Indigenous Australian Patients: Evidence-Based Discussion

Indigenous Australian Patients: Evidence-Based Discussion of Patient Care and Reflective Practices

Providing health care to indigenous Australian people, specifically Yvonne, a 14-year-old Yolngu girl from Yirrkala poses several significant challenges. The Yolngu people, an Aboriginal community inhabiting the Arnhem Land in northeast Australia, have limited knowledge of Western medical practices. Instead, they place an emphasis on alternative medicinal treatment based on traditional health practices (Mununggirritj).

Studies have shown that Yolngu people harbor strong feelings of distrust towards Western medicine (McGrath, P. 2006). Lack of understanding of clinical notions of pain relief, fear of administration and associated side effects, and the idea that Western pain medications will speed up the dying process and inhibit the transmission of traditional knowledge that occurs during end-of-life, all contribute to the refusal of treatment. McGrath (2006) also demonstrated that Yolngu culture believes in the natural progression of pain, which makes them less likely to complain. This further complicates the delivery of optimal treatment for the patient.

The primary symptoms of the presenting patient are very general and require a comprehensive history. Fevers and abdominal pain are applicable to a large number of possible diagnoses. A medical history of the Yolngu peoples shows a high prevalence of diabetes and kidney disease. Abdominal pain is an associative symptom for kidney disease but in no way conclusively eliminates other diagnoses. It may also be caused be a urinary tract infection, food poisoning or allergies, all of which may be relevant for the patient. It therefore becomes critical to communicate effectively with the patient to gain an understanding of past illnesses, ingestion of plants or other foods that may be related to the fevers and a history of the symptoms' progression.

Yvonne proves quiet and non-communicative and generally non-compliant to receiving medical care. She regularly leaves her room to sit outside with other members of her community. These difficulties are pervasive. A nurse-practitioner must be sensitive to the cultural values of the patient and sympathize with the distrust she has towards Western medicine. It is also worth acknowledging that English can be anywhere from a third to a tenth language for the Yolngu people (Anan. 2011). Cass (2002) shows that miscommunication between healthcare providers and Aboriginal peoples is pervasive. One study identifies communication difficulties in 28.7% of all Aboriginal patients, a prevalence that is 31 times higher than those in non-Aboriginal patients (Cheng, WY. 1996). Specific problems that were frequently cited include lack of patient control over the language, marginalization of Yolngu knowledge, absence of resources to construct a body of shared understanding, lack of staff training in intercultural communication and overreliance on biomedical knowledge (Cass, A. 2002). The patient, culturally inclined towards mistrust, is thereby further alienated from the treatment process.

The nurse-practitioner must overcome these cultural and language barriers in order to effectively treat Yvonne. She clearly lacks faith in the practitioner and feels uncomfortable with the hospital environment. In order to engage in culturally safe practices, the nurse practitioner must approach the Yolngu relatives of Yvonne. She must show cultural awareness and recognize the traditional perspective of these people. Trained interpreters, although shown to provide only a partial solution to bridging the gap between patient and healthcare provider, should be recruited to improve channels of communication. In order to assess Yvonne and her symptoms, the nurse practitioner must show patience and understanding. In the treatment of the symptoms, whether to relieve the fevers or perform scans and tests to find the source of the abdominal pain, the nurse practitioner must give Yvonne and her relatives significant input into the management of the illness. Optimal outcomes can be achieved by providing information to the patient that decreases fear, timely involvement of the doctor in the administration of pain medications and emotional support (McGrath, P. 2006).

Reflective practices can have considerable effectiveness in the care of Yvonne. In a paper discussing the benefits of reflective care, Ben Hannigan (2001) argues that reliance on practical knowledge alone is insufficient to solving medical problems as they are rarely abstract in nature. Reflection by the nurse practitioner embeds the medical problem into the social context and allows the practitioner to engage directly with the relevant difficulty at hand. In the case of Yvonne there may be a technical and simple solution for her fever and abdominal pain but it is mired in layers of cultural disparities. Reflective practices may remove the practitioner's frustrations towards the patient's incompliance and lead to more cultural awareness. Johns (1996) suggests that reflective practices may be a way for practitioners to "realize" care instead of "performing" care and thereby be more engaged in the patient's needs.

It appears that reflective practices carry many benefits for a beginning nurse practitioner. They have increasingly become an integral part of the curriculum for nurse practitioners. It has been shown that reflective practices, especially ones that incorporate written reflective materials, improve the assessment performance and communication ability of nurse practitioners (Atkins, S. & Murphy, K. 1993).

Countless studies point to the benefits of communication for effective patient care and outcomes. Ultimately, the effectiveness of Yvonne's treatment lies in the ability of the nurse practitioner to surmount cultural and language barriers and engage effectively with the patient.