Indigenous Elders Who Have a Diabetes Management Problem - Term Paper Example

Indigenous Elders Who Have a Diabetes Management Problem Student’s Name Institutional Affiliation Indigenous Elders Who Have a Diabetes Management Problem The practice of nursing care is afforded to people with diverse needs within multiple contexts (Bennett et al., 2009). Indigenous elders find it hard to access and use primary healthcare in the management of diabetes because they lack health literacy in rural areas. This essay will address the issue of health literacy as a remedy for poor diabetes management in a population of Indigenous elders. Health literacy is recognized as a key health determinant as well as being close to social determinants such as education, culture, income and literacy (Mancuso, 2011). Having health literacy refers to having the ability to understand and access information needed to manage their health on a daily basis. This is especially important for individuals with diabetes because the condition is chronic. The target population is indigenous elders who do not have access to information and thus, they lack understanding to make important health decisions. This essay will explore the health promotion approach which shows how the knowledge and understanding of primary health care approaches are applied in nursing, explore the promotion of health literacy amongst diabetic indigenous elders and discuss how a nurse can use the empowerment approach to promote health literacy to help in the management of diabetes in Indigenous elders. Management of type 2 diabetes is a greater challenge for Indigenous elders because of issues with literacy, resources and language. The knowledge and competence needed to meet a wider variety of care needs may be daunting, but it hinges mainly on the ability to apply evidence-based approaches to healthcare in a particular context. The bridge between knowledge and application is facilitated by nursing programs and interventions designed to meet a desired need. The understanding and knowledge that the nurse is privy too can be translated to effective practice within the context of nursing program. The intervention in this case is meant to meet the needs of nursing practice within a community context (Bennett, 2009). In Australia and the UK, the skills and knowledge needed before one becomes a registered nurse are structured so that the nursing student can focus on the development of proficiencies that provide care to a particular niche of clients or patients. The application of this knowledge in practical areas is based on understanding certain issues that crop up when nursing interventions and programs are established. Knowledge about the individual is essential in developing effective programs. For instance, if one is to develop literacy programs, they need to know the cultural, social and psychological elements of their target group health (Chinn, 2011). There community being targeted in this case is an indigenous population of elders. Shaping and customizing information so that the target population receives it needs the nurse to have information on the individual. Indigenous elders have higher incidences of type 2 diabetes owing to lower levels of health literacy (Chinn, 2011; NICE, 2008). Other than that, knowledge about the environment is vital as well because it includes issues that have an effect on applying nursing practice in a community setting. Before nursing practice is applied, the context within which it is implemented has to be compatible (Buse & Walt, 2000). In addition, the nursing practice has to use evidence-based knowledge in implementing programs (Berkman et al., 2011). The concept being primary health care has been gaining popularity in the last two decades as a response to the evaluation of community health needs. The evaluations revealed that there are larger percentages of individuals who lack access to appropriate healthcare services (Hardie et al., 2011). Owing to this, primary healthcare has been occupying a central position in the discourses of strategies to meet different healthcare needs. Among the central concepts of primary health care is community participation. Knowledge in this area will help in implementing nursing programs that are concerned with community issues and participation. The Australian healthcare system has incorporated primary health care as a critical strategy for improving the health of citizens. Using this approach, the healthcare resources that are available are divided equitably and distributed to different population groups as required. Information is a resource as well, and it is distributed to different populations through health literacy (Donovan-Kicken et al., 2011). Consequently, essential healthcare is made available to all families and individuals in an acceptable manner. This healthcare is characterized by the full involvement and participation of individuals. This enables the country to maintain a health standard that allows individuals to live economic and socially productive lives. Owing to the importance of primary health care, it is essential to identify and serve small communities and populations within their context (Kahan & Goodstadt, 2001). For instance, the manner in which type 2 diabetes literacy is delivered to indigenous elders will not be the same as that delivered to other populations. The government recognizes the importance of primary health care and that it cannot be undertaken by the Ministry of Health as the sole provider. There has to be full participation by the public or community. For people to participate effectively, they have to be educated on issues that affect their health and healthcare decisions made by them and by the government (Lytle & Perry, 2001). Indigenous elderly communities need and should take the responsibility of improving and maintaining their health care. Nurses have a vital role because they are often the only professionals who are available to implement health programs in different communities (Macabasco-O'Connell & Fry-Bowersm, 2011). Knowledge in this area helps nurses move from a curative mode of approaching health issues to one of health promotion and disease prevention with emphasis on the participation of the community. One of theories that are often adopted in community health nursing is Block and Josten’s ethical theory of population focused nursing (Lindquist et al., 2011). The theory was developed by educators in public health and it is focused on intersecting the fields of nursing and public health. The theory focuses on an obligation to the community or population, the primacy of prevention and the centrality of a relationship based care (Chapter 2, 2004). This implies that relationship between the healthcare sector and the community is essential for the success of community health programs and interventions. Before the issue of health literacy is promoted, it is essential to understand what the term means to the health system of Australia. Health literacy is used to describe a situation in which the degree to which an individual understands, access, communicate, and evaluate information allowing one to engage the different demands of health necessitated by different contexts so as to maintain and promote good health (Car et al., 2011). Thus, health literacy is not just about having information but also about applying and transmitting it. Health literacy is an essential element that enables the government to manage their health. It does not only refer to the capacity that individuals have in health decisions but also to information providers within health systems and the health systems themselves. The information is essential as it enables the patient to understand as well as carry out different instructions for self-care. This ability includes having the capacity to effectively administer daily medical regiments (Campbell & Cornish, 2010). In addition, it enables the recipients to plan for and implement lifestyle changes that are in the necessary for improved health outcomes (St Leger & Nutbeam, 2000). Health literacy will also give the recipients knowledge and skills to access healthcare from the correct sources. It will also enable them to share health promotion activities with the community thereby addressing issues of health in the society and community (Marvanova et al., 2011). Given that the prevalence of chronic diseases is getting higher as better technology and medication is availed to the public, it is essential to address this area in health literacy. There is an additional risk factor for indigenous elders because healthcare in Australia has always had issues when it comes to providing equitable health care services to the entire nation (Ghaddar, 2012). Despite more people living with chronic conditions such as diabetes, there are also more deaths resulting from chronic illnesses indicating that the issues needs to be addressed in health literacy (Jana, 2012). Studies have shown that a larger percentage of Indigenous adults in Australia are not competent enough to fish and use information on healthcare to effectively manage chronic health conditions including diabetes (Osborne, n.d). The populations that endure the greatest struggles with lower levels of health literacy are often indigenous populations, immigrants and older adults. This indicates that the target population for this programs posses two of the elements of the most vulnerable including being elders, having chronic conditions (diabetes) and being Indigenous (PriceWaterhouseCoopers, 2001). The implication for susceptible groups is that they also lack the benefit that health literacy skills bring with them. Other than influencing the individual health of vulnerable people, lack of health literacy also has financial implications for the entire country costing up to 5 percent of the total budget on health (Easton et al., 2010). Health literacy is an asset because it allows an individual to play an active role in health communication and education, hence, developing competencies in the respective area (Syurina et al., 2011). In addition, it is a method through which the indigenous elders would gain the ability to exert a greater degree of control over the environmental and social determinants of their health. Better health for indigenous elders with diabetes requires the health literacy program to meet certain needs including developing a program that addresses the social influences and determinants of health in the community (Vernon, n.d.). In addition, the health risk posed by the condition should also be reduced significantly resulting in improvements, in health outcomes. The urgency of addressing health issues in Indigenous populations is evident in the lower level of life expectancy they have which is 61 for males and 67 for females (Baker et al, 2007). Basic health needs are also inaccessible to those living outside the metropolitan areas, which indicate that the program needs to focus on communities living within these regions. The major domains of health literacy are community, cultural, scientific and fundamental, which are all addressed in different programs meant to meet the needs of particular communities (Safeer & Jann, 2005). It is essential for nurses who implement health programs to take these into consideration as they relate to the targeted community. Part 1 Circumstances that effect rural indigenous elderly to manage their diabetes Diabetes management is an essential part of diabetic development. Effective management can delay the prognosis of the disease significantly. The Aboriginal populations in Australia make up 2.5 percent of the population and they are highly affected by diabetes (Australian Diabetes Council, 2011). Elders living in rural indigenous areas have an additional disadvantage because of their age vulnerability and location and these affect them greatly as they attempt to manage diabetes. The elements of their susceptibility and disadvantage include age, genetic, and geographic issues. Additional subjective demerits are the social determinants of their health including lifestyle, socioeconomic, culture and environmental factors. The Australian health system has acknowledged that people living in remote and rural areas are at a disadvantage. The levels of illness and the risk of mortality rises as one gets further from the major cities since that is where the main health centers are located. In addition, these areas have higher hospitalization rates and prevalence of ill individuals owing to ineffective health services and smaller healthcare institutions. Consequently, they also have less access to health services and primary health care providers. Owing to their isolation, remote communities are unable to sustain traditional health models leaving the residents with the only choice of going to urban centers for health services. Accessing bigger hospitals in the city is also a problems resulting in lack of monitoring and healthcare continuity. Geographic disadvantage makes it harder for Indigenous elders to go for checkups, access health services and get educated on diabetes management issues (Baker et al, 2007). An additional vulnerability is that Indigenous Australians have a genetic disposition such that they are 3 times likely to get diabetes than their Western counterparts. (Bennett et al, 2009) argues that lifestyle and genetic issues contribute to a higher prevalence of type 2 diabetes amongst indigenous Australians. Evidence from literature shows that the metabolic processes in Aboriginal Australians makes them better at a traditional lifestyle of hunting and gathering (Campbell & Cornish, 2010). The changes they have had to adapt including different food types and living conditions have overwhelmed their systems making them susceptible to poorer control of obesity, hypertension, diabetes and other chronic conditions (Chapter 2, 2004). Older individuals (over 35 years of age) living in indigenous communities are have a higher risk of getting type 2 diabetes (Levene & Donnelly, 2008). Elders have a harder time adjusting their lifestyles to cope with their condition because of fading motor functions and other complications that come with age. The Aboriginal culture is also a barrier to their adoption of Western styles of managing chronic conditions (McDonald & Gray-Miceli, 2007). The circumstances mentioned above put Indigenous elders in a vulnerable position where their systems are catalysts to the progress of diabetes. The lack of effective management complicates their condition further. Eight percent of deaths among indigenous Australians are caused by diabetes and it is also the leading reason of lower limb amputation owing to non-traumatic reasons as well as the end stages of Kidney transplant, disease and dialysis (NICE, 2008). Poor health literacy results in poor management of diabetes An effective step towards delaying the progress of diabetes and preventing it amongst indigenous elders needs to be customized to the culture and environment within which indigenous elders live in. The higher rates of prevalence, morbidity and mortality in the population are evidence of poor diabetes management (PriceWaterhouseCoopers, 2001). This in turn shows that there is poor diabetes literacy. The concept of health literacy has been evolving over the past 25 years. Its original constitution was the numeracy, reading and writing skills required in the health domain. Its evolution has resulted in it being understood as a multifaceted concept that is applicable in different situations. WHO defines the term health literacy as the social and cognitive skills that determine the ability and motivation that individuals possess to understand, use and access information for the purpose of health promotion (Pubmed health, 2010). In essence, health literacy requires people to possess the ability to gain insight on issues that concern their health and understand how different social determinants of health affect their health as well as being able to seek and apply preventive and managerial measures to different health conditions. These skills give them a greater degree of autonomy over the decisions that pertain to their health resulting in empowerment (Safeer & Jann, 2005). Behaviors displayed and decisions made following such empowerment enhance an individual’s health. From this, it can be deduced that poor health literacy is not the result of deficiencies in knowledge but also the product of multiple social determinants of health. Health literacy amongst aboriginal individuals is severely impaired owing to social determinants Health literacy is essential to self-management and social determinants have resulted in Indigenous elders lacking access and opportunities to enhance health literacy. Indigenous elders are also at a higher level of susceptibility owing to the contextual and environmental risk factors emanating from social determinants of health. There are also additional issues such as lower education levels (Frost, Reich & Fujisaki, 2000) which subsequently affect the capacity that individuals have to apply health information in an effective manner. Because of isolation and poor access to social services including jobs, they also face financial difficulties, which greatly affect access to health services. This limits the choices they have for medication and healthy foods, which in turn has a negative effect of management of diabetes. Infants are also subjected to poor dietary choices, which make them susceptible to chronic conditions in future because of relatively weaker immune systems. Individuals also have to endure rundown, overcrowded and unsanitary housing that influence the spread of non-communicable diseases (Ghaddar et al, 2012). These diseases have the potential to accelerate the progress if diabetes. Subjective and objective issues such as genetics and social determinants respectively influence health concerns in Indigenous populations. If the social determinants were to be overcome, there are additional issues such as lower self-determination affect the literacy levels in this group. WHO posits that the right to self-determination includes the right that people have to freely dispose their resources and natural wealth and that these individuals should not be deprived of their suitable means of subsistence (Hardie et al, 2011). Natural wealth in this case is native land. There is very little of this land available for these individuals implying that they are valued a little resulting in lower self-determination. Consequently, they face a greater challenges in managing diabetes. This also causes emotional and mental problems for these population owing to stress resulting in less ability to control health, poor insight of health and lower empowerment levels (Jana, 2012). Ineffective management of diabetes amongst Indigenous elders is related to an array of issue including financial constraints, ineffective knowledge of diabetes, mental and emotional factors. Thus, nurses should take an empowerment approach to establish and sustain health literacy, which will help rural indigenous elders to overcome the issues that prevent them from sustaining diabetic management (Kahan & Goodstadt, 2001). Key principles of health promotion are to focus on the promotion of the entire community’s wellbeing. The concept of health literacy is founded on the principles of primary health care moving the focus from treating illnesses to developing a method of sustainable wellbeing for a particular population (Lindquist et al, 2011). Primary health care sees the inequalities in health care as social inequities. Thus, it too can be combated or prevented using health promotion principles including creating a supportive environment, building public policies related to health, re-orienting health services, development of personal skills and strengthening community action. Hence, reducing preventable diseases and improving wellbeing and health hinges on empowering an individual, community development, family participation and strengthening environmental influences and broad public policies. The community nurse needs to place focus on the individual needs as well as considering the health determinants of the entire group being treated. These practices will guide the community health nurse in developing and implementing intervention programs such as those of health literacy. This is because they help them know where to focus their energy through understanding the particular social determinants that affect the population’s well being (Lytle & Perry, 2001). In addition, they take to consideration the fact that addressing the determinants will have little effect if the individual has little expertise on how to benefit from these systemic changes (Mancuso, 2011). Thus, while working on changing the social determinants, other focus should be on empowerment (Macabasco-O'Connell & Fry-Bowersm, 2011). Part 2 Community nurses need to have the expertise on how to improve their diabetes management strategies as individuals and as a group as well. Health literacy involves different approaches meant to meet the needs of a particular population. If the program is to be effective and successful, the participants need to be empowered. Thus, an empowerment approach should be used because it enhances the confidence of the individuals who participated in the program. The empowerment model has proved successful in other cases of health literacy (McDonald & Gray-Miceli, 2007). Peer teaching is a tool that is often used to ensure this confidence is attained. The nurses instructing indigenous elders should create a rapport with them. Older nurses will deliver information more effectively. In cases where they are unavailable, nurses who are already known at the local healthcare centers can deliver the information (Farrell, 2011). Thus, the nurse delivering the instructions should train the local nurses and seek the help of other healthcare staff who have been successful in delivering such information before. This means that the nurse needs to do research on the community, which consists of elders with diabetes. Since the niche is smaller, the information can be found at the healthcare center where the individuals get their services (Zamora & Clingerman, 2011). Thus, the healthcare center in the area will be a major tool in delivering the health literacy. The health center should also be the location for instructing these individuals. In addition, the information should also be delivered in some homes to show the elders how they can administer insulin injections at home. Since the recipients are elders, some of the instruction sessions should include those who care for them. The focus of such forms of instruction is to enhance individual enhancement and the engagement of the community. Programs used in adult literacy should be used to introduce the program to the community through developing the resources for health literacy which should be tailored to the Indigenous cultural context (Pubmed health, 2010). The development should be facilitated using the existing ESL diabetes health literacy programs because English is a second language in these areas. The local hospital should be the main area for developing material for health literacy. Public health efforts should be employed to ensure the continuity and accessibility of the diabetes literacy sessions. The best practices of managing diabetes should be highlighted and those who are using these methods should be commended. The acknowledgement of healthy behavior is essential in enhancing its adoption in other fields as well. The challenges and solutions that come out during the sessions should be documented for use by the hospital and the elders as well. healthy living behaviors should be highlighted to the population so that they are aware of habits that promote their health and those that do not (Simpson et al, 2003). Health literacy does not happen; it is created. The environment that supports the implementation and running of such a program is created and sustained by the nurse in charge. Before the process begins, the endeavor needs to be supported by a range of policies and measures, which eventually result in increased skills and knowledge amongst the clients. Interest and motivation are the main outcomes of empowerment. The individual will also gain perceived control, higher self esteem and the intent to act are also the result of empowerment. The empowerment approach is also beneficial because it results in higher levels of information dissemination amongst the recipients of the health literacy program. empowerment also allows individuals to participate in the healthcare system and in the decisions that pertain to their health. Public health care is focused on addressing the social injustices and inequalities that exist in the distribution and access to products of social policies such as healthcare and their social determinants. These are often outside the control of the individual (Barrett, Austin & McCarthy, 2000).Nurses interact with clients more closely than any other group of individuals involved in the healthcare system. Thus, they are in a better position to inform policies and interventions that will assist in ensuring equitable distribution of resources and to prepare populations to access these resources. Using advocacy as well as mediation, nurses are able to help clients by showing them how to navigate the bureaucratic system so that they can access health, financial and social services. In order to address the systemic inequities, nurses also have to fight for policy change. They have the opportunity and capacity to use their knowledge and connections to effect policy changes through raising awareness of the situation their clients are faced with (Buse & Walt, 2000). Making use of partnerships in healthcare infrastructure mobilize community participation in healthcare reforms promoting Indigenous health literacy at all levels (Mancuso, 2011). Developing a health literacy program requires impeccable planning and collaboration before the exercise commences. The nurse needs to make overt alliances between education institutions and health sectors (St Leger & Nutbeam, 2000). Improving health literacy in an indigenous population of elders with diabetes involves more than simple transmission of information. The individuals receiving the information need to be helped and inspired to act on the information they have received. This can be achieved using more personal communication forms such as home visits. Delivering health literacy also requires one to understand the political aspects that are embedded within education since they influence the nature of health and education institutions. References Australian Diabetes Council. (2011). BEAT IT: Physical Activity and Lifestyle Program. Australia, Canberra: ADC publication. Barrett, D., Austin, J., & McCarthy, S. (2000). Cross-sector collaboration: lessons from the International Trachoma Initiative. Paper presented at the Workshop on Public-Private Partnerships in Public Health. 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