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NURS13137 Outward Bound Nursing Studies

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NURS13137 Outward Bound Nursing Studies

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NURS13137 Outward Bound Nursing Studies

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Course Code: NURS13137
University: Central Queensland University

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Country: Australia

Question:

The Australian National Health Priority Areas (NHPA’s) highlight areas where primary health care is essential for improving health outcomes in the future.
This information is often presented as an educational activity by registered nurses.
Your assessment will be based around the NHPA of either, diabetes mellitus Or obesity.
Scenarios: Thursday Island.  
Thursday Island is the main centre of all the Australian Islands between Cape York and mainland New Guinea.  In 2011, the population of Thursday Island was recorded as 2610 people with 64.6% of the residents identifying as Aboriginal and Torres Strait Islander people.  As part of your placement, you travel to outlying islands to offer clinics to the residents.  While you are there, you take part in an Adult Diabetes Clinic.  You note that most of the patients have identified as Aboriginal and Torres Strait Islander.  
You speak to your preceptor, John, and ask if you can do an education session on diabetes for the Aboriginal and Torres Strait Islander people.  John tells you, “Yes, however, you must first identify and justify the need for such an event with your evidence.  After all, we are an evidence-based profession”.

Answer:

Introduction
Management of chronic diseases in most parts of the world requires constant communication between the patients and primary care providers like the nursing professionals, physicians and midwifes (Adams et al., 2017). In this case, the community is informed of the causes, symptoms, prevention measures, and management strategies of chronic disease such as diabetes  and this informed care is not only provided to the adults but also to the children using family centered care. In most cases, physicians do not have ample time to interact and advice their patients, which is critical in management of the disease (Moore et al., 2012). On the other hand, Lee et al. (2018) indicate that lack of communication between the caregivers and patients leads to higher mortality rate as well as increases the complexity of care process. This is because the patients also need to be involved in making critical decisions about their healthcare so that they can communicate their mode of lifestyle and causes of the disease to the caregivers that help in the management of their conditions (Paul et al., 2017).
This assignment discusses about diabetes related chronic health condition of Thursday Island, which is the main centre of all the Australian Islands between Cape York and mainland New Guinea. 64% of the population of this island are aboriginal and while taking part in the adult diabetic clinic it was observed that majority of the patients belong to this community. As diabetes is associated with lifestyle related disorder, in this evidence bases assignment an educational session and health promotional event will be designed for the aboriginal community with application of cultural intelligence to justify the cultural event and for this purpose, the clinical reasoning cycle will be used.
Application of cultural intelligence in the Educational practice for aboriginal community
While going through the adult diabetes clinic it was observed most of the aboriginal, Torres Strait islanders in the community are affected with diabetes, and therefore it was realized that this health issue need to be investigated (Hill et al., 2018). This was fulfilled by applying the Principles of Nursing Practice in my educational practice (American Diabetes Association, 2014). In this case, a detailed description regarding everyone’s involvement in the study and his or her contributions to towards a successful educational practice was described.
According to a publication by the Australian Human Rights Commission, the health status among the Torres Strait Islanders and Aboriginals is poor compared to that of the majority groups in the country (Parker & Milroy, 2014). One of the causes of these disadvantages is the widespread social and political inequality in the region. As a result, many of the members of this group might feel like they are “children of a lesser god” and fail to fully comply with the requirements of the study (Durey & Thompson, 2012). Therefore, they should be treated with the respect they deserve and sought their cooperation in the entire healthcare process. Another principle that was applied in this research involved taking responsibility for the actions as professionals albeit after consulting with the patients and their carers (Hotu et al., 2018).
Thus, this is one of the principles that were used while helping the aboriginals and Torres Strait Islanders to manage their diabetic condition. Management of the risks was another principle that was taken care of during the educational practice (Thompson, Woods & Katzenellenbogen, 2012). Most of the members of the educational group were not aware of the dangers of prolonged diabetes without proper treatment and thus it was the duty of healthcare professionals to inform them about the urgency of the matter. There were high chances of increased mortality rates if the risks associated with diabetes were not managed. Old age is also associated with high risks of suffering from diabetes. The condition is in progression and thus needs to be controlled to prolong the life of the patients (Armstrong, et al, 2018). The third principle that guided the educational practice was the involvement of the service users, patients and those who take care of them as well as a preceptor (Hays et al., 2015). Therefore, a meeting was arranged with all of them so that the issue of diabetes from a professional point of view could have been discussed and they were welcomed to provide their suggestions. After that, the next step will be convincing them of the need to take medical issues seriously since that would leave them healthy to continue with their normal businesses (Hotu et al., 2018).
Assessing, recording, and reporting the communication process during the treatments was also important in managing the situation. The confidentiality of the information will be handled in a sensitive way and all the complaints raised will be addressed (Hill et al., 2018). This part is important since some of the participants do not want the details of their ailments to be discussed in public. Honoring that agreement will thus be critical in coming into terms with the Torres Strait Islanders and Aboriginals who are the subject in the case study (McNamara et al., 2018). If there are some factors or issues that should be known by the Australian Institute of Health and Welfare (AIHW) then they will be indicated for revision purposes. Nurses can better understand social, economic, financial, or family issues affecting the patients since they are always in direct contact with their patients.
The World Health Organization has instigated various health strategies following which, the health of the patients will be improved (World Health Organization, 2016). In addition, the Australian Institute of Health and Welfare has published many risk factors, indicators, and general health information. Most of these factors focus on specific populations of interest since they have different health-related issues (Adegbija, Hoy & Wang, 2015). Further, while obtaining training, there are several skills acquisition opportunities are provided to the nursing professionals that help them to manage critical patient situation. Combining all these factors from different organizations will help in managing diabetes situation between the Aboriginal and Torres Strait Islanders in the Thursday Island (Hill, et al, 2018).
The nursing principle to be used in this case will be applied by following a number of steps. Firstly, understanding of the health professionals involved and their colleagues, patients, and their carers will be obtained by the end of the planning (Parker & Milroy, 2014). Such a step will allow the healthcare professionals involved in the planning to prepare for the goals of the practice and act as a benchmark for measuring achievements. On matters of growth, all the professionals will be asked to reflect on how the application of these nursing principles will help in their growth as a professional, the experience they gained from the project and advanced their knowledge in giving care to the community (Durey & Thompson, 2012). Thirdly, in the process of the educational practice, all the involved professionals will generate discussions with their preceptor on the approaches, attitudes, and behaviors that should be followed in a successful nursing care (Hays et al., 2015). Each nursing principle has special recommendations that need to be looked at in any nursing practice. For instance, not all communities in Australia are well-educated in matters of healthcare which makes it difficult for some community members to manage their health (Hotu et al., 2018). These areas will be looked at, where the principles are being practiced and those that seem not taken care of in order to establish what should be done. The patients and their families will also play part in making the practice a success (Dowden, 2017).
As mentioned in the nursing principles the practice will seek the attention and contributions of the Aboriginals and the Torres Strait Islanders in the management of diabetes in the region. In so doing, the patients and their carers will be able to compare the outcomes of the treatment with the goals they had established (Browson, 2017). This boosts the willingness among the residents to take part in the exercise. Also, in a case where they feel that certain expectations have not been met then they will be able to check their checklist and with the help of health professionals, the issue will be solved.
Health issues related to diabetes mellitus among the Torres Strait Islander and Aboriginals
Diabetes is a chronic disease that needs to be checked regularly before it becomes uncontrollable (Lecam Wasam, Ekinci, MacIsaac, Saffery & Dwyer, 2017). According to NCD Risk Factor Collaboration (2016), the disease is characterized by high glucose levels in the blood that are caused by insulin resistance to action or little or no production of insulin in the body. Some of the complications caused by diabetes are amputation of the lower limb, kidney problems, heart diseases, blindness, and stroke making it one of the top ten causes of deaths in Australia (Kapellas et al., 2017). As early as 1996 the disease claimed a total of 2991 deaths in Australia and it has been affecting people in various forms (McNamara et al, 2018). Diabetes type 2 also commonly referred as diabetes mellitus is the most predominant condition not only in Australia but also in other parts of the world (Holland, 2014). The disease is known to affect senior citizens above the age of 50 years and is characterized by the insufficiency of insulin in the body (Dowden, 2017). In nursing practice while posting in was Thursday Island this disease was the cause for alarm. Gestational diabetes was also an issue of concern among the Aboriginals and Torres Strait Islanders as well as Diabetes type 1 which accounted for about 15% of all diabetes cases.
The Australian National Health Priority Areas (NHPA’s) initiatives to manage the situation
The first diabetes initiative aimed at addressing the issue of diabetes was commenced back in the year 1999 when the vision impairment program was started in April. Secondly, there came the Defuse Diabetes campaign that was commenced in November 1999 (Hyde et al., 2017). The National Diabetes Strategy had also been endorsed the same year in August. Lastly, the Australian Institute of Health and Welfare later commenced the national diabetes register. The fact of the diabetes initiatives was started in 1999 shows how critical the issue was then and still, it is today.
Associated Complications and Diabetes Risk Factors
High prevalence rates of being overweight or obese among the persons suffering from diabetes are high. That’s the reason some of the patients on Thursday Island will be asked to change their lifestyle and embrace exercise to control the situation (Lukaszyk, et al, 2018). Another risk factor is that most of those aboriginals and Torres Strait Islanders do not participate in any form of aerobic exercise (Parahoo, 2014). This leads to overweight and accumulation of fats which increases the chances of suffering from a heart attack. Blood pressure prevalence rates are also among the Torres Strait Islanders and the Aboriginals. Some of these risks if not checked as per the aim of this research will result in some life-ending complications. For example, diabetic nephropathy and end-stage renal diseases have been on the increase not only between the two minor groups but also in other parts of Australia (Carey et al., 2017). Foot problems among the sick sometimes can be severe and lead to amputations of the lower limb. Stroke and emergency of heart diseases are also experienced among the diabetic people in the Thursday Island (Coffin & Green, 2016).
Data
The following data was extracted from various groups in the Australian communities. The data was extracted based on the socioeconomic and remoteness of the various communities.

 

Hospitalizations per 100,000 population(a,b)

Socioeconomic Groups

Males

Females

Persons

     Group 1 (lowest)

5,221

4,062

4,600

     Group 2

4,435

3,272

3,815

     Group 3

4,161

2,951

3,513

     Group 4

3,890

2,572

3,181

     Group 5 (highest SES)

3,172

1,975

2,527

Aboriginal and Torres Strait Islander status

 

     Indigenous

11,843

14,727

13,350

     Non-Indigenous

3,883

2,716

3,266

Source: The Australian Institute of Health and Welfare’s National Hospital Morbidity Database
From the data, it is clear that the more remote a community is the high the prevalence of diabetes among its members. For instance, in major cities in Australia, there were about 2870 and 4167 females and males respectively who had been hospitalized after suffering diabetes per every 100,000 people sample (Funston & Hering, 2016). At the same time, there were 14,727 and 11,843 females and males who were hospitalized after suffering from diabetes. In this case, the 2001 Australian Standard Population was used to standardize the age of the sample (Holland, 2014).
The remoteness can also be attributed to poor socio-economic factors that lead to bad living habits that could accelerate the condition. Finally, all the data was retrieved from the Australian Institute of Health and Welfare’s National Hospital Morbidity Database. The target population sampled in this case is 2015-16. The conclusion from this data is that the more remote areas and socioeconomic conditions of people have a positive relationship with the level of diabetes type 2.
Cultural differences between the Aboriginal and Torres Strait Islander with other majority groups
Most indigenous people like the Aboriginals and Torres Strait Islanders do not have equal health opportunities with non-indigenous Australians. Because of these disadvantages, they are exposed to greater risks of exposure to environmental and behavioral health issues. The conditions in which the Torres Strait Islanders and Aboriginals live do not in any way support good health (Funston & Herring, 2016). Health infrastructure and primary health care like how to detect and manage diabetes are long shots for the indigenous communities living in Thursday Island. Based on the figures of hospitalized indigenous people as recorded by the Australian Institute of Health and Welfare (AIHW) the rate has not significantly decreased over the last 10 years (Lee, et al, 2018). After realizing this during the practice session in Thursday Island, the idea was taken as alarming situations affecting the Torres Strait Islanders and Aboriginals. Precisely, there have been very little efforts to minimize the rate of diabetes between these two groups. This research will be used to air out this problem and urge relevant authorities to look at the matter.
The current high population of the youths among the Torres Strait Islanders and Aboriginals means that the issue will only get worse as years progress. From the site analysis, during the practice, It was confirmed that there is a booming population of indigenous youths in the Thursday Island. Every member of the community had to be kept safe to realize the best results of the study. This means that if research like this one is not conducted and used to air concerns about these groups then the health professionals might face worse medical situations in the future. The government should increase services in the region and control the situation early enough (Adegbija et al., 2015). Maintaining the status quo will only mean more people will compete for fewer resources in the future leading to worse health inequalities. ‘Systematic and avoidable’ health inequalities is the term that is commonly used by The Royal Australasian College of Physicians. The lack of better and advanced health services in the region is a deliberate and systematic discrimination that has been perfected over the years (Brownson, 2017). While posting in the Island, it was also observed in practical scenario that at Thursday Island was that most of those suffering diabetes are members of Aboriginal and Torres Strait Islanders, which confirms the Royal Australasian College of Physicians statement.
The Clinical Reasoning Process Applied
The Clinical reasoning cycle was applied in this scenario of educational campaign in Thursday Island.  This is because, the Levett-Jones clinical reasoning cycle provides a detailed reasoning for the applied interventions, its benefits, further action required and allows the professionals to reflect on it. In case of this educational intervention for aboriginal people of Thursday Island affected with diabetes was done using the eight steps.
Consideration of the patients’ problems
The community of aboriginal people was affected with diabetes and they were the considered patients for this educational session. They were chosen as the population in question because they were the majority population in the Island and the rate of diabetes occurrence was higher in this community.
Collection of Information and cues
The second step was to collect details of what could have led to high prevalence of a disease among a certain community more than any other community could. The culture and poor health and transport infrastructure were the main issues raised and aligned as per the recent statistical data about the community and research articles.
Processing of the information
The information collected was processed to measure its reliability in a clinical and nursing study.
Identification of problem and issues
The issues that could have led to diabetes among the aboriginal communities in the region were listed and their correlation to high diabetes levels in the region was also determined.
Establishment of facts
The healthcare team established that in deed the living conditions, lifestyles, and cultural tradition practices in the region were the main issues leading to high diabetes prevalence in the region. The facts were compared with causes of diabetes and we concluded that in deed the three factors were the cause of diabetes in the region.
Action taken
The healthcare professional’s team that were responsible to carry out the educational session decided to engage senior healthcare professionals by asking them to allow the team to educate the residents on the cause, symptoms, preventive measures, and treatment options of diabetes. In addition, the team also wrote to the health ministry requesting health education to be incorporated in the few hospitals in the region to help reduce the cases of diabetes.
Evaluation of outcomes
The research aimed at highlighting and teaching residents on the dangers posed by lifestyle and cultural traditions. The team will be evaluating the outcomes of these strategies in the region twice per year.
Reflection of the process
The process was successful and intends to improve the health situation in the region. It can also be used in other nursing research processes not only in Australia but also in other parts of the world where minority community living away from city lights have high prevalence of diseases.
References
Adams, K., Liebzeit, A., Browne, J., & Atkinson, P. (2017). How’s Your Sugar? Evaluation of a Website for Aboriginal People With Diabetes. JMIR Diabetes, 2(1), e6.
Adegbija, O., Hoy, W., & Wang, Z. (2015). Predicting absolute risk of type 2 diabetes using age and waist circumference values in an aboriginal Australian community. PloS one, 10(4), e0123788.
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), S81-S90.
Armstrong, G., Ironfield, N., Kelly, C. M., Dart, K., Arabena, K., Bond, K., … & Jorm, A. F. (2018). Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait islanders who are experiencing suicidal thoughts and behaviour. BMC psychiatry, 18(1), 228.
Brownson, R. C. (2017). Dissemination and implementation research in health: translating science to practice. Oxford University Press.
Carey, T. A., Dudgeon, P., Hammond, S. W., Hirvonen, T., Kyrios, M., Roufeil, L., & Smith, P. (2017). The Australian Psychological Society’s Apology to Aboriginal and Torres Strait Islander People. Australian Psychologist, 52(4), 261-267.
Coffin, J., & Green, C. (2016). THIS CHAPTER’S CENTRAL focus is to demonstrate how Aboriginal constructs, such as the Coffin Cultural Security (CCS) Model and the Cultural Security Continuum (Coffin 2007), offer culturally secure ways forward for Aboriginal and Torres Strait Islander people engaged in and affected by community development processes. We do this by focusing on two community development projects under-taken in the health and local government sectors in rural and regional Western Australia. The motivation for community …. Mia Mia Aboriginal Community Development: Fostering Cultural Security, 73.
Couzos, S., & Thiele, D. D. (2016). Aboriginal peoples participation in their health care: A patient right and an obligation for health care providers. Aboriginal and Islander Health Worker Journal, 40, 6.
Dowden, A. (2017). Improved Communication for Safer Patient Care: The Implementation of SBAR.
Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous Australians: time to change focus. BMC health services research, 12(1), 151.
Funston, L., & Herring, S. (2016). When will the stolen generations end?: A qualitative critical exploration of contemporary’child protection’practices in Aboriginal and Torres Strait Islander communities. Sexual Abuse in Australia and New Zealand, 7(1), 51.
Hays, R., Esterman, A., & McDermott, R. (2015). Type 2 diabetes mellitus is associated with Strongyloides stercoralis treatment failure in Australian aboriginals. PLoS neglected tropical diseases, 9(8), e0003976.
Hays, R., Esterman, A., Giacomin, P., Loukas, A., & McDermott, R. (2015). Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults. Diabetes research and clinical practice, 107(3), 355-361.
Hill, K. L., Harvey, N., Felton-Busch, C. M., Hoskins, J., Rasalam, R., Malouf, P., & Knight, S. (2018). The road to registration: Aboriginal and Torres Strait Islander health practitioner training in north Queensland. Rural and remote health, 18, 3899.
 Holland, C. (2014). Progress and priorities report 2014. Close the Gap Campaign Steering Committee.
Hotu, C., Rémond, M., Maguire, G., Ekinci, E., & Cohen, N. (2018). Impact of an integrated diabetes service involving specialist outreach and primary health care on risk factors for micro?and macrovascular diabetes complications in remote Indigenous communities in Australia. Australian Journal of Rural Health.
Hyde, Z., Smith, K., Flicker, L., Atkinson, D., Almeida, O. P., Lautenschlager, N. T., … & LoGiudice, D. (2018). Mortality in a cohort of remote-living Aboriginal Australians and associated factors. PloS one, 13(4), e0195030.
Kapellas, K., Mejia, G., Bartold, P. M., Skilton, M. R., Maple?Brown, L. J., Slade, G. D., … & Jamieson, L. M. (2017). Periodontal therapy and glycaemic control among individuals with type 2 diabetes: reflections from the PerioCardio study. International journal of dental hygiene, 15(4), e42-e51.
Lecamwasam, A., Ekinci, E. I., MacIsaac, R. J., Saffery, R., & Dwyer, K. M. (2017). The threat among us: significance and scale of diabetic chronic kidney disease in Australia. Internal medicine journal, 47(12), 1339-1341.
Lee, I., Purbrick, B., Barzi, F., Brown, A., Connors, C., Whitbread, C., … & Death, E. (2018). Cohort profile: The Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. International journal of epidemiology.
Lukaszyk, C., Radford, K., Delbaere, K., Ivers, R., Rogers, K., Sherrington, C., … & Broe, T. (2018). Risk factors for falls among older Aboriginal and Torres Strait Islander people in urban and regional communities. Australasian journal on ageing, 37(2), 113-119.
McNamara, B., Gubhaju, L., Jorm, L., Preen, D., Jones, J., Joshy, G., … & Eades, S. (2018). Exploring factors impacting early childhood health among Aboriginal and Torres Strait Islander families and communities: protocol for a population-based cohort study using data linkage (the ‘Defying the Odds’ study). BMJ open, 8(3), e021236.
Moore, K. L., Boscardin, W. J., Steinman, M. A., & Schwartz, J. B. (2012). Age and Sex Variation in Prevalence of Chronic Medical Conditions in Older Residents of US. Nursing Homes. Journal of the American Geriatrics Society, 60(4), 756-764.
NCD Risk Factor Collaboration. (2016). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4· 4 million participants. The Lancet, 387(10027), 1513-1530.
Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan International Higher Education.
Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet, 25-38.
Paul, C. L., Ishiguchi, P., D’Este, C. A., Shaw, J. E., Sanson-Fisher, R. W., Forshaw, K., … & Eades, S. J. (2017). Testing for type 2 diabetes in Indigenous Australians: guideline recommendations and current practice. The Medical Journal of Australia, 207(5), 206-210.
Thompson, S. C., Woods, J. A., & Katzenellenbogen, J. M. (2012). The quality of Indigenous identification in administrative health data in Australia: insights from studies using data linkage. BMC medical informatics and decision making, 12(1), 133.

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