Module 2 NUR2207
Define health
"Not just the physical well- being of the individual but the social, emotional and cultural well- being of the whole community. This is a whole of life view and it also includes the cyclical concept of life-death-life."
What is the code of professional conduct
1) Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues. 2) Nurses promote and protect the interests of people receiving treatment and care. This includes taking appropriate action to ensure the safety and quality of their care is not compromised because of harmful prejudicial attitudes about race, culture, ethnicity, gender, sexuality, age, religion, spirituality, political, social or health status, lifestyle or other human factors. 3) Nursing and Midwifery Board of Australia (2008).
Nine guiding principles for nurses that underpin SEWB
1. Health as holistic 2. The right to self-determination 3. The need for cultural understanding 4. The impact of history in trauma and loss 5. Recognition of human rights 6. The impact of racism and stigma 7. Recognition of the centrality of kinship 8. Recognition of cultural diversity 9. Recognition of Aboriginal strengths
Define cultural awareness
is observing and being conscious of similarities and contrasts between cultural groups, and understanding the way in which culture may affect different people's approach to health, illness, and healing.
What common and cultural and psychosocial issues do Indigenous people face
o Colonisation o Welfare o Trauma of dispossession o Removal of children o Abuse o Violence o Feelings of powerlessness o Shame/loss/uncertainty o Low self esteem o Greif o Lack of proper housing and basic amenities o Poor sanitary conditions o Stigma associated to social inequity o Racism o Poor education o Poor immunisation
2. Define the term culture
Definition of culture is Characteristics and knowledge of a particular group of people, defined by everything from language, religion, social habits, cuisine, music and arts
How to be welcoming
Be welcoming. • Use plain English. Think about what you intend to say. Link your ideas in a logical order. • Speak clearly and relatively slowly. Break the content into manageable segments. • Pause between segments or sentences to allow time for understanding. • Obtain feedback. Wait for, and expect a response to make sure you are being understood. • Check back, preferably using a question, such as: what is your understanding of the discussion so far? • Keep in mind the answer can mean many things. • Repeat key statements. Emphasise the content words (usually nouns and verbs). • Remember sometimes ACTIONS SPEAK LOUDER THAN WORDS. Explain meanings by gesture/example. • Be aware that cultural differences exist DON'T BE AFRAID TO ASK. • Remain calm. If someone offends you, point out the reason calmly and clearly. • Use accredited interpreters. • Develop your own network of resources. • Take your time.
What describes CALD people
Born in a country where the national language is not English. • Born in Australia but have a parent who comes from a mainly non-English speaking country. • Identify with, or have a social orientation towards, a non- English speaking culture. • Mental Health Division (2001). A Transculturally-Or
Define Social and emotional wellbeing (SEWB)
Broader than 'mental health' and 'mental illness' or individual behavioural and emotional strengths/ ability to adapt and cope with the challenges of life (AIHW 2012). Connection to land, culture, spirituality, ancestry, family and community, how these connections have been shaped across generations, and the processes by which they affect individual wellbeing. It is a whole-of-life view Includes the interdependent relationships between families, communities, land, sea and spirit and the cyclical concept of life-death- life (SHRG 2004). Situating mental health within SEWB framework aligned with Aboriginal and Torres Strait Islander concepts of health and wellbeing emphasising wellness, harmony and balance rather than illness and symptom reduction.
What is the 4 of the 5 principles for delivery of social and emotional well-being services
Checking for change: Identify Indigenousness, consult family and/or carer in assessment ratings Provide feedback to consumers and carers in a way that supports communication about change and promotes hope
What are the barriers to establishing an effective clinician-patient relationship
Communication barriers from lack of common language Incorrectly interpreting non-verbal communication (for example, use of space, body language, voice quality) Misunderstanding the consumer's expression of illness and illness expression Difficulty establishing agreed treatment goals and methods and achieving effective treatment.
What is the 5th principles for delivery of social and emotional well-being services
Considering clinical care: Take into account the experience and knowledge of the individual and their family, and The knowledge of the broader relationship between consumer and community
What are the 5 principles for delivery of social and emotional well-being services
Consumer and carer focus: Context and community: Continuity of care: Checking for change: Considered clinical care:
What is the first of the 5 principles for delivery of social and emotional well-being services
Consumer and carer focus: recognise that consumers, family members and carers all have experience with mental health problems, and their experience and role in recovery must be recognised and supported
What is the second of the 5 principles for delivery of social and emotional well-being services
Context and community: Maximise engagement and involvement of people from the local community Understand kinship structures and promote the importance of family, and Appropriate cultural and linguistic assessments
What is the third of the 5 principles for delivery of social and emotional well-being services
Continuity of care: Understand early warning signs, look for risk factors and triggers, Engage consumers in continual planning and regular review
What is cultural competency
Cultural Competency: • A set of congruent behaviours, attitudes and policies that come together in a system, agency or among professionals and enables systems of those professionals to work effectively in cross cultural situations. • Valuing diversity by accepting that the people served are from different cultural backgrounds and will make different choices based on culture. • Assessing its sense of culture by recognising that the organisation itself is shaped by its own culture and by analysing how it interacts with other cultures.
Define cultural sensitivity
is being aware of (and understanding) the characteristic values and perceptions of your own culture and the way in which this may shape your approach to patients from other cultures.
4. Develop an understanding in which migration and settlement experiences impact upon the lives of the CALD population
Humanitarian resettlement Began in 1947 and since then more than 750,000 people from different countries have arrived in Australia. Australia's Humanitarian Program has two components: o Offshore resettlement for people in humanitarian need overseas; Onshore protection for those people already in Australia who engage Australia's protection requirements under the United Nations 1951 Refugee Convention. On 18 August, 2012 the Migration Act 1958 amended to allow for regional processing of Irregular Maritime Arrivals (IMAs) to Australia.• • Refugees Number of refugees settling in Victoria approx. 4,000 people annually. Asylum seekers on bridging visas settling in Victorian community, approx. 10,000. Victoria receives one-third of all refugees and asylum seekers entering Australia, more than any other state/territory. Complexity: Most refugees and asylum seekers have experienced traumatic events eg physical and psychological trauma or torture, deprivation and prolonged poverty, periods in immigration detention and poor access to health care prior to arrival. Health care and support in the early periods of settlement. Successful settlement - including active participation in family, schooling, working and community life - is more likely once health is restored.
Name the 3 levels of racism
Institutional: Practices, policies or processes experienced in everyday life which maintain and reproduce avoidable and unfair inequalities across ethnic/racial groups (also called systemic racism); interpersonal: in interactions between individuals either within their institutional roles or as private individuals; Internalised, where an individual internalises attitudes, beliefs or ideologies about the inferiority of their own group
What is a social determinant of health
Racism (social discrimination)
What damages Health and explain how this is linked
Racism damages Health Racism linked with colonisation and oppression. • Tertiary sector, health systems and service providers can perpetuate Aboriginal health care disparities through attitudes and practices
Barriers for not seeking mainstream mental health services
The main reasons include the: o lack of cultural respect o lack of cultural sensitivity and cultural safety o lack of family involvement o lack of trust of mainstream mental health services due to the impact of Colonisation, Welfare, trauma of dispossession, o removal of children abuse and violence have all taken their toll. Feeling of powerlessness and shame, feelings of uncertainty, loss and low esteem o racism and the impact of social inequity
LO 3) Develop a holistic assessment for Aboriginal & Torres Strait Islander people incorporating the notion of emotional and social well-being
The mental health practitioner: Acknowledges and articulates diversity among people, carers, families and communities in areas including age, gender, class, culture, religion, spirituality, disability, power, status, gender identity, sexuality, sexual identity and socioeconomic background Facilitates care, treatment and support in a manner that demonstrates respect for the diversity of people, families and carers, and the cultural and social context in which they live Recognises that a positive, secure cultural identity is a protective factor for the mental health and wellbeing of the person, family and carers Respectfully uses culturally appropriate assessment instruments and techniques, where available and appropriate, and demonstrates awareness of the way in which cultural issues may impact upon appropriateness of assessment, care and treatment Determines if there are cultural considerations that, if taken into account, could assist the person and family/carers to feel more comfortable during service contact Implements culturally specific practices as described in relevant national, state and local guidelines, policies and frameworks Facilitates service delivery in a manner that accords respect for people's individual qualities, abilities and diverse backgrounds, and takes into account their age, gender identity, sexuality, sexual identity, ethnic group, gender and social, cultural and religious backgrounds Supports the delivery of equitable care and promotes equality of opportunity Articulates the extent and limits of their own cultural understanding and seeks cultural advice or support if needed Communicates effectively with the person and, where relevant, with family members and/or carers through the assistance of Aboriginal and Torres Strait Islander health and/or mental health professionals, interpreter services and bilingual counsellors Liaises and works collaboratively with culturally and linguistically appropriate care partners such as religious ministers, spiritual leaders, traditional healers, local community-based organisations, Aboriginal and Torres Strait Islander health and mental health workers, health consumer advocates,interpreters, bilingual counsellors and other resources
Why is it needed
To enable these aspects and individuals to work effectively and respectfully in cross-cultural situations
5. Acknowledge and analyse your own cultural values and beliefs and reflect on their implications for Mental Health care with CALD populations
We must consider the following: • notice our own cultural practices and individual behaviours and the impact these may have on Aboriginal and Torres Strait Islander people • understand and acknowledge the impact of our shared history since European invasion • learn about Aboriginal and Torres Strait Islander people's diverse cultures and what is important to them • act differently to our usual culturally preferred ways in order to respond to the issues we have learnt about • take initiative to create cultural safety and • continuously review and be open to direct and indirect feedback.
Explanatory models: The Bio-Psycho-Social Model
Widely accepted in Western countries. Mental illness a complex interaction between biological, psychological, and social and cultural factors. Biological Factors: eg genes. Psychological Factors: eg. self-esteem. Social Factors: eg. a stressful situation. Cultural Factors: eg. child-rearing expectations.
What does the MMHA - Multicultural Mental Health Australia promotes
ctively promotes the mental health and well-being of Australia's diverse communities and seeks to improve access, responsiveness and quality of mental health services for these communities. It achieves this through partnerships with the Australian mental health sector, transcultural mental health and refugee services and networks, federal, state and territory governments as well as the community.
How to help maintain and improve the mental health and wellbeing of culturally and linguistically diverse (CALD) people
eat well get enough sleep exercise regularly spend time with friends and family share their feelings with others do activities that they enjoy take time to relax.
What Cultural physical health concerns
o Overall in terms of indigenous health, they have higher rates of disease and illness when compared with the white Australian population. o This can be combated by providing them health care that adopts a model that incorporates the principles of indigenous community - controlled services which build capacity, strengthen ad roster relationship, and retain flexibility in addressing needs of aboriginal and Torres strait islander understanding of health and mental health. o They are more likely to be unemployed, less likely to own a home and are at more risk of being homeless which also puts a massive strain on their physical and mental health status.
What are the key elements of cultural competence identified in Mental Health
o Respectful and non-judgemental curiosity about other cultures, and the ability to seek cultural knowledge in an appropriate way; o Tolerance of ambiguity and ability to handle the stress of ambiguous situations; o Readiness to adapt behaviours and communicative conventions for intercultural communication.
What Impacts on mental health That indigenous people experience
o Violence o Abuse o Loss of culture o Loss of identity o Loss of community o Suppression o Exposure to disease
What are the reasons for Mental Health illness impacts upon Indigenous people
o community grief and loss of aboriginal community o living in continual poverty o loss of identity and culture o chronic disease o low-self-esteem and self -worth o premature death o poor education outcomes o breaking up of families - removal of children o poor living conditions o alcohol abuse o substance abuse problems o socioeconomic disadvantages o Limited access to health care services
1) Define the term social and emotional and well-being within the Aboriginal & Torres Strait Islander people
relates to a person's overall social, emotional, psychological (mental), spiritual and cultural wellbeing.
How to communicate in a positive way
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What appropriate and competent communication skills do students need to develop when working with Aboriginal and Torres Strait Islander people.
• Be aware of differences in verbal and non-verbal communication; • Appreciate the variations in linguistic and cultural aspects of interactions; • Recognise miscommunication; and • Understand the serious consequences of communication breakdown.
6. Utilize knowledge of CALD in a range of mental health context to be responsive to the client's cultural needs
• CALD = culturally and linguistically diverse backgrounds • CALD principles are: o Engage with consumers with sustainable, o reciprocal relationships o leadership and accountability o building on strengths within that community that you're working with o shared responsibility and decision-making • Relating to CALD backgrounds: o listen to patients experiences and health care concerns o access to health services o stigma surrounding seeking health o integrating the delivery of services so not just working normally but integrating with other members of the community
6. Utilize knowledge of CALD in a range of mental health context to be responsive to the client's cultural needs
• CALD principles are: o Engage with consumers with sustainable, o reciprocal relationships o leadership and accountability o building on strengths within that community that you're working with o shared responsibility and decision-making • Relating to CALD backgrounds: o listen to patients experiences and health care concerns o access to health services o stigma surrounding seeking health o integrating the delivery of services so not just working normally but integrating with other members of the community
What Factors are important to social and emotional wellbeing
• Connection to country • Spirituality and ancestry (family history) • Relationships with family members and friends (kinship) • Connection to community
4. Develop an understanding in which migration and settlement experiences impact upon the lives of the CALD population: A) Cultural and ethnicity B) ethnicity
• Culture is the customary, learned manner in which human groups organize their behavior and thought in relation to their environment. o Behavioral: The behavioral component refers to how people act, and especially interact, with one another. o Cognitive: Cognition involves how people perceive, classify, and interpret their world
Define cultural safety
• Goes a step beyond cultural sensitivity (being accepting of difference) to understanding that there exist inherent power imbalances and possible institutional discrimination that derive from historical relationships with people of different origins. It implies that the care provider has reflected on her own identity and the perceptions of them that others from different cultures may hold. Culturally safe practice implies the ability to keep these differing perspectives in mind whilst treating the patient as a person worthy of respect in their own right.
Ensure Factors are taken into Consideration (LO6)
• Listen to and understand the patient's perspective of the problem • Explain your perception of the problem and your strategy of treatment • Acknowledge and discuss the differences and similarities between perceptions • Recommend treatment while remembering the patients cultural parameters • Negotiate the treatment and form an agreement
A critical approach in Mental Health
• Mental health is a contested specialty • Treatments problematic • Culturally derived norms and values impose labels on behaviour ie diagnostic bias • Regulatory role: Managing the social and personal problems in society • Technical perspective assumes mainstream frameworks and treatments can be universalised to all patients/clients need for more sensitivity and overcoming linguistic and cultural barriers
What is cultural competence in Mental Health
• Refers to the attitudes, knowledge, and skills of practitioners necessary to become effective health care providers for patients from diverse backgrounds • Emphasis is on the attributes of the service provider and outcomes of the cross-cultural encounter rather than the unfamiliar culture of the consumer/carer.
What principles underpin cultural competency
• Rights (including human rights and the fundamental right of all Australians to access health care which meets their needs) • Meeting legislative requirements (e.g., Equal Opportunity Acts) • Responsibility (e.g., for action to address rights and legislative requirements) • Diversity (rather than treating everyone the same, acknowledging and respecting cultural differences and diversity in experiences) • Equity and inclusiveness (such as equality of access and non- discrimination).
Critical versus technical approaches
• Technical o Aim is to deliver care efficiently and increase utilisation. o Does not ask questions about power imbalances between groups. • Critical o What is going on when interventions developed for one population are applied to another? What are the underlying power relations? Whose interests are being served? Is there a covert attempt to impose the values and perspectives of the dominant group? o Becoming a user of Western health care involves accepting its underlying philosophy and values "acquiring health literacy"
What does cultural competence means on an individual level
• Understanding the concept of culture and how it influences behaviours, as well as interpretations and evaluations of behaviours. • Demonstrating an openness and willingness to identify and explore one's own cultural values, beliefs and attitudes. • Demonstrating an openness and willingness to explore the same things from the perspective of people from other cultural backgrounds than your own. • Demonstrating the ability to identify useful and culturally appropriate strategies for working with people from diverse cultural backgrounds.
Explanatory models help explain
• Why something happened: • Why it happened to that particular person at that particular time and in that particular way; • How it came to happen or what caused it; • What should happen over the course of time; • What should be done about it; • What will happen with a given response.
What influence a person's social and emotional wellbeing
• discrimination and racism • physical health problems • child removals and unresolved trauma • violence and family violence • death of family members or friends • substance and/or alcohol use • social and economic factors (education, employment, income, housing)
