Community Health Care in Nursing and Midwifery Practice

Introduction to Role of Community Nurse in Aboriginal Community

The region of Kimberly is a remotely placed region, with an estimated about approximately 40,000 residents populated in. These figures were collected and verified last in the year of 2019. This regional area represents for almost one sixth portion of Western Australia (Department of primary industry and regional development, Government of Western Australia, 2019). It can be deemed to be twice as big as region of Victoria. This region has also been recognized as one of the most culturally and environmentally fixated region in the area. This locality is acknowledged for its intrinsic value, economic, social as well as cultural opportunities as well. This is a culturally rich area in habitats more than 40 percentage of population as Indigenous population. The small locality makes up for the home town of more than 150 aboriginal communities, accommodating them within its landscape. COVID-19 is one of the most recent calamities that human race has been subjected to. It is still an ongoing pandemic war, affecting almost every nation in the world. The condition has been fatal for many population groups, irrespective of their region, race, age or sex. Ever since the beginning of this pandemic, the Australian government has been very quick and responsive in taking action to contain the infection from spreading in these localities. The Australian government recognizes the region as one of the designated biosecurity areas and it has been restricted with outside interaction, under the Biosecurity Act (Kimberly development commission, 2019). This has been done, ever since the first outbreak of corona virus, in order to protect the highly valuable Aboriginal population located and living in these regions. The paper will help in highlighting the health concerns of this community. It will also help in shedding light on underlying social determinants of health which impact the population directly and provide an angle to explore its strengths and limitations. The paper will also help in pondering upon the importance of role of healthcare nurse in enabling smooth transition of healthcare services within these communities.

Demographics

The demographical spread in the region of Kimberly is quite diverse (Spencer, 2017). These remote communities also enclose remote travellers, who have settled in these dwellings over the due course of time. The town is also harboured by a fishing port that helps in connecting it with the other communities. These communities are also marked by an isolated impact. This is created by an environmental impact marked in these remote communities as compared to rural metropolitan settings. In terms of remoteness the region is also measured and compared to other regional areas. As per the accessibility/ remoteness index of Australia (ARIA), the whole region of Kimberly is deemed as very remote area. It is rated as 97% of the region classified efficiently under the ABS index as Very Remote (LoGiudice, 2020). The other two regions comprising of the remaining 3% constitutes regions of Broome and Kununurra.

Health Issues

The health issues of the region are broadly classified into multiple categories. The categories stratified into specific sections include the following:

  • Maternal health- Evidential statistics have shown that Indigenous women have a poor maternal health status as compared to their non-indigenous counterparts. There is a higher rate of infant mortality and lower birth weight observed in aboriginal women. These women have been observed to have a higher reported use of smoking and alcohol consumption during pregnancy (Carlin, 2019). This has also contributed to increased number of still births and miscarriages amongst the females. Gestational diabetes is another complication observed in these communities, adding to the overall healthcare burden to the young infants.
  • Child and Adolescent health- Issues like low birth weight has led to the development of multiple disorders in the children. These are generally observed in terms of delayed development both physical as well as mental, impaired cognition and intellectual, multiple underlying health ailments etc. (Dossetor, 2019).
  • Adult health- These concerns are mainly related to the chronic health diseases. As per recent surveys almost 30% of the whole population of Kimberly is suffering from one or the other type chronic illness. The tops five types of cancers observed to be noted in the region include, skin cancer, prostate cancer, breast, colorectal and lung cancer. Amongst the chronic diseases, some of the major health related concerns include diabetes (Manifold, 2019). This is because of risk factor of obesity observed in the region. Cardiovascular diseases, leading to ischemic heart disease and eventually stroke. Other diseases observed are respiratory illness and kidney diseases. These conditions have been observed in higher rates in indigenous population as compared to their non-indigenous counterparts.
  • Mental health- The adults residing in the Kimberly region have been found to be diagnosed with mental health related issues, twice than the non-residents of the region. Amongst few conditions are depression, anxiety and high rates of youth suicides observed in the community. The rate of mental health disorders is more in young adult population of age group 12-16 years, as compared to their elder counterparts (Stanley, 2016). This is concern to be pondered upon with grave importance.

Social Determinants of Health

The social determinants of health are very crucial for planning the best possible intervention and management plan. It is carried out mainly to ensure that the gaps in the service delivery model are keenly identified and the plan is crafted specific to the requirements of the same. Some of the social determinants of health identified in the region of Kimberly as mentioned-below:

  • Housing- There is a direct link between the overcrowding and spread of infection in these communities, as a pattern observed. Some of these infections that have been observed commonly in these settings are scabies, hookworm and trachoma. These infections can be deemed as some of the most life-threatening disease. Apart from these infections, people living in cramped spaces in these dwellings have also shown to reflect upon conditions like, pneumonia and rheumatic heart disease (Habibis, 2019). There has been a recent spike in rheumatic heart diseases, observed in children as per statistical findings. There is also a dire need of strong funding process to be included in the system, to ensure that enough homes are built to reduce the over-crowding of people in community settings.
  • Environmental health- This is of crucial importance as it will help in preventing the transmission of communicable diseases. There is a higher incidence of environmental impact and deterioration observed in the community. There is a severe lack of proper funding model in these regions, due to which, best possible efforts are not made to marginalize the gap. There has been a strong neglect in the community in terms of managing rubbish, presence of animals such as dogs and pests, increased presence of dust that is because of maintenance and so on (McMullen, 2016). All these factors have been hampering the overall promotion of health in the region of Kimberly.
  • Food security- One of the main methods by which health can be promoted is, intake of good and healthy food. This is crucial from the point of view of managing chronic ailments and ensuring prevention of the same in long run. Having an access to safe and healthy food products is one of the basic necessities of the human race. The statistical data of Kimberly region reflects otherwise. There is a restriction to the access of healthy food items for indigenous population group in Kimberly area (McKay, 2019). This is mainly pertaining to multiple factors, such as cost-effective quality food items, perishable food items for sale and purchase in the community, ineffective transportation system to manage the influx and efflux of food items within the region of Kimberly. The other major reason is the education for proper nutrition that lack in this community. All of these factors cumulatively effect on the overall health status of the people living in these suburbs.

Relevance of PHC and Role of Community Health Nurse

Primary health care set ups in such remote areas can be a good and sound choice of initiative, that can help in promoting health of an individual (Primary healthcare in Australia, 2019). The role of primary health care centres can be deemed as the most priority based, as they are the one delivering healthcare solutions through multiple aspects in these communities. The community health nurses and midwives can be considered as the main climate basis for healthcare reforms in these settings. They can be observed to be directly aligned in multi-facet approach, covering various aspects of health care models. These aspects can include, emphasising on the identification and prevention of chronic disease in these communities, promoting overall health status of the individual, preventing any disease or injury to the person and advocating for the patient’s rights to narrow down the underlying health inequalities in the structural foundation. In current times of COVID-19 pandemic the role of community nurse can be very crucial in managing the spread of infection as well as providing required standards of care to the people infected by the same. The community health nurse can be useful in managing the condition in the below-mentioned manner:

  • Providing primary care support through a person-centred approach model. This can be delivered on the basis of integrating quality care model with newer scientific methodology to be used.
  • By being closely engaged in increasing the healthcare funding in these community settings and from preventing overall illness and injury to the individuals.
  • By recognizing the acute care needs of the patient and recognizing its impact on the individual. The linkage is to be established to prioritize the community as well as the condition to be treated, along with the factors causing the same (Warwick, 2019).
  • They can help in establishing a respectful partnership between the communities and the individuals involved in managing care of the patients. Community nurses play a pivotal role in aligning various healthcare professionals together, such as managers, researchers and various healthcare providers including physicians. This person-centred approach through an interdisciplinary action can help in attaining a maintaining optimum health levels for each individual.
  • These community nurses can also work in liaison between the community individuals to manage acute care and health promotion in the region, through collaborative approach.

Conclusion on Role of Community Nurse in Aboriginal Community

Aboriginal communities form the composite part of the diverse culture and ethnicity of the region. There is a lack of proper healthcare infrastructure in the region, which limits its health promotion. The remoteness of the region of Kimberly from the main lands, adds to the multiple underlying disadvantages for the area. However, there are primary healthcare centres engaged in patient care in these regions, there is a dire need of elaborative planning and organizing of better care facilities in the region. This should be done to provide the required standards of care and marginalise the health inequalities in the region.

References for Role of Community Nurse in Aboriginal Community

Carlin, E., Atkinson, D., & Marley, J. V. (2019). ‘Having a quiet word’: Yarning with Aboriginal women in the Pilbara region of Western Australia about mental health and mental health screening during the perinatal period. International Journal of Environmental Research and Public Health16(21), 4253. https://doi.org/10.3390/ijerph16214253

Department of primary industry and regional development, Government of Western Australia, 2019. https://app.remplan.com.au/kimberleyregion/community/population/indigenous.

Dossetor, P. J., Thorburn, K., Oscar, J., Carter, M., Fitzpatrick, J., Bower, C., ... & Martiniuk, A. L. (2019). Review of Aboriginal child health services in remote Western Australia identifies challenges and informs solutions. BMC Health Services Research19(1), 758. https://doi.org/10.1186/s12913-019-4605-0

Habibis, D., Phillips, R., & Phibbs, P. (2019). Housing policy in remote Indigenous communities: How politics obstructs good policy. Housing Studies34(2), 252-271. https://doi.org/10.1080/02673037.2018.1487039

Kimberly development commission, 2019. https://kdc.wa.gov.au/covid-19/

LoGiudice, D., Josif, C. M., Malay, R., Hyde, Z., Haswell, M., Lindeman, M. A., ... & Smith, K. (2020). The well-being of carers of older Aboriginal people living in the Kimberley region of remote Western Australia: Empowerment, depression, and carer burden. Journal of Applied Gerontology, 40(2), 28-31. https://doi.org/10.1177%2F0733464819898667

Manifold, A., Atkinson, D., Marley, J. V., Scott, L., Cleland, G., Edgill, P., & Singleton, S. (2019). Complex diabetes screening guidelines for high-risk adolescent Aboriginal Australians: A barrier to implementation in primary health care. Australian Journal of Primary Health25(5), 501-508. https://doi.org/10.1071/PY19030

McKay, F. H., Haines, B. C., & Dunn, M. (2019). Measuring and understanding food insecurity in Australia: A systematic review. International Journal of Environmental Research and Public Health16(3), 476. https://doi.org/10.3390/ijerph16030476

McMullen, C., Eastwood, A., & Ward, J. (2016). Environmental attributable fractions in remote Australia: The potential of a new approach for local public health action. Australian and New Zealand Journal of Public Health40(2), 174-180. https://doi.org/10.1111/1753-6405.12425

Primary healthcare in Australia, 2019. https://anmf.org.au/documents/reports/PHC_Australia.pdf

Spencer, P. B., Sandover, S., Nihill, K., Wale, C. H., How, R. A., & Schmitt, L. H. (2017). Living in isolation: Ecological, demographic and genetic patterns in northern Australia’s top marsupial predator on Koolan Island. Australian Mammalogy39(1), 17-27. https://doi.org/10.1111/mec.14185

Stanley, S. H., Laugharne, J. D., Chapman, M., & Balaratnasingam, S. (2019). The physical health of Indigenous people with a mental illness in the Kimberley: Is ongoing monitoring effective?. Australasian Psychiatry27(4), 358-361. https://doi.org/10.1177%2F1039856219833776

Warwick, S., Atkinson, D., Kitaura, T., LeLievre, M., & Marley, J. V. (2019). Young aboriginal people's perspective on access to health care in remote Australia: Hearing their voices. Progress in Community Health Partnerships: Research, Education, and Action13(2), 171-181. https://doi.org/10.1353/cpr.2019.0017.

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