Australia Indigenous Cultural Palliative Care Nursing - Term Paper Example

Australia Indigenous Cultural Palliative Care Nursing Institutional Affiliation Student’s Name Australia Indigenous Cultural Palliative Care Nursing Chronic illnesses, such as stroke, diabetes, hypertension, kidney and heart diseases, offer the greatest threat to the health of the Aboriginal people. Consequently, unexpected deaths within the community are common (Abernethy, et al. 2013). Statistics from different studies and palliative care services done within health services, and Aboriginals and Torres Strait Islander communities, have revealed that very few people from those communities are accessing palliative care support (Sinclair, Williams, Knight & Auret, 2014). Aboriginal Australians, who are terminally ill, choose to be supported by their families, community or primary health care services of the Aboriginal origin so that they can get culturally sensitive care (Shahid, et al. 2013). Community health services from the Aboriginal community, however, may not be funded to offer the needed palliative care. Furthermore, the nurses and staff in the community services may not be well trained to handle such specialized care (Marr, Neale, Wolfe & Kitzes, 2012). In some cases, Aboriginal clients are referred to palliative care at a very late stage in their illnesses, and therefore, patients with complex symptoms may not receive adequate care from the general health care providers, leading to death (Marr, Neale, Wolfe & Kitzes, 2012). It is, therefore, clear that people from Aboriginal origin will not take up referrals to palliative care, unless the care provided is culturally sensitive, or there is presence of Aboriginal staff. This essay discusses some of the cultural practices, beliefs and traditions that are related to the Aboriginal people in Australia, in relation to death and dying. The essay further, discusses the ways in which culturally sensitive nursing care can be applied in a palliative care setting for Aboriginal people, to access health care services that are culturally appropriate. According to Shahid, et al. (2013), death and dying is a familiar event in the Aboriginal community, due to the high death rates, and the several funerals that take place within the community. Shahid, et al. (2013) adds that the life expectancy of the Aboriginal people in Australia is significantly lower than that of mainstream Australians. Due to the awful health status of the Aboriginal people in Australia, death and funerals seem to be never ending. According to Marr, Neale, Wolfe and Kitzes (2012), death within the Aboriginal community is never settled, leading to an accumulation of grief, trauma, shock and sorry time. This does not only affect the individual, but the community as a whole. Consequently, when Aboriginal people enter hospitals and palliative care settings, they are mostly depressed and angry (Holloway, et al., 2013). Jagosh, et al. (2012) argues that such response is due to the ongoing traumatic issues in their lives. This response is related to being identified as Aboriginals and not due to their individual situations. There are common instances of late diagnosis of diseases because many Aboriginal people enter the terminal stage of the disease, before it is diagnosed (Jagosh, et al. 2012). This habit greatly affects the provision of palliative care. According to Condon, et al. (2013), various reports show that Aboriginal people die from circulatory diseases, renal failure, AIDS, poorly managed diabetes and injuries, more than they die of cancer. In a palliative care setting, the needs of Aboriginal people suffering from both malignant and non-malignant diseases need to be addressed (Eastman, Dalton & Le, 2014). While some diseases are non-cancerous, they are terminal and they may not be recognized as so, until they reach the final. Aboriginal patients suffering from such non-cancer, but terminal diseases also need specialized palliative care. For the Aboriginal people, it is important for family members to visit the sick or dying person. It is common for the patient to demand the presence of his or her friends and family members (Johnston, Vukic & Parker, 2013). Relatives will, therefore, make sacrifices and travel for long distances, to be present. Relatives usually request for permission to sit with an ailing family member at night or during resting times. According to the Aboriginal culture, it is important for Aboriginal family members to pay their last respects before death (Johnston, Vukic & Parker, 2013). It is, therefore, very distressing for family members to be given the limitations, through policies that dictate hours of visits and the number of visitors. Most Aboriginal people suffering from terminal illnesses, therefore, tend to avoid palliative care settings, or their relatives deny them access to the palliative care services, so that they can carry out their cultural responsibilities. According to Holloway, et al. (2013), although some Aboriginals agree to access palliative care services, they refuse to stay in the inpatient settings. Their decisions are related to the design features in the palliative care wards that limit or inhibit the number of visitors that can be allowed in. Some features also limit or inhibit view of the outside landscape or access to the outside areas (Holloway, et al., 2013). When providing culturally sensitive palliative care, nurses should take into consideration the role of emotional, social, cultural and spiritual factors that affect the decision of the patient to access palliative care. For example, in some hospitals, not more than two or more people are allowed to be with a dying patient (O’Brien, et al. 2013). When this is applied to Aboriginal people, it can be a barrier to their grieving and healing process. Respect, time and space are critical in the healing process, and to the Aboriginal people, the elements are equally important (Isaacson, et al., 2014). To increase the length of stay of a patient in a palliative ward, factors such as family friendly facilities, access to the outside environment, artwork and good and clear explanations about care should be taken into consideration (Isaacson, et al., 2014). Aboriginal patients should also have an access to an Aboriginal health worker. According to Taylor, Thompson, Wood, Ali and Dimer (2011), when health care practitioners and patients share the same cultural and linguistic background, optimal health care takes place. Thus, when Aboriginal patients have constant access to Aboriginal health care givers, they receive a culturally congruent healthcare (Taylor, Thompson, Wood, Ali & Dimer, 2011). There are distinct differences in the way different communities of the aboriginal origin view life and death. The Aboriginals not only focus on the social, emotional, cultural and spiritual wellbeing of an individual, but of the entire community (Ray, Fried & Lindsay, 2014). The Aboriginals do not fear death, rather, they see it as the time when someone’s spirit leaves the body and goes back to the Dreaming, to wait for reincarnation. There are varying grieving and mourning customs, according to various Aboriginal communities and groups. While some Aboriginal groups believe that the spirit goes to live in the Sky Camp, others believe that the spirit goes to live in the sky (Holloway, et al., 2013). Furthermore, while some family members may find it necessary to smoke in the room where the deceased passed onto cleanse it, others may not stand the practice. When the cleansing practice is going on, other Aboriginal patients within the facility may feel the need to leave the room, until the ceremony is completed (Johnston, Vukic & Parker, 2013). Health care practitioners in a palliative care setting should take the diversity of cultural practices of the Aboriginal people into consideration, when providing care for them. To make sure that Aboriginal patients understand the reasons why they are being hospitalized, it is important for Aboriginal patients to have access to Aboriginal liaison officers. Aboriginal liaison officers provide support to Aboriginal people receiving palliative care, and making them understand the kind of treatment they are receiving. Rather than having a static palliative care model that is imposed on communities of Aboriginal origin, palliative care settings should come up with flexible and living models that embrace diversity, according to obstacles, resources, service aims, populations, needs and geography. According to Johnston, Vukic and Parker (2013), the Living Model is an effective first step in providing culturally relevant palliative care to diverse aboriginal communities. It is advisable to treat every Aboriginal person differently or as a unique individual, and therefore, stereotyping should be avoided (Eastman, Dalton & Le, 2014). When interacting with an Aboriginal patient, the needs of the patient have to be applied and interpreted in the context. Their acceptance and willingness to cooperate and participate builds consistency and trust and establishes a commitment to the patient. Aboriginal people regularly express their desire to die in their own communities. Eastman, Dalton and Le (2014), points out that the concept of a good death is contributed by an Aboriginal patient dying at their preferred places of death. Almost all Aboriginal people will choose to die at their homes or what they refer to as their “belonging places”. According to Anderson & Devitt (2004), the term “belonging place” is used by the Aboriginal people to refer to their country or a particular place where their ancestors were born, lived and died. Aboriginal people value genealogical links (Jagosh, et al. 2012). Jagosh, et al. (2012) and Shahid, et al. (2013) argue that palliative care services should be made mobile so that an aboriginal patient can die at his or her “belonging place”. Healthcare professionals should provide the best conditions for Aboriginal people that are dying. They should make sure that aides and equipments are made available at minimal costs to the people in the remote areas (Johnston, Vukic & Parker, 2013). Such people should also have access to support and ongoing education so that they are able to support a patient who wishes to die at home. Nursing strategy for end of life care should incorporate a culturally appropriate model. The final stage of life is sensitive and significant to the Aboriginal patients and their family members (Shahid, Durey, Bessarab, Aoun & Thompson, 2013). The time before death, during death and following death are characterized by various significant customary practices. When there is an expected death of an Aboriginal person, there is usually a gathering of family members. The cultural practice is important to the Aboriginals because they believe that life is a part of a great journey (Shahid, Durey, Bessarab, Aoun & Thompson, 2013). Aboriginal people believe that gathering together of a dying patient’s family members helps prepare him for the next stage of their journey. After death, it is taboo in the Aboriginal culture to mention or write the name of the dead person. Aboriginal people believe that calling the name of the dead person is calling back the spirit to the world it departed (Taylor, Thompson, Wood, Ali & Dimer, 2011). Furthermore, some family members may request to keep a lock of hair from the deceased person. Although there may be restrictions on interfering with the body of a dead person, nursing care should be sensitive to such issues by allowing the family members to perform such practices in private. Culturally sensitive care can be practiced by allowing the dead person’s family members to ask for permission from the treating doctor to perform their cultural practices and documenting the practices in the patient’s notes. The family of the deceased person can be allowed to keep his or her clothes if they request. Finally, health care practitioners can respect the wishes of the deceased person’s family members having a sorry camp. Health care practitioners should expect a crowd of people and loud mourning. To facilitate respect for the after-death mourning period, health care givers should assign the family members a room where they can carry out their cultural practices in private, without interrupting other patients (Taylor, Thompson, Wood, Ali & Dimer, 2011). In conclusion, Aboriginal people feel that it is their responsibility to take care of their ailing family members and, therefore, regard it as an important family responsibility. They resist the idea of inpatient palliative care, which involves taking an aboriginal Australian patient from their community or homeland, to a metropolitan area. Several studies done at the end of life service provision for the Aboriginal people reveal that clients of Aboriginal origin are either referred to palliative care at a very late stage of their illnesses, or are not referred at all. 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