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A: Certainly! Usually, the minimum would be two weeks. There would be some orientation including cultural awareness, information around the communities and induction regarding processes in remote practie, such as aeromedical retrievals, the sue of Standard Treatment Manuals and Section 100 Pharmacy, as well as awareness of region specific diseases such as TB and Acute Rheumatic Fever. the hope would be that you step into a well-functioning team, have a positive experience and become a regular returnee! Perhaps even come for longer!
From my nursing experience, I often observed a prolonged silence from Aboriginal patients when nursing or medical staff asked questions. Silence is an important consideration for nursing and medical staff when they are interacting with Aboriginal people because this may be interpreted as the patient not understanding or resisting treatment.
The use of silence needs to be understood by nursing and medical staff because silence is a valued part of many Aboriginal communication styles. Information from knowledge is often not freely accessible. Certain people have the right to certain knowledge. Personal health information may not freely be disclosed to nurses and doctors and this will depend if nurses and doctors have taken the time to develop a meaningful partnership with the patient based on rapport and trust.
From the Aboriginal patient’s point of view, processing medical information into their first language and responding back in English will take time. Because many non-Aboriginal words and concepts have no equivalent in Aboriginal world view, silence may also reflect the time it takes to process non-Aboriginal words and concepts into Aboriginal world views.
Practical solutions can include avoiding the use of medical jargon and using plain English. Visual aids are often helpful in explaining medical terminology or treatment options. Never make the patient feel uncomfortable by standing over them. Sitting shoulder to shoulder, facing the same direction may be more appropriate. Respect Aboriginal communication styles when silence occurs and be patient.
Documenting and understanding the unique and personal experiences of Aboriginal people from remote communities who access specialty cardiac services in hospital formed the basis of my Master of Nursing, in research I did from 2004-2007.
I thought this was a great opportunity for Aboriginal people to share their stories about what it was like for them to leave their country to access health care in the ‘big smoke’.
This research identified several concerns the patients had, including an intense fear and anxiety of dying. The patients said that they died during the surgery and would be resuscitated by the doctor after the surgery. This intense fear may be compounded by the experience of kin who may have had relatives leave their community for hospital care, never to return home.
One of the elderly men that I talked to described his experience of coming to Adelaide:
“Sometimes when they get there, they lose their memory. Their memory won’t wake up again. Adelaide, you get to Darwin, you wake up.” (Mr. H, 2006)
One of the men told me that the reason for his sick heart was as a result of some wrong doing by a relative in the past and he needed to suffer the consequences.
Another man said to me that his son’s heart condition resulted from climbing up the side of the house as a young boy and when he fell down, he injured his left foot. The father then proceeded to draw an imaginary line with his finger, from his left foot up to the left side of his chest, connecting the left foot injury with the heart.
As a nurse, I needed to listen to the patient, respect their cultural understandings and also spend some time talking about non-Aboriginal understandings of ill health.
Using visual aids and drawing pictures was a useful way to explain to the patient about the nature of their heart disease
A: I do not believe so. I’ve always had an holistic approach to patients – acknowledging diverse cultural backgrounds and beliefs, being respectful and truthful in matters discussed, and focusing on solutions. I have always taken an educative approach using a variety of formats. I have always enjoyed learning from others and being part of a team. Now I get to do all of this in a different context and landscape, sometimes in a different language!
Orientating patients to the ward and introducing them to other patients will help with breaking the ice. If there are other Aboriginal patients on the ward, you will need to find out if it is culturally appropriate for introductions to be made. The patient will firstly ask you for the other patients’ surnames and the community the other Aboriginal patients come from before they decide whether it is culturally appropriate for communication to occur. Working in partnership with the hospital’s Aboriginal liaison team is also really important to make sure phone calls to the patient’s family back home are made regularly.
Personally and professionally, I have felt greatly enriched by my experiences over more than 12 years providing nursing care for Aboriginal people from remote communities. It has set the foundation for my career and resulted in the passion I have to dedicate myself to work in Aboriginal health.
It is really important to minimise the ‘power imbalances’ between a patient and nurse. When talking to your patient, never stand over them. Sitting next to them shoulder to shoulder or sitting on a chair and facing the same direction as the patient is more culturally appropriate. Allow time for the patient to respond as English will not be their first language and many non-Aboriginal concepts and meanings have no equivalent in Aboriginal world view.
A: Working in a remote Aboriginal community made me feel like I was really using my skills and doing something very worthwhile – and this had lessened in my previous years as a GP. Now I want to maintain my skill level. Working with and learning from Aboriginal people, around all manner of things, is amazing. The main skill set is team participation and adaptability with respect for the client and the rest of the team. Holistic care in a culturally competent manner and developing awareness of population and community health issues and strategies are valuable skills also. There is the opportunity to receive training in emergency skills, imaging and program support such as chronic disease. Developing teaching expertise was also helpful to support health workers, nurses and a variety of students.
A: I encourage medical practitioners not to worry – as many do – about their emergency skill set, because much of what we do is not emergencies. Most of it is around chronic disease and other problems in primary health care, with emergency response being a small part of that. A lot of people – as I did – worry about their skills in these situations, and they need not. There is lots of support and up-skilling.
On a busy ward, it’s not always possible to take the time you’d like to get to know patients, but building rapport vastly improves the quality of care we provide, so we need to think creatively on how we can achieve this.
Over time, a reciprocal partnership between a patient and their nurse will more likely lead to trust, minimise fear and anxiety, and facilitate disclosure of important personal information to assist with decisions based on their care. The more vulnerable the patient, the more trust is needed, the harder it is to generate.
From my experience, building rapport and eventually, trust, can be achieved through sharing information with your patient while you are assisting them in the shower, making their bed or attending to their wound dressings. Quite often, I would take patients for a walk outside in a wheel chair during my lunch break so we could both enjoy the fresh air and sunshine. In between attending to the care of my other patients, I would frequently pop in to see if they were okay to minimise feelings of isolation and reassure them that I will return.