Political and Social Context of Healthcare in Australia - Report Example

Political and Social Context of Healthcare in Australia 2009 Introduction In any multi-cultural community, health differences and hence healthcare requirements are determined by the cultural, social and economic parameters. Analysis of determinants of health differences between communities and then the requirements of healthcare customers are then essentially one of studying the materialist conditions resulted by the social inequalities in terms of environmental factors. However, social hierarchies may not always obviate the differences in health attainment. Although health researchers accept the fact that socio-economic status - the most obvious and obtainable data - is the bedrock of studying public health, there may be various levels of differences in the socio-economic strata that complicate the matter. Over the years, the Australian government has framed a number of policies for the country’s healthcare sector to develop cultural competence. The legislative structure for Australian healthcare is targeted for the culturally and linguistically diverse society. In this paper, I will first discuss the sociology of healthcare and then analyze the healthcare intervention in Australia. Expectations of healthcare customers Australia’s healthcare profession is found to be deficient in providing culturally competent nursing services that recognizes the needs of people from diverse backgrounds. Besides technical education, nurses need training to deal with patients from diverse cultural and linguistic background (Gorman, 1995). Developing culturally competent care services imply acquiring the knowledge, skills, attitudes and personal traits of the particular group of people differentiated by religion, race, ethnicity or community. In an increasingly diverse society, cultural competence in healthcare is essential to provide effective services. For best patient outcomes, nurses need to be sensitive to the cultural mores, religious beliefs, lifestyle and family patterns. It is essential for nurses to continually acquire cultural competence so that they may incorporate the cultural aspects of care in all the domains of operation. The professional nursing associations, education institutes and the healthcare fraternity on the whole is responsible for assessing the cultural competence of nurses as well as to continually educate them about client needs in a changing society. Typically the literature on cultural competence in healthcare emphasize less on race than on sub-groups related to the elderly, homeless, women, mentally ill and so on. As a result of lack of transcultural education, nursing care has not been meaningful for these ethnic communities. Nursing education requires guidelines in the planning of curriculum carefully developed for greater cultural competence. The rapid growth in cultural diversity as a result of migration, changes in fertility rates and demographic patterns has given rise to the issues of cultural growth and the need of cultural competence in the nursing literature. Healthcare professionals are challenged to overcome stereotypes, prejudice, discrimination and racism. In particular, vulnerable groups like illegal immigrants, migrant workers and the homeless require unique healthcare services that are often overlooked by the dominant service providers. Besides, rapidly moving populations bring in unfamiliar diseases, new diseases, treatments and medicines that challenge healthcare professionals to alter the existing treatment procedures and cultures. The expected roles of nurses may also vary across different cultural groups (Jeffrys). According to the literature on cultural competence of nurses, the following themes emerge (cited in Jirwe et al, 2006): Awareness of diversity – awareness of one’s own identity as well as the patient’s so that the nurses are aware that each one has a cultural background. This would diminish the tendency of cultural stereotyping Ability to care for individuals – this requires cultural knowledge about the individuals to whom care services are provided. Cultural knowledge about nutrition, childbirth, pregnancy, death rituals, spirituality, traditions, family values, etc. are essential for providing appropriate care. This knowledge stems from not only educational cultural knowledge but also from world view, documented cultural knowledge and encounters with people from different cultures. Educational cultural knowledge may be imparted through training courses but nurses may also enhance their cultural knowledge through interactions with people from different cultures. Developing world views on care would familiarize nurses with different attitudes towards illnesses, diagnosis and care. This would make the nurses more responsive to patients’ problems. Cultural encounters between nurses and patients are also essential since nursing culture is very important to the patient, being dependent for the time being on the patient. Non-judgmental approach – Nurses must realize that each culture has different notions about health, illness, diagnosis, care and lifestyles. A non-judgmental approach makes communication between healthcare professionals and patients more effective. Skills in cultural assessment – Nurses’ cultural assessment of patients and themselves are based on collection of data during the process of care. The data collection relates to various types of lifestyle issues of different cultures. Developing cultural competence continually – Cultural competence is not a static skill but needs to continuous updates related to the changes in the society as well as world developments. The most important nurse-patient interaction is through communication skills. Although language skills may not be so easily acquired by nurses from different cultural backgrounds, there are various nuances that may be picked up. Evaluating on the basis of these communication skills need to be done to develop effective training modules. For example, nurses may need to begin with small talk with the patients to overcome the initial communication resistance on the part of the latter. The use of colloquialism may create artificial barriers with the patients. The nurse needs to understand the verbal and body language of the patient for better care. For example, if the patient avoids eye contact, it may be more because of shyness than mistrust for the nurse. Also, it may also be the case that the patient nods his head and says “yes” out of respect for the physician or the nurse even when he does not comprehend what is being told. The staff needs to be evaluated on his or her respect for the patients’ cultural beliefs on health and illness. It should be recognized that the traditional religious and cultural beliefs of Pakistanis are widely different from the western cultural beliefs. The nurse should be evaluated on the basis of his or her ethnicity, recognition of differences and the respect that she or he has for other beliefs. The nurses may be evaluated on the basis of answers that the patients give. For example, the patient may feel that a disease is created by God when the nurse knows that it is inherently caused by the lifestyle. The illness may also be perceived as part of penitence and the patient may turn to prayers instead of formal therapy. The patient may be unduly fatalistic or hopeful and the nurse needs to understand the parameters of cultural psychology. The patient may simultaneously use alternate therapy that might hinder the clinical care. The nurse must deal with this in a sensitive manner to dissuade from the practice if it is perceived harmful. The two South Asian communities, Indians and Pakistanis, who are predominant in Australia, are broadly similar in culture while there are obvious religious differences, India being a secular country with predominantly Hindu population and Muslims as the second largest population group while Pakistan is an Islamic state. In the present times, immigrants are more trans-cultural in nature, retaining cultural affiliations and connections to the country of origin, than earlier when immigrants adapted to the culture of the adopted country. Hence, requirements for developing cultural competence on the part of healthcare workers are all the more crucial. Similar to Indians, Pakistanis are at high risk of coronary heart diseases and diabetes mellitus. In addition, Asian women are at risk of dyslipidemia and cardiovascular diseases than white women. Other health problems of Asians include tuberculosis, hypertension, oral submucous fibrosis as a result of tobacco chewing habits, cancer, particularly resulting from smoking or submucous fibrosis. Asian immigrant women are also at higher risk of breast cancer than those at home (Periyakoil, n.d). Many of these diseases are related to poor nutrition, lifestyle patterns including smoking and tobacco chewing, early marriage or marriage between first cousins putting them at risk of thalassemia or infection carried at the time of immigration or during travels to home country. The traditional health beliefs of Asian Muslims are based on Unani, which is a kind of therapy based on mind-body unanimity. According to Unani, the environment, food & beverages, movement & rest, sleep & wakefulness, eating & evacuation and emotions determine the state of health (Periyakoil, n.d). Diseases are caused when any of these factors are obstructed, according to the traditional beliefs. Many Muslims believe that the religious priests may cure diseases and that diseases may be tests imposed by God. Hence, there is often a resistance to formal western therapy. Religious beliefs of Muslims affect the lifestyle as well. For example, most religious Muslims follow the routine of five namaaz (prayer) a day and the Friday special namaaz. The month of the Ramadaan is meant for fasts during the day when drinks, food, smoking or sexual relationships are not allowed during daylight. Muslims eat only Halal, or sanctified meat, and are not allowed to eat blood, porcine or Haraam, or unsanctified meat, including all forms of pork like bacon and ham (Periyakoil, n.d). There may be resistance to using porcine insulin as well. Traditional Muslims prefer same sex nurses and particularly women prefer women nurses for X-rays, physical examination, mammogram, etc. There are specific cultural norms regarding treatmentt of Asian elders. For example, elders are shown great respect in the Asian community hence they expect similar treatment from healthcare workers. Most Asian families prefer not to communicate end of life states to the patients and even when there are no possibilities of success in clinical therapy, religious beliefs are held on to. Language is a common barrier to patient-nurse communication. Typically, elder Asians and new immigrants have limited English language skills. Employment of Asians in the healthcare profession in areas that are dominated by Asians are required to break the communication barrier. Many Pakistanis may wear religious accessories like amulets and skull caps. These should not be removed without the consensus of the patient. Besides, sensitive issues like sexuality, political inclinations and cultural peculiarities should not be enquired upon since these might affect the patients’ sensibilities. Research has found that cultural insensitivity in care practices in Australia leads to unsatisfactory health outcomes. Therefore, it is essential that cultural competence of the nursing force is promoted. This may be aggressively done by collaborating with the overseas and immigrant nursing profession (Chenowethm et al, 2006). In particular, the vulnerable population like refugees and asylum seekers require particular attention towards cultural competence of nurses (Pacquiao, n.d). Skill Mix of the Nursing Force Australia had a total nursing force of 244,360, including employed registered and enrolled nurses, which accounted for 1,133 nurses per person in 2005. The average age of nurses was 45.1 years and the profession is predominantly a female one. Around two-third of the nursing force was employed in the public sector (Australian Government). The ageing nursing population has been found to be a major hindrance to provide competent nursing services in Australia and to meet the future needs of the healthcare facilities in the country. The phenomenon of ageing population has been significant over the last 15-20 years, making nursing education critical as a large number of employed nurses will retire in the next 15-20 years. The Nursing Workforce 2010 (cited in Iliff and Kearney, 2006) projects demand of 180,522 registered nurses in 2010 and a shortfall of 40,000 nurses. Hence, a projected increase of 120 percent nursing graduates is required by 2020. Similarly, a shortage of 3,000 midwives was found in 2005 (cited in Iliff and Kearney, 2006). Besides, as much as half of the nursing workforce is employed part time to balance work and family. The number of nursing force per capita is declining in Australia but accessing to world nursing force is not a possible solution since this is a global phenomenon. Beside, the aggressive recruitment from developing countries in Asia poses as a serious ethical threat on the strength of the nursing forces in these home countries. Nurses have always been highly mobile. Australia gets a large number of nurses from other countries, mostly from Asia, and Australian nurses travel to other countries like USA, Canada, Middle East, South Africa, United Kingdom and New Zealand. However, there has been a net increase in the flow of nurses into Australia, a large number of nurses who come into Australia being permanent immigrants. For many such immigrant nurses for whom English is not the first language, cultural and linguistic competence may turn out to be major issues (Australian Nursing Council). The ageing population and affluent lifestyle in Australia has meant that obesity and non-communicable diseases will remain the predominant healthcare intervention requirement in the country. This implies that nurses will be needed most for integrated care, chronic disease management, screening and health education. Nurses will be needed the most to encourage healthy lifestyles and improve environmental conditions. People with chronic and life threatening diseases may require home-based nursing services. The ageing population in Australia implies that more nursing forces will be required in aged care, community services, mental health services, diabetes educators, rehabilitation services, orthopedic services, wound specialists and cardiac rehabilitation services (Eggert, 2009). Nurses are increasingly being required in collaborative care and in acute and long term care. In the context of high demand for nursing graduates, unregulated nursing workers may also be used but not as substitutes for registered and enrolled nurses. Majority of enrolled nurses in Australia are employed in acute care illnesses so it is not possible to use unregulated workers to replace them (Australian Nursing Council). The decline in the number of the nursing force in Australia has been because of dissatisfaction with the management of the healthcare profession. Typically, referrals to bed based services are made only if nursing services are required in addition to medical services otherwise patients are treated in out-patients’ department. Nurses have reported to have the feeling of undervalued as they face lack of management support and expected to sacrifice personal routines for work rosters. Therefore, young nurses leave the population even after taking education or migrate to other countries. Besides, the general tendency of nursing education being availed by women has meant that a large proportion of trained nurses leave the profession on personal reasons. The hierarchical structure of the nursing profession, derived from the military profession, does not gel well with the nursing education received. The chain-based command system in the profession lead to nurses feeling undervalued hence less incentivized to develop culturally competent skills. Attracting immigrant nurses to Australia has been a medium term solution to the problem but this set of nurses are prone to have the same feeling of dissatisfaction after the period of acculturalisation. Conclusion Thus, the growth of Australia as a multicultural nation and the immigration from various countries with different cultural parameters has meant that the nursing profession needs to change according the socio-political shifts. Nurses need to develop cultural competence on the basis of expected roles and cultural beliefs and attitudes of different patient groups. It is therefore extremely important that besides the technical education on care provisions, nurses are educated in cultural sensitivities. The problem in Australia is aggravated because of the ageing of the nursing population and the dissatisfaction of the nursing force with the management of the healthcare profession, which results in a large number of trained nurses leaving the profession or migrating from the country. This is usually solved by recruiting overseas nurses, usually from the developing countries which are also home countries of many new immigrants. This is supposed to problem of cultural competence of nurses as well. However, this is only a medium term solution as these nurses also tend to develop the same level of dissatisfaction. Therefore, it is necessary that there is a continuous level of education and enhancement of the skill set of the nurses, including cultural competence. Works Cited Periyakoil, Vyjeyenthi S et al (n.d). Health and Health Care for Pakistani American Elders. Stanford University. Retrieved from http://www.stanford.edu/group/ethnoger/pakistani.html Gorman, Don, Multiculturalism and Transcultural Nursing in Australia, Journal of Transcultural Nursing, Vol. 6, No. 2, 27-33, 1995 Australian Government, Labor Force – Nurses and Midwives, http://www.aihw.gov.au/labourforce/nurses.cfm Iliffe, Jill and Ged Kearney, Providing a Nursing Workforce for Australians into the Future, 2006, http://www.anf.org.au/anf_pdf/anf_submissions/Sub_Providing_Nsg_Workforce_Future.pdf Australian Nursing Council, Submission to a National Review of Nursing Education, www.dest.gov.au/archive/highered/nursing/sub/130.rtf Eggert, Marlene, Impact of the Nursing Crisis on the Health Workforce, Submission to the Productivity Commission Health Workforce Enquiry, 16 August, 2009, www.pc.gov.au/__data/assets/file/0018/9801/sub026.rtf Chenowethm, M et al, Cultural competency and nursing care: an Australian perspective, International Nursing Review, 2006, March 53 (1), http://www.ncbi.nlm.nih.gov/pubmed/16430758 Pacquiao, Dula F, Nursing care of vulnerable populations using a framework of cultural competence, social justice and human rights, Cnontemporary Nurse, http://www.contemporarynurse.com/archives/vol/28/issue/1-2/article/2346/nursing-care-of-vulnerable-populations-using-a Jefrrys, Marianne, R, Teaching Cultural Competence in Nursing and Healthcare, Springer Publishing Company, 2006 Read More