Week 10: Health Literacy

An inadequate level of health literacy can lead to lower health outcomes and higher costs to the individual, community, State and Commonwealth.  The social determinants of health were associated with those most at risk.  Higher risk correlated to more frequent use of emergency and hospital services and lower levels of self-health care.

The World Health Organisation states that countries, communities and people who are empowered to make changes to health, literacy and lifestyle are less of a burden on their health systems  (Kanj & Mitic, 2009).  Strategies to improve literacy including reading through key points of provided literature, questioning for understanding, being culturally aware etc will assist those at risk to become more literate and better able to help themselves.

The interview with Peter was less relevant to health literacy than the next topic, disability.  He appeared to have a high level of literacy despite being affected by many of the social determinants.  He gave an example of hospital staff not listening/understanding his allergy to ventolin which caused an almost fatal outcome.  This made me think that people working within healthcare should be responsible for their own literacy and motivation to change as well as being able to teach it to others. Nurses must not assume that they know the patient better than the patient and take time to listen to what they say.

I felt that health literacy as one of the factors affecting health is lacking in many at risk groups and have personally seen this in the aged and health compromised.  Questions are not asked and treatment provided is not optimal because of this. 

I learnt that the strategies to assist health literacy, health and well-being can be provided but people must want to change and staff must have time and skills to deliver training.  The strategies used are similar to adult education principles and felt confident I could deliver except that spending enough time may not always be possible.

In my work, taking every opportunity I could to help the client understand and learn would assist to improve literacy levels.  Spending the time, using basic active listening and questioning techniques along with technology and medical resources would help me provide the best service I could to the patient and potentially reduce their time in hospital or motivate them to take action of their own when they got home.

Picture 6: Can you Read. Pharmacy Times (2016) 

References

Kanj, M., & Mitic, W. (2009). Health Literacy and Health Promotion. 7th Global Conference on Health Promotion, "Promoting Health and Development: Closing the Implementation Gap" (p. Track 1). Nairobi: World Health Organisation. found on http://www.who.int/healthpromotion/conferences/7gchp/Track1_Inner.pdf

Week 9: Equity and Diversity in the Workplace

This discussion concentrates on working with people that are not like us, that is, diversity.  How we treat each other, assimilation, and stereotyping all affect everyone’s experience at work.  Having a diverse workforce can bring innovation, service improvement and improved management practices or it can lead to challenges such as culture shock, conflict, communication and knowledge transfer issues.  Of particular focus was indigenous Australians, gender and generational diversity in the workplace. The Australian Health Leadership Framework (AHLF) (Health Workforce Australia, 2013) is a framework designed to produce better healthcare leaders.  Better leaders produce a happier workplaces and higher retention rates which in turn leads to innovation and improved client outcomes.

Nurses might really eaten their young, or anyone different from them.  I felt the article regarding the challenges of nurses from South Asia (Walters, 2008) interesting and an eye-opener.  I have experienced the disrespect of the older generation of nurses at CQU and paramedical and hospital systems.  I have also experienced a reverse culture shock whilst working with a majority Nepalese workforce.  I felt isolated, alone, found communication difficult, and was snubbed when trying to make friends.  Being older also made me feel as if my opinion and work was not valued which diminished my work experience and I chose to leave.  I note however, upon reflection, that when I work as a private paramedic, as an older female, I am the person people look to as the most experienced.

Australians original from over 200 countries, speak over 300 languages and more than 100 religions.  One of the fastest growing groups in recent years is people born in Nepal. In 2011 there were 24,600 people born in Nepal, compared to 2,600 in 2001, a five-fold increase in just five years (Australian Bureau of Statistics, 2013). I learnt that the government acknowledges the need for diversity training in the healthcare workplace and hoped that the AHLF will change attitudes so that I might have a more pleasant experience in my future healthcare jobs.

The most important point that I take away from this lecture is that respecting all people is paramount and that the welfare of the patient should always be my top priority.

Picture 5: LEAP. Health Workforce Australia (2013)

References

Australian Bureau of Statistics (a). (2013, Apr 30). The 'Average' Australian. Retrieved from Australian Bureau of Statistics: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30April+2013

Health Workforce Australia. (2013). Health LEADS Australia: the Australian Health Leadership Framework. Canberra: Australian Government.

Walters, H. (2008). The experiences, challenges and rewards of nurses from South Ausia in the process of entering the Australian nursing system. Australian Journal of Advanced Nurses, 25(3), 95-105.

Week 8: Cultural Competence and Care in Communities

This week covered working within community as a healthcare provider and issues such as being accepted and trusted which affect utilisation of the service.  Expanding this, specific community groups were explored such as drug users, Indonesian brides, homelessness, anti-vaccination, rural/indigenous communities.  Improvement strategies included changing from institutional to patient centred-care including showing people respect and acknowledgement of being heard.  Lastly the positive role of Community Liaison officers (CLOs) was discussed and how they help to engage and empower a community.

The interview with Rosalie and Rikki provided some very helpful insights on how to care for someone with an intellectual disability.  It alarmed me that Rikki would be sent to hospital by herself without a carer.  This places quite a burden on a nurse without a carer and medical/personal history especially with her fear of operations.  Chris also related back his difficulty with stereotyping and assumptions of hospital staff that they knew better than him on his treatment.

Chronic illness, mail-order brides, gay, anti-vaccinations, homelessness and rural issues were either my own or family/friend’s lived experiences.  I felt that topics were covered well but did not agree with the vaccination presentation.  The pro-vaccination presenter used wording and suggested strategies that made me feel there was no option but to vaccinate.  If I was mother confronted with this language and instructions, I would have walked out and never returned.  I felt that the presenter did not foster a patient-centred approach and did not make me feel that I could trust her or would have been listened to if I was considering conscientious objection.

I learnt that the social determinants of health were difficult to provide whilst allowing people to lead a life they choose.  A lack of health literacy, lifestyle, chronic illness, housing issues and location of resources all contribute to reduced health outcomes and risky behaviour (Fisher, Milos, Baum, & Friel, 2014).  The use of CLOs assist the government to better service the needs of at risk communities through higher level funding and policy, however I learnt that when in need and let down by community, people turn to non-government sources such as St Vincent De Paul and the Salvation Army (Baum, et al., 2014) for help.

In practice, I will used strategies such immersion to become accepted and trusted in a community.  Approaches like stereotyping lead to discrimination and assumptions for treatments made which can lead to reduced health outcomes.  I must be truly and genuinely interested in the patient with enough knowledge of local resources to enable the person to feel empowered to make their own decisions. 

Picture 4:  Dont Feed Them. Cartoon Art Museum (2016)

References

Baum, F., Freeman, T., Jolly, G., Lawless, A., Bently, M., Vaarto, K., . . . Sanders, D. (2014). Health promotion in Australian multi-disciplinary primary health care services: case studies from South Australia and the Northern Territory. Health Promotion International. Retrieved from http://m.heapro.oxfordjournals.org/content/29/4/705.short

Fisher, M., Milos, D., Baum, F., & Friel, S. (2014). Social Determinants in an Australian Urban region: a 'complexity' lens. Health Promotion International. Retrieved from http://m.heapro.oxfordjournals.org/content/early/2014/08/08/heapro.dau071.short

Week 7: Multiculturalism and Health

Picture 3: Migrants Rights. Migrant Tales (2016)

This topic concerns the cultural and health issues of immigrants into Australia.  The videos from Mark and Asif compared a resident visa, English speaking background, planned migration contrasted to an asylum seeker, temporary bridging visa, non-English speaking background, health and mental health issues.  Another video presented Mercy, an educated English speaking academic, talked about her culture and ease of assimilation into Australian life.  She also gave advice on how to speak to people about their culture or religious needs in a hospital setting. 

I was surprised to note that 60% of Australian population growth was due to migration and that at 30 June 2014, 28.1% of Australians were born overseas (Australian Bureau of Statistics, 2014).  The barriers to accessing healthcare and negative health outcomes posed a question about why migrants would not want to assimilate which would lead to friendships and easy support networks rather than voluntarily ostracisation. I also felt that Mercy presented herself and Ghana with dignity.  She taught me not to stereotype and how to respectfully ask about needs of culturally diverse patients.  Asif and Mercy’s examples of negative health outcomes were disappointing to hear from Australian hospitals. I researched some of the birth practices of Ghana women and found some will cut a baby’s face to ward off evil and perform “outsiding” or naming ceremony within three days of birth (Moyer, Adongo, Aborigo, Hodgson, & Engmann, 2014).  

I learnt that my family and culture has biased my thinking towards a White Australia Policy attitude (Jayasuiriya, 2015).  Previously, I felt I was open to cultural diversity, but upon reflection of my interactions with asylum seekers and planned migration colleagues,  I may not have given any of them the compassion and empathy I should have and never asked any of them whether I could help them in any way.

I will take away from this topic more empathy towards the hardship of moving to new country, by choice or force.  I now understand the types of suffering and will allow patients more time to get their ideas/message across.  In a healthcare setting, I felt that Mercy provided me with a way to show respect for someone without diminishing my own culture and value systems.

References

Australian Bureau of Statistics (b). (2014). Australia's Population by Country of Birth: 3412.0 - Migration, Australia, 2013-14. Retrieved from Australian Bureau of Statistics: http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/3412.0Main%20Features32013-14

Jayasuiriya, L. (2015). Transforming a 'White Australia': Issues of racism and immigration. Anthropological Forum: A Journal of Social Anthropology and Comparative Sociology, 25(1), 20.

Moyer, C., Adongo, P., Aborigo, R., Hodgson, A., & Engmann, C. (2014). 'They treat you like you are not a human being’: Maltreatment during labour and delivery in rural northern Ghana. Midwifery, 30(2), 262-268.

Week 6: Cultural Health Practices and Beliefs

Picture 1: Outback View of the Burqa. Inkcinct Cartoons Australia (2010) 

This week gave a brief overview of the issues in healthcare regarding a person’s culture, faith and religious practices focusing on death and complementary and alternative medicine (CAM).   The videos were particularly interesting as I am a degree qualified naturopath with an interest in palliative care.  

I was disappointed not to hear more homeopathic research.  In the palliative care video, I admired the candour of the nurse and bravery of the patient to articulate their needs.  I reflected whether I would be as emotionally capable to assist.  Also I questioned whether in reality, CAM or any patient cultural health practices are treated with the respect this week advises.  

My experience with the lack of ingestion therapy CAM use in hospital (Samueli Institute and Health Forum, 2010), was backed up in Soklaridis, Kelner, Love, & Cassidy (2009) and Hart (2012), with manual therapy more widely accepted (Hart, 2012).  I have experienced the compassion of nurses in palliative care at Redcliffe Hospital but none asked cultural/spiritual belief questions around the death experience for the patient.  Nurses are taught to promote holistic care in the Standards for Providing Quality Palliative Care for All Australians (Palliative Care Australia, 2005) but more could be done to improve assessment of spirituality and culture (Matzo & Witt Sherman, 2015).

From the notes, I became aware of the trap of assuming patients from a religion or culture will have the same needs as the majority or their perceived needs. (Matzo & Witt Sherman, 2015). 

In conclusion, this week provided a reminder of some of the diverse spiritual and cultural needs of patients and a recognition that my job as a future nurse is to be more aware of those wants and needs on an individual basis.  I intend to reflect more on my attitudes and values around provision of a cultural and spiritual support and mentally investigate my ability to complement and support a palliative care process.

Picture 2: Religious Diversity GoGraph (2016)

References

Hart, J. (2012). Patients and Evidence Motivate Hospitals’ Increase in CAM Services. Alternative and Complementary Therapies, 18(1), 21-23.

Matzo, M., & Witt Sherman, D. (Eds.). (2015). Palliative Care Nursing: Quality Care to the End of Life (4 ed.). NY: Springer Publishing.

Palliative Care Australia. (2016, Jan). Standards for providing quality palliative care for all Australians. Retrieved from Palliative Care: http://www.palliativecare.org.au/Portals/46/Standards%20for%20providing%20quality%20palliative%20care%20for%20all%20Australians.pdf

Samueli Institute and Health Forum. (2010). 2010 Complementary and Alternative Medicine Survey of Hospitals: Summary of Results. USA: Samueli Institute.

Soklaridis, S., Kelner, M., Love, R., & Cassidy, J. D. (2009). Integrative health care in a hospital setting: Communication patterns between CAM and biomedical practitioners. Journal of Interprofessional Care, 23(6), 655–667.