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

Introduction to Elderly Aboriginal Population in Remote Locations of Australia

The Aboriginal and Torres Strait Islander population of Australia experiences a staggering gap in terms of healthcare access, life expectancy, disease burden, and overall well-being (Rheault, et al., 2019). This gap prevails de to a range of factors that involve social exclusion, stigma, prejudice, and limited availability of healthcare services in remote locations. As the population of the country is aging, the fraction of elderly population in the Aboriginal and Torres Strait Islander community is also rising (Sivertsen et al., 2019). This paper will discuss the health status of the elderly in the Aboriginal and Torres Strait Islander population in terms of social determinants that impact their health and the health inequalities that are prevalent in the community. This report will also discuss the health inequities in healthcare provision to the Aboriginal and Torres Strait Islander population and identify the nursing practices and care considerations for the well being of the community.

Social Determinants of Health and Their Impact on The Population

The World Health Organisation defines the social determinants of health as conditions in the environment in which an individual is born, plays, lives, works, and ages that impact the overall health and quality of life of the individuals (Rheault, et al., 2019). The impact of social determinants of health also impacts the disease risks and overall physical as well as mental health of the individuals (Sivertsen et al., 2019). The social determinates that impact the health of the elderly population of the Aboriginal and Torres Strait Islander community are education, healthcare access, and mental well-being. These social determinants have a significant impact on the health and well being of the community (Temple et al., 2020). Health literacy in the elderly of the Aboriginal and Torres Strait Islander community is impacted by linguistic barriers. About 59% of the Aboriginal and Torres Strait Islander adults lack adequate health literacy (Department of Health, Australia, 2018). This prevents them from applying suitable interventions and taking required precautions for their well being and thus makes them more vulnerable to diseases and poor quality of life eventually reflecting in the lowered life expectancy and increased mortality rates. Healthcare access in remote locations in Australia is limited rendering participation of the Aboriginal and Torres Strait Islander community and care access for the elders (Department of Health, Australia, 2019). The elders of the Aboriginal and Torres Strait Islander community are also more likely to be less comfortable with the medical aid that is available with fears of generational trauma, stigma, and lack of competent practices in the health care services. The other social determinants that are associated with the health and well being of the elderly in the Aboriginal and Torres Strait Islander community includes poor income, employment, and housing conditions that impact the health status of the population (AIHW, 2018).

Health Inequalities

The health status of the elderly population in the Aboriginal community is critical. It has been reported that long term health conditions, that is chronic health problems are prevalent in 88& if the individuals in Aboriginal and Torres Strait Islander community, who are aged above 55 years (Department of Health, Australia, 2018). That is, almost nine in ten individuals in the elderly population of the Aboriginal and Torres Strait Islander community develops a chronic health condition. The most common health conditions that are associated with the population include diabetes, cardiovascular risks, and respiratory diseases. The community has higher mortality rate and lowered life expectancy than the non-indigenous population of Australia. in 2016, about 5% if the Indigenous population was aged above 65 years with about 16% of the non-indigenous population classified as elderly. The older individuals of the Aboriginal and Torres Strait Islander community have an increased risk of disability than the non-indigenous population. As per the census report of Government of Australia for the year 2016, 27% of the elderly Aboriginals reported the need of primary assistance for daily activities and care that included basic assistance for mobility, communication, and self-care. (Department of Health, Australia, 2018). In contrast, these needs were expressed in only 19% of the non-indigenous elderly individuals of Australia (Department of Health, Australia, 2018).

Health Inequities

The population of the Aboriginal and Torres Strait Islander community is more vulnerable to economic distress and poverty impacting the health and well being of the community (Rheault, et al., 2019). The health gap is also prevalent due to limited access to healthcare services. As per the reports by the government of Australia, 24% of individuals that belonged to Aboriginal and Torres Strait Islander community reported that they had problems in accessing the health care services (Department of Health, Australia, 2019). This was more prevalent in remote locations with 33% of individuals from the Aboriginal and Torres Strait Islander community reporting limited healthcare access. This impacts the healthcare status of the elderly as well as the community as a whole (AIHW, 2019 a). Due to limited access to the healthcare services, it was reported that the rate of preventable hospitalizations in the Aboriginal and Torres Strait Islander community and the non-indigenous Australians has a difference of 3.4 times. Less than 1% of the patients in the permanent residential aged care facilities in 2016-2017 had identified to be from the Aboriginal and Torres Strait Islander community (Department of Health, Australia, 2019). Further, the age profiles of individuals in the identified individuals from the permanent care facilities were much lower than that of the non-indigenous population with 26% of Aboriginal individuals aged below 65 years compared to 3% of non-indigenous patients aged below 65 years in the care facilities (AIHW, 2019 b). The care facilities that are availed by elderly the Aboriginal and Torres Strait Islander community mostly belong to the non-remote areas, as per the AIHW national aged care data, four in five (80%) Aboriginal individuals who availed the permanent care facilities belonged to non-remote areas with only 20% elderly individuals from remote or very remote areas (AIHW, 2019 a).

Health Outcomes

Due to limited access, increased risk of chronic health conditions, and poor health literacy in the elderly Aboriginal and Torres Strait Islander community, the individuals of the community aged between 65-74 years are three times more likely to seek home support (AIHW, 2019 a). The elderly population of remote Aboriginal and Torres Strait Islander community is also seven times more likely to require home care and two times more likely to need residential aged care (Department of Health, Australia, 2019). The elderly also require more comprehensive care with cultural competence and inclusion to ensure their holistic well-being (AIHW, 2019 b). The impacts of the limited access and poor health status of the elderly of the Aboriginal and Torres Strait Islander community is also reflected in the life expectancy and the mortality rate. The life expectancy of an individual from the Aboriginal and Torres Strait Islander community is 10-12 years less than that of a non-indigenous individual (AIHW, 2018). Further, the elderly individuals from the Aboriginal and Torres Strait Islander community are also likely to develop chronic conditions after the age of 55 years with about 90% of elderly individuals suffering from long term health complications (AIHW, 2018). The mortality rate and disability rate of the elderly in the Aboriginal and Torres Strait Islander community is also high due to the prevalent gap in the health care access, limited healthcare knowledge, and social gap that is prevalent in the indigenous and non-indigenous community of Australia (Temple et al., 2020).

Nursing Care Considerations

The primary factors that are associated with the healthcare disparity in the elderly care in the Aboriginal and Torres Strait Islander community and the non-indigenous community are access to healthcare, social exclusion and stigma, and limited health literacy (Temple et al., 2020). As a nursing professional focus should be on the improving the care culture and enhancing the reach of the health care services through health advocacy to promote the health of elderly from the Aboriginal and Torres Strait Islander community (Sivertsen et al., 2019). Attention to culture can impact the healthcare given and improve the quality of care. Cultural competence is significant to the Aboriginal and Torres Strait Islander community in the aged care facilities and is known to be significant in improving the care delivery and outcomes (Beks et al., 2019). Lack of understanding cultural competence. The elderly competence and needs of the Aboriginal and Torres Strait Islander community can result in limited healthcare access and participation in the care services (Salmon et al., 2018). The ethical code of conduct established by the Nursing and the midwifery Board of Australia ascertains that every working health professional should ensure cultural competence in the delivery of care (Fisher et al., 2019). The nursing professionals must also consider the significance of effective communication in care and assure to mitigate the linguistic barriers in the care provided through assistance from the Aboriginal Liaison officers and translators (Reath & O'Mara, 2018). This will promote effective communication and assist in the provision of culturally competent and holistic care to the individuals of Aboriginal and Torres Strait Islander community (Beks et al., 2019). The care provided to the elderly in the Aboriginal and Torres Strait Islander community can be ensured through the application of the Registered Nurse’s professional working standards developed by the Government of Australia (Nursing and Midwifery Board of Australia, 2018).

Standard 2: Engaging in A Therapeutic and Professional Relationship

While caring for the elderly population from the Aboriginal and Torres Strait Islander community, the healthcare professionals must ensure cultural competence and holistic care (Szczygieł & Almeida, 2017). The meaning of “health” in the terms of Aboriginal and Torres Strait Islander community varies from the of the general terms. The elderly in the community are closely attached with their Indigenous values and thus care should be provided in consideration of the same (Salmon et al., 2018). This health in the Aboriginal and Torres Strait Islander community indicates the holistic well being of the community and not just of an individual. While caring for an elderly from the Aboriginal and Torres Strait Islander community, therefore, it should be ensured that shared decision making and a collaborative approach is taken into consideration for the development of a therapeutic as well as a professional relationship (Swannell, 2020). Effective communication should be fostered to ensure understanding the needs of the patient and thus promotes well being with the highest quality care (Swannell, 2020). This standard of practice ensures that the nurse is able to establish and sustain boundaries and a professional relationship with the patient (Nursing and Midwifery Board of Australia, 2018). Therefore, patient privacy should be ensured and professional conduct should be encouraged. The nurse must also recognize that the individuals have complete right to express in accordance with their experiences and use delegation, coordination, and effective supervision to ensure the highest quality care. While caring for the elderly from the Aboriginal and Torres Strait Islander community, the nurses must foster collaborative practices and ensure cultural safety through engagement with the health practices that are competent and suitable for the patient and thus ensure person-centred care (Sivertsen et al., 2019). A nurse professional should also participate in the advocacy of health for the elderly in the Aboriginal and Torres Strait Islander community and promote their well-being through constant support and delegation. Engagement in a therapeutic relationship with the elderly from the Aboriginal and Torres Strait Islander community will also ensure them psychological support along with physical health improvement and promote their holistic well being (Beks et al., 2019).

Standard 3: Maintains Capability of Practice

The standard three of the professional nursing practice guides the healthcare professionals to be responsible and accountable individuals with insurance of safe practice and care (Nursing and Midwifery Board of Australia, 2018). Under this professional standard, the nurses must ensure to consider and respond to the care needs of the patient with health and well-being promotion. A critical component of this standard that should be applied for care provided to the elderly of the Aboriginal and Torres Strait Islander community is to ensure patient education and self-management of the health (Temple et al., 2020). A large section of the elderly population that belongs to the Aboriginal and Torres Strait Islander community bears the load of chronic health conditions. Through effective communication and health education, the self-management of chronic health condition can be promoted (Beks et al., 2019). This will also ensure that the preventable hospitalizations are reduced and the quality of life of the elderly in the Aboriginal and Torres Strait Islander community is improved. The health professionals, under the obligation of this standard and also as a moral imperative promote and practice feedback and ensure constant improvement in the practice (Sivertsen et al., 2019). By promotion of education and self-control of the health education in the elderly of the Aboriginal and Torres Strait Islander community will promote the taking of necessary precautions and also promote longevity. Through this, medication adherence can also be improved in the Aboriginal and Torres Strait Islander community and thus the existing gap can be reduced (Salmon et al., 2018).

Standard 5: Develops a Plan for Nursing Practice

The standard five of the professional nursing practice guides healthcare professionals to develop suitable care plans and communicate in the care facilitation (Nursing and Midwifery Board of Australia, 2018). The plans should be developed through partnership and with relevance indicated via evidence based practice. While caring for the elderly from the Aboriginal and Torres Strait Islander community, the nurses should ensure that the plans are developed in consideration with the cultural and social priorities of the patient (Reath & O'Mara,, 2018). The plan must be based on the assessment data and should follow an evidence based structure for the application of interventions. A collaborative practice is encouraged for the development of the plan. Along with healthcare professionals, the input should be taken from the patient and the allies to ensure culture safety and shared decision making should be encouraged in the practice (Szczygieł & Almeida, 2017). The nurses must also document, evaluate and modify the plans as per the consideration of the patient with a timely assessment and engagement in the care practice. The resources in the care should be coordinated effectively and planned actions should be ensured with an informed consent before the application of the plan based interventions (Swannell, 2020).

Conclusion on Elderly Aboriginal Population in Remote Locations of Australia

A significant disparity exists in the health status of the individuals belonging to the Aboriginal and Torres Strait Islander community and the non-indigenous individuals. This disparity is even more prominent in the elderly population in Australia. This paper provides a critical analysis of the social determinants of health that impact the health of the elderly of Aboriginal and Torres Strait Islander community in contrast with the individuals belonging to the non-indigenous population of Australia, A critical analysis of the health inequalities and health inequities has also been performed. Impact of these disparities has been reflected on the health status of the elderly population of Aboriginal and Torres Strait Islander community in terms of lower life expectancy, increased burden of chronic illnesses, and increased mortality rate. This paper also explored the nursing considerations that should be followed while providing care to the elderly of the Aboriginal and Torres Strait Islander community and identifies the established nursing standards that can be of assistance in same.

References for Elderly Aboriginal Population in Remote Locations of Australia

AIHW (2018). Older Australia at glance. Retrieved from: https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/diverse-groups-of-older-australians/aboriginal-and-torres-strait-islander-people

AIHW (2019a). Aged care for Indigenous Australians. Retrieved from: https://www.aihw.gov.au/reports/australias-welfare/aged-care-for-indigenous-australians

AIHW (2019b). Insights into vulnerabilities of Aboriginal and Torres Strait Islander people aged 50 and over—in brief. Retrieved from: https://www.aihw.gov.au/reports/indigenous-australians/vulnerabilities-aboriginal-torres-strait-50-over/contents/table-of-contents

Beks, H., Binder, M. J., Kourbelis, C., Ewing, G., Charles, J., Paradies, Y., ... & Versace, V. L. (2019). Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: A systematic scoping review. BMC Public Health, 19(1), 1115. https://link.springer.com/article/10.1186/s12889-019-7463-0

Department of Health, Australia (2019). Actions to support older Aboriginal and Torres Strait Islander people Canberra: Department of Health. Retrieved from: https://agedcare.health.gov.au/actions-to-support-older-aboriginal-and-torres-strait-islander-people

Department of Health, Australia (2018). 2017–18 Report on the operation of the Aged Care Act 1997. Canberra: Department of Health. Retrieved from: https://www.gen-agedcaredata.gov.au/www_aihwgen/media/ROACA/2017%e2%80%9318-Report-on-the-Operation-of-the-Aged-Care-Act%e2%80%931997.pdf

Fisher, M., Battams, S., McDermott, D., Baum, F., & MacDougall, C. (2019). How the social determinants of Indigenous health became policy reality for Australia's National Aboriginal and Torres Strait Islander health plan. Journal of Social Policy, 48(1), 169-189. http://search.proquest.com/openview/e44af2f997921806278933ce7d0fe4ca/1?pq-origsite=gscholar&cbl=6289

Nursing and Midwifery Board of Australia (2018). Professional nursing standards. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Reath, J. S., & O'Mara, P. (2018). Closing the gap in cardiovascular risk for Aboriginal and Torres Strait Islander Australians. Medical Journal of Australia, 209(1), 17-18. https://www.mja.com.au/system/files/issues/209_01/10.5694mja18.00345.pdf

Rheault, H., Coyer, F., Jones, L., & Bonner, A. (2019). Health literacy in Indigenous people with the chronic disease living in remote Australia. BMC Health Services Research, 19(1), 523. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4335-3

Salmon, M., Doery, K., Dance, P., Chapman, J., Gilbert, R., Williams, R., & Lovett, R. (2018). Defining the indefinable: Descriptors of Aboriginal and Torres Strait Islander peoples’ cultures and their links to health and wellbeing. BMC Public Health, 19(1), 1115. https://openresearch-repository.anu.edu.au/handle/1885/148406

Sivertsen, N., Harrington, A., & Hamiduzzaman, M. (2019). Exploring Aboriginal aged care residents’ cultural and spiritual needs in South Australia. BMC Health Services Research, 19(1), 477. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4322-8

Swannell, C. (2020). Aboriginal Australians with atrial fibrillation three times more likely to have a stroke than non-Aboriginals with AF. The Medical Journal of Australia, 1. https://www.mja.com.au/journal/2020/aboriginal-australians-atrial-fibrillation-three-times-more-likely-have-stroke-non

Szczygieł, N., & Almeida, M. (2017). Housing policies for the elderly: Why should we care?. Public Policy and Administration, 16(4), 583-592. https://www.ceeol.com/search/article-detail?id=608164

Temple, J. B., Kelaher, M., & Paradies, Y. (2020). Experiences of racism among older Aboriginal and Torres Strait Islander people: Prevalence, sources, and association with mental health. La Revue canadienne du vieillissement, 39(2), 178-189. https://www.cambridge.org/core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement/article/experiences-of-racism-among-older-aboriginal-and-torres-strait-islander-people-prevalence-sources-and-association-with-mental-health/C3657006EC31691D908DB7F2272BE1BF

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