Acute Care Nursing Practice

Indigenous people in Australia have been influenced by discrimination and inequality throughout ages and this have a negative impact on their health and wellbeing till today (Yiallourou et al., 2019). Although a number of actions, policies and frameworks are developed to impart equality for the Indigenous people in Australia but they are still ineffective. This is because the indigenous people need more support than equal treatment. Equity in spite of equality can be effective for them. Aim of the assignment is to provide a critical reflection in consideration to the topic of “Indigenous health and inequality”.

It include a proper investigation to the values, beliefs and assumptions that I have for the Indigenous people followed by the source of these ideas. The assignment also discuss the cultural, social and political practices followed in the privileged and ignored ideas for the Indigenous people in terms of health equity and equality. The assignment strives to investigate the topic of “the principle of equal treatment seems a noble one, yet does this actually mean equality for all?” It uses the principles of the Nursing and Midwifery care of Indigenous Australians in addition to the development of cultural safety philosophy through the principles of New Zealand Maori midwives.

The Ingenious people of Australia have always been under the influence of immense pressure and discrimination. They have not only struggled for equality or equity but they have struggled for their survival and existence. The historical policies laid by the Australian government at the time of colonization bought up a black phase for the Indigenous people (Wylie & McConkey 2019). They were considered as incapable of surviving so they were forcefully removed from their families and made to live in foster homes. There wages were snatched and they were considered as inefficient for education, employment and health (Wylie & McConkey 2019). Their traumatizing history still have a negative impact over their lives. They were being stereotyped which still exist in the society. Even though the government have bought up programs and policies for their betterment but they still lack far behind the Non-Indigenous people.

During my clinical practice I met a number of Indigenous people who were significantly impacted by their traumatizing history. Their traumatizing history have led to severe inequality and discrimination till date. I believe that the Aboriginal people have different cultural patterns in comparison to the Non-Aboriginal people in terms of their language, communication pattern, body language and lifestyle choices. These people feel it difficult to fit in the modern English society due to their conventional Aboriginal speaking culture. They are left inaccessible with proper healthcare services, timely assessment and correct treatment. A number of Indigenous people are afraid of being treated by a Non-Indigenous physician because of their traumatizing history (Goodman et al., 2017).

One of the patient I was caring for was suffering from depression due to lack of social support, inter-generational trauma and lack of access to healthcare. The patient stereotyped Non-Indigenous nurses of being incapable of treating Indigenous people because he considered that Non-Indigenous nurses will exploit him and provide him with ineffective treatment. I thus assumed that the Indigenous people are under the influence of immense stress, transgenerational trauma, inequality, and discrimination. His unacceptance to the treatment by a Non-Indigenous nurse made me assume that it is not equality what can save these Indigenous people in society but it is equity which can help them gain health, wealth and lifestyle changes.

According to Lane et al., (2017), equality is giving same resources to every person without the consideration of their social, economic or health consideration. And, equity is a phenomenon in which everyone is provided with resources as per their needs (Pietila et al., 2020). It consists of support to increase the social, economic and health status of the people from the most disadvantaged group of the society. After caring for a number of Aboriginal and TSI (Torres Strait Islander) people I realized that these people need more of equity in spite of equality.

I faced a number of patients with different language preference in the healthcare but it was most difficult for me to care for the patients with Aboriginal language. This is because I am not privileged with the knowledge of Aboriginal language. According to Sanders and Crozier (2018), privileged knowledge is the knowledge or information that a person have by birth. These people do not make extra efforts to gain a certain peace of information which is called as privileged information (Sanders & Crozier 2018). The nurses and midwives in the healthcare department having an Aboriginal background are privileged with their cultural knowledge and they are able to deliver equal and supportive healthcare. Application of culture-based healthcare in the hospitals is thus an effective strategy for imparting equitable healthcare.

According to Nambiar-Greenwood (2017), cultural safety is a concept of imparting culturally safe, equal and effective care to all the people irrespective of their race, religion or cultural beliefs. It was firstly discovered by Irihapeti Ramsden who was a Maori nurse (Nambiar-Greenwood 2017). The concept of cultural safety is a philosophy that have a main purpose of improving the health of TSI and Aboriginal people in the society. It was primarily a response to increase the health status of the New Zealanders by the Maori New Zealanders nurse but now it is a global intervention to improve the health status of the people (Moffat et al., 2017). The knowledge of cultural safety is often ignored in the healthcare sector.

During my nursing practice I saw a number of nurses who did not care about the cultural background of the patients and treated them equally. Some of their actions were even unacceptable to the patients which even led to conflicts. This was basically because of lack of cultural awareness and cultural safety in the premises. During my second year of clinical placement I saw a registered nurse who was being very normal with the patients and she was even making eye contacts with the patients to keep them engaged in the healthcare. But, one patient from the Indigenous background got hurt and started to yell at the registered nurse. This incident made me curious and I wanted to know why the patient started to yell at the registered nurse even though she was being kind.

A fellow nurse told me that the Aboriginal people have different cultural beliefs then the Non-Aboriginal people (Moffat et al., 2017). She said that “some cultural beliefs that are acceptable in one culture are highly unacceptable in the Aboriginal culture. For example, use of slang, eye contact and physical touch during communication.” Use of eye contact with the patient made him aggressive which in turn resulted in aggressive reaction of the patient. Had the nurse been aware of cultural safety then she would have been careful with the patient.

According to standard 2 of the registered nurse standards for practice NMBA (2017), the registered nurse must communicate effectively with the patients with proper consideration to their values, beliefs, dignity, culture and rights. A culture of safety and consideration can help a nurse or midwife impart equal healthcare to the patients without racism or discrimination (Henderson, Horne, Hills & Kendall, 2018).

The idea of stereotyping, lack of access to healthcare and lack of available services for the Indigenous people are shaped by a number of cultural, political and social practices (Phillimore et al., 2019). Primary factor that lead to reduced healthcare access for the Indigenous people is remoteness. A number of patients that I encountered during my clinical placement belonged to remote areas. According to Ramjan, Hunt and Salamonson (2016), the Indigenous people are the most disadvantaged groups of Australia. They mostly lives in colonies and in remote areas to live a cultural life style. Remote locations often makes it hard for the healthcare organisation and government agencies to reach to them (Abers, Oliveira & Pereira, 2017).

Moreover, the patients themselves avoid reaching to healthcare services for basic symptoms. This also results in delayed diagnosis and poor health results for the ingenious people (Abers, Oliveira & Pereira, 2017). Political agencies are more concerned toward imparting equality for the Indigenous people. But, there is a need to understand that equal opportunities and equal access cannot improve their overall status (Coleman, 2019). The Aboriginal and TSI people must be recognized in consideration to their social, economic and health status. And, treatment, interventions or support according to their status must be imparted (Hinchy, 2017). Closing the gap policies must be followed to lift up the living standard of the Indigenous people with proper equity and awareness (Hinchy, 2017).

My idea of poor cultural safety in the healthcare setting is maintained because people in the healthcare organisation still does not have ample awareness about cultural safety. Cultural practices of people also have negative impact over their lifestyle (Nagel & Lemel, 2019). For example, the people of Aboriginal background have a sweet tooth. Moreover, they celebrate occasions with a lot of unhealthy food. A majority of Aboriginal people have sedentary lifestyle and influence of intergenerational trauma. This has made them vulnerable to heart disease, diabetes, COPD and depression.

My practice has served my interest of cultural safety for the Indigenous people. I considered that the Aboriginal and TSI people does not get ample healthcare access which have influenced them to have a negative lifestyle. Cultural safety is a measure of imparting equal and safe healthcare to the disadvantaged people of the society (Smith, Fatima and Knight, 2017). Even though the government is making a considerable amount of steps but more considerable actions are required. I believe that cultural safety is an important aspect of maintain healthcare equity and equality so it should be constrained in my nursing practice.

I learnt that cultural safety is an important nursing philosophy and it must be followed by all the nurses and the midwives. I must think of Aboriginal and TSI people as individuals and provide them care as per their needs. I should understand the beliefs of the patients and help them with their medical condition while being empathic and compassionate. I think that it is important for the nurses and the midwives to understand the importance of equity and equality in healthcare and impart required care to the patients on the basis of their cultural health. I have to work on cultural safety philosophy in order to increase my knowledge about cultural beliefs of different cultural groups. According to Long (2016), having cultural knowledge and awareness can improve the working efficiency of a nurse.

In conclusion, he indigenous people are highly influenced by their traumatic history and harmful government policies. They have been subjected to traumatic change, separation from families and social inequalities which has made it difficult for them to adjust in the present time. Patients have been influenced by severe traumatic changes which has subjected them to stereotyping. The patients stereotype that Non-Indigenous health professionals provide ineffective care to the Indigenous patients. I learnt that patients often stereotype physicians but nurses and physicians must exhibit cultural awareness and manage patients according to their needs. Privileged information is often neglected by nurses and midwives however it is important for patient care and safety.

I learnt about the philosophy of cultural safety and cultural awareness. The idea of stereotyping, lack of access to healthcare and lack of available services for the Indigenous people are shaped by a number of cultural, political and social practices. A factor that lead to reduced healthcare access for the Indigenous people is remoteness and lack of available support and services. Favorable services by government agencies and healthcare organisation can contribute to enhanced healthcare results of the Indigenous people. Political agencies are more focused on imparting equality for the Indigenous people in Australia. Although, there is a need to understand that equal opportunities and equal access cannot improve their overall status. The Aboriginal and TSI people must be recognized in consideration to their social, economic and health status with equity and support.

Reference for Indigenous Health and Equity

Abers, R. N., Oliveira, M. S. D., & Pereira, A. K. (2017). Inclusive development and the asymmetric state: big projects and local communities in the Brazilian Amazon. The Journal of Development Studies, 53(6), 857-872.

Coleman, J. S. (2019). Equality and achievement in education. Abingdon: Routledge.

Goodman, A., Fleming, K., Markwick, N., Morrison, T., Lagimodiere, L., Kerr, T., & Society, W. A. H. R. (2017). “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver's inner city. Social Science & Medicine, 178, 87-94

Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: a concept analysis. Health & Social Care in the Community, 26(4), 590-603.

Hinchy, M. (2017). A global perspective on the problem of ‘closing the gap’in life expectancy between indigenous and non-indigenous populations in Australia and New Zealand: an economic demographic model. Evidence of a pre-1788 sedentary population in Central Murray area,‘irrigated agriculture’and aquaculture–can be downloaded for free from Mike Hinchy on ResearchGate.

Lane, H., Sarkies, M., Martin, J., & Haines, T. (2017). Equity in healthcare resource allocation decision making: a systematic review. Social Science & Medicine, 175, 11-27.


Moffat, S. M., Foster Page, L. A., & Thomson, W. M. (2017). New Zealand’s School Dental Service over the Decades: its Response to Social, Political, and economic influences, and the effect on Oral Health inequalities. Frontiers in Public Health, 5, 177.

Nagel, I., & Lemel, Y. (2019). The effects of parents’ lifestyle on their children’s status attainment and lifestyle in the Netherlands. Poetics, 74, 101357.

NMBA. (2017). Registered nurse standards for practice. Retrieved from

Phillimore, J., Bradby, H., Knecht, M., Padilla, B., & Pemberton, S. (2019). Bricolage as conceptual tool for understanding access to healthcare in superdiverse populations. Social Theory & Health, 17(2), 231-252.

Pietilä, A. M., Nurmi, S. M., Halkoaho, A., & Kyngäs, H. (2020). Qualitative Research: Ethical Considerations. In The Application of Content Analysis in Nursing Science Research (pp. 49-69). Springer, Cham.

Ramjan, L., Hunt, L., & Salamonson, Y. (2016). Predictors of negative attitudes toward Indigenous Australians and a unit of study among undergraduate nursing students: A mixed-methods study. Nurse Education in Practice, 17, 200-207

Sanders, R. A., & Crozier, K. (2018). How do informal information sources influence women’s decision-making for birth? A meta-synthesis of qualitative studies. BMC Pregnancy and Childbirth, 18(1), 21.

Smith, K., Fatima, Y., & Knight, S. (2017). Are primary healthcare services culturally appropriate for Aboriginal people? Findings from a remote community. Australian Journal of Primary Health, 23(3), 236-242.

Wylie, L., & McConkey, S. (2019). Insiders’ insight: discrimination against indigenous peoples through the eyes of health care professionals. Journal of Racial and Ethnic Health Disparities, 6(1), 37-45.

Yiallourou, S. R., Maguire, G. P., Eades, S., Hamilton, G. S., Quach, J., & Carrington, M. J. (2019). Sleep influences on cardio-metabolic health in Indigenous populations. Sleep Medicine, 59, 78-87.

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