Assessment : Clinical Reasoning Scenario

PROFESSIONAL FORMAT OF SCENARIO:

Cultural safety is defined as "Behaviours, attitudes and policies that enable systems, organisations, professions and individuals to work effectively in cross-cultural situations" (National Health and Medical Research Council, 2006). When recipients of care believe that the care meets their cultural needs, then the care can be considered to be culturally safe.

SCENARIO:

Shakira is a 7-year-old girl living in a remote Indigenous community in the Northern Territory. She has 2 brothers and 2 sisters between the ages of 3 to 12 years.

She is now cared for by different family members in communities scattered over a large area of the NT as her family frequently travels. Her mother Jasmine is 27 years old and has recently lost custody of her children as she was frequently found to be drinking in town and not caring for or feeding her children. Her father cannot be located.

Shakira was diagnosed 2 years ago with Rheumatic Heart Disease and is required to have injections every 3 weeks for at least 10 years as well as follow up cardiac tests. These tests include Echocardiography which can only be done in city hospitals. Shakira started her life underweight at birth and has suffered many middle ear infections leading to decreased hearing which has affected her speech.

Shakira frequently misses school but when she does attend she is fed breakfast to start her day as often food is scarce within the family. She is still underweight for her age.

Research and then provide the following information about Shakira:

Q1. Briefly discuss Rheumatic Heart Disease and the cause, including factors that may have led to Shakira contracting the disease.

• Identify and explain two social determinants of health that may have made Shakira more susceptible to the disease.

• Explain how one of these determinants may have affected Shakira's families decision-making around her care.

• Include the standard treatment required

• Include relevant Indigenous statistics for RHD compared to the mainstream population.

Q2. Explain how you will provide culturally safe care as an Enrolled Nurse by defining and giving one example of the following terms:

(a) Cultural awareness

(b) Cultural sensitivity

Q3. By acknowledging the impact of events and issues throughout the history of Australian and Torres Strait lslander people it helps the Enrolled Nurse gain insight into the current physical, mental, social, economic and political situations affecting Australian and Torres Strait lslander people and their engagement with community services and health systems.

3.1 Research via the link: https://www.legislation.gov.au/Details/C2012C00258

In your own words briefly explain the objectives of The Aboriginal and Torres Strait Islander Act 2005.

3.2 Considering the health generally of Aboriginal and/or Torres Strait Islander people provide an explanation in your own words of the significance of one the following and briefly explain how they may be affecting the day to day health and wellbeing of these people.

(a) The impact of European settlement/Colonisation

(b) Loss of land and culture

(c) Kinship/skin system

(d) Mabo case/ Terra Nullius

(e) Forced removal of children (‘Stolen Generations')

Q4. Successfully working in partnership with Australian and Torres Strait lslander people requires effective communication. Gaining their full participation by consulting with them and involving the individual and at times the community in their health care decisions is essential to providing culturally safe nursing care.

Select one of the following strategies and discuss how this strategy can assist the Enrolled Nurse to improve communication and build a rapport to provide culturally safe care.

Consultation with community representatives

(a) Community participation in decision making

(b) Health clinics built in such a way that male and female areas are separate and have separate entrances. Both male and female health professionals are present.

(c) Kinship

Q5. Considering Shakira, briefly discuss two ways that an Enrolled Nurse could ensure effective communication when consulting with her and her family.

Q6. A culturally safe organisation consults with Indigenous Australian community leaders and workers. Health services should develop culturally appropriate policies and procedures that provide direction for workers dealing with Indigenous Australian individuals.

Choose one of the strategies below and briefly explain how this would ensure that Shakira and her family would feel comfortable accessing the service.

(a) Employing culturally and linguistically diverse staff throughout the health organisation.

(b) Choose one accessible resource related to a Shakira's health issues that if available to health employees would assist.

(c) Displaying Aboriginal or Torres Strait Islander art and posters that are clearly visible from the entrance to the building.

Q7. By regularly reflecting on situations you encounter in your work practice you will develop your own cultural safety practices.

How well do you integrate cultural safety into your practice as a student Enrolled Nurse? Briefly discuss one of the following questions.

(a) Do you understand how Indigenous Australian culture and history shapes Indigenous Australian people's interaction with non-Indigenous society?

(b) Do you show you are prepared to re-shape your own values and perceptions to accommodate the needs of Indigenous Australian individuals and co-workers?

Q8. To evaluate the extent to which cultural safety is integrated in your own work and in your workplace it is a good idea to put yourself in the shoes of an Aboriginal or Torres Strait Islander individual.

(a) List two questions an Aboriginal or Torres Strait Islander may ask themselves when considering if they will access the health service.

(b) List two indicators of a culturally unsafe service.