Nursing Practice 6: Consolidation of Contemporary Nursing Practice in Diverse Settings

Cardiovascular health includes the veins, arteries, heart, and other elements of the heart system. The term used to include all the diseases related to the circulatory system and heart is cardiovascular disease (CVD). CVD is a significant issue addressed in aboriginals specifically in elder people of Australia. Numerous amounts of aboriginal people have been hospitalized due to cardiovascular health problems in the past many years. This is becoming the leading cost of short life expectancy of aboriginals and increased heart patients in the country. Sadly many Torres Strait Islanders and aboriginal people die because of heart problems. The following report will address this issue and the rate of CVD in aboriginals in detail. Based on the study, the report will formulate a nursing practice plan using Registered Nurse Standards I respect to strategies in handling cardiovascular health problem in aboriginals. We have chosen elder aboriginals of Australia as a diverse population for this study. The report is constructed defining the health inequalities and inequities and social determinants of health for aboriginals.

Diverse Population

Over past decades, the average mortality rates of Australian have fallen substantially, with short life expectancy growing in both males and females. This fallen rate of mortality has summed up to population evolution and the proportion of Australian older people is constantly decreasing. According to the report of 2015, there was a projected 3.5 million elder Australians, demonstrating one in every seven individuals i.e. 15.1%. This percentage has amplified to 14.3% in 2012 from 13.3% in 2009. The imminent growth of Australian’s aged population has significant inferences of the establishment of services required by the older population (LoGiudice, 2016). The problem arises because many of the old age people are forced to live independently as Australia is a developed country and every individual earns for his livelihood. Heart diseases are generally caused by tension, trauma, or severe anxiety attacks because of challenges that came around in life. Most of the cases reported prior symptoms of hypertension and high cholesterol level among old age people. Other reasons for CVD can be excessive use of tobacco, cigarette, overweight, obesity, high blood pressure, poor nutrition, and diabetes (Poudel, Zhou, Story, & Li, 2018). The proportion of people aged between 65 and 85 is noticeably smaller in aboriginals as compared to the non-indigenous population i.e. 16% and 2.1% respectively. This reflects the lower lifespan and higher mortality range of indigenous people in Australia. Hence, preparation for elderly care facilities takes account for aboriginal people aged 50 and above and for-indigenous people are 65 and above.

Social Determinants and Their Impact

The situations in which people live and work are the drivers of wellbeing and health that fall outside of the health care network. The factors like employment, education, housing, communal relationships, capital, poverty, and distribution of resources are considered as social determinants of health. These social determinants have affected the aboriginals and Torres Strait Islanders of Australia in several ways. About 30-50% of the wellbeing gap between aboriginals and other Australians is endorsed to social determinants of health. However, the impacts of social determinants can be positive and negative both (Southgate institute for health, society & equity, 2019). Positive impacts include self-determination, sovereign rights, community control, control over income and property, etc. On the other hand, colonization, racism, poor housing, stress, social rejection, and others are the negative impacts reported in the aboriginals of Australia (Olubanwo, 2017). The National Census in 2001 discovered that the income of aboriginals in Australia was about 364 USD per week while non-indigenous people have 585 USD per week of income. Moreover, the unemployment rate of aboriginals was 20% which is three-time larger than that of non-indigenous people.

Health Inequalities

The deprived health grade of Torres Strait Islander and Aboriginals is an eminent fact in Australia. A significant inequalities gap exists between non-indigenous people and the aboriginal of the country. Despite the government's multiple strategies and frameworks, very few improvements can be seen in past years concerning the aboriginals. The life expectancy of aboriginals was reported to about 59 years for males and 65 years for females while the numbers are high for other Australians 77 years for males and 82 years for females. Besides, the rate of hospitalization of heart patients among aboriginals was double than of other Australians as reported till 2003. The inadequacy of food and vegetable consumption drives the health risk factors among elderly aboriginals. Elderly aboriginals people form low-income households rate their health as poorer to about 31% as compared to non-indigenous people which is about 12% (Nichols, Peterson, Herbert, Alston, & Allender, 2016).

Health Inequities

When examining CVD risk factors and mortality occurrence rates based on income groups, it is noted that elderly people from minor socioeconomic position are more susceptible to CVD as compared to higher socioeconomic position. Evidence of the inequity gap and opposite social group discloses those death rates are higher in the inferior revenue group. Another root cause of health inequity is the inadequate distribution of resources and power including societal courtesy, goods, and services. The absence of access to nutritious and affordable food and greater smoking rates contributed to increasing CVD cases in aboriginals (Temple & Russell, 2018). The inequities in government policies, law, and culture are included in structural inequities. The major causes foster health inequities are psychological suffering, monetary stress, and food insecurity. The treatment gap can also be considered as a part of health inequity. This gap is a result of inappropriate guidelines for surgeons, health care policy and systems, the higher cost of therapy sessions, cultural barriers like stigma from long-term medication. Moreover, there are differences in urban and rural access to health care services which results in increasing death rates (Van Gaans & Dent, 2018).

Health Outcomes

It was reported that aboriginals likely to have higher smoking and alcohol consumption habits at young ages which later turned into chronic disorders including heart and circulatory diseases. In elderly aboriginals, the major factor of risk existing in cardiovascular disease is also associated with a higher rate of developing frailty and weakness. In 2004-05, one out of eight indigenous old age Australians had suffered from cardiovascular disease for long durations (Adegbija, Hoy, & Wang, 2015). The CVD was the leading cause of death, about 27% of Aboriginals died due to cardiovascular health problems. The hostile risk factor profile of elderly aboriginals indicates that efficient primary and secondary interferences to meet the requirements to reduce the risk issues promoting cardiovascular health problems by increasing their survival rate and ultimately eliminating the disparities with the non-indigenous population.

Moreover, compared to the non-indigenous population of the country, the older indigenous group have a significant rate of diabetes and obesity along with hypertension and high cholesterol level. Each of these health problems has autonomously shown in the leading condition of CVD in elderly aboriginals. In respect to maximizing impending positive outcomes, the government has developed multiple strategies related to health care services and the well-being of the community. The perspective of these practices is to promote changes in lifestyles, individual’s connection with family, and equal communal guidelines for social exposure. The National CLAS Standards aim to improve health equity, advance quality, and health care corporations to initiate linguistically and culturally appropriate facilities (Lucero et al., 2014).

Nursing Care Norms in Link with Registered Nurse Standards

The Australian indigenous society has a wide history of cultural ad linguistically diverse environments and therefore, Registered nurse standards for exercise are to be learned in the context of elderly aboriginals. RNs identify the significance of culture and history to wellbeing and health.

The person-centered standards are a combination of collaborating and establishing relationships with mutual understanding and trust. A registered nurse is somebody who has completed the prescribed education groundwork, validates competence to practice, and is listed under the Health Practitioner Regulation National Law as an RN in Australia. Each RN has the criteria that stipulate how that standard is validated. Person-centered care has been found to associate with a patient’s capability to commence personal health preservation and stick to complex treatment systems.

Standard 1: Thinks Critically and Analyses Nursing Practice

The aged individuals are sensitive in nature and become worried about their lifespan once diagnosed with any type of chronic disease. The nurses have to deal with patience and provide them with quality services. RN 1 uses a variety of thinking practices and comes up with the best evidence for decision making. The standard aims that a nurse must provide quality, safe, and appropriate services to the patients. To deal with adult age persons, nurses should access and evaluate the health history of the person. This allows learning the patient of the consequences had faced in past and makes it easy for the nurse to eradicate the treatment. The standard teaches to adopt practice through experience and personal reflection. A nurse should have experience with old age people as a part of the job and through the experience, it becomes general to handle the situation. Elderly people are sensitive not only about their health as well as for their culture and background. However, nurses are liable to sustain common law, acts, and legislation while delivering the services (Cashin, 2017). A nurse needs to maintain a code of ethics during the practice and remember never to cross the protocols. Standard one demands to maintain proper and comprehensive documents consisting of regular test reports of the person. Because many of the elder people hospitalized for treatment have no family members to attain their medical requirements, these nurses are the only persons who are responsible for taking care of such aged patients. This situation demands patience and kindness as a part of the job which is also an outcome of the standard. Another consideration nurses should compile with is to contribute to the quality improvement of the patients and relevant study. Nurses must understand the principles of elder people's health, priorities, and practices in respect of identifying and reacting to the root causes and social determinants of health, sickness, and health inequalities. Proper information and data should be monitored to assess the requirements of old age people and work to enhance health and wellbeing with positive healthcare experience (Duggleby, 2015). An old age aboriginal during the treatment should have equal access to health screening, promotion, and other facilities following social inclusion.

Standard 2: Engages in Therapeutic and Professional Relationships

This standard is applicable in practices to establish therapeutic relations and partnerships through effective, safe, and unbiased communication. Nurses are liable to understand individual differences, requirements, and capabilities. Effective communication development is the main aspect of this standard. Effective communication is another vital part of delivering health care services. The interpersonal communication skills of listening, feedback, and questioning must be considered for establishing trustful relations with the aboriginal population. The nurses are supposed to accomplish with multiple communication skills and knowledge to provide person-centered care and improve the quality and safety of services. The elderly aboriginals suffering from chronic diseases e.g. CVD may also possess different health issues like anxiety, distress, or depression. These issues must be taken into consideration while giving treatment for major suffering. The therapeutic ethics to maintain engage and disengage when required from professional caring relations and must dignify professional boundaries (Taylor & Guerin, 2019). . The current legislation must be understood and applied by nurses while caring adults and should pay special attention to the rights of diverse people, including those with complex requirements ascending from elderly, mental impairment, long-term problems, and towards life termination. The concept of self-care and promoting a willingness to live for adults with long-term and acute problems by using effective communication strategies is a foremost consideration for caring elderly aboriginals. During terminal illness, the recognition of changing behaviors and needs of adults and their families is also compulsory.

Standard 3: Maintains the Capability for Practice

This standard effectively establishes and accomplishes relationships by understanding the fine line between personal and professional relationships. The nurse should be accomplished in providing support and directing people to the required resources helpful in optimizing their health condition. The practice says that a nurse should become the voice for elderly aboriginals to quote them as they are incapable of explaining their problems. The nurses must have practiced in a non-judgemental, sensitive, and caring manner that escapes false assumptions, discrimination, and supports social presence by recognizing and respect individuals' choices and feelings. The challenges like inequality, ignorance, and rejection that cause barriers in accessing health care services for aboriginals should be opposed by the professionals. An aboriginal’s identity, dignity, wellbeing, and rights should be respected in the profession (Scanlon, Cashin, Bryce, Kelly, & Buckely, 2016). The roles and responsibilities of a nurse should be perfectly comprehended to meet the changing constraints of old age individuals. They are also liable to consider continuous professional development by enhancing their awareness and abilities over time. Professional practice also recognized with some limits while delivering services. The nurses should adhere to these limits of the profession along with ensuring satisfying care to the person. The objective of improved health outcomes must be considered with the use of delegation, dedication, supervision, consultation, and coordination to build professional relationships. The main objective should be to decrease the morbidity and mortality rate of elderly aboriginal. This can be achieved by promoting changing lifestyles and providing easy access to health care facilities not only in urban but in the rural aboriginal region too. Nurses are accountable to maintain standards of healthcare and must be able to respond assertively and autonomously in uncertain situations.

Nurses should adhere to all considerations aligned with RNs along with empowerment and involvement of patient and family. These considerations make it easy to make elderly people conformable throughout the treatment process. For this, a proper nursing plan should be developed and followed by the concerned nurses to come up with positive health outcomes. The RNs standards also foster nurses’ knowledge and awareness about nursing practices (Zwar, 2017). Adult nurses should be considered able to provide governance in managing adult nursing care, coordinate and understand interprofessional services when required, and communicate with expert teams. They must be flexible and adaptable, and also possess the capacity to lead the situations in absence of a concerned person.

References for Cardiovascular Health in Elderly in Aboriginal Community

Adegbija, O., Hoy, W., & Wang, Z. (2015). Prediction of cardiovascular disease risk using waist circumference among Aboriginals in a remote Australian community. BMC Public Health15(1), 57.

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian24(3), 255-266.

Data, G. A. C. (2016). Australia's health 2016 Web report 2016. Diabetes. Retrieved from https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/chapter-5-health-of-population-groups

Duggleby, W., Kuchera, S., MacLeod, R., Holyoke, P., Scott, T., Holtslander, L., & Chambers, T. (2015). Indigenous people's experiences at the end of life. Palliative & supportive care13(6), 1721-1733.

LoGiudice, D. (2016). The health of older Aboriginal and Torres Strait Islander peoples. Australasian journal on ageing35(2), 82-85.

Lucero, A. A., Lambrick, D. M., Faulkner, J. A., Fryer, S., Tarrant, M. A., Poudevigne, M., ... & Stoner, L. (2014). Modifiable cardiovascular disease risk factors among indigenous populations. Advances in Preventive Medicine2014.

Nichols, M., Peterson, K., Herbert, J., Alston, L., & Allender, S. (2016). Australian heart disease statistics 2015. Melbourne: National Heart Foundation of Australia.

Olubanwo, T. O. (2017). Assessing Cardiovascular Disease Burden: An Epidemiological Report of Cardiovascular Disease Trend in Canada.

Poudel, A., Zhou, J. Y., Story, D., & Li, L. (2018). Diabetes and associated cardiovascular complications in American Indians/Alaskan Natives: a review of risks and prevention strategies. Journal of diabetes research2018.

Scanlon, A., Cashin, A., Bryce, J., Kelly, J. G., & Buckely, T. (2016). The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian23(1), 129-142.

Southgate institute for health, society & equity. (2019). Social Determinants of Indigenous Health and Closing the Gap. Retrieved from https://www.flinders.edu.au/content/dam/documents/research/southgate-institute/social-determinants-indigenous-health-policy-brief.pdf

Taylor, K., & Guerin, P. (2019). Health care and Indigenous Australians: cultural safety in practice. Macmillan International Higher Education.

Temple, J. B., & Russell, J. (2018). Food insecurity among older Aboriginal and Torres Strait islanders. International Journal of Environmental Research and Public Health15(8), 1766.

Van Gaans, D., & Dent, E. (2018). Issues of accessibility to health services by older Australians: a review. Public health reviews39(1), 20.

Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell Davies, G., & Hasan, I. (2017). A systematic review of chronic disease management.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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