Determinants of health that are impacting Aboriginal and/or Torres Strait Islander peoples-Ben case Study

CASE STUDY

Ben is a 14year old young Wiradjuri man from Dubbo who has recently moved off country with his family to Forster NSW after his dad Peter started a new job. Ben and his family have developed an excellent relationship with the local GP at Tobwabba Aboriginal Medical Service since they moved to the area. Recently Ben had contracted COVID-19 which has resulted in an exacerbation of his asthma, his parents have been concerned for his potential deterioration so contacted their GP who instructed them to go straight to the Hospital for treatment.

On arrival to the hospital Ben and Peter were cautious and guarded as historically the hospital can be a very discriminatory place. Ben’s grandfather, a member of the Stolen Generations, had been taken from his mother at a regional hospital as a baby, and this pain and trauma has been passed on to Peter and his family in many ways making them both feel uncomfortable in the hospital environment. To their surprise they were greeted at the entry by a nurse who gave a warm reception and showed them the way to the Emergency Department (ED). This made Ben and Peter feel welcome in the space.

In ED, their nurse Jen could tell Ben and Peter were uncomfortable based on non-verbal cues so asked if they would like the curtains closed for privacy. She sat beside him and started some general conversation asking about Ben’s siblings and interests before asking if she could take his vital signs. Jen explained the treatment plan so both Ben and Peter understood and discussed further management once they go home. She also asked whether he identified as Aboriginal and/or Torres Strait Islander to which Peter replied “yes, Aboriginal,” she followed on to ask if Ben and Peter would like access to the Aboriginal Liaison Officer (ALO) whilst they were in the ED, acknowledging that it is an overwhelming environment, and a challenging time with Covid limiting the number of family allowed. Peter was surprised but also incredibly grateful for this service. This opened the conversation further and Jen could tell Ben and Peter were feeling a bit more relaxed. She pointed out the mural painted by a local Aboriginal artist in the community that she admired and took the time to tell the story behind it which turned out to be someone Peter knew. Just as Jen left to see her other patients, Megan, the Aboriginal Liaison Officer was already in the ED and popped over to meet with them whilst Ben received his treatment.

Megan noticed that Ben was quiet and avoiding eye contact, so she pulled up a chair beside him and began yarning about family, sport, and school before exploring how he has been feeling lately. Peter, feeling comfortable in the setting disclosed that he feels Ben has been spending more time than usual in his room and not seeing friends as much as he normally does. At first Peter had thought this was due to Ben being unwell with Covid, but as he got more comfortable in the conversation Ben disclosed, he has been feeling “a bit off lately and disconnected” and “not really wanting to see his mates.” Having never felt this way before he was unsure about discussing it with family, certain it would pass but said he was missing his family back home in Dubbo. With Peter and Ben’s consent, Megan discussed her concerns with the nurse who suggested the Youth Social Emotional Wellbeing (SEW) Assessment, a culturally specific version of the HEEADSSS assessment used in the hospital which highlighted the need for support. The Hospital made sure to send a prompt discharge summary to Ben’s GP at Tobwabba, where he was then connected with some regular check-ins and support through Tobwabba’s Social and Emotional Wellbeing Team. A few months later Ben and Peter returned to the Hospital to catch up with the ALO Megan and thank her for her care and consideration. Ben was back playing sport and hanging with his mates. They were planning a trip back to Dubbo the following week to spend time with family.

Questions;

1. Using the six guiding principles of trauma-informed care, critically discuss what was done well in this scenario and why? Support your answer with evidence-based research (20 marks)

2. Considering how a culturally safe environment was ensured for Ben throughout his hospital admission, critically discuss the impact of cultural safety in the healthcare setting on future health outcomes for Aboriginal and/or Torres Strait Islander peoples? Support your answer with evidence-based research (20 marks)

3. Identify three significant risk factors that can impact the Social and Emotional Wellbeing of Aboriginal and/or Torres Strait Islander Peoples? Critically discuss these in relation to the case study (20 marks)

4. Reflect on what was done well in this scenario in providing care for Aboriginal and/or Torres Strait Islander peoples. How could you learn from this in your future nursing career?

Consider how a culturally unsafe environment or one’s unconscious bias could negatively impact the healthcare experience and health outcomes for patients like Ben (20 marks)