Cultural awareness and sensitivity at first contact may be the tool to providing better health care to indigenous Australians. Maher (1999) points out that within Aboriginal communities there are many differences in cultural beliefs and that caution should be taken to not generalize these beliefs because there is often variation across aboriginal Australia. The inherent need is to focus on the individual beliefs of each individual client. Aboriginals often see the cause of illness has having to do with supernatural forces that require assistance to have these forces removed (Maher 1999). They believe this illness is caused by the dysfunction of their social and spiritual being. Maher (1999) discusses the indicators aboriginals believe causes sickness and states there are generally three main cultural reasons for their illness. These are breach of a taboo, accident or illness and injury or death.
Any death outside of normal death patterns of old age or at birth are considered to be related to supernatural causes (Maher 1999). It is important in communicating with Aboriginal Australians that the carer is aware of the reason why the client believes they are sick. The fact that the aboriginal Australian is sick and has to attend a hospital exposes the client to their community, in a public way, their belief and acceptance of having breached a taboo. It is important for carers to understand the feelings and emotions that may be present when an Aboriginal Australian attends a health centre. This may be one of the reasons Aboriginals do not attend hospitals as often as necessary for checkups as they believe that if they followed their taboos properly, then they would have good health, so admitting to illness or the lack of strength of character to follow taboos may cause distress in a public way when they attend hospitals or health centres (Maher 1999). Knowledge of intrinsic and external factors that bring Aboriginals to present themselves at hospitals needs to be acknowledged by the carers, because as Medicine Australia (2006) points out, experiences of the past in relation to large buildings and hospitals are linked to Aboriginals thinking of these as a threat.
It is important for the carer to promote feelings of safety and security when indigenous people attend a health centre or hospital. This can be done through sensitive communication and active listening for the cultural needs of the client. Queensland Health points out that the way a carer addresses clients, and the situation presenting have significant effect on Aboriginal Australians.
Maher also (1999, p. 3 of 9) points out that aboriginals have clear roles within their communities relating to gender and health care. There is ‘mens business’ and ‘womens business’ and breaches to the confines of this business will bring shame and distress. Carers should be aware of the needs of nurse gender relationship constraints in care of aboriginals. Aboriginals prefer same sex caring and for aboriginal women it is important that a male not be left in the room alone with her (Maher 1999). Areas of health to be particularly aware of when caring for Aboriginal Australians include birth rituals and birth control, the concept of care, death rituals and preparation, blood transfusions and preferred gender care (Queensland Helath 2006).
Aboriginal Adolescents health is another area of cultural safety that needs to be explored in respect of promoting a good health outcome for the patient, both for the present and for future generations benefit. Hughes & Gray (2003, p.457) explain that within minority groups and adolescents there is a high prevalence of ‘mental health problems, lifestyle disorders (such as obesity), and self harm’.
Indigenous Australians often see Hospitals as a threat so it is important that carers provide care that is sensitive to the individual needs of every indigenous client. They may have interventions foisted upon them that don’t meet their believed needs and so they may feel it is not worth their co-operation (Queensland Health, 2006). To ensure the relationship between client and nurse is therapeutic and culturally safe it is important to ensure that there is understanding and sensitivity in the carers initial approach (Tabbner 2005). Frustration with the health system because it is not linked to internal beliefs of Indigenous Australians can result in interference with their self determination and their autonomy (Crisp & Taylor 2005).
Promoting this therapeutic environment may include the inclusion of Aboriginal Art on the hospital corridor walls, ensuring that same gender care is given, listening carefully to the clients beliefs for the reason they are ill, staff having genuine respectful behaviour towards indigenous clients, incorporating cultural practices and beliefs into the care plan, provide access to aboriginal advocates and healers, and recognition of the position of power that the indigenous client places in the medical team in (Wilson 2003). This can be done through active communication techniques of listening attentively and ‘reading’ the body language and communication styles. A Carer needs to speak clearly and clarify any misinterpretations, understand issues of access to health services and monitor and review their own behaviour in relation to cultural care and each individuals unique needs (Queensland Health 2006). It is important to rephrase information gleaned from the patient and reflect it back to them so as to ensure that the carer properly understands what is being communicated to them.
Treatment of any patient is most often more successful when the client understands clearly what is happening and is involved in making decisions regarding their own health. Communicating can be effected by using people and things they relate to. Cultural safety is about adjusting the way a carer responds to individuals in a way that gives them rights of involvement in their health outcome. Simple words and language are best used on any patient as large words and terminology can be detrimental to the client understanding of what is being discussed. It is important to note that care needs to be particularly taken with the social and spiritual values of Australian Aborigines (Hunter, 1998). Medicine Australia (2006, p. 1 of 8) outlines the most common causes of ill-health in indigenous Australians which includes ‘…circulatory disease, cancer, respiratory disease and injury and poisoning’. Factors described that prevent indigenous Australians from presenting at health centres in a timely way include distance, transport, finances, social supports, disability, timing, paperwork, fear and cultural hesitation as they are obligated more strongly to their family than they are to their own well being.
It is important in the nurse/client relationship with indigenous Australians that the carer has an understanding of the amount of emotional effort it takes for an Aboriginal Australian to attend a hospital or health centre. First impressions then, especially of support for the client are of vital importance. The carer needs to provide communication that promotes respect and understanding utilizing skills of active listening and body language that is appropriate, such as lack of eye contact, and strategies that promote cultural safety such as not leaving a female client alone with a male doctor.
Conclusion: By ensuring communication approaches and techniques are appropriate and culturally safe, the nurse promotes an environment and experience of the mainstream health system that is conducive to the care of culturally diverse peoples. Brown (2001) points out that a closer liason between workers and Australian Indigenous peoples will ensure reconciliation, healing and improved holistic health. This paper outlines the importance of initial contact with ?Aboriginal Australians and recommends a level of awareness for cultural care that advocates active communication techniques that are appropriate and based on individual needs. Cultural safety is an important consideration for care of all clients and should be kept uppermost in the approach method of all health care workers.
References:
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