The Principles of the Cultural Respect Framework - Roy's Story - Case Study Example

One would count the aboriginal culture as being one of the oldest in the world- it is diversified and numerous in terms of value additions and typologies, which would signify in essence that the constituents of the culture are various kinship and language groups that have adapted to diverse living conditions throughout Australia over many thousands of years. Torres Strait Islanders are a separate people with distinct identity and culture. Aboriginal cultures and Torres Strait Islander cultures are still dynamic and evolving and, for Aboriginal and Torres Strait Islander individuals and communities form the context for the development of health policy.   Health cannot just be understood in terms of physical wellbeing of the person but in terms of the social and cultural heath of the individual. This would mean that in order for a person to be correctly treated the medical practitioner would need to be aware of, and sensitive toward the cultural views of the person, especially in the context of the healthcare professional. Health has been defined by WHO as a state of complete physical, mental and social wellbeing, is recognised as both a fundamental human right and an important worldwide social goal.   In the context of the Australian population it must be noted that as a whole, they are one of the healthiest populations of any developed country and have access to a world-class health system. Life expectancy for Aboriginal and Torres Strait Islander peoples is some 20 years for males and 19 years for females below that of other Australians. With respect to healthcare there are those that call the cultural respect framework as manifestation of protectionism. The policy of ‘protection’ has been defined as the need arising from ‘the disparity of the parties, the strength of the one and the incapacity of the other, to enforce the observance of their rights”, (Aborigines Protection Society, [APS], 1837). The situation was such that it ‘constituted a new and irresistible appeal to our compassionate protection”. On closer observation, one understands that rights have been defined only as ‘the righteous and profitable laws of justice.’ Thus, even a statement such as the APS’ claim that ‘as a nation, we have not hesitated to invade many of the rights which they hold most dear’ is problematic. It assumes that the APS are somehow privy to knowledge of that which Indigenous Australians call ‘rights’, and to which rights they apparently ‘hold dear’. The idea in this case would be the implementation what the Australian Health Ministers' Advisory Council. Standing Committee for Aboriginal and Torres Strait Islander Health Working Party, (2004) calls the model of cultural respect by seems to have garnered more and more support in recent years as a framework for the promotion of behavioural changes in the medical and care professional, along with coming up with alterations to the health care systems themselves. For the purpose of this discussion one could restrict oneself to the definition of Cultural respect as given the national Aboriginal Health Organisation Fact sheet, which defines the concept as ‘recognition, protection and continued advancement of the inherent rights, cultures and traditions of Aboriginal and Torres Strait Islander Peoples’. The model entails four basic elements highlighting the importance of ‘Knowledge and Awareness’ that informs ‘Skilled Practice and Behaviours’ as well as the development of ‘Strong Relationships’ between (health) institutions, individuals and communities in order to achieve an ‘Equity of Outcomes’ (p. 10). The Cultural Respect Framework for Aboriginal and Torres Strait Islander health, 2004-2009 recommended strategies that could be implemented to improve access to health care for Indigenous clientele as well as suggestions in a number of areas including education and training. Australia was able to come up with a Workforce Strategic Framework, that had its basis in the pledge to nine ideology as outlined in the National Strategic Framework for Aboriginal and Torres Strait Islander Health. Where the intrinsic philosophy of cultural respect is concerned therefore the idea remains that that the medical care professional needs to ensure that diversity in cultural lineage, views and rights, along with the expectations Aboriginal and Torres Strait Islander peoples have with respect to medical aid is respected in the deliverance of culturally appropriate health services. The second most important step tro be taken in the implementation of healthcare for aborigines is to ensure that there is a level of community control of primary health care services. This would mean that there be a support of the indigenous people in the wholesome manner; there should be the control of health sector in recognition of its demonstrated effectiveness in providing appropriate and accessible health services to a range of Aboriginal communities and its role as a major provider within the comprehensive primary health care context. Given the fact that access to and acceptance of modern healthcare systems has been abysmally low where Aboriginals are concerned, one of the major steps taken to correct the situation, and streamlining aborigines incorporating them in the mainstream health plans would be an innate requirement. The idea therefore is the Incorporation of insightful work, based on research focusing on participation along with the implementation of guidelines that are ethical, ensuring that the administration of medical aid is carried out in a amore culturally sensitive manner. Where the focus of the cultural respect framework is concerned one finds an innate difference from that of transcultural nursing in as much as cultural safety would not as the nurse to discover cultural aspects of any culture other than their own, never for a second believing that the nurse could or even should gain an insider’ understanding of any culture other than their own. It does not focus o cultural systems of care, it does not even refer to the care that is culturally appropriate. The focus instead is on the client’s experience as the determinant of effective nursing care. The idea therefore would be centered on the way power influences society and its members life chances. As a result, it is about the nurses’ personal, professional and institutional power and the manner in which it is to be managed for serving people. It is also about trust and could be understood as a personal, cultural and institutional construct. The idea therefore would be to focus on the nurse as a cultural bearer and power holder. According to Ramsden, (2002), its is therefore concerned with issues of power and prejudice rather particular aspects of aboriginal culture. The first thing for the nurse to ensure when dealing with an aboriginal patient would be to ensure first and foremost that the nurse has the patient’s trust. The establishment and the maintenance of this trust is the essential prerequisite to negotiating and delivering care which is culturally safe. The concept of cultural respect helps in as much as it provides a critical cultural lens for addressing health care inequities. The idea behind the scope of cultural respect framework is that it heps remind a person of the fact that culture would always influence the care one provides and the nature in which this care provided is received by the care taker. The idea therefore would be that It demands that we address the power relationships between the nurse and those they serve. It calls us to understand and address the ongoing social, political, and historical processes that shape health care and the health of Indigenous peoples. While there has been increasing recognition of access and equity issues in Australia's current neo-colonial period, actual improvements have been very slow to emerge. Meanwhile many Aboriginal people continue to experience poor levels of health. Where impact of past and present colonisation practices and shifts health care towards collaborative healing and well being models that are more supportive of Aboriginal people and their needs. Thus, as in emphasized in the research by McGrath, et., al (2006), in the treatment of aborigines there are certain considerations that the mainstream healthcare provider would have to keep track of and ensure. The first would be a meeting place for the family, given the inordinate amount of importance that is assigned to family by the aborigines. The healthcare provider should also ensure that the family is contacted and met with given the fact that where aborigines are concerned, family meetings are seen as the medium for ensuring that the patient has some sense of choice and control of their health situation. The notion of cultural safety in the context of this case would automatically then require that the nurse treats Roy’s Story Roy with respect, especially in the context of nationality, culture, age, sex, political and religious beliefs. This notion is in contrast to transcultural/multi-cultural nursing care, which encourages nurses to deliver service irrespective of these aspects of a patient. A key element of culturally safe practice is establishing trust with the patient. Culturally safe care empowers people because it reinforces the idea that each person’s knowledge and reality is valid and valuable. It facilitates open communication and allows the patient to voice concerns about nursing care that he or she may deem unsafe. The innate idea in this context therefore is for the care giver, one would need to ensure that care is not perceived as being unsafe. This could happen in instances when the patient is humiliated, alienated, or directly or indirectly dissuaded from accessing necessary care. Cultural safety involves recognizing the nurse as the bearer of his or her own culture and attitudes, and that nurses consciously or unconsciously exercise power over patients. Cultural safety is a political idea because it attempts to change health professionals’ attitudes about their power relationships with their patients. Objectives of Care: According to Long and McAuley (1996) the nursing care has to ensure that there is an adequate identification and documentation of seizure activity, performance of appropriate interventions, and deal with the signs of toxicity or other complications.. The idea is not just to share the responsibility of taking care of epilepsy patients, but also to help in patient and family education as it relates to long-term management. Becoming better informed of the plan of care for epilepsy patients helps optimize expected outcomes and enables patients and families to manage this illness better. The management goals of the pre operative process can be enumerated as being: A maintenance of the vital functions Abolition of seizures thereby allowing the patient to lead a normal life Elimination of all precipitating factors Reversing correctable causes Institution of the importance of drug therapy- here there are two basic ideas that should be clarified. First, that drug therapy is in fact just a means of controlling the condition; it is not a cure and second, in the initial stages, dosage should ideally be monitored and then gradually altered to provide maximum control with minimum side effects. Observations: Neurological Obs -Neurological obs form a big part of the patient monitoring in epilepsy cases because of the risk of neurological deterioration (General Nursing Practice Guidelines, 2009). These are: 1. Eye opening 2. Verbal response 3. Best motor response The responses were weak during the beginning period of treatment, there was usually no response to speech, when question related to simple facts such as time and space were asked there was incoherence and the motor skill commands like asking to lift a hand usually met with very feeble response as well. But these improved from a ‘C’ on the Glasgow Coma scale in to a B+ and even an A as the treatment progressed. The idea here is that while the methods of traditional healthcare are being used these need to be tailored to the specific needs of the patient. The cultural respect framework for Aboriginal and Torres Strait Islander health 2004-2009 defines cultural respect as ‘recognition, protection and continued advancement of the inherent rights cultures of Aboriginal and Torres Strait Islander cultures. The framework was developed after extensive consultation to address issues of inequity and cultural safety for indigenous peoples with the goal being to ‘uphold the rights of Aboriginal and Torres Strait Islander peoples to maintain and to protect and develop their cultures and achieve equitable health outcomes. Furthermore, the framework aims to ensure that cultures respect is embedded into the provision of health service, polices and strategies.  It is the responsibility of health service administrators to work in collaboration with Aboriginal and Torres Strait Islander people for the implementation of the framework at the state and at the local levels. Cass et al., (2002) promote the development of interpersonal relationships between health service providers and clients as necessity to improve health outcomes. In their study, Cass et al., (2002) advocate the development of strategies for non-indigenous health service providers to communicate effectively with Indigenous clients and families. Importantly, an adage to the concept of cultural respect and safety is the concept of cultural security, which the Western Australian Department of Health (2005) defined as the ‘a commitment to the principle that the construct and provision of services offered by the health system will not compromise the legitimate cultural rights, values and expectations of Aboriginal people. It is a recognition, appreciation and response to the impact of cultural diversity on the utilization and provision of effective clinical care, public health and health systems administration”. In order for a medical system to achieve cultural security, the innate requisite is that there be an the presence of the ‘administrative, clinical and other service domains of the health system [to] be systematically reviewed to ensure that their operation appropriately incorporates culture in their delivery’. The idea behind the concept of cultural security is that medical care practitioners ensure that the singularity of voice where the Indigenous Peoples are concerned would not be lost concerning the result on their health of colonization, cultural security can be operationalized along a range of separate but joint interests, with stress being given to what domain is most urgent. The idea therefore is the creation of a situation, where one is able to prevent hostility in the cultural safety needs of an Aboriginal patient when he or she is being treated. It is understandeable that any patient when he feels neglected and discarded would find it that much more difficult to recover from whatever illness he suffers from. Furthermore, if the operationalization of cultural safety is to be effective, it also needs to be reconceptualized and positioned as a process outcome of cultural competence. This is because, as with any area of practice, a critical (although not the only) component of safe practice is competent practice at both individual (person) and organizational (system) levels. In conclusion therefore one could argue in keeping with the suggestions made by Johnstone and Kanitsaki, (2007), the idea of removing problems with healthcare in aborigines would be rooted in a concerted effort towards the development of a robust cultural safety research and critical scholarship development program wherein, the focus is that of redresses of the theoretical and practical weaknesses in healthcare services aiding the development of a strong culture of culturally sensitive support to healthcare providers. Reference: Mcgrath, R., Patton, H., Rayner, M., and Holewa, P., (2006). ‘The Importance of the 'Family Meeting' in: Health Care Communication with Indigenous People: Findings from an Australian Study’. Australian Journal of Primary Health. 12(.1). pp56-64 Western Australian Department of Health (n.d.) Aboriginal cultural security: a background paper. Retrieved August 29, 2010, http://www.aboriginal.health.wa.gov.au/htm/aboutus/Cultural%20Security%20Discussion%20Document.pdf Aborigines Protection Society, Report of the Parliamentary Select Committee on Aboriginal Tribes (British Settlements), reprinted with comments, William Ball, London, 1837  Jones G, Endacott R and Crouch r, 2002, Emergency nursing care: principles and practice, Edition: illustrated, Published by Cambridge University Press, p67 Long L and McAuley J W, 1996, Epilepsy: a review of seizure types, etiologies, diagnosis, treatment, and nursing implications, pub, Critical Care Nurse, Vol 16, No 4, pp83-92 NAHO., (2005). Fact Sheet: Cultural Safety. Origins and Background Johnstone, M. J., and Kanitsaki, O., (2007). ‘An Exploration of the Notion and Nature of the Construct of Cultural Safety and Its Applicability to the Australian context.’ Journal of transcultural Nursing. 18(4). P217 Read More