NSG 3101 – ASSESSMENT 1 – WRITTEN PAPER
Length: 2,000 words
Mark loading: 50%
1. You are required to prepare an academic paper that critically analyses the literature related to the Community Care of one of the following patient types: Select one cohort to discuss.
∙ Care of a chronically ill child or adolescent in the home or in the community ∙ Care related to a person with a sexual health concern in the community ∙ Care of an elderly person in their home
∙ Care of a person living in a remote or rural area
∙ Refugee, immigrant or Indigenous health care in the community
∙ Care of a person who is homeless/displaced
1. 2. Select a health issue that could be managed in the community for your selected patient from one of the cohorts listed above. i.e. a chronic/life limiting condition.
Your paper must provide an evidence based (literature) supported discussion that must include:
a) An introduction that clearly identifies the patient type (cohort) and the health issue this patient has that will be best managed in the community.
b) A discussion regarding the rationale for caring for this patient in the community. i.e benefits/advantages.
c) The nurse’s role, and nursing considerations/responsibilities when coordinating care (for your particular patient) as it relates to:
a. Assessment and documentation required (E.g home risk assessment) b. Resources required (E.g clinical, medications, equipment)
c. Appropriate collaboration, communication and team meetings
d. Data collection and information sharing among multidisciplinary practitioners e. Referrals
f. OH & S- safety of the nurse/health professional and patient
g. Legal, ethical and cultural considerations
h. Family capacity to support care and/or the resources family/carers may need to access
i. Any challenges that may arise when caring or coordinating care for the patient in the community
d) The conclusion should include a summary of key findings and clearly and succinctly tie together what you have discussed throughout your paper.
This paper analyses the health condition within the following care as discussed below. The paper also discusses the rationale for caring for the patient within the community. In the later section, the nursing role, consideration and responsibilities while coordinating the care for the patient is discussed.
Mr. Samuel is 35 year old having history of chronic alcohol and other illicit drug use. He was admitted to hospital for pain in abdomen and vomiting. He was feeling dizzy and axious and fatigued. He has history of suffering from pain in abdomen frequently and is diagnosed with grade 2 liver swelling. He was given medication for his pain and vomiting by physician and advised counseling for stopping his alcohol. He was discharged to his home along with some referrals and support references which could help him control his addiction and mange her health in adequate manner.
He lives in the remote countryside with his extended family; he was a painter in local area but has quit working 6 months before owing to his addiction. He is now largely dependent on his family for meeting his needs. He is very close to his community and explains that since childhood all his habits were highly influenced by the peers within the community.
He has a working wife and they often argue about his employments status and addiction at home, they live in small compartment and dream of having their own house. When he was boy he wanted to be a doctor but due to lack of resources and guidance end up being unemployed and uneducated, his current conditions and few instances of discrimination while seeking jobs have triggered his addiction for alcohol and other drug substance.
SELECTED COHORT GROUP- REFUGEE, IMMIGRANT OR INDIGENOUS HEALTH CARE IN THE COMMUNITY
Mr. Samuel belongs to the refugees, immigrants and the indigenous cohort. Due to significant unmet health needs delivering the health care system to them continues to be the biggest challenge to the Australian healthcare system. Refugee, immigrant or Indigenous population is recognized to be an underserved population with a higher rate of mental health disorders, Alcohol and other drugs and infectious disease. Alcohol and other drug substance consumption are one of the major causes of disease preventable illness in Australia (Australian Government Department of Social Services, 2014. Studies within Australia have found that people who are drinking alcohol or injecting drugs regularly tend to experience considerable poor health outcomes. Also, there is an evident relationship between alcohol and other drug dependency and conditions like homelessness, relationship stress, mental disorder, indulgence in crime and discrimination.
.The statics have found that alcohol and other drug abuse is comparatively high in the indigenous population than in the non-indigenous population (Australian Government Department of Social Services, 2014). Another survey has found that Aboriginal and Torres Strait Islander are more likely to develop drug dependency which can be 1.5 times higher than their non-indigenous counterparts. In the survey conducted 31% of respondents from the community were drinking alcohol whereas twenty-five per cent were drinking up to the level of acute alcohol poising. Also, 25 per cent has used the illicit substance including drug like cannabis whereas seven per cent has used sedatives for non-medical purposes (Australian Bureau of Statistics, 2013).
The factors for health issues for Mr. Samuel include socio-cultural influence within the community, experimentation, peer pressure, feel-good factor associated, and cope with the changing environment. He is also exposed to stressors related to the cultural, economical and living conditions contributing to AOD (Mwanri & Mude, 2021). The challenges due to difficult social and economical conditions intensify the feeling and behaviors toward the alcohol and drug abuse among immigrants and refugee.
The feeling of oppression, deprivation and loss of their identity has resulted in the feeling of being abandoned leading to increased cases of alcohol and other drugs. Discrimination, poor health, Low access to services and resources, lack of education, unemployment is some of the factors that influence the access to the healthcare service of the cohort further enhancing the health issue (Islam et al., 2018).
RATIONALE FOR CARING FOR THIS PATIENT IN THE COMMUNITY
Caring for Mr. Samuel with the home and community is more important than caring for him in hospital because strengthening the community services and healthcare system is a crucial strategy for reducing the inequalities among the marginalized population and improving the integration of the migrants, refugees and indigenous population with the local Australian community. Specialist community clinics have found to be effective in addressing the possible problem within the community. Mwanri & Mude, 2021 conducted a systemic review indicating that equity, cultural competency and creating community-based leadership were the best intervention provided to the compromised communities under the evidence-based guidelines. Mantovani, Pizzolati & Gillard, 2015 emphasized that community care for alcohol and other drug dependencies provides operational supervision within the community, reduce discrimination and promotes the value for human life. Also within the community setting through targeted outreach programs the health promotion, disease screening and prevention was possible due to collaboration, trust and advocacy.
The core elements for the success of the healthcare delivery system for indigenous people are based on the practices that enhance the cultural and linguistic education which are the biggest barrier to service accessibility while caring for Mr. Samuel in hospital (Mwanri & Mude, 2021. Alcohol and drug misuse are identified as a challenge to re-engaging the people hence setting them on a constructive health pathway at the comfort of home and within the community is an appropriate strategy. Furthermore, hospital care without community support cannot provide long term continuity of care (Mantovani, Pizzolati & Gillard, 2015). Community care lower chances of losing hope and turning again to alcohol and other drug use. The literature describes that the community and family have a protective role among the youth from the population and if they feel disconnected from the culture, community and family the chances of relapses are increased to three-folds (Abbas et al., 2018).
The cause of the alcohol and other drug abuse among the population is mostly contributed to the learning behavior of the individuals either due to feeling of disruption or influence hence connecting within the community may exert a positive impression and move toward a better quality of life (Islam et al., 2018).. Also with the community, there are probable factors including peer pressure or negative experience from being in a particular community and may cause the development of risk-taking behaviour (Mantovani, Pizzolati & Gillard, 2015).
Federal government projects reports including the Senate Inquiry into Mental Health, National aboriginal health strategy, Aboriginal Drug and Alcohol Complementary Plan, it was indicated that the indigenous communities required their own AOD services outcomes which needs to be provided with the skills of the trained healthcare professional capable of addressing the linguistic, cultural and communication barrier (Baker et al., 2019). Hence the report suggested that this can only be achieved when healthcare services are set up within the community. These services should be available through community health services for example the immigrants and refugee clinic and the ACCHSs that can provide comprehensive primary care which is controlled by the community. This should be advocated through employing the professionals within the community helpful in reducing institutional discrimination (Mwanri & Mude, 2021).
Several foundations are working within the community set up to enhance the service accessibility and capacity of people within the marginalized population. One such project was Foundation House, which worked within the Karen community in Western Melbourne for re-engaging the youths of eth community for future pathways and opportunities by promoting positive health behavior in regards to alcohol and drug use (Dixit & Sambasivan, 2018). The program was successful in reducing alcohol and drug abuse. The biggest success of the project was the leadership within the community where the forum was set up to discuss, support and community capacity building (Baker et al., 2019).
NURSING ROLE, CONSIDERATIONS/RESPONSIBILITIES WHEN COORDINATING CARE
In 2017, as per the workforce strategy, the government of Australia proposed the fit for purpose model for the development of RN role while treating the indigenous population in the most remote areas of Australia (Dixit & Sambasivan, 2018).
In Mr. Samuel case the nurse responsible for screening the risk factors and delivering a range of interventions in their scope of clinical practice. The responsibility includes analysing the past medical history, psychosocial issues, indicators of risk, physical signs and symptoms, current mental health status. For this the tools required are the mental state assessment form, suicide risk assessment form, Alcohol Use Disorders Identification Test guidelines, Depression, Anxiety, Stress Scales, Severity of Dependence Scale, Indigenous Risk Impact Screening form, Nicotine Tolerance Questionnaire (Ministry of health, 2021). To provide early promotion and education within the community the material is required with the native language (Dixit & Sambasivan, 2018). Due to poor injecting practice, these individuals are at higher risk for developing multiple infectious diseases hence nurses can play an important role in providing them medicinal support including Hepatitis B vaccination (Baah, Teitelman, & Riegel, 2019). The equipment required while working with Mr. Samuel for his home care are basic equipments required for evaluation monitoring of condition including glucometer, blood pressure machine etc (Russell et al., 2019).
As Mr. Samuel is living with the extended family hence he have complete family to care of him so they should also be taken account for care planning and decision making process. Due to the risk behavior related diseases including blood-borne disease and sexually transmitted disease. The wife should be made aware of the possible risk factors associated and the precautions that should be taken, also nurse is responsible for providing him the necessary vaccination or his risk of developing hepatitis B due to frequent injecting habits (Russell et al., 2019). Individuals diagnosed with Hepatitis B should be referred to a specialist. Referrals are required in case of in case of intoxication, overdose, acute withdrawal and repeated relapses (van Gaans & Dent, 2018).
For surveillance and reporting of the drug and illicit drug use to the local authority as a responsibility nurse work in collaboration and complete all the reporting formalities in the set format. The data should be collected properly and information should be shared with competent authorities (Devine & Lawlis, 2019). Taking the illicit drug is a criminal offence as per the drug act hence for illicit drug use the healthcare setting may include police custody, liaisoning and diversion services that works closely with police and courts, hence nurses are responsible for supporting the safe transition from the custody to the community, relapses prevention, addressing the vulnerabilities and tendency to suicide. In case of Mr. Samuel the nurse need to work with the Aboriginal Liaisons officer. (Corscadden et al., 2019).
As Mr. Samuel is having AOD the risk of visiting him at home may include the safety concern that might raise due to his state of toxication. He might get violent and aggressive under the influence of alcohol and drug and may harm the nurse. Through cultural and communication competence nurse are responsible to establish therapeutic relationships with individual, their families and careers. They use their expertise to influence the decision making of the group within a positive direction; they promote the support and behavior of self-care through respect and integrity. The ethical and legal nursing consideration while working with Mr. Samuel may include human right and ethical conduct of nurses. The prime legal and ethical issue may include the informed consent, which should be provided in the local language. All the consent should be dully signed by him and the family before starting home care plan for him. Being a vulnerable population they should be dealt with respect and integrity on one hand and respecting their choice and self-determination as part of their autonomy (Robards et al., 2019).
Though various government surveys and studies we understood that interventions provided to the Aboriginal and Torrens islander, immigrants and the refugee facing alcohol and other drug dependencies should be focus on communities, individuals’ levels and family. The level of interventions provided in the light of practice of scope of nurses should include promotion, prevention, intervention, and rehabilitation based on the pillars of respect, care, support and human rights.