Aboriginal and Torres Strait Islanders

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Aboriginal and Torres Strait Islanders 2017-04-27T04:43:46+00:00

Acknowledgement

We would like to acknowledge the traditional owners of Australia, both past and present.

We would like to thank Indigenous Australians for sharing their stories and experiences. We would like to create an environment that focuses on cultural safety, where the identities and traditions of Aboriginal and Torres Strait Islanders are recognised and respected. We would like to come together to celebrate shared listening, shared knowledge and dignity for all Australians.

This website does not claim to provide answers to indigenous health issues, yet offers an opportunity for Australian healthcare professionals to learn and adapt with flexibility in their clinical practice. Through greater understanding of culture across our diverse nation, organisations can strive to optimise patient-centred care and improve health outcomes for all Australians living with bronchiectasis.

Culturally Sensitive Care

When working with an Aboriginal Health Worker (AHW), Aboriginal Liaison Officer (ALO) or interpreter, it is vital that the healthcare provider acknowledges the relationship to country of the individual Indigenous professional. In many circumstances they will provide care that is focused towards a particular region or cultural area. It may be inappropriate for them to work with a certain patient or family based upon geographical, traditional or social factors.

To ensure that you are providing culturally sensitive care, liaise in person with the Indigenous professional and talk through the story before meeting with the patient. If they are unable to provide support, they will often be able to guide you towards an appropriate service.

Respecting and Involving Family

Each healthcare provider should take the time to meet with patients and listen to their stories. With focus on person-centred care, every Australian should be offered the opportunity to receive care in private – or in the company of family and friends – depending on individual preference.

Respect for family is paramount to many cultures, including Aboriginal and Torres Strait Islander traditions in Australia. Integral roles and responsibilities are often shared amongst the extended family, and it is important to understand how social relationships interact with acute and community healthcare. Family roles are not necessarily determined by biological relationships. A biological ‘auntie’ or ‘uncle’ may be referred to as ‘mother’ or ‘father’. A biological ‘cousin’ may be referred to as ‘brother’ or ‘sister’. A biological ‘granddaughter’ or ‘niece’ may be referred to as ‘daughter’.

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The acknowledgement of family roles varies between regions and connection to country. In some Indigenous cultures the roles are determined by matriarchal or patriarchal lineage. In other cultures the roles are defined through social relationships. Understanding family roles is essential when identifying an appropriate next of kin – this may not be a spouse or immediate family member, but alternatively, an extended family member or community elder.

To ensure that your patients are treated with respect, you should meet with the individual person and ask if you can listen to their family story. You may be able to ask whom they would like to help make decisions, and who they would like to be present when receiving healthcare information.

It is important to consider that medical decisions may need to be made in the presence of multiple family members, rather than one next-of-kin – particularly if the patient is a young child. Family-assisted treatments may also be the responsibility of an extended family member, rather than an immediate next-of-kin. For example: It may be culturally inappropriate for a biological mother to administer antibiotics to her young daughter with bronchiectasis, as this may be the responsibility of a biological auntie or grandmother.

Kinship Who's Who

Professional Relationships

Arrange a time to meet with your patient, their family and support team which may include an AHW, ALO or translator. It is important to establish open communication for shared listening and knowledge, where the patient has adequate time to tell their story.

In some cases it may be most appropriate to set up multiple sessions just to talk through a plan, without completing any procedures. In other cases a person may wish to minimise contact with their healthcare service. Focus on patient-centred care will enable respectful interactions, recognising the needs of the individual and their family.

Professional Body Language, Contact, and Communication

Expectations surrounding respectful social engagement vary significantly across Aboriginal and Torres Strait Islander communities. To ensure conduct is respectful, healthcare professionals are encouraged to read local resources, meet with cultural advisors and learn from community elders. There are key aspects of social interaction where respectful recognition of culture will promote and preserve patient safety.

Understanding ‘Please’ and ‘Thank You’:

In many languages of Aboriginal and Torres Strait Islander origin, words for ‘please’ and ‘thank you’ do not exist. This is because there is an expectation that if you are speaking with someone, you should always meet him or her with respect.

It is important that health providers adjust their own expectations and recognise that conversation should always be maintained with respect, without necessarily relying on certain words or phrases. It is disrespectful to suggest that a patient should say ‘please’ or ‘thank you’, if they are requesting help from a staff member.

Understanding Shame:

You may hear patients, families, elders or Indigenous professionals refer to the concept of ‘shame’. This is not purely a feeling arising from an act committed by the person, as would often be noted in English interpretation. ‘Shame’ may also be felt in a situation or circumstance involving personal attention.

People might feel shame for being in hospital, experiencing pain, taking medications, or missing important family events. People might also feel shame if they do not understand the information being presented to them, and may reply with common phrases such as ‘yes’ or ‘I am alright’ to avoid attention.

It is important that health providers take responsibility for patient comfort, and engage with family and Indigenous staff members to ensure that patients are supported during healthcare interactions.

Eye contact:

Avoiding eye contact is a sign of respect in many cultures. In other circumstances averting eye gaze may signal to a person that the topic of conversation is sensitive or significant. You are encouraged to meet with your ALO or AHW to learn of local traditions and expectations.

When establishing a professional relationship, introduce yourself whilst looking towards the patient and their family. If you are met with direct eye contact, you may be able to offer the same in return. If gaze is averted, a person is likely offering respect – acknowledgement through the aversion of your own gaze is an important action that will create a safe and open environment for the patient.

Body language:

Many languages of Aboriginal and Torres Strait Islander origin place significant emphasis on hand gestures and postural stance. You are encouraged to meet with your ALO or AHW to learn of essential body signals that may demonstrate respect or cause offence. This includes your overall body position in relation to the person you are meeting with.

Avoid postures that may create a power dynamic over a person or their family. If you are meeting at a patient’s bedside, it may be most respectful to sit on a chair next to the bed, looking in the same direction as the patient. If you are meeting in the community, you may need to ask permission to stand or sit with the family.  Through genuine interest and learning in the local culture, you are more likely to provide culturally sensitive care that demonstrates insight and respect.

Body contact:

Body contact is a common element of healthcare provision. When working with people with bronchiectasis, it is standard to assess auscultation, expansion of the lungs, peripheral observations, mobility and vital signs. However, it is fundamental that healthcare professionals are mindful of social context and gender roles, as well as sensitive questions or procedures. If you would like to complete a specific assessment or procedure, you should aim to:

Optimise the accessibility of information

Explain the procedure to the patient

Ensure privacy from, or inclusion of relevant family members

Gain consent as would be expected in any situation of patient-professional interaction

If the patient declines, offer alternatives. Would they like to discuss the procedure with family? Would they like to meet with an AHW or ALO? Would they prefer a different health professional to perform the procedure? It is important to remain open to these strategies – declining a procedure often reflects a barrier due to gender, age or cultural expectations, rather than the skill or interpersonal ability of the professional.

Some aspects of body language may create confusion, and it is important to recognise the cultural meaning of common western gestures such as shaking hands, hugging or walking beside someone. A kind courtesy seen by one individual may create distress or offence to another, and can result in barriers between a person and their healthcare team.

Language & Reading Skills:

Australian Indigenous languages are amongst the most complex in the world, in terms of words, descriptions and sentence structure. However, due to the ancient origins of these languages, most have not traditionally involved written form.

To optimise information accessibility, take the time to ask your patient and their family which languages they speak. It is disrespectful to assume that people do not speak, read and write in English. However, it is also inappropriate to create an expectation that people must communicate in English to effectively engage with healthcare services.

Modern technology is particularly helpful – investigate options for applications, online services, videos and audio when developing information tools for patient care.

Communication:

As languages mould together there are often discrepancies or differences in meaning that can either deliver a sense of respect, or result in social offence. Again, it is important to meet with your local team to learn of expectations specific to the region, culture or connection to country.

The following common examples may offer insight:

Cheeky – may refer to a person who has behaved with deliberate and harmful disrespect, or an amusing and relatively innocent sense of irreverence

Deadly – may refer to something that is excellent or great, a fatal instrument, or an action resulting in death

Finishing up – may refer to the end of a set time frame such as a medical appointment, or may indicate that a person is nearing end of life

Through meaningful learning a healthcare professional can encompass respectful elements of culture in their daily practice. For example: a Pitjantjatjara Aboriginal woman may refer kindly to a younger, female Caucasian health professional as kungka – meaning woman. However, it may be appropriate in response for that health professional to refer to her patient as minyma – a mature and respected woman.

Also be mindful of your vocal volume and length of conversation. In many cultures it is respectful to discuss sensitive or significant issues in a whisper or lower vocal volume. Silence forms an integral part of conversation in many languages, and it is important to allow for breaks in discussion, particularly if you have just asked a question. Allow the patient and their family time to respond in a way that respects culturally sensitive social interaction.

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