Community Health Nurse Roles - Essay Example

Community Health Nurse Roles and skills required to improve equity and access to Renal Healthcare for Australian Aboriginal peoples from a population health perspective Introduction The chronic renal disease is wide spread among the Australian Aboriginal people and is indeed a very complex problem. The disease results from the gradual and in many cases permanent dysfunction of kidneys for a certain period of time depending on the health status, lifestyle and other factors that affect the individual at the time. It is also called the kidney failure. When kidneys fail to function in this manner, there is an accumulation of wastes in the body; water is not fully utilised; and other toxic materials are not excreted from the body system as should be in a normal case. Due to the loss of renal functions, there are other conditions that develop which compound the problem making it hard for family members to take care of such a patient at home without serious healthcare support from hospitals. Such complications include, anaemia, acidosis: a condition where there is a lot of acid in the body fluids, high blood pressure, bone diseases, general cholesterol and fatty acids disorders( Couzos, 2004, pp.186-189; Deeble, 2003). It is medically known that such patients do require constant healthcare support which in many cases consists of constant monitoring, testing, and treatment through dialysis and in many cases these patients require on time kidney transplants (Australian Nursing Federation, 2009, pp.2-12). . The problem of renal failure within the Australian aboriginal people has been attributed to many factors. However, the most outstanding and astonishing of all factors is the issue of inequality that exists within the Australian community based on certain aspects of society such as resource mobilization and distribution, basic human needs and rights provision, access to education and professional training, participation in national building, economic factors, social segregation and generally all forms of discriminative practices that have historically categorised these people as second class citizens ( Couzos, 2004, pp.186-189; Deeble, 2003). This paper seeks to address the Community Health Nurse Roles and skills that are required to improve equity and access to Renal Healthcare for Australian Aboriginal peoples from a population health perspective. This is in response to the problems that have affected the aboriginals for many years without concrete approaches being put in place to address them. Explanation of key terms Primary healthcare refers to essential health care that is basic and is based on scientifically sound and socially acceptable methods combined with technology; is practically given, universally available and accessible to all individuals and families in a given community who need it(WHO, 2006).. This primary healthcare provision should be on the basis of full participation and at a reasonable cost to that community in question and that the relevant country is in a position to afford its provision and sustain such efforts at all the developmental stages of that community with the main view of making them self-reliant and ensuring self-determination(WHO, 2006).. This is actually a method used to tackle health away from the known traditional systems of providing healthcare and thus does focus on a social policy that is equity-producing. This is as per the adoption of the declaration made by the International Conference on Primary Health Care in Alma Ata in the year 1978 or the Alma Ata Declaration, which later became the core concept that is applied by the World Health Organization in its critical goal of providing or ensuring health for all. In accordance with better health policy the WHO, there are key elements that ensure achievement of primary healthcare and these include the reduction of exclusion practices in communities and the social differences that do exist in healthcare provision hence having a universal approach; organizing the health services in relation to the needs of people affected and around their expectations; pursuit of models of healthcare provision that ensure collaboration and propagation of the policy of full dialogues through better leadership reforms; integration of healthcare into all the sectors of the country as a matter of universal public reforms; and finally, adding on the level of all stakeholder participation in healthcare provision. Looking at this declaration, we find that the Australian government has literally failed the aboriginal people in coming up with a public policy on healthcare and implementing it to the latter so as to cover all people, including the minority groups (WHO, 2006). Equity and access to health care refers to the differences that exist in the quality of the healthcare provision across the different communities in Australia. Equity is about fair distribution of resources to the people especially when there are differences in terms location, tribe, ethnicity, and culture, among others (Eileen, et al., 2008, 56-109). Equity is achieved in healthcare when all the different communities feel that there are no differences in the provision of healthcare to them, presence of disease is same across all of them, health outcomes are similar, and that they all have the capacity to access medical care. This is not the case in Australia. Access is about being able to get what is needed and is available when required (Eileen, et al., 2008, 56-109). Nursing roles and skills in Community Health Provision of community healthcare, especially to the aborigines, in the nursing practice is diverse, constantly changing and challenging (Briggs, 2004, 19-23). This is because of the unique needs that this community has and also their characteristics are different from those in urban areas. Same community nursing practices might not apply in this setting, although some universal concepts could be used. The community health nursing roles and skills required in this case do deal with various aspects such as engaging in community development; promotion of health for these people; cultural safety issues; clinical attendance; critical thinking in line with the kidney disease problems; and building of human relations with these people (Australian Nursing Federation, 2009, pp.2-12). The most important role to be played by the community health nurse is the aspect of community development engagement. This has to do with incorporating the community in the finding out and reinforcement of those activities that are beneficial to the communal well-being in everyday life, such as political activity, economics, and cultural practices. They thus have a role of promoting the bottom-up approach to community development such that the power and authority is left in the hands of the individual, family, and community while the community nurse only acts as a supporter and facilitator towards the process of being healthy(Australian Nursing Federation, 2009, pp.2-12). The community health nurse has another role of applying his or her skills in the work of mobilizing the aboriginal community to build partnerships with various stakeholders. They can also work with aborigines in the programs and services aimed at the development of health interventions to address the critical issue of chronic kidney diseases (Cass, et al., 2002, pp.466-470). The aborigines, being indigenous people of Australia, have a shorter life expectancy that is less than that of other non-indigenous by about 20 years. This low life expectancy rate of the aborigines has been attributed to major historical issues such as premature death from chronic diseases like diabetes, kidney failure, stroke, and other serious ailments(Briggs, 2004, 19-23).. These problems are not just common; shockingly they occur at a very tender age of the aborigines within the age bracket of 29 to 45 years. As a matter of fact and health policy, kidney failures have been singled out as having up to 100 times more prevalence, which is higher than the normal national rate. There are various risk factors that cause kidney failure; these include poor diet quality, too much smoking, poor living conditions and exposure to environmental health hazards such as chemicals, physical inactivity, and central obesity among others. The other health conditions such as diabetes do interact with these kidney diseases to make the mortality risk more amplified hence higher rates of deaths (Briggs, 2004, 19-23). Fig 1. Prevalence of kidney disease between different age groups expressed in percentage Fig 2. Hospital admissions between the different age groups expressed in percentage Fig 3. Prevalence of hypertensive disease between the different age groups expressed in percentage Fig 1, 2 and 3 Source: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4715. Chronic kidney failure leads to very serious illness and eventually death and this could be faster if appropriate medical care is not given to the patient. Deterioration of such patient’s health leaves only one of the two choices for survival which is transplant of the kidney or full dependence on dialysis for survival (McMurray 2007, pp.30-36).The most appalling thing is that even though this disease could be chronic and is wide spread in the aboriginal people, it is a preventable and treatable condition if good healthcare is given to the patient. This actually explains the extent at which continued negligence of these people has gone to. First of all, it is important to note the effects that hunter gatherer lifestyle of the aboriginal people has on their health and in the prevention of such poor health conditions such as kidney failure diseases. The research carried out in 1980, in the West Kimberley region of WA, showed that the hunting and gathering lifestyle was very important in the reduction of the risk prevalence of these people to chronic diseases such as diabetes and kidney failures due to the fact that it made them exercise and lose weight (Moodie, 2008, pp.82-167). This could be attributed to the notion that for one to fully hunt and be a successful hunter, he needs to be physically fit. Thus exercising was part of their traditional activities. However, with the expansion of the urban settlements and the banning of careless hunting did affect this community and thus they have no place to carry out this exercise (Moodie, 2008, pp.82-167). The roles that the Community Health Nurse would play in this community to avert the kidney disease problem, treat and prevent further new cases, are varied and quite many. Based on the studies done, it was established that there are many interventions that are community based that have fully demonstrated the possibility of having a positive change in those issues considered as markers of these chronic kidney diseases and exposure to the risks and that these interventions could be easily achieved at the level of population (Australian Nursing Federation, 2009, pp.2-12). . The human relations aspect is very essential in the provision of healthcare to this community. There is need to have amicable human interactions that ensure the community eventually benefits. The role of the registered community health nurse is to effectively interact with the aboriginal patients, their close families, and other stakeholders to ensure that the goal of healthcare provision to the kidney diseases patients is achieved (Cass et al., 2002, pp.466-470). The community health nursing providers can work with the local community by helping them change their lifestyle. This could be done through the use of interpersonal communication skills that the nursing practitioners are normally encouraged to develop in order to serve their patients effectively. This kind of approach would require that the research and implementation of strategies that would ensure general nutrition and constant supply of essential food is important. This is where the government could come in to help the community health nurses in achieving their goals. At this point the skills and knowledge in nutrition by these community health nurses come in handy (McMurray2007, pp.30-36). Clinical roles and skills could also be applied in the sense that healthcare services are provided. The nurses therefore have a role to use their healthcare skills in providing for the community health nursing services as per the policies, standards, procedures and clinical programs that are stipulated and required of them. They also need to explain the healthcare services being provided to the community and avoid blanket clinical services. In their clinical roles, they need to collaborate with other stakeholders such as doctors and the government in ensuring that needed clinical services are provided in accordance with the medical practices and government policies (Cass et al., 2002, pp 466-470). The nurses have a role of monitoring their patients. The role of monitoring patient needs certain medical skills such as testing, which the nurses already are well acquainted with. They could thus take part in a community-wide testing of the aborigines to find out their status in terms of kidney conditions so that a good record is kept of the exact number of people who need healthcare attention. When this has been done, the technique of follow-up could be applied where the nurses are distributed in the community to track the patients and observe certain factors that would have been identified as essential (WHO, 2006). In this process, the community health nurses need to establish whether these patients are following the instructions given to them in terms of regular medication as needed, if they have changed their lifestyle to suit their medical condition, and if other necessary interventions such as dialysis are needed in cases where the patients’ conditions are chronic. The nurses also have a role of ensuring that they maintain the knowledge and skills that are necessary for the provision of community health services in practice such as control of infections, preventive healthcare provision and proactive healthcare practices (WHO, 2006). It is necessary to point out that measures taken in bits might not have a major impact when it comes to the roles that these community health nurses will provide in this community and in the application of their skills. It is thus imperative that a holistic kind of approach to providing healthcare is taken into consideration. This is a method where the healthcare provision to the aborigines is done by incorporating the body, mind, spirit, land, environment, and socio-economic status of the people. As has been noted, the primary healthcare is in itself an aboriginal cultural construct and it thus does incorporate an integrated care that is built upon practical, scientifically sound and socially acceptable technologies and procedures, which are practical to the aboriginal community (Eileen, et al., 2008, 56-109). The community nurses require an intimate knowledge of the aboriginal community in terms of their health needs, lifestyle, and socio-economic problems related to healthcare and thus, a preventative, rehabilitative, curative, and treatment approach is needed. Health promotion is thus very necessary and this has to do with the actions that are aimed at empowering these aborigines so that they are able to have control over their personal health (Dollard, et al., 2001, pp.28-30). This could be done through the community nurses’ helping the aborigines to have control over the determinants of good health and thus avoid exposure to risk factors. This still revolves around use of critical nursing skills to influence the health of these people in terms of food they eat, peace, social connections, shelter, sustainable environment, income and access to education for the children (Dollard, et al., 2001, pp.28-30). Cultural safety could be employed in tackling these kidney problems through recognition of those negative attitudes and various stereotypes of the ethnic group. They thus need to act in a way that will be able to ensure recognition of the aboriginal culture, earn them respect and be able to help nurture their unique cultural identity and thus safely meet the needs of these people. Demeaning and disempowering the cultural diversity, identity, and well-being of these aborigines would mean that the community health nurses have failed in their duty to provide healthcare to these people (Eckermann, et al., 2010, pp.123-189). The community health nursing providers also have a role to apply their critical thinking skills so as to tackle the decision-making and in most cases, the problem-solving skills that are required in both the settings of clinics and operational areas within the aboriginal community health nursing. They thus have to develop the ability of effectively anticipating the various needs of their clients and be able to manage their situation as far as the patients suffering from renal failures in this aboriginal community are concerned (Cass et al., 2002, pp 466-470). Thus, the decisions made need to be based on the evidence within the medical or nursing professions. In cases where the nurses are not sure of the way forward, consultation should be applied without fear of prejudice given that to some extent, these aboriginal people have issues that are unique to themselves (Cass et al., 2002, pp. 466-470). Conclusion The roles of community health nurse in this kind of setting are very critical to the survival of the patients and working towards the reduction of risk levels through tackling risk factors associated with the origin of the chronic renal diseases. It has been established by other researchers that chronic kidney disease comes with numerous impacts on the individual, the family or community affected, and the health services providers. The risk factors that are very widespread and prevalent in the country, the number of those Australian who are at risk of having kidney failure diseases is on the increase, although; not as faster as it is for the aborigines due to social, cultural, economic and political disparities mentioned. The community health nurses have, therefore; a critical role of applying their skills to the betterment of the patients suffering from kidney failures in aboriginal community, as well as the community and Australian nation as a whole (Eileen, et al., 2008, 56-109). References Australian Nursing Federation (2009), Primary Health Care in Australia, A nursing and midwifery consensus view, pp.2-12. Retrieved on 6th October 2011, from http://www.rcna.org.au/WCM/Images/RCNA_website/Files%20for%20upload%20and%20link/policy/documentation/position/consensus_statements_PHC_Australia.pdf Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin, B and Brown I (2002) Sharing true stories: improving communication between Aboriginal patients and healthcare workers, Medical Journal of Australia 176(10): 466-470. Retrieved on 6th October 2011, from http://www.mja.com.au/public/issues/176_10_200502/cas10830_fm.pdf Couzos, S., (2004), ‘Practical measures that improve human rights - towards health equity for Aboriginal children', 15 (3) Health Promotion Journal of Australia, pp.186-189. Retrieved on 6th October 2011, from http://www.healthinfonet.ecu.edu.au/key-resources/bibliography/?lid=3461 Briggs L (2004). An overview of current workforce issues, Aboriginal and Islander Health Worker Journal 28(3): 19-23. 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