Nursing Assignment: Medical Case Analysis of Aboriginal Man

Question

Task: Cardiac Scenario
An Aboriginal Elder man living in a rural community at Lake Tyers (350 kilometres from Melbourne in East Gippsland, Victoria), experienced increasing shortness of breath and a heavy chest on a Friday afternoon. The patient’s brother died of cardiac complications a year ago. His family encouraged him to attend the local clinic and he was found to be having a myocardial infarction (heart attack) and was rapidly sent to Bairnsdale (69km from Lake Tyers) and then Melbourne. Initial urgent treatment occurred at both hospitals, and then he had surgery.

There was no room on the retrieval plane (Adult Retrieval Victoria, Ambulance Victoria) for the man’s partner, so the partner was driven to the nearest town, got a lift to Bairnsdale and then caught the train to Melbourne. On arrival in Melbourne, the partner stayed in a hostel, visiting the hospital every day. The hostel was a 45-minute tram ride away from the hospital. Apart from his partner’s visits, the patient had few interactions with staff or other patients.

There was no interpreter service for their first language available on arrival in Melbourne, and English was both the patient and the partner’s third language. A telephone interpreter was located in order to obtain informed consent for treatment and surgery. Ongoing discussion and explanations were given to the patient in English, but some staff were too busy and spoke quickly, and the patient and his partner also had difficulty understanding the doctor’s accent. There was no Aboriginal hospital liaison or social work support available until the following Monday. The social worker assisted in arranging financial assistance, so that the partner could afford to stay at the hostel in Melbourne. Neither the patient nor the partner had any family in Melbourne to support them.

The patient had a relatively uncomplicated recovery after his surgery, and was flown back to Bairnsdale Hospital within three days post-surgery, where he was reassessed. Two days later the patient and his partner returned to their own community on the bush bus (the local public transport service). Their local health service provided follow-up care, in collaboration with the cardiac clinical nurse consultant in Bairnsdale. The local health service was within walking distance from their home and had Aboriginal health care workers on staff. His partner and children were able to provide support during his recovery.

NURSING ASSIGNMENTTASK: Your task is to read the above scenario and address the following questions:

Question 1a.
Using the information provided in the scenario above complete the table below.
We want you to consider and record what is important for, and about, the individual person entering the patient journey and his home, work or community situation. Cues:

Consider the person’s usual situation and the impact of new challenges or considerations once a health journey begins. The columns in the tables provided below may be adjusted to match your answers; please do not use their current size as an indication of the amount you need to write in each section (it may be more or less than the number of lines currently provided).

Dimensions of Health (Table 1)

Describing dimensions of health involves consideration of the whole person entering the health journey, and identification of what is important to them.

Question 1b
Discuss why it is important to collect the information listed in Table 1 and the possible consequences of not enquiring about, or recording, this information.

The columns in the tables provided below may be adjusted to match your answers; please do not use their current size as an indication of the amount you need to write in each section (it may be more or less than the number of lines currently provided). You may decide that you do not have information to include in every section of the table. It is your decision as to which sections you complete, as relevant.

Question 2a. (Table 2)

Complete the table below, using the patient journey described in the scenario above, from the perspectives of those individuals, groups or topics listed in the first column of the table.

Question 2b
Discuss why it is important to consider multiple perspectives in the patient journey and the possible consequences of not enquiring about, or recording, this information.

Evaluate pt. experience
Question 3
Identify the key findings, such as the main gaps and the strategies you could use to address those gaps, evident from your analysis of this patient’s journey.

You will need to use current, relevant, reliable and credible sources to support your discussion here.

Cultural support
Patient support needs
Patient support strategies
The importance of concepts i.e. the importance of available aboriginal liason officers or the importance of culturally competent health care staff

Analyse and improve current practice that is in place
Liasing with the aboriginal health services in oreder to better understand aboriginal culture and build a better relationship with the patient. Develop strategies and plan to meet the pt. needs and their families’ needs.

Have the organisation introduce culturally appropriate material and artworks to make the aboriginal pt feel welcomed and included.

Provide education and guidance to staff to better understand aboriginal culture,

Question 4
Discuss, in detail, one strategy (identified in your answer to question 3) that could be applied to address the gap/s you have identified in the case study patient journey.

You will need to use current, relevant, reliable and credible sources to support your discussion here. You will need to consider how you will implement your strategy, who will need to be involved and how you will measure the impact.

Question 5
Reflect on what you have learnt, professionally and personally, from this activity.

Cues:
Was there something that challenged you professionally or personally? Is there something that you could change in the future? How could you incorporate what you have learned in your nursing work?

Answer

Introduction
In the current case situation of nursing assignment, an aboriginal man is seen to have witnessed a heart attackpost which he is admitted to Bairnsdale hospital and then sent to Melbourne. He received initial and urgent treatment at the hospitals and was finally operated. The patient did not receive interpreter services for their first language and a telephone interpreter was referred to. The patient did not receive social support until a social worker arranged for an affordable stay for his partner. There was no family support available to the patients. The patient had uncomplicated recovery post-surgery and was taken back to Bairnsdale hospital for reassessment. Post-discharge, the patient had to refer to the local health service for recovery, which had aboriginal health care workers and family support was also present during the recovery process.

Question 1a.

Dimensions of Health (Table 1)

Question 1b
In order to deliver patient-centric care, it is essential that all cues are collected regarding the patient in a detailed manner. Any patient's health outcome is determined by environmental factors, socio-economic factors, and healthcare factors tremendously. For overall patient health outcomes, it becomes essential to understand the relevant and associated factors impacting a patient's health such that his/ her health can be suitably determined (Li, 2017). Patient-centric healthcare not only focuses on collecting information regarding the patient's environmental factors but also assessing and analyzing them to understand the effects associated with such factors. Analyzing the patient's journey in totality will allow understanding the varied determinants of health impacting patients, especially in the case of aboriginal patients, who receive not-at-par treatment as against other Australians. This will also allow rendering a safe and effective treatment care plan for the patient affected. It is important to record the patient's journey, his home, wok, or community situation for analysing the impact of any new challenges or considerations when the health journey begins. The Victorian services of health work continuously towards improvisation of patient safety and to collect necessary information and cues from the patient such that adequate care in transitioning is accounted for especially in the high-risk steps.

The possible consequences of not enquiring regarding the patient's journey and possible impacts and considerations affecting a patient's health will in turn lead to long-term health-related consequences (Worrall-Carter et al, 2016). In case the patient situation is not known adequately then there are possible risks from avoiding crucial information that might be needed in rendering patient healthcare outcomes. Hence not recording such information or not inquiring about them might lead to missing out on crucial information needed for appropriate patient care outcomes.

Question 2a. (Table 2)

Question 2b
It is essential to consider multiple perspectives on the patient journey to understand and evaluate the most crucial factors that impact a patient's health. As a patient experiences ill-health and thereafter received treatment followed by a path to recovery, at each stage, there are several factors influencing patient healthcare outcomes. At each stage, such influences might be different against one another. Considering multiple perspectives on the patient's journey enables diagnosing the most essential or relevant impact that either enhances or deteriorates patient health (McDonald et al, 2018). This in turn allows accommodating suitable intervention options such that adequate is can be undertaken for the patient. The patient experience had been substantially different during different times in his patient journey. Such as in this case, the patient felt shortness of breath, post which he received initial treatment at both the hospitals, only after which surgery procedures were conducted on him. He realizes that he received appropriate treatment and in-time which saved his life and in a similar situation his brother had expired. So, though he is happy from receiving appropriate treatment yet he is not clear regarding the type of treatment received and not aware of the post-discharge procedure. Lack of interpreter or the nursing staff communicating in a hasty manner with the patient has affected the patient's knowledge related to his treatment. So, while all necessary interventions are enclosed in documents, there is absent patient confident communication regarding the procedure he has faced. It can be said that the entire patient journey had been in the dark and in the absence of his acknowledgment. In case such perspectives are not considered then it is not possible for providing suitable nursing intervention strategy. For instance, in this case, if the community center nursing practitioner does not become aware of all this experience taken place with the patient, then he/ she will not be able to provide suitable intervention such as in pharmacological planning or counselling for recovery. The nurse will be able to adequately apprehend the patient's condition for diagnosing a suitable plan for intervention. Hence for providing appropriate nursing interventions and avoiding possible consequences of failure from such interventions, it becomes essential to enquire about, record the information related to the patient's experience.

Question 3
The key findings from the patient experience include lack of social, personal, and cultural support that has hampered patient comprehensive health care and rendering safe patient care. Every hospital and healthcare center in Australia, which provides healthcare and healthcare support to aboriginals and Torres Strait Islander people need to have staffs or culturally supporting patients in need. There needs to be available aboriginal liaison officer culturally competent health care staff that can adequately assist in not the only interpretation of information but also in offering comprehensive treatment to patients in a culturally appropriate manner. The gap, in this case, is the absence of cultural support and strategies which could assist in addressing this would be through the appointment of an aboriginal liaison officer (Kelly et al, 2018). As evident from the patient journey, the patient and his wife could not comprehend information that was provided to them and there was no interpreter available, only there was a telephone interpreter available for minor translation. The patient and his wife could not understand the language or comprehend what the healthcare staff wanted to communicate. Post this analysis, in order to improve current practices that are in place, a liaison officer can be appointed, who along with aboriginal health service providers can better understand the aboriginal culture. This would assist in establishing a better relationship with the patient. The culturally appropriate framework will make the patient feel welcome and included in care planning. This will improvise his health outcome as he will feel cared for and his needs attend to. Another gap present that was prevalent from the patient experience includes the absence of patient support needs. In order to address this gap, there need to be adopted strategies that can effectively address every patient's needs in particular. The patient and his family needs have to be adequately identified, there needs to be social support extended to the family and especially to the patient (State of Victoria, 2020). Patient support strategies through social support will provide the patient and his family assurance that they are being cared for. Inpatient support strategies when a social supporter will be called then it will reassure the patient and will assist in meeting his healthcare needs. Inpatient support strategies, culturally suitable education needs to be provided to the staff such that proper guidance and a better understanding regarding the aboriginal culture can be developed, which in turn enables rendering a culturally appropriate strategy.

Question 4
In this current patient journey, there have been significant gaps identified along with suitable strategies which in turn could enhance patient healthcare outcomes. One strategy that could be applied in the case study patient journey is patient support strategy by adequately training staff for rendering suitable care. Healthcare staffs already receive prior education and support related to providing culturally appropriate treatment to aboriginal people. As in this case, the patient can be seen to be not receiving any culturally suitable interventions in the entire patient journey and the healthcare staff being not taking care of the same, these staffs need to be provided suitable training. The healthcare staffs need to be trained regarding ways of communication that they can approach in the absence of an aboriginal liaison officer or they can also be made aware to remain conscious when rendering services to aboriginal people. Then they will be asked to undertake appropriate approaches in consultation with aboriginal people such that they can attain better healthcare outcomes. This will greatly influence the health care outcome of the patient as this will include providing service by recognizing the cultural distinction of the aboriginal people. The strategy will be implemented by way of the on-the-job training process and all healthcare staff will be engaged in such training. The impact of such strategies will be measured by understanding the sustainability of healthcare outcomes. There can also be adopted as a feedback procedure for understanding the effectiveness of such strategies.

Question 5
The case analysis has provided significant learning, from the point of view of the personal and professional domains. I had learned in my course regarding culturally appropriate practices but was not aware as to how such practices could impact patient services. With this case study analysis, I became aware of how culturally ineffective services can hamper patient healthcare outcomes. This case analysis challenged me significantly as I personally was not aware of the effective strategies to be planned for attending to the gaps. I had to search through relevant sources for arriving at suitable outcomes in regards to the same. I apprehend that in the future, I could make use of this learning and apply culturally significant and suitable strategies while caring for aboriginal people. In the future, I could make my colleagues aware of this challenge faced and then provide suitable interventions for the same. I will incorporate the learning’s in my nursing work by adopting culturally appropriate strategies in the future.

Reference
Kelly, J., Dwyer, J., Mackean, T., O’Donnell, K., & Willis, E. (2018).Coproducing Aboriginal patient journey mapping tools for improved quality and coordination of care. Australian journal of primary health, 23(6), 536-542.Doi: 10.1071/PY16069.

Li, J. L. (2017). Cultural barriers lead to inequitable healthcare access for aboriginal Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207-210. Doi: 10.1016/j.cnre.2017.10.009.

McDonald, H., Browne, J., Perruzza, J., Svarc, R., Davis, C., Adams, K., & Palermo, C. (2018). Transformative effects of Aboriginal health placements for medical, nursing, and allied health students: A systematic review. Nursing assignmentNursing & health sciences, 20(2), 154-164.Doi: 10.1111/nhs.12410.

State of Victoria.(2020). Safe Patient Care Act 2015.Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015. Retrieved from Worrall-Carter, L., Daws, K., Rahman, M.A., MacLean, S., Rowley, K., Andrews, S., MacIsaac, A., Lau, P.M., McEvedy, S., Willis, J. &Arabena, K. (2016). Exploring Aboriginal patients’ experiences of cardiac care at a major metropolitan hospital in Melbourne. Australian Health Review, 40(6), 696-704. Doi: 10.1071/AH15175.