What is A Reconciliation Action Plan and why it is important to improving Nursing practice

       A Reconciliation Action Plan (RAP), is a document that outline a framework for how individual organisations will help with the national reconciliation effort. It has practical actions that will drive an organisation’s contribution to reconciliation both within, and in the community in which it operates. The RAP helps to advance the five areas of reconciliation by supporting organisations develop; respect, create meaningful opportunities, and relationships with Aboriginal and Torres Islander people through collaboration.  Improving health conditions for Aboriginal and Torrs Islander people is a long-standing challenge in Australia (Reconciliation Action Plan, 2018). The gap in health status between Indigenous and non-indigenous people remains wide. For example, the maternal and perinatal outcomes for indigenous mothers is poorer than those of non-indigenous women. The death rates for indigenous individuals are much higher than non-indigenous population across all age groups (Health, 2018).  The reasons for this a multidimensional and complicated, some are social cultural, and others are institutional. The aim of this paper is to analyse how the RAP currently used by Anglicare, helps promote reconciliation and the impact it has had in reducing the health inequality in Australia. The main areas of for analysis are collaboration and building respectful and meaningful relationships.  This paper will also analyse how Anglicare plans on fostering a culture of mutual love and respect in their own organisation (Anglicare rap, 2017).

Summary

      The Anglicare reconciliation plan has three main overarching areas, these include; relationships, respect, and opportunities. In dealing with relationships, Anglicare is committed to developing effective collaborative relationships with Aboriginal and Torres islander people.  Relationships that are mutually beneficial between indigenous people and non-indigenous peoples.  This means listening to Aboriginal and Torres Islander peoples, so that the programs that are developed, reflects the needs the individual indigenous communities that Anglicare operates in. Secondly, Anglicare is committed to respecting Aboriginal and Torres islander cultures, land, and history.  The hope is that through Aboriginal cultural awareness and collaboration, meaningful relationships can be built. Thirdly, the RAP, values knowledge, understanding, experience, and relationships that are held by aboriginals and Torres islander people.

      Increasing opportunities for indigenous people within the organisation would bring new ways of viewing and solving complicated issues among Aboriginal and Torres Islanders. Fixing health inequality due to lack of access to medical care in Aboriginal communities should not be viewed as a simple case of spending more money and building more hospitals to bridge the gap (Mclean et al., 2019). In many communities with access to hospitals, there is still a gap in access to health care services. Reasons for this are many, ranging from mistrust due to colonialisation and the stolen generation. Also, there is a difference in the perception of health between Indigenous people and non-indigenous people. Hence closing the gap must be done in collaboration and building meaningful relationships with local Aboriginal and Torres Islander community elders. There is often a difference in perception of needs and the actual needs of the community (Aboriginal and Torres Strait Islander Concept of Health – Cultural Ways, 2020). Having Aboriginal and Torres Islander elders on the advisory board, ensures that the services developed, are culturally sensitive and reflect the needs of the community (Mclean et al., 2019). Other areas addressed in the Anglicare RAP include; continuous education among Anglicare staff in Aboriginal and Torres islander cultural practices. And having people on their staff that represents the people being cared for. This is done through having a weekly recruitment list of positions on offer which is sent to the aboriginal liaison (Anglicare rap, 2017).

The Framework

      One way the RAP contributes to the reconciliation process, is through building respectful programs in partnership with aboriginal community leaders.  It has done this through the development of an in-house cultural capability program in partnership with Indigenous staff and local elders. The cultural competence programs are based on the specific communities in which Anglicare operates and are facilitated by aboriginal staff. The programs are developed and tailored to meet specific barriers to accessing services in Aboriginal and Torres Islander communities. Another way the RAP contributes to the conciliation process is through Anglicare’s commitment to employing Aboriginal and Torres islander people. This is done through a weekly recruitment list of positions which are sent to the Anglicare liaison and then forwarded to the communities that Anglicare operates. These include Aboriginal health services, local Aboriginal land councils, and Aboriginal workers in Centrelink offices. The list also includes Aboriginal and Torres Islander artwork to attract Aboriginal and Torres Islander applicants. Finally, the RAP contributes to the reconciliation process through its commitment to celebrating Aboriginal art and culture in all its beauty.

     A key part of the RAP is forming meaningful relationships, with Aboriginal and Torres islander community leaders. Anglicare plans on doing this through having an Aboriginal and Torres islander advisory board.  The aim of building relationships is to understand the values and cultures of the communities. Understanding the culture would help the government authorities and health care workers develop health care programs that suit specific Aboriginal and Torres Islander communities. The RAP plans on achieving this through making sure that the organisation has Aboriginal and Torres Islander peoples on the working group.  This helps the organisation develop a framework for the delivery of health care that is targeted to communities. Collaboration with Indigenous leaders in matters of health, will help health care workers become embedded in the culture and traditional practices (Anglicare rap,2017).

Area of Improvement

      While the RAP does well at emphasising the need for collaboration and education in aboriginal culture, there is however no clear plan on how this will be integrated in the general Anglicare organisation. Learning about the culture is a lot different from living in the culture. For example, when, Zambia got its independence from Britain. The first head of state mandated that people would not go to school in their own town or tribe, this forced people to integrate. So, over the years through integration, people have intermarried within tribes that most Zambians do not know with accuracy which tribe they belong to. This is another way of forced integration and is like the busing legislation after Brown v Board of Education in America. Busing was a way the supreme court sort to remedy racial injustice by forcing integration in schools. Initially people did not like it, but over the years people have gotten used to it. And while there is still a lot of work to be done, America is a lot less segregated than before busing (History – Brown v. Board of Education Re-Enactment, 2019).  People tend to hate or are fearful of what they do not know. Anglicare could put as part of the general yearly competence that all Anglicare staff work in Aboriginal communities or have a roaster that is on a rotational basis. This would enable nonindigenous health care providers to experience the culture, learn the language and hopefully develop better ways of communicating with aboriginal and Torres Islander people.

 Area of Focus

       The area of focus for analysis is Respect.  Anglicare is committed to respecting aboriginal and Torres Islander cultures, land and people. The aim is to develop relationships that are based on mutual love and respect.  Promoting indigenous culture and understanding the language barriers is essential for several reasons. Firstly, it will help health care professionals develop effective ways care of indigenous people can be continually improved.  For example, Aboriginal cultures and Torres islander tend to value building and maintaining relationships (Communicating Effectively with Aboriginal and Torres Strait Islander People, 2016). Taking the individual before business approach will help form this relationship and build trust (Cabinet, 2016). Often when a staff member builds trust with the whole family, it is a good indication of how well the individual will respond to the service offered. In health care the first few minutes of meeting a patient are essential for establishing trust and rapport. Therapeutic relationships that are characterised by trust, respect and rapport provide better care experiences for patient. A therapeutic relationship also, goes a long way in in alleviating anxiety and stress and enhances patient involvement in the decision-making process about their own health (Bell, 2016).

        Communication difficulties between health care workers and indigenous peoples are mostly pronounced in remote areas where cultural and linguistic differences are the greatest. The close interdependence of language and culture makes the gap even wider. Many rural Aboriginal and Torres islander cultures to not speak English as there first language. Some also speak a different English dialect. Some aboriginal cultures view direct eye contact as rude, disrespectful and even aggressive. In this case, to convey respect the health care provide would avert and even lower their eyes in conversation. It is important to point out in health that a clinician is not just caring for the patients with the illness but also the family. This is especially true in some Aboriginal cultures, where due to kingship structures and relationship, decision making usually includes the input of other family members (Aboriginal Culture and History – Aboriginal Cultural Capability Toolkit , 2019). A nurse must check with the patient if their decision requires consultation from other family members. This is especially important when having discussions about end of life or palliative care. There is often a lot of ritual around how Aboriginals and Torres islander people deal with death.  People that believe in the afterlife will often approach the dyeing process different from those that do not.  

Leadership Qualities

      The first leadership quality that is embedded in the RAP is respect. One of the main important areas of nursing is treating every patient with a sense of dignity and respect  (Nursing and Midwifery Board of Australia – Fact Sheet, 2019). In health care making patients feel respected or valued is complex and multifaceted. This involves more than just recognising the autonomy of the individual. While the definition of respect is different for every patient. Most patients believe that  respecting people involves the following elements; empathy, autonomy, provision of information, recognition of individuality , worth and attention to the needs of the individual (Clark, 2019). (Mansel & Einion, 2019) found, empathy to be an inherent expectation that patients expect from health care workers. Empathy is a connection and it is all about letting people know that they matter. Having a collaborative relationship with the aboriginal and Torres islander community will hopefully create a culture of love and respect.

     Culturally safe and respectful practice forms part of the code of conduct for nurses in Australia. Under the code of conduct, a nurse while caring for patients must acknowledge that social, economic, cultural, historic and behavioural factors will have an impact on health. Both at an individual, community and population level. A nurse must also understand that only the person / the family being treated can determine whether or not the care being provided is culturally safe (Nursing and Midwifery Board of Australia – Fact Sheet, 2019). It is important to be mindful of not viewing Aboriginal and Torres Islanders as a monolith. While there is over 200 different Aboriginal and Torres islander cultures, each with distinctive traditional practices. It is essential for a health care worker to also realise that at the heart of the community or family is the individual. But the individual must be cared for as part of the community. The Aboriginal conception of the individual is in relation to the community, tribe, the land and the spiritual beings of the lore. An individual’s physical, emotional, social, spiritual and cultural needs and wellbeing is intrinsically connected and cannot be separated. Hence for any care strategy to be effective, it must not just treat the individual, but the family as well. For example, when developing a care plan to manage diabetes and for it to be effective. The care plan and implementation must focus on educating the whole family about what it means to have healthy eating habits ( Aboriginal Culture and History – Aboriginal Cultural Capability Toolkit, 2019). 

       The third leadership quality that is implicit in the RAP is communication. For any change to be effective, engagement and collaboration through clear purposeful communication is important. Good communication between nurses and patients is essential for successful health outcomes (Tuohy, 2019). To achieve this, the nurse must understand and help their patients, demonstrating curtsey, kindness and sincerity. Communication is an intrinsic human need; it can be verbal or non- verbal. Conflict and bad health outcomes can come from a breakdown in communication. Good communication between health care professionals and the patients they serve helps build meaningful relationships. In a multicultural society good personal relationship means the nurses communicate with kindness and provide information in a way that is non-judgemental. Communication that demonstrates interest and feeling of acceptance, trust and harmonias relationships. A therapeutic relationship is an essential prerequisite to effective communication between nurses and patients in order not only to give information, but also to effectively deal psychological processes which are triggered by it. The communication between health care workers and patients include the ability to voice concern for the care of the patient and the individual becomes a part of the care strategy (Mansel & Einion, 2019).

Effective communication Strategies

       Nurses must recognise that aboriginal and Torres islander people have different ways they communicate. It is important to realise when communicating with indigenous people that the nurse must choose strategies that makes the patient comfortable. For example, direct eye contact during communication is considered as rude.  The nurse needs to be aware of the patient’s body language and their own body language. It is also important not use a lot of complicated terms and the instruction that is simple and clear.  For example (Amery, 2017) found that many Yolnu and speakers of other indigenous languages do not comprehend the concept of percentages. A shading of the kidney was done showing 2% functioning and the other scalarised. The patient responded with shock and had a better dialysis participation. In addition, storytelling is an essential part of the aboriginal culture, from a very young age, stories play a role in educating children about life. Story telling is a way of sharing and interpreting experiences and can be effective way of communicating with indigenous people.

Conclusion

       Understanding Aboriginal and Torres Islander cultures will improve the nurse’s interaction and communication with patients. For example, knowing that aboriginal and Torres islander cultures prefer indirect approach to questioning, helps in the assessment of health issues. Direct questioning may lead to misunderstanding, discourage participation and make obtaining of information hard. This also means that it is important for health care professionals serving in Aboriginal and Torres Islander communities know the aboriginal basic language. Aboriginal and Torres islander leaders also play an important role in advising effective communication strategies when developing health promotions.

References

Aboriginal and Torres Strait Islander concept of health—Cultural Ways. (2020). Australian Indigenous HealthInfoNet. Retrieved June 7, 2020, from https://healthinfonet.ecu.edu.au/learn/cultural-ways/aboriginal-and-torres-strait-islander-concept-of-health/

Aboriginal Culture and History—Aboriginal Cultural Capability Toolkit. (2019). VPSC. Retrieved June 6, 2020, from https://vpsc.vic.gov.au/html-resources/aboriginal-cultural-capability-toolkit/aboriginal-culture-history/

Aboriginal Culture and History—Aboriginal Cultural Capability Toolkit—VPSC. (n.d.). Retrieved June 6, 2020, from https://vpsc.vic.gov.au/html-resources/aboriginal-cultural-capability-toolkit/aboriginal-culture-history/

Amery, R. (2017). Recognising the communication gap in Indigenous health care. The Medical Journal of Australia, 207(1), 13–15. https://doi.org/10.5694/mja17.00042

Anglicarerap_may2017.pdf. (n.d.). Retrieved June 6, 2020, from https://www.anglicare.org.au/media/3258/anglicarerap_may2017.pdf

Bell, J. M. (2016). The Central Importance of Therapeutic Conversations in Family Nursing: Can Talking Be Healing? Journal of Family Nursing, 22(4), 439–449. https://doi.org/10.1177/1074840716680837

Cabinet, P. M. and. (2016, May 25). Communicating with Aboriginal and Torres Strait Islander Audiences [Text]. https://www.pmc.gov.au/resource-centre/indigenous-affairs/communicating-aboriginal-and-torres-strait-islander-audiences

Clark, C. M. (2019). Fostering a Culture of Civility and Respect in Nursing. Journal of Nursing Regulation, 10(1), 44–52. https://doi.org/10.1016/S2155-8256(19)30082-1

Communicating effectively with Aboriginal and Torres Strait Islander people. (2020). 2.

Health, A. G. D. of. (2018, June 5). Pregnancy care for Aboriginal and Torres Strait Islander women [Text]. Australian Government Department of Health; Australian Government Department of Health. https://www.health.gov.au/resources/pregnancy-care-guidelines/part-a-optimising-pregnancy-care/pregnancy-care-for-aboriginal-and-torres-strait-islander-women

History—Brown v. Board of Education Re-enactment. (2020). United States Courts. Retrieved June 6, 2020, from https://www.uscourts.gov/educational-resources/educational-activities/history-brown-v-board-education-re-enactment

Mansel, B., & Einion, A. (2019). “It’s the relationship you develop with them”: Emotional intelligence in nurse leadership. A qualitative study. British Journal of Nursing, 28(21), 1400–1408. https://doi.org/10.12968/bjon.2019.28.21.1400

Mclean, H., Naylor, N., Griffin, D., Simpson, R., Smith, C., Bonson, L., & Sharp, J. (2019). A Collaborative Approach To Engaging Aboriginal People In Their Health. Heart, Lung and Circulation, 28, S46. https://doi.org/10.1016/j.hlc.2019.05.119

Nursing and Midwifery Board of Australia – Fact sheet: Code of conduct for nurses and Code of conduct for midwives. (2019). Retrieved June 6, 2020, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ/Fact-sheet-Code-of-conduct-for-nurses-and-Code-of-conduct-for-midwives.aspx

Reconciliation Action Plan. (n.d.). Retrieved June 6, 2020, from https://www.wa.gov.au/government/publications/reconciliation-action-plan

Tuohy, D. (2019). Effective intercultural communication in nursing. Nursing Standard, 34(2). https://doi.org/10.7748/ns.2019.e11244

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