Aboriginals and Torres Strait Islanders are the marginalized groups of the Australian population. They experience poor health and die earlier than the non-Indigenous population. They have high rates of morbidity and mortality from chronic illnesses. The government is taking steps to improve the status of Aboriginals' health through various programs and initiatives. The interventions and programs include equitable access of Primary Health Care services to all Australians, better access to Medicare services, immunization services, research, corporations in remote health groups, and tackling behavioral issues through an integrated team-based approach. This requires effective programs and consultancies for evaluation of programs.
Equity and equality in healthcare are two different things, Equity is the term used to describe that the needy people are given all the possible services to give hem the best possible health. Equality is treating everyone with the same respect and distributing resources without any discrimination. The basis on which the resources are distributed is geographically, economically, socially, or demographically. The community of Aboriginals and Torres Strait Islanders has been given comprehensive care through community-controlled services for many years. It involves the integration of community involvement, multidisciplinary teams, respect of culture, accessibility to strategies, prevention, and promotion to work and advocacy along with intersectoral approach.
The issues are related to cultural and social determinants of health such as education level, income level, etc. in the accessibility of healthcare. There are several ways in which Indigenous people are facing issues like reduction in costs of payment, transportation availability, cost of care, consultation timings, community involvement, and individual's interference. In Australia, Medicare is the mainstream that is run by the government for attaining Universal Health Coverage. Through this approach, all the citizens of the country are allowed to avail of primary medical care free of cost. The doctors are appointed by the government to provide free medical consultations. These Indigenous people experience a high-level of inequities in health because of social determinants like income, culture, gender, caste, education, and lifestyle (Browne et al., 2019).
Aboriginal community-controlled health service (ACCHS) is the framework that is decided to overcome the disparity between Indigenous and non-Indigenous populations. This framework has worked to close the gap with investments and initiatives by the government in improving the status of emotional and social health for the betterment of society. The activity like primary health care is the area that has been built to coordinate with people in building a healthy environment. Also, the model focused on leading with good governance, Aboriginal community care services, minimizing the barriers in access to healthcare, reducing the impact of racism and marking the progress in improving the health conditions of Indigenous people.
The models of care like comprehensive primary health care and patient-centered medical home are there for the Australian population's health. ACCHS includes cultural safety, promotion of health, planning activities, community engagement, and research as the basis of the model. The model mainstream the evidence, resources, and time to manage the problems that need to be addressed during the consultation. The patient-centered medical home (PCMH) model is there that involves the performance of different tasks with leadership, team-based management, and patient-centered care (Taylor & Guerin, 2019).
NSQHS are the National Safety and Quality Health Service Standards that are designed for the public welfare and consultation with highly educated professionals. Standard 1 from NQSHS relates to clinical governance to provide the best possible care and bridge the gap with the adoption of effective strategies to get the best outcomes. The standards revolve around governance within healthcare organizations for quality and safety, medication safety, consumer participation, control and prevention of hospital-associated infections, patient identification, handover of patient records, blood management, injury handling, patient fall, and provision of acute care.
The actions that the hospitals can take for getting improved outcomes of Aboriginals and Torres Strait Islanders health are prevention and control of healthcare-associated infections. The action should be such that the healthcare institution should daily monitor and recognize the rate of infection in all the wards and units. This can help in preventing and controlling healthcare-associated infections. Also, the health care organization implement and monitors the strategies to meet the quality and safety priorities for Aboriginals and Torres Strait Islanders.
Risk management should be done that will involve the policies, procedures, and protocols for aseptic techniques, reporting of notifiable diseases, antimicrobial prescribing, environment cleaning and disinfecting, disposal of bio-medical waste, management of blood substances and processing the reusable medical devices. The implementation plan will include improving the cultural awareness and cultural competency to meet the demands of Aboriginals and Torres Strait Islanders. This will help in managing the patients and creating a welcoming environment that recognizes the importance of beliefs and practices of Indigenous groups.
The patients with colonization and infections to decide for necessary treatment and management. The appropriate and safe goal for the clinical governance system should be established to achieve the goal. Risk management principles implementation will be done and it will promote a hygienic environment for healthcare workers and patients. Effective communication will be required to provide carers, consumers, patients, and service providers an infection-free environment (McGough, Wynaden & Wright, 2018).
NSHQS standard 2 will be based on partnering with consumers. This will be achieving clinical outcomes and quality, experiencing care, and delivering the best possible care. The implementation of actions to improve the health of Aboriginals and Torres Strait Islanders that will include the achievement of patient-centered care with decreased mortality rate, decreased readmission rates, reduced number of days in the hospital, improvement in the functioning of different departments, and strict adherence to treatment plans. The actions will include governance of partnerships in diverse backgrounds to interact with more people and get prompt feedback. The patients and their families should be involved in taking decisions for quality care and service. They will provide relevant measures for the management of the quality and safety of the patient (Sarmiento, Paredes-Solís, Andersson & Cockcroft, 2018).
Cultural safety is of foremost importance in the healthcare system concerning Aboriginals and Torres Strait Islanders. The nursing professionals and midwives are expected to engage with the people in a culturally safe and respectful environment. It is done to provide care with compassion, honestly, openly, and with privacy and confidentiality. The staff in organizations is trained enough to provide a safe environment. It reflects the assumptions and the order of work with relationship maintenance of Aboriginals and Torres Strait Islanders. Nurses and midwives are considered the best contributors to the achievement of the best possible outcomes (Richardson, 2014).
I, as a nursing professional, is taught in my classes to focus on better health outcomes than non-Indigenous people. The cultural safety was taught to us to contribute towards the way of cultural safety and enhanced health condition. 5 cultural safety principles are partnerships, positive purpose, process, personal knowledge, and protocols. The cultural safety provision does not mean minimizing the power but, they can provide their services by ensuring no discrimination and extent of cultural safety and security to indigenous groups. Client engagement should be ensured to enhance decision-making and willingness to receive hospitalized care. The two principles of cultural safety are a positive purpose and personal knowledge.
The NMBA standards could be achieved by taking strategic actions and personal knowledge like clinical leadership and leadership support. This action could be achieved by maintaining and ensuring the following leadership charter. It will provide clear pathways with a deep understanding of the plan of care and will ensure the safety of patients. The action plan will include sessions on advisory board learning and change management. It will strengthen the courses and pathways for members and a sense of leadership. The malpractices related to discrimination on the grounds of culture will be minimized up to a greater extent. Hence, it would lead to developing cultural safety mechanisms and reports. This will include all the nursing professionals and midwives for encouragement. This way personal knowledge in the healthcare setting will be increased and the measures against the progress of cultural safety will be marked for improvement (Lock, 2018).
The second action would include compliance of protocols and hence appropriate care could be achieved by patients and hence, reviewing and strengthening the governance system. It requires the updation and enhancement of documents related to governance for nursing professionals and midwives. All the members of the healthcare setting will be taken to ensure that all the mechanisms are followed as per said in the documents. The implementation plan will include the circulation and promotion of protocols, training, and governance material.
The plan will also include the consideration of inter-disciplinary, inter-agency, and inter-directorate collaborative environments. This will establish and formalize the governance system for the improvement of nursing professionals and midwives for cultural safety. The evaluation of the framework would be done that will involve the monitoring of reports, Key Performance Indicators, and discussion papers. The implementation of models like the safewords model will ensure the implementation and management of patients. Hence, the nursing staff and midwives will be included in the formation and regulation of these programs (Bryce, Foley & Reeves, 2018).
Aboriginals community care services are the important players in the Indigenous community that fulfills the goals by taking care of people and providing them with all the services they need. It involves the exercise of self-determination, responsibility of action, improvement of Indigenous people's health, setting the frameworks to shift to the health and well-being of the community. The government should provide full support in leading the initiatives and programs of primary health care provision. The actions and implementations in the healthcare settings will help in achieving organization standards, goals, and objectives.
Browne, A. J., Varcoe, C., Smye, V., Reimer‐Kirkham, S., Lynam, M. J., & Wong, S. (2019). Cultural safety and the challenges of translating critically oriented knowledge in practice. Nursing Philosophy, 10(3), 167-179.
Bryce, J., Foley, E., & Reeves, J. (2018). The importance of cultural safety, not a privilege. Australian Nursing and Midwifery Journal, 25(10), 16.
Lock, M. J. (2018). Australian Healthcare Governance and the Cultural Safety and Security of Australia's First Peoples: An Annual Critique. No. 1: Focussing on Knowledge Governance. Committee Pty Ltd, Newcastle.
McGough, S., Wynaden, D., & Wright, M. (2018). Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study. International journal of mental health nursing, 27(1), 204-213.
Richardson, S. (2014). Aotearoa/New Zealand nursing: from eugenics to cultural safety... Nursing Inquiry, 11(1), 35-42.
Sarmiento, I., Paredes-Solís, S., Andersson, N., & Cockcroft, A. (2018). Safe Birth and Cultural Safety in southern Mexico: study protocol for a randomized controlled trial. Trials, 19(1), 354.
Taylor, K., & Guerin, P. (2019). Health care and Indigenous Australians: cultural safety in practice. Macmillan International Higher Education.
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