and health care providers are maintaining health equities under investigation. Aboriginals experience more inequities as compared to the non-Indigenous population (Kinchin & Doran, 2018). They get a low level of healthcare services in terms of medicines, investigations, and interventions because of lack of competency towards healthcare system. However, the rights are equally important for Indigenous people in this world. Hence, nursing professionals in healthcare organizations are contributors to ethnic and racial inequity in healthcare. Though, the relationship in therapeutic means is very important and they provide cultural safety that creates awareness and acknowledgement of difference to vulnerable groups that influence an intentional and unintentional basis. The nursing professionals and healthcare institutions need to address policies, practices, education, and training to the members for cultural safety and cultural competency. To eliminate ethnic health inequities from the Indigenous population, the social determinants are to be addressed to ensure cultural safety with appropriate and equitable care (Tsey, Whiteside, Haswell‐Elkins, Bainbridge, Cadet‐James, & Wilson, 2018).
While I was reading the National Aboriginals and Torres Strait Islander's plan 2013-2023, I came to know that the Australian government is now changing its policies and regulations to provide equal accessibility of services within the healthcare organizations to achieve good health status and improve life-expectancy between Aboriginals, Torres Strait Islanders, and non-Indigenous Australians. They are organizing a platform to measure the gap and assess at regular intervals for healthcare improvement in terms to close the gap.
From the year 1967 to 2017, the institutional racism was persistent in Australia. That however affecfted the Indigenous population of Australia. In the year 1967, the Australia only used to follow one policy that was “White Australian Policy”. At this time, the Aboriginals and Torres Strait Islanders were the first time counted in Australian population. Slowly, it got changed and in 1970s non-European migrated in significant numbers for the first time. This was the time when multiculturalism was seen in the country. Now, they are having diverse culture and nature in the country. With the high level of diversification, Australia is comfortable with nature and culture. The Australians also has the culture of immigration. But, it is reverse in the countries like United Kingdom and USA, also the other parts of Europe. The country because of harmony in the culture under section 51, it got power to make laws with respect to any race of the people. But, the people like Aboriginals amd Torres Strait Islander faced high level of institutional racism. Maybe they are treated like this because of low socio-economic status and black skin. There is a great relationship of institutional racism towards the access to health care services, employment and education. The economic, political and social environment has a great link with each other. The Indigenous population does not receive equity in any of the terms like education, employment, and health care. They are always discriminated against groups of people based on race and ethnicity. The increased rate of unemployment results in poor health and education (Lai, Taylor, Haigh & Thompson, 2018). At the small level of employment, Aboriginals and Torres Strait Islanders have very little engagement. It is found that self-employment practices lead to advancement in the economic system and make the person independent. The educational deficits are considered to be the primary cause of poor outcomes. The researches have concluded that the Indigenous population is involved in entrepreneurship at a very low level because of poor educational status. Whereas the white population of Australia shares the major contribution to self-employment through the means of entrepreneurship. There is no transparency in the system at a political and economic level. Gray and Hunter in their research found that in the earlier days, factors contributing to the probability of employment and participation in the labour force were differentiated in two groups Indigenous and non-Indigenous groups (Kinchin & Doran, 2018). After the improvements in the education system, more and more people got involved in urban markets. This enhanced to solve the differences in race and ethnicity in quality, attitude, schooling, and discrimination. The healthcare sector also lagged. The white people were only entertained in healthcare institutions with advanced facilities. They were only allowed to get treatment from multi-specialty hospitals. No focus was been given on the Indigenous population. The policies, plans, strategies at the national, regional and state levels were formed instead of the non-Indigenous population. The population covered under the laws and regulations were the marginalized and vulnerable groups of people. The government of Austraila passed the laws but till now they are not implemented and the people are prone to diseases such as cardiovascular, Type 2 Diabetes, malnutrition, disability, mental illness, respiratory and other diseases. This has affected their life in terms of education, health and employment and thus, have 10 to 12 years less life expectancy than the non-Indigenous population. The laws like HIPPA (Health Insurance Affordability and Protection Act) is legislated in the country to maintain thr privacy of records and ensure health care delivery. The educational system is also not effective in the country that is why the people are not too much educated and the discrimination is there. There are no proper laws for education and employment in the country. The country was having a greater extent of discrimination and affected the growth of the country. The black Australian were always discriminated by white Australians in terms of using resources of country.
In Australia, the government is working on the accreditation process to ensure health safety and quality standards to ensure a culturally safe environment for Indigenous patients (Kinchin & Doran, 2018). This will help in achieving optimum healthcare outcomes. This is usual that in Australia the healthcare is demeaned and disempowered to fulfil the demands of the Indigenous population. It had completely reduced the adherence to treatment and disengagement to clinical care. The Indigenous personalities have requested the government to provide a culturally safe environment in the healthcare institutions to close the gap of the healthcare delivery system. To address this issue, the nurses in the healthcare organizations are advised to follow the holistic attention towards the mental, spiritual, physical and emotional wellbeing of a person and the community (Mazel, 2018). Cultural safety is ensured by the nursing professionals to integrate and allow greater equity of access. As an example, the Indigenous population needs to improve equity to the patients requiring emergency care with angiography. The authors have explained the whole of the procedure, complications and care plan similar to the non-Indigenous population. Cardiovascular diseases are the leading causes of death among the Indigenous population of Australia. Clinical nursing leaders have identified diseases for culturally safe healthcare to improve the health outcomes of the Indigenous population. Indigenous model of care has focused on the barriers to improve clinical effectiveness between patients and the nursing personnel. They focus on decolonizing, awareness of differences, implementing reflective practices, considering power relationships to maintain a culturally safe environment. Nursing professionals have also played a major role in providing education to patients. They teach the best self-care practices like hand washing techniques, teaching nutritional needs, health systems strengthening, care of mother and child, prenatal, postnatal and mother care during delivery and elderly care to manage the status of morbidity and mortality (Mazel, 2018).
Reporting: Nurses in Australia have played a vital role in improving the healthcare system and providing services in a culturally safe environment. They had served in education, service provision and support the Indigenous population. After studying this topic, I came to know that they have improved the systems regarding racism and disparities in healthcare. They organize cultural safety programs that provide education to the population for the improvements of health practice (Lai, Taylor, Haigh & Thompson, 2018). These are the short-term services and some of the programs leading to water, sanitation, and hygiene are provided on a long-term basis.
Responding: The evaluation was done by the nursing professionals to evaluate the performance of the population. I realized that they are now more eager to serve in the population regarding emerging disease trends. They do not do any criticism and discrimination for providing healthcare services. They provide the services in a coordinated manner by understanding the roles of coordinators and liaison officers. The nursing professionals provide culturally appropriate tools, education, treatment, care plans including families and adequate follow-up (Kinchin & Doran, 2018).
Relating: I feel that nursing professionals have embedded in providing a culturally safe environment to get accreditation according to the standards of the healthcare profession. This commitment has invested in professional development and enhancement of clinical education with accountability. The health accreditation bodies have set the standards to measure the performance of healthcare institutions in the area where the Indigenous population resides (Kinchin & Doran, 2018). They monitor the performance based on safety and quality standards in healthcare to collaborate on standards to provide culturally safe practice and develop healthcare settings racism-free. The professionals to comply with the standards, they work on collaboration and cooperation, equity and sustainability, systematic reflection and wellbeing of Aboriginal healthcare workers. They provide education to the Indigenous population for improving healthcare status. They provide care with compassion, accountability, and responsibility to reduce disparities in the healthcare system.
Reasoning: They are working as an interface to serve the people and experience them equity in health outcomes in Australia. They follow the fact that healthcare institutions are the starting place to address health inequity (HealthInfoNet et al., 2019). It is therefore considered that healthcare professionals maximize the positive impact within healthcare interaction.
Reconstructing: However, they have contributed to reducing the burden of disease as they experience two and a half times greater than non-aboriginal Australians. Hence, they will have improved life expectancy and minimizing the disease burden. Also, the government should focus on increasing the number of staff in health care institutions and community (Fogarty, Bulloch, McDonnell, & Davis, 2018).
Deacon‐Crouch, M., Skinner, I., Tucci, J., & Skinner, T. (2018). Association between short sleep duration and body mass index in Australian Indigenous children. Journal of Pediatrics and Child Health, 54(1), 49-54.
Fogarty, M., Coalter, N., Gordon, A., & Breen, H. (2018). Proposing a health promotion framework to address gambling problems in Australian Indigenous communities. Health Promotion International, 33(1), 115-122.
Fogarty, W., Bulloch, H., McDonnell, S., & Davis, M. (2018). Deficit discourse and Indigenous health: how narrative framings of aboriginal and Torres Strait Islander people are reproduced in the policy. Deficit Discourse and Indigenous Health: How Narrative Framings of Aboriginal and Torres Strait Islander People Are Reproduced in Policy, xii.
Harfield, S. G., Davy, C., McArthur, A., Munn, Z., Brown, A., & Brown, N. (2018). Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Globalization and Health, 14(1), 12.
HealthInfoNet, A. I., Burns, J., Drew, N., Elwell, M., Harford-Mills, M., Hoareau, J. & Trzesinski, A. (2019). Overview of Aboriginal and Torres Strait Islander health status 2018, 2(1).
Kinchin, I., & Doran, C. M. (2018). The cost of youth suicide in Australia. International Journal of Environmental Research and Public Health, 15(4), 672.
Lai, G. C., Taylor, E. V., Haigh, M. M., & Thompson, S. C. (2018). Factors affecting the retention of Indigenous Australians in the health workforce: a systematic review. International Journal of Environmental Research and Public Health, 15(5), 914.
Mazel, O. (2018). Indigenous health and human rights: a reflection on law and culture. International Journal of Environmental Research and Public Health, 15(4), 789.
Tsey, K., Whiteside, M., Haswell‐Elkins, M., Bainbridge, R., Cadet‐James, Y., & Wilson, A. (2018). Empowerment and Indigenous Australian health: a synthesis of findings from Family Wellbeing formative research. Health & Social Care in the Community, 18(2), 169-179.
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