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Palliative care service for indigenous cancer patients: Nursing Essay

 

Introduction

Indigenous Australian medical health system is intertwined with cultural beliefs that make is different from the mainstream health care system (Horsfall et al, 2011). The case of Pam is an example of this complexity. There are a few notable things before we can analyse the case at hand. First, western medicine was adopted as a result of the force used by the government to compel the indigenous people. Second, Pam is suffering from cancer and according to indigenous beliefs, this is a serious illness. Lastly, she requests to be taken to her community, away from western palliative health care. This means she does not hold western medicine as the ultimate solution; there are other “better” solutions.

This essay will seem to bring to light Pam’s actions. To achieve this, the essay will review relevant literature and discuss three indigenous cultural beliefs and aspects, two reasons why Pam wants to return to her home community, present culturally safe palliative care services appropriate for Pam, and then draw a conclusion.

a. Using the case of Pam explore relevant literature and discuss 3 views, attitudes, approaches or cultural aspects to culturally competent health care delivery for Indigenous Australians.

There are many beliefs and aspects related to health as far as the indigenous Australian people are concerned. These beliefs vary from types of illnesses to death and they are distributed among the various indigenous groups (Couzos et al, 2008). Even with this diversity, they have one character in common; they are all similar and related no matter the indigenous community and the location. The traditional beliefs of disease among indigenous Australian communities are interconnected with several aspects of life among them land, religion, and kinships obligations. Here are three cultural aspects related with health.

i. Illness causation

According to Thompson et al (2011), there are several factors, which are regarded as to play a part in disease causes. These factors are on the sociomedical system on which the health ideology of indigenous communities revolves around. The system holds; the wellbeing of an individual is dependent on social and spiritual matters. An illness is a sign of the dysfunction of this system. Based on this approach, the wellbeing of a member of a community is dependent on social responsibilities. According to Thompson et al (2011), social responsibility can take precedence over ones health because of the regard with social relationship is considered.

Under this aspect of disease causation, the sociomedical system has four categories of people depending on their health (McMaster, 2012). The first category is the strong. These are people in normal condition both mentally and physically able to undertake daily responsibilities. Second are the weak. These are persons with conditions considered minor. Such conditions include toothache, headache, etc and they can be treated with specific treatment and rest. Third are the wounded. These are persons with open wounds sustained through accidents, fights, etc. the fourth are the sick. These are persons unable to undertake their social responsibilities and they need assistance.

Serious sicknesses are believed to be an influence of supernatural and spiritual and for one to heal, spiritual and supernatural interventions are necessary.

ii. Spiritual and supernatural intervention

According to McMaster (2012), sorcery and supernatural are part of indigenous people way of life. They have a major role in indigenous health systems. Cases of sickness like for the case of Pam, will find explanation is in terms of sorcery or supernatural acts. The death of an in fact, an old person, or a chronically ill person is considered to be normal…it can happen in normal conditions (Trankle & Haw, 2009). However, anything outside this is considered abnormal and the perfect explanation is due to supernatural influences. The goods might be furious with the individual or the family-line or, it could be as a result of supernational acts targeted to the individually an adversary.

As stated by McMaster (2012), “There are many beliefs associated with supernatural interventions and sorcery: sorcery exists in many forms, its effect is to manipulate and alter behaviour and cause morbidity and mortality…” many diseases come from the secret sacred sites attributed with supernatural powers. According to Horsfall et al (2011), uninitiated and unskilled persons can release these powers –sorcery – in secrecy to a target person for the sake of retributions. Supernatural on the other hand is attached to the gods. For both sorcery and supernatural, spiritual intervention is needed to cure the patient, if the illness is curable.

iii. Preventive health

Even though indigenous health system has both preventive and curative measures, it seems to lay greater emphasis on the preventive measures (Couzos et al, 2008). It is interesting in that, while in western health and medical system preventive measures are attributed to pre-ailment, in the indigenous Australian health system it can be used as a treatment measure. The idea behind preventive health is; for an individual to be in good health, he or she should adhere to a given pattern of behaviour (Prior, 2009). The approved pattern of behaviour is all about observing given guidelines while at the same time, keeping off those considered dangerous.

There are a number of issues in these two groups. The approved guidelines that one needs to observe include adhering to social responsibility, respect to others and respecting others. On the other hand, there are dangerous behaviours one has to keep off to remain healthy or be cured shows. The list is based on laws that govern behaviour (Sedlak et al, 2007). They include; avoidance of prohibited foods during life crises or ceremonies, observing taboos and prescribed rituals, being careful as to not abuse others property or trespass, avoid prohibited sacred sites or accessing them with ritual protection, etc

The preventive principle is directly linked to what are considered causative measures. However, if one crosses the line and they get sick, then preventive measures can be adopted to cut the illness or prevent further advancement of the condition (Sedlak et al, 2007). For example, if one crosses the sacred line and accesses a sacred place without the right permission, then prevent measures can be used to cut on the wrath of the gods by appeasing them.

b. Discuss two reasons why Pam may want to return to her community at this end-stage of her life.

Because Pam is suffering from metastatic diseases with primary cervical cancer and death is imminent, she has come to the bitter realization of that, she is dying. With this acceptance, comes desperation and even though it is not included in the provided case, there are cases of moodiness and anger (Sedlak et al, 2007). With depression and despair, all Pam wants is spiritual guidance. Because indigenous Australians have strong attachment to the land, religion and kinship relations, there is no better place to spend one’s last days than in ones community. In the community, Pam will around people she loves and an environment she best identifies with.

Secondly, Pam is definitely seeking peace of mind for her last days on earth (Thompson et al, 2011). It is obvious that in the hospital, she will be not having the freedom that she might want. She is bound by hospital and ward regulation like visiting hours, routine tasks, and the hospital environment. On the other hand, in her community and presumably at her home, she will have all the freedom she wants. She can be visited by whomever and whenever, and she does not have to stick to a tight schedule like in the hospital. Apart from these features, there is an aspect of being in ones local that cannot be compared. This aspect is relaxing and contenting, the primary ingredients to peace of mind.

Another reason that might have contributed to her resolve to spend her days in her community is to cut on medical bills. Cancer palliative health care services are quite expensive. Because death is the final event, it would be wise to give up on the intensive care and prevent accumulation of bills…that are to be offset by the survivors.

c. Considering culturally safe practice, detail the discharge information including access to appropriate palliative care services you would supply to Pam and her family.

Cultural safety is a key factor in the delivery of palliative care services to aboriginal and Torres Strait Islander cancer patients. This aspect extends beyond cultural sensitivity and awareness to allow the caregiver reflect on; own culture and values, culture and values of the health organization, impact of the former two on care provided, how care can be improved and the perception of palliative care by the community as a whole (McMaster, 2012). The appropriate discharge and post-discharge care would include three items.

The first is inclusion of indigenous organization in the planning, provision and monitoring of palliative care in the community. Many organizations, both state and non-governmental are active in indigenous based health care systems. These organizations and the personnel in this initiative are well aware of the culturally safe requirements for addressing palliative care at home (McMaster, 2012). Organizations and personnel operating in indigenous Australian communities have the experience and the knowledge needed to provide western health system in line with the culture of the indigenous communities.

On the other hand, as these organizations are in the rural field, they have a network of patients. This provides an appropriate counselling program. During this terminal period, anger and stress are prevalent. The best way to manage them is to engage in a counselling program. As these have a network of operation in the community, it is easy for them to organize a group of patients who will then serve to encourage each other.

The second item is communication with the patient’s family and the community at large (Payne, 2010). The prime objective of communication is to pass the idea why palliative care system should be continued. The communication event should be done in a persuasive manner to attract the family and the community adopt the western-based palliative health care. Communication is done based on the understanding that, the family and by extension the community, are now the caregivers of the patient.

Communication can be done in both oral and written format. While the written format is for reference purposes, the oral communication is for persuasive purposes. Written communication should contain all the necessary details for the palliative care program (Payne, 2010). The details contained in this can vary but the more the details, the better for effective guidance.

The third item that should be done to ensure appropriate palliative care is training of personnel to provide palliative care in indigenous communities. Working in indigenous communities is not the same as working in the mainstream medical field. Because of the cultural aspect of aboriginal and Torres Strait Islander communities, training or even retraining of professional specifically for these communities is necessary (Couzos et al, 2008). Otherwise, the communities will shun the palliative care system based on contradiction of their culture.

To best utilize this strategy, it is advisable to search for indigenous professionals who are qualified in palliative health care. The fact that they are indigenous serves to create an acceptance level for the western services. An indigenous professional stands on a better platform to talk the indigenous community to accepting the western oriented palliative care services.

Conclusion

Aboriginal and Torres Strait Islanders have health care systems that differ from the western health system. The difference is due to aspects, beliefs, and views that are sourced from cultural backgrounds. There are three aspects presented in this essay that influence indigenous health and medicine. The first is illness caudation. This aspect holds that, for one to fall ill, there are spiritual and supernatural matters influences. The second is preventive health. The majority of indigenous measures are meant to prevent illnesses from occurring. The principle behind preventive health is avoidance of the causative agents, which are mostly spiritual. The third aspect is spiritual intervention. This requires that, to solve health and medical matters, there have to be spiritual influence.

Pam wants to spend her terminal days in her community because of the welcoming and accommodative nature of the community. These are conditions necessary for a peaceful state of mind, and provide the freedom she needs. To ensure that Pam receives the best palliative care while in the community, the following strategies are appropriate; inclusion of indigenous organization in the planning, provision and monitoring of palliative care, communication with the patient’s family and the community, and training of personnel to provide palliative care.

 

 

References

Australian Health Ministers’ Conference (2010). Supporting Australians to live well at the end of life: national palliative care strategy 2010. Canberra, Commonwealth of Australia.

Couzos, S., Metcalf, S. & Murray, R. (2008) Ear health. In: Couzos S, Murray R, eds. Aboriginal primary health care: an evidence-based approach. 3rd ed. South Melbourne: Oxford University Press: 265-307

Devanesen, D. (2000) Traditional Aboriginal Medicine Practice in the Northern Territory. Quarterly, 33:10-13.

Eastwood, H. (2000) Why Are Australian GPs Using Alternative Medicine? Postmodernisation, Consumerism and the Shift Towards Holistic Health. Journal of Sociology, 36:133-156.

Horsfall, D., Noonan, K. & Leonard R. (2011) Bringing our dying home: creating community care at end of life. 1-64. University of Western Sydney.

Maher, P. (1999) A review of ‘traditional’ aboriginal health beliefs. Australian Journal of Rural Health 7(4):229-36

McMaster, Y. (2012) More rural palliative care problems.

Morgan, D., Slade, M. & Morgan, C. (1997) Aboriginal Philosophy and its Impact on Health Care Outcomes. Australian and New Zealand Journal of Public Health, 21:597-601.

Payne, S. (2010) EAPC Task Force on Family Carers. White paper on improving support for family carers in palliative care: part 1. European Journal of Palliative Care; 17(6):238-245.

Prior, D. (2009). The meaning of cancer for Australian Aboriginal women; changing the focus of cancer nursing. European Journal of Oncology Nursing. 13: 280-286.

Sedlak, C. A., Doheny, M. O., Estok, P. J., Zeller, R.A., & Winchell, J. (2007). DXA, health beliefs and osteoporosis prevention behaviors. Journal of Aging Applied multiple and Health, 19, 742-756.

Thompson S.C., Shahid, S., Bessarab, D., Durey, A. & Davidson, P.M. (2011). Not just bricks and mortar: planning hospital cancer services for Aboriginal people. BMC Res Notes; 4:62.

Towney, L.M. (2005) The power of healing in the yarn: working with Aboriginal men. International Journal of Narrative Therapy & Community Work; 1: 39-43

Trankle, S.A. & Haw, J. (2009), Predicting Australian health behaviour from health beliefs, Electronic Journal of Applied Psychology, vol. 5, no. 2, pp. 9-17

Weeramanthri, T. (1997) Painting a Leonardo with finger paint’: Medical practitioners communicating about death with Aboriginal people. Social Science Medicine; 45: 1005–1015.

 


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