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Acute Care Nursing Practice

Introduction to Impact of Trauma in Indigenous People

The essay reflects light on the impact of past experiences in Indigenous community on their future. Past experience leaves marks both on one’s present as well as one’s future. Impact of past experiences accumulates trauma throughout generations. One of the evident examples where intergeneration trauma is prevalent is the Indigenous community in Australia. The Indigenous people are considered weaker section of the society and lack access to quality education and healthcare as well. The Indigenous community is considered politically, socially, economically, and culturally deprived and resulted in dearth, trauma including various other forms of disadvantages from generations to generations. The past intergeneration trauma is still impacting the life of Indigenous people. The aim of the essay is to replicate the quotation written by Sir William Dean which states, ‘The past is never fully gone. It is absorbed into the present and the future”. The essay projects the importance of past trauma in Indigenous communities and also its impact on the present generation in terms of healthcare and midwifery. It also focuses on intergeneration trauma on the mental and physical state of Indigenous people. Nursing staff act as key component in relieving the intergenerational trauma by improving individual nursing practices to achieve concepts of equal care in health care systems for quality care.

The Traumatic Past of Australia’s Indigenous Community

Trauma can be related to the helplessness, anxiety, horror flash back of different situations. The Indigenous people have been experiencing community based oppression and racism which leaves depression and suicidal tendencies in the people. The Indigenous people living with their families were forefully from their loved ones in the past, about 1910-1917s under the rule of brutal and racist government. (Nogrady,2019). The Indigenous community being culturally and economically poor sections of the society were easily forced to follow British settlers. The separated children were taken to foster homes where they faced unequal care, bringing mental trauma from generations to generations. The ruling settlers sealed their shelter and this affected the Indigenous community mentally and emotionally and left them with poverty. Loss of shelter creates socio-economic barriers in the community. Epidemics and diseases were prevalent in the community and increases mortality rate among the community. It has been studied that about 50% of the Indigenous population deaths occurs due to small pox, a spiking disease during early 1970s (Apponyi, 2020). Poor access to health care systems due to remote presence restricts them from basic immunization in the patients. The epidemic consequently spreads from generation to generations and those who survived eventually die due to poverty. The associated trauma with the mental and physical health is assumed to accumulate through generations (Apponyi, 2020).

The consequent results of high costs for healthcare, loss of land and cultural barriers creates space for intergenerational trauma in Indigenous Australians. The associated traumatic condition leads to stress, personal harm, suicidal tendencies. Poverty forces them to rob privileged classes and hence remain associated with the criminal justice structure. Indigenous people life patterns and living is thought to be below than the basic standards. Health is majorly influenced by the culture and living practices and the social determinants of life were often considered with the state of living. World health Organization (WHO) co-related health with the living patterns and defined it as social determinant of health. Health status can be judged by the conditions in which individual is born, works, and grows (Menzies,2019). In the Indigenous community, the state of health is more often affected with socio-economic dimensions rather than the diseases. High healthcare cost and lack of quality nursing were considered social health determinants which continuously cause ntergenerational trauma. One of the biggest factors for not addressing the health issues in Indigenous people was lack of government conscience. It created a background for the discrimination at institutional which transform into unequal therauptic care (Menzies,2019).

Impact of Intergenerational Trauma

Discrimination on the basis of social and cultural aspects promotes intergenerational trauma among the Indigenous community. Unequal care services between the Indigenous and non-Indigenous remained prevalent throughout generations in Australia. Basic life expectancy in Indigenous is comparatively 10 years shorter in both males and females (Waterworth et al.,2015). The major factor contributing for health gap is prevalence of non-communicable diseases. Cardiovascular disease is the leading factor contributing followed by unequal health services. Moreover, diabetes contribute 10% and respiratory diseases around 9% (Waterworth et al.,2015). Indigenous people are more involved in smoking, alcohol and drug abuse due to low economic status and illiteracy. Smoking was found prevalent even among pregnant women, the state in which most non-Indiginous women are known to quit smoking. These factors directly project high health risk dimensions. Illiteracy and poverty increased the cases of domestic violence among Indigenous women and females were being dominated by men in Australia. This leads to traumatic conditions more in women compared to men. Intergenerational trauma and mental disorder accumulate at a larger extend among Indigenous populations which consequently gives rise to posttraumatic stress disorder (PTSD) including depression, anxiety, and schizophrenia (Heffernan et al, 2015).

In some cases, relapse of mental stress give rise to posttraumatic stress disorder in healthy individuals due to continuous low socio-economic status of Indigenous people. Psychological stress is more often influenced by political and cultural discrimination. Moreover, separation of children from families and keeping them under custody were two other key factors influencing traumatic stress among children. The pain of mental trauma is prevalent in the present and can adversely impact the present and future generations of Indigenous Australians as well. Mental and emotional inequalities during hospital stays favored mental trauma in Indigenous generations ( Radford et al.,2017). Language is one of the key elemental barriers for healthcare inequalities. Indigenous people do not speak English as their native contrary, while white Australians communicate usually in English. This leads to ineffective communication which consequently directs therapeutic inequalities. Indigenous Australians being the weaker section of the society experience disrespect from the nursing staff. The nurses usually ignore and do not attend the patient if belonging to Indigenous community. Nurses even make them stand for longer hours without even comforting them which makes them feel outsiders even living in their own nation. Nursing staff must respect Indigenous people which can reduce inequality in terms of mental, physical, and therauptic care (Lumbers et al., 2019).

Implications in Nursing Practice

Socio-economic barriers have influenced Indigenous people at a greater extend. Cultural differences, reduced access for appropriate health services, social health determinants are some of the factors contributing towards unequal healthcare services among Indigenous people. Disrespect shown by the health care providers including nursing staff is another common factor, which restrict the use of quality health services. Support from nursing staff help the Indigenous people in receiving quality care. Non-Indigenous nursing staff should make efforts to understand their cultural background and must be maintain throughout their professional life. (Lai et al.,2018). Barrier between Indigenous patients and non-Indigenous nurses can be solved by receiving training and education to understand their native language. Peer mentorship programmes for both nursing staff and patients as well can create opportunities for improved patient-nurse relationship. Training will enhance working skills apart from their formal qualification. Increasing the hospital staff by appointing nurses from Indigenous communities will create opportunities for increased patient-nurse bond. Indigenous nurses can communicate better with the Indigenous patients and create a healthy therauptic environment. They can easily share their inner thoughts and pain with the Indigenous nurses which leads to improved patient outcome (Durey et al.,2016).

Nurse's staff uses different combination of words to interact with the Indigenous patients. It helps to build not only to build trust with the patients but gain acceptance before starting their treatment process. Effective engagement with the Indigenous patients increases their access for healthcare services. Effective communication in healthcare settings is meant for understanding the verbal and non-verbal thoughts of the patients. The role of effective communication leads towards a strong patient-nurse relationship. In Australia, patients from Indigenous community lack superior health care services and language barrier is a key component for ineffective communication. Language barrier results in less care and safety and makes them shy as they cannot understand and reply to the nurses for what is being asked. Non-white Australians remain deprived of basic education and therefore lack confidence to ask questions which makes them non-responsive consequently. Nurses must apply intervention for providing equal healthcare services.(Shahid et al.,2017).

Strategies and Principles

Discussions with the Indigenous patients involve multiple feedbacks to reach to a final point during treatment process. Nurses and Midwifery Board of Australia (NMBA) in association with different states and territories have standardized primary rules and regulations for every health care professional (Cashin et al.,,2017). The primary aim of the principles is to protect the rights of every patient to receive equal and advance care from healthcare professional. The Board has also standardized a team of quality assurance for maintaining the effective care services to achieve effective care goals in the health care settings (Cashin et al.,,2017). Strong communication and cultural bonding are important factors which help in achieving the standards for effective and equal care. Equal health care services relieves the patient from mental and emotional trauma which has can affect not only the present but the future generations as well. The standards guide the health care professionals, multidisciplinary teams, and patients. They have homogenized cultural and social dimensions for effective care and safety to improve patient outcomes. The load of intergenerational trauma gets neutral by the application of these strategies. Discussion for treatment process in requires exchange of ideas and thoughts which can be achieved by continues practice, quality education, and mentorship. Indigenous community lack thought expression and nurse with advanced communication skills minimizes communication gap to achieve equal care standards. (NMBA,2017)

The nurses are trained for understanding both verbal and non-verbal expressions of the patients. Indigenous Australian patients express more with actions and body language. The skilled nurses understand the body language of the patient and try to improve treatment process after understanding continues feedback from the patients (ACHQS,2017). Effective care aids in identifying early illness of the patients. Direct eye contact between non-Indigenous staff and white nurses is considered dishonest & disrespectful and therefore understanding body signs is a key part of the effective care and helps to improve their mental and physical pain as well (GWAH, 2020). Nurse staff plays a critical role, which aids in achieving effective care goals in western healthcare setting. The equal care services in the Indigenous families creates strong and healthy environment. Understanding need and mental pain of the aboriginal patients in western healthcare setting has become important to impart effective care. Respecting their beliefs and thoughts promote effective palliative care in patients belonging to Indigenous communities. Nurses can role play a judge for providing equal healthcare services and policies to Indigenous communities which is important for minimizing intergenerational trauma (Cashin et al.,2017).

Conclusion on Impact of Trauma in Indigenous People

Trauma can be related to the helplessness, anxiety, horror flash back of different situations. The Indigenous people have been experiencing community based oppression and racism which creates trauma and suicidal tendencies among the people. Indigenous community being culturally and economically poor sections of the society were easily forced to follow the white Australians. Children were separated from their families. These children were then taken to foster homes where they faced unequal care. It brings pain and trauma which remains prevalent from generations to generations. The ruling Australians government sealed their mother land and this affected the Indigenous community mentally and emotionally. Loosing shelter makes them poor and helpless. The major factor contributing for health gap is prevalence of non-communicable diseases, cardiovascular disease being the leading factor Moreover, diabetes contribute and respiratory diseases around. Nursing staff must respect Indigenous people which can reduce inequality in terms of mental, physical, and therauptic care. Nurses and Midwifery Board of Australia (NMBA) in association with different states and territories have standardized primary rules and regulations for every health care professional. The primary aim of the principles is to protect the rights of every patient to receive equal and advance care from healthcare professional. Nursing staff must respect and understand cultural background in Indigenous people which consequently acts a ladder towards effective and equal healthcare services. Effective therauptic environment increases patient care and minimizes intergenerational trauma among Indigenous community.

References for Impact of Trauma in Indigenous People

ACHQS. (2017). National safety and quality health service standards. Retrieved from https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

Apponyi, S, (2020). Australia together. Retrieved from https://australianstogether.org.au/discover/the-wound/intergenerational-trauma/

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., &Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255–266.

Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., & Bessarab, D. (2016). Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Services Research, 16(1),1-13.

GWAH. (2020). National safety and quality health service standards accreditation policy. Retrieved from https://ww2.health.wa.gov.au/About-us/Policy-frameworks/Clinical-Governance-Safety-and-Quality/Mandatory-requirements/National-Safety-and-Quality-Health-Service-Standards-Accreditation-Policy

Heffernan, E., Andersen, K., Davidson, F., & Kinner, S.A. (2015). PTSD Among Aboriginal and Torres Strait Islander people in custody in Australia: Prevalence and correlates. Journal of Traumatic Stress, 28(6), 523–530.

Lai, G., Taylor, E., Haigh, M., &Thompson, S. (2018). Factors affecting the retention of indigenous Australians in the health workforce: A systematic review. International Journal of Environmental Research and Public Health, 15(5), 914.

MahB, L., Pringle, K.G., Weatherall,L., Keogh, L., Schumacher, T., Eades, S, Brown, A., Lumbers, E.R., Roberts, C.T., Diehm, C., Smith, R., Rae, K.M., (2019).Pregnancy stress,healthy pregnancy and birth outcomes – the need for early preventative approaches in pregnant Australian Indigenous women: A prospective longitudinal cohort stud. Journal of Developmental Origins of Health and Disease, 10, 31–38.

Menzies, K.(2019).Understanding the Australian aboriginal experience of collective, historical and intergenerational trauma. International Social Work, 62(3),1-13.

NMBA.(2017), Enrolled nurse standards for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/enrolled-nurse-standards-for-practice.aspx

Nogrady, B. (2019). Trauma of Australia’s indigenous “stolen generations” is still affecting children today. Nature, 570 (7762), 423–424.

Radford, K., Delbaere, K., Draper, B., Mack, H.A., Daylight, G., Cumming, R., & Broe, G.A. (2017). Childhood stress and adversity is associated with late-life dementia in Aboriginal Australians. The American Journal of Geriatric Psychiatry, 25(10), 1097–1106.

Shahid, S., Durey,D., Bessarab, D., Aoun, S.M., & Thompson,S.C. (2013). Identifying barriers and improving communication between cancer service providers and aboriginal patients and their families: the perspective of service providers. BMC Health Services Research,13(460), 1-12.

Waterworth, P., Pescud, M., Braham, R., Dimmock, J., & Rosenberg, M. (2015). Factors influencing the health behaviour of indigenous Australians: perspectives from support people. PLOS ONE, 10(11), 1-17.

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