Aboriginal Community Controlled Health Services - Free Samples

Question: Discuss about the Aboriginal Community Controlled Health Services. Answer: Introduction The contemporary nursing profession is increasingly focusing on the patient rights and issues on shared decision making. Nurses are not only required to be accountable to their patients, but also to the public, their employers and other stakeholders. However, the application of these principles requires deep understanding of the culture and social issues facing the patient (Cherry and Jacob, 2016). The perspectives and cultures of the Aboriginal people play a critical role in the palliative care decision-making process. The multiplicity of players that influence this critical decision create a fertile ground for conflicts and legal conundrums (Crawley and Koffman, 2015). This is the situation that arose in the management of Tom, a patient who was placed in palliative care. The nurse in charge of Tom faces numerous professional and legal issues to deal with in the management of the patient. The primary duties of a nurse include the care of all patients, confidentiality, and autonomy. These duties are supplemented by the principles of beneficence and non-maleficence. However, autonomy is complicated in cultures such as the Aboriginal society where the whole family (and sometimes including extended family) is needed to make the management decisions (Johnston, Vukic, and Parker, 2013). It obscures the process of informed consent when each of these members has differing opinions or understanding of the patient management. In the situation of Tom, the nurse needed to respect the palliative wishes of the patient in his management. These included the use of morphine/midazolam for the treatment of his pain or dyspnea and the regard of his medical registrars notes. However, the health of the patient is also deteriorating to the dislike of the family, and better supportive care need to be initiated. The biggest challenge is the person responsible for the final decisions of the patient. While the family is aware of the wishes of Tom for palliative care, they are also concerned about his deteriorating health. The person Tom had assigned to make decisions on his treatment and be his guardian, Cec, was present when Tom decided to use the morphine and be subjected to terminal care. Tom had also done an advanced care paper. However, the daughter wants to override these decision and uses her power as an attorney to implement the changes. She wants better treatment strategies for her father, which causes distress to the other family members. Her wishes are justified within the legal confines, but create a clinical conundrum in the management of the patient. The legal issues in the situation extends beyond the basic understanding of the law to the frameworks of the Aboriginal culture. Their indigenous life requires that family strength is maintained, and an effort to divide the family may be disrespectful (Duggleby, 2015 p. 1722). Consequently, the decision on the management of Tom will need to be collective and protracted. However, there is need to also maintain the professional nursing ethos and standards in applying the decisions from the family members on the health of the patient. At the end of the day, the nursing care provided to the patient are based on his best interests. Goals in the management of the patient The complication of Toms situation arose from the need of Carina to apply modern laws in a setting that is influenced by cultural forces. The fact that Tom has already gone back to the community and consulted with the other members means that the family is at peace with the palliative care process. It took consultation with the senior members of the society before agreeing to use the morphine treatment. However, Carina believes that the treatment is not appropriate for his deteriorating father, and uses her legal powers to override any prior consent. In such a situation, there is need for wide consultations between the family members and nurses to determine the most appropriate methods of managing the patient. The cultural issues surrounding the palliative care of Tom need to be considered while ensuring that professionalism is observed. Therefore, as a nurse in the hospital, there is need to establish appropriate palliative care aims that will be acceptable to the patient and improve the quality of life of the patient. The first basic principle is to ensure that Tom suffers the minimum pain possible. The use of morphine is intended to reduce the pain and dyspnea, but it has not dealt with the symptoms that were being experienced by the patient appropriately (Kamal et al., 2012). Tom has not improved on his long breath gaps and reduced appetite, which is beginning to cause concern with the family members. However, the patient was categorical on the morphine dosage to avoid drowsiness as he wants to spend the last moments with the family. As a palliative care nurse, the comfort and well-being of the patient are the core objectives. The fact that Toms symptoms are not improving is a cause of concern to both the nurse and the family members. Therefore, the use of supportive therapies to alleviate these symptoms is fundamental (Panaretto et al., 2014). It is imperative to discuss these issues with Carina and other family members to see if there is a need for other medical interventions. The nurse needs to plan a shared decision-making process with the family. This can help to identify the best medications to alleviate the symptoms. The palliative care should also aim to create a spiritual and emotional well-being of the patient and the caregivers. The process includes accommodating the friends, family, and community of Tom in the hospital according to their customs. These members had appreciated the significance of the palliative care provided to Tom before Carina came. It is also important that Carina also understands the plan and process of managing his father. The nurse has an obligation to understand Carinas perspective and inform her of the possible benefits and risks of the available options (Kelley and Morrison, 2015). This will lead to meaningful interactions, which will make the whole family understand any interventions and procedures incurred in the palliative care process. Carina will also understand that a higher dosage of morphine could reduce the observed symptoms, but might make her father drowsy. Course of action The end-of-life care is an emotional moment for the family members of the patient. The nurse in charge needs to establish a proper communication platform that can enable an appropriate exchange of information between the two parties. Communication is essentially vital in the situation facing Tom due to the cultural and social barriers to nursing care (Morton et al., 2017). The family could provide useful cues that might help in the management of the patient without creating any fears or discontent among the family members. The first course of action would be a brief highlight of the events that led to the present care of the patient. As Carina was not there initially, she would have missed the reasons her father is being subjected to palliative care. However, the Aboriginal societies are family-oriented (Lau et al., 2012).Any decisions or insights from the discussion with carina need to be approved by the other family members. Therefore, it is important to involve the family members in the management plan of Tom in this situation. Deliberations between the members will lead to a common ground that can inform the future management of Tom. Shared decision making will inform the willingness of the Aboriginal members to accept and adopt the palliative care plans. Satisfaction services might improve the perceptions of these indigenous groups to palliative care (Shahid et al., 2013). One of the issues that had made Tom skeptical of the palliative care was the morphine effects observed in another member of the community, Aunty Joyce. However, the little doses of morphine that Tom is receiving at the moment are not helping to alleviate his symptoms. The sharing of evidence-based decision with family members such as Carina will help improve their knowledge on the available options and improve the accuracy of their expectations on the possible harms or benefits (Hohler and Faan, 2017). The nurse also needs to develop a therapeutic plan to address the symptoms that Tom is experiencing. These medications can help to alleviate the symptoms such as shortness of breath and missing meals. However, this needs to be based on evidence-medicine and wide consultations with the family (Becker, 2016). The discussions with the family could also expose cues to other possible medications that Tom might have used in the past. Nevertheless, the plan should ensure that the wishes of Tom as the patient are respected, and the nursing professionalism is maintained throughout the process. Conclusion The management of Tom is surrounded by cultural, ethical and legal dilemmas. The goals of the management of Tom should include alleviation of the symptoms he experiences, and the fostering of an appropriate spiritual and physical environment for the transition. There is need to establish a proper communication channel with the family members that might provide useful hints in the management of the patient. The shared decision-making process with the family members would provide a realistic appreciation of the probable risks and benefits of the treatment options. It would also help the family to make informed decisions on the potential outcomes. References Becker, R., 2016.Fundamental Aspects of Palliative Care Nursing 2nd Edition: An Evidence-Based Handbook for Student Nurses(Vol. 3). Andrews UK Limited. Cherry, B. and Jacob, S.R., 2016.Contemporary nursing: Issues, trends, management. Elsevier Health Sciences. Crawley, L. and Koffman, J., 2015. Ethnic and cultural aspects of palliative care.Oxford Textbook of Palliative Medicine, p.84. Duggleby, W., Kuchera, S., MacLeod, R., Holyoke, P., Scott, T., Holtslander, L., Letendre, A., Moeke-Maxwell, T., Burhansstipanov, L. and Chambers, T., 2015. Indigenous people's experiences at the end of life.Palliative supportive care,13(6), pp.1721-1733. Hohler, A.D. and FAAN, M., 2017. Shared decision making. Johnston, G., Vukic, A. and Parker, S., 2013. Cultural understanding in the provision of supportive and palliative care: perspectives in relation to an indigenous population.BMJ supportive palliative care,3(1), pp.61-68. Kamal, A.H., Maguire, J.M., Wheeler, J.L., Currow, D.C. and Abernethy, A.P., 2012. Dyspnea review for the palliative care professional: treatment goals and therapeutic options.Journal of palliative medicine,15(1), pp.106-114. Kelley, A.S. and Morrison, R.S., 2015. Palliative care for the seriously ill.New England Journal of Medicine,373(8), pp.747-755. Lau, P., Pyett, P., Burchill, M., Furler, J., Tynan, M., Kelaher, M. and Liaw, S.T., 2012. Factors influencing access to urban general practices and primary health care by Aboriginal AustraliansA qualitative study.AlterNative: An International Journal of Indigenous Peoples,8(1), pp.66-84. Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2017.Critical care nursing: a holistic approach(p. 1056). Lippincott Williams Wilkins. Panaretto, K.S., Wenitong, M., Button, S. and Ring, I.T., 2014. Aboriginal community controlled health services: leading the way in primary care.The Medical Journal of Australia,200(11), pp.649-652. Shahid, S., Bessarab, D., van Schaik, K.D., Aoun, S.M. and Thompson, S.C., 2013. Improving palliative care outcomes for Aboriginal Australians: service providers perspectives.BMC palliative care,12(1), p.26.

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