Clinical Issues for Aboriginal People

Discuss About The Considering Aboriginal Palliative Care Models.

This case study is based on Tom, an aboriginal man in Australia. In this essay legal and clinical issues related to Tom will be identified considering his cultural background and medical condition. Goals will be established for him to improve his clinical condition like pain and insufficient breathing. Intervention provided for him based on the goals will be discussed. Intervention will be provided to him based on his cultural background and his family members will be involved in providing care to him.

In case of Tom clinical issue identified is trouble in breathing and pain. Legal issue identified is NFR, not for CPR, not for ICU admission.  

People like Tom with pain are vulnerable as compared to the people without pain. Other than physical and physiological issues, other issues like cultural background, emotions, and psychological or spiritual issues can also contribute to pain. Spirituality plays important role in life od Aboriginal people because they believe in cyclical concept of life-death-life and they consider health as whole-of-life (Boddington & Raisanen 2009). For these people death is not the end but spirit anticipates reincarnation. These people believe in mourning and grieving customs ceremonies help in leaving spirit the body and return to sacred place through reincarnation. Hence, family members of these people take more responsibility of unhealthy family member. In case of Tom also his daughter Carina claims por of attorney and wish to save his father. On the other side his son stated that his mother Cec is Tom’s enduring guardian. Nurse can resolve this Tom’s family conflict by incorporating social worker in his care. Tom belongs to Indigenous people. In indigenous people pain might be under-assessed or poorly managed due to their perception and misunderstanding (Demaio et al., 2012). There are varied risk factors responsible for the occurrence of pain like medical, emotional, psychological, spiritual, cultural problems and pain due to trauma or injury. Tom is also complaining about pain, he is not eating properly due to alteration in appetite and he is exhibiting insufficient breathing.  

Tom is exhibiting problem of trouble in breathing. Respiratory disease like insufficient breathing are more prevalent in aboriginal people because approximately 8 % of the people develop respiratory disease. It is more prevalent in aboriginal people due to unhealthy lifestyle of these people and less access to the healthcare services. In Tom, insufficient breathing might also occur due to pain after his fall. Due to fall, he can also become anxious and it can also lead to development of insufficient breathing in him. Clinical issues need to be decided based on the palliative assessment and discussion among different professionals like doctors, nurses, clinical laboratory scientist, psychologist and physiotherapist. Moreover, cultural, ethical and social issues need to be considered in clinical decision making of Tom (Jahn Kassim & Alias, 2016; Jull et al., 2015).  

Pain Management for Tom

‘’NFR, not for CPR, not for ICU admission’’ is mentioned in his progress report. It is collectively called as Do not resuscitate (DNR). It is a legal order which indicate cardiopulmonary resuscitation would hold. It is the wish of the patient to stop their heart or to stop their breathing. In DNR, other than CPR all other healthcare services required to be provided. In indigenous people, most of the people are not aware of DNR and they wish to discuss this topic with healthcare professional. Hence, nurse need to give complete information to Tom about DNR. In case of Tom, DNR was signed on his previous admission. Medical officer need to clarify this DNR from one admission to the another. It is the legal responsibility of the nurse to ger it reviewed and signed from the medical officer. If nurse doesn’t follow this, there is possibility that nurse might face legal action and might also lose nursing registration (NSW, 2014).

Goals need to be decided for Tom based on his aboriginal culture because decided goals should be achieved. Aboriginal people have different beliefs in medical intervention. Moreover, health needs and requirements of the Aboriginal people are different from the Non-Aboriginal people (Demaio, Drysdale & Courten 2012). These are based on the various cultural, social and emotional aspects of these people and these should be appropriate with these aspects. For these people along with medical intervention other aspects like dignity, self-esteem, and control over physical environment are also important. Tom need to verbalise his pain because these people are not always ready to verbalise their sufferings (Lowell et al., 2012). It can be achieved by establishing effective communication with Tom. Therapeutic and social communication is one of the important aspects of providing quality nursing practice. Specific aspects need to be discussed in communication and it should not be only verbal communication rather non-verbal communication also plays important role in therapeutic communication. Active listening and analysing expressions can be helpful in assessing health condition of the patient.  However, in Aboriginal people communication proved to be major barrier for therapeutic communication mainly due to the language problem, social and cultural aspects of Aboriginal people (Lowell et al. 2012). Even though few of the Aboriginal people are good in English, difference in cultural aspects of healthcare provider and Aboriginal people can lead to miscommunication and misunderstanding between them. Even though Tom was in suffering due to pain, nurse didn’t assess his pain. Merely, she stated that he is in pain and with insufficient breathing. This is not appropriate situation for Aboriginal patient like Tom. Hence, it can adversely impact healthcare service to Tom.  In such situations family members need to participate in patient’s care; hence, Tom was expecting his wife Ces to arrive there. There was miscommunication between nurse and Tom with his family members because nurse is not aware of the cultural aspects of the Aboriginal people (O’Brien et al. 2013). Aboriginal people are reluctant to adhere to medical treatment. Moreover, in palliative care it is difficult to provide medical intervention because patients lose hope in medical intervention. Tom need to exhibit improved well-being due to improvement in the pulse rate, blood pressure, body posture and respiratory rate. Aboriginal people are associated with multiple health and social issues. Hence, mostly they are anxious. Hence, there can be alteration in their vital signs and in most of the patients of palliative care vital signs are usually abnormal. Tom is using both pharmacological and non-pharmacological interventions for the management of pain (Hicks et al., 2012). Tom is exhibiting improvement in the mood and coping because pain can lead to altered mood and reduced capacity to cope up with the pain. Aboriginal people need to be provided with more than one intervention because they do not stick to the single intervention. Moreover, their coping capacity for pain is less.

Cultural Factors in Providing Care for Tom

Pain in Tom need to be acknowledged immediately and immediate action need to be taken to relieve pain in Tom because pain might get aggravated due to anxiety and fear of pain. Cultural background of Tom also indicate that these people are more anxious about diseased condition.  External stressors and sources of discomfort need to be eliminated from Tom because it can exaggerate pain sensation. These people are associated with various adverse social and cultural stressors. Tom need to be encouraged to take rest, relax and sleep because it can avoid fatigue and exhaustion due to pain. Family members of Tom need to be incorporated in his care to provide him with relaxed and comfortable care. Pharmacological treatment like morphine need to be administered in him. Non-pharmacological interventions like distraction techniques, relaxation exercise, breathing exercise and music therapy need to be initiated in him to get relief from pain (Schreiber et al., 2014). Interprofessional care with effective communication among different professionals like healthcare providers, social workers and family members can improve health condition of the patient in the palliative care (O’Brien et al., 2013; Peres, 2013).

Tom should be encouraged for proper body alignment for maximum breathing. Aboriginal people do not give much attention to alterations in the vital signs like respiratory rate. These people believe that these alterations can occur due to other reasons than medical condition (Santiago et al., 2014). Patients in the palliative care need to be encouraged to adhere to medical conditions. Hence, scope of improvement in the health condition of these people can be improved. It is evident that Aboriginal people and health care workers are not fully aware of the palliative care. These people believe that inpatient care to their family members separate their ill family member from the other members of the family. These people don’t wish to separate their family members from at the end of their life (O’Brien et al. 2013). Tom and his family members might not be aware of the palliative care and therapeutic intervention in the palliative care. This might be due to miscommunication between nurse and Tom and his family members and inability of nurse to assess health needs of Tom due lack of knowledge of his cultural aspects. Assistance need to be offered for him in performing daily activities. Hence, involvement of family members in his care is important aspect.

Conclusion:

Identification of actual clinical and legal issues are important for providing care to people of Aboriginal culture like Tom. Culturally appropriate care need to be given to these people and effective communication need to be established with patient and family members for providing effective palliative care

References:

Boddington, P, & Raisanen, U 2009, ‘Theoretical and practical issues in the definition of health: insights from Aboriginal Australia’, Journal Of Medicine & Philosophy, 34, 1, pp. 49-67.

Demaio, A, Drysdale, M, & de Courten, M 2012, ‘Appropriate health promotion for Australian Aboriginal and Torres Strait Islander communities: crucial for closing the gap’, Global Health Promotion, 18, 2, pp. 58-62.

Hks, R, Hernandez, J, & Wanzer, L 2012, ‘Perioperative pharmacology: patient-controlled analgesia’, AORN Journal, 95, 2, pp. 255-265.

Jahn Kassim, P, & Alias, F 2016, ‘Religious, Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making’, Journal Of Religion & Health, 55, 1, pp. 119-134.

Jull, J, Giles, A, Boyer, Y, & Stacey, D 2015, ‘Cultural adaptation of a shared decision making tool with Aboriginal women: a qualitative study’, BMC Medical Informatics & Decision Making, 15, 1, p. 1.

Lowell, A, Maypilama, E, Yikaniwuy, S, Rrapa, E, Williams, R, & Dunn, S 2012, ”Hiding the story’: Indigenous consumer concerns about communication related to chronic disease in one remote region of Australia*’, International Journal Of Speech-Language Pathology, 14, 3, pp. 200-208.

NSW government health 2014, ‘Using Resuscitation plans in End of life Decisions’, Reviewing the Resuscitation plan, pp. 21 Retrieved from https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2014_030.pdf on 02.05.2018

O’Brien, A, Bloomer, M, McGrath, P, Clarke, K, Martin, T, Lock, M, Pidcock, T, van der Riet, P, & O’Connor, M 2013, ‘Considering Aboriginal palliative care models: the challenges for mainstream services’, Rural & Remote Health, 13, 2, pp. 1-10.

Peres, J 2016, ‘A Time and Place: The Role of Social Workers in Improving End-of-Life Care’, Journal Of Social Work In End-Of-Life & Palliative Care, 12, 3, pp. 185-194.

Santiago, J, Mansbach, JM, Chou, SC, Delgado, C, Piedra, PA, Sullivan, AF, Espinola, JA, & Camargo, CA Jr. 2014, ‘Racial/ethnic differences in the presentation and management of severe bronchiolitis’, Journal of Hospital Medicine, 9, 9, pp. 565-72

Schreiber, JA, Cantrell, D, Moe, KA, Hench, J, McKinney, E, Preston, LC, Weir, A, & Brockopp, D 2014, ‘Improving knowledge, assessment, and attitudes related to pain management: evaluation of an intervention’, Pain Management Nursing,  15, 2, PP. 474-8