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1. Describe how Justin’s health and well-being might be impacted by his recent life events.

Justin’s health and overall well being may have been impacted by the death of his Uncle, who was his families traditional healer, spiritual and cultural anchor (School of Nursing & Midwifery, CaseWorld – Justin O’Dowd, 2013). This may have exacerbated his feelings of sadness leading to feelings of isolation, unwillingness to socialize, trouble sleeping, and a lack of appetite resulting in significant weight loss. A person unwilling or unable to deal appropriately with grief and loss may impact his/her ability to cope and lead to Justin’s doctor diagnosing him with clinical depression. The significant grief that comes along with a loss of a family member, does not always lead to a mental illness developing, although if a person does not deal with or cope with their grief very well, it may affect their overall long-term mental health. It is very important to be aware of any cultural aspects of grief on an aboriginal person and their family. For example, visits from a deceased person’s spirit should not be misunderstood as a sign of mental illness but rather a grief process (Freeman, D. Freeman, B. 2009). Research shows that having diabetes more than doubles the risk of developing depression and that living with and managing a chronic condition like diabetes may increase the risk of a person developing depression or other mental health issues (Diabetes Australia, 2018). Being diagnosed with Type 2 Diabetes and not managing it very well might have made Justin feel hopeless, especially since his parents and sister also have the condition and are also unable to manage it. Having a family history of the disease may impact his outlook on life and that he has a bleak future ahead. Unemployment affects both the physical and mental health of an individual. Justin’s employment situation may have contributed to his overwhelming feeling of bleakness, with the constant worry of finding a reliable job leading to his disturbed sleeping patterns, clinical depression, lack of motivation, weight loss, and social isolation, (Muirer-Cochrane E, Levett-Jones T, Rudd C, Barkway P, O’Kane D, McAllister M, Gillham D, Edmondson W, Rigney D, 2014, p122).

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2. How might Justin’s cultural interpretation of mental illness be different from your own?
I believe that culture is one of the major factors of how a persons beliefs and customs evolve over time and influences a persons’ development. Cultural interpretations of mental illness can vary widely between people depending on how that person defines mental health themselves. It can vary from culture to culture and can be quite confusing to others outside of that cultural circle. My own interpretation of mental illness is where a person is unable to cope with everyday stresses of life or has an unmanageable problem that significantly affects how they feel, thinks and interact with other people around them. A person that is unable to cope with everyday life, one who suffers a bereavement, experiences a relationship breakdown, long-term unemployment, experiences moderate to severe social isolation, suffers a major physical illness or disability may not develop a mental illness but may be unable to cope. Mental illnesses cause a great deal of suffering to those experiencing them, as well as their families and friends around them (National Mental Health Strategy, p2).
3. Identify how your own attitudes and values relating to mental illness may influence any communication with Justin?

Every person has the right to be heard and treated with dignity and respect regardless of their cultural beliefs. Open honest communication and understanding is paramount when treating any patient, however, when interacting with Aboriginal or Indigenous people an understanding of cultural beliefs and practices will benefit both the patient and healthcare worker during their treatment/hospital stay. Communication gaps between healthcare providers and the patient can impact a patients’ understanding
of their care needs, increases complication rates and can reduce positive health outcomes, (Shahid S, 2013, p460). When approaching someone outside your own culture or community to discuss their mental health, you should always be aware of what is a respectful way to communicate with the person, including body language, seating position and the use of certain words which may differ from community to community and region to region, especially between urban, rural and remote areas, (Mental Health First Aid Australia, p2, 2008.)

4. How can partnerships with Justin and his immediate and/or extended family be developed and maintained throughout his journey of care to enhance recovery?
The term “recovery” means vastly different things to different people, although there may be various models of recovery ultimately each individual and their family need to work out what recovery means for them in particular. While recovery was originally thought of as a largely individual journey, it is increasingly
being seen as an “inherently social process” (Marino, 2015, p. 68). Recovery occurs in social contexts and for many individuals experiencing mental illness, the family is the most important aspect with estimates indicating that over 50% of Australia’s mental health service users have daily contact with family member/s (Morgan et al., 2012). Cultural respect and awareness of the importance of a holistic approach to mental health and well being too mental illness are critical in the delivery of any health services to Aboriginal and Torres Strait Islander (ATSI) people. While some services are provided through Aboriginal Community Controlled Health Services, mainstream services need to be culturally proficient so that ATSI people feel confident to seek assistance when required (Fourth National Mental Health Plan, pg 4). Developing strong family bonds/ties will help Justin’s recovery journey, highlighting family strengths will encourage and promote recovery and coping abilities. Justin also has access to the following programs that assist mental health consumers on their journey to recovery;
*The Partners in Recovery (PIR) initiative
*National Mentor Program
*Mustering Wellness Program (looking forward program etc)
*Support Group/Community Services Networks
*Outreach Programs/Aboriginal Support Network
*The Bentley-Armadale PIR Organisation

5. What are the social and cultural implications for Justin leaving his home and community for assessment and treatment in the city?
The term social and emotional well being is used by many Aboriginal people to describe the emotional, social, cultural and spiritual well being of a person. The term recognizes the personal connection to land, culture, spirituality, family, and community which can impact on their overall well being. It also recognizes that a person’s social and emotional well being is influenced by policies and past events. (Australian Health Ministers, 2003). Mental health is a term that is used mainly by non-Indigenous people, to describe how people think, feel, and cope with everyday life. Many Aboriginal people believe that mental illness focuses too much on the negatives and does not describe or characterize all the factors that make up and influence a person well being. Because of this, most Aboriginal people prefer the term social and emotional well being as it fits well with a holistic view of health (Garvey, D. 2008)

6. What needs to happen to ensure culturally safe care for Justin once he is hospitalised?
Australia’s health care system is based on Anglo-Celtic cultural beliefs about health and health-related behaviours. When Indigenous clients need to access health care services, the differences between their cultural beliefs and values and those of the health care service provider can create barriers to them receiving the appropriate care (Gorman, pp. 194-202). To ensure culturally safe practice for Justin whilst he is in the hospital and receiving treatment, health professionals should respect his cultural beliefs and that we do not impose our own values and beliefs on him during his care. Practising cultural safety means respecting the culture of the patient by using the appropriate language and behaviour, never doing anything that causes the person to feel shame, supporting the person’s right to make decisions about seeking culturally-based care, (Mental Health First Aid Australia, p2, 2008.) Justin has also requested that a male nurse be his primary/key nurse during his hospital stay. Cultural safety requires that the person feels that his or her culture is respected and that they are not being judged by the values of another person culture. (DeRosa, N. ; Kochurka, K. 2006, p24).

7. From the information in the Mental Health Assessment and Mental State Examination, what are the identified areas of concern and the priorities of care planning for Justin?

Suicide Ideation
Establish a therapeutic relationship with Justin, identify the level of suicide precautions needed,
assess and maintains a safe environment, assist Justin in identifying thoughts, feelings, and behaviours that may increase his suicide ideation, anxiety reduction techniques, coping enhancement and crisis interventions, identify and acknowledge the stresses unique to culturally diverse individuals, assess for the influence of cultural beliefs, norms, and values on the individual’s perceptions of suicide, with the client’s
consent, facilitate family-oriented crisis intervention, refer to mental health counselling, validate the individual’s feelings regarding concerns about the current crisis and family functioning, refer family members and friends to local mental health agencies and crisis intervention centres, avoid false reassurance; give honest answers and provide only the information requested.

Unmanaged Diabetes Mellitus’s
Monitor blood glucose levels regularly, medication routine and adherence, educate the importance of self-care, including diet and exercise, assess dietary intake/nutritional status, blood pressure monitoring, foot care, and leg care.

Ineffective Coping, Anxiety ; Depression
Use empathetic open and honest communication, encourage a client to verbalise any fears, express emotions whether negative or positive, set realistic goals, encourage a client to make choices and participate in planning of care and scheduled activities, provide information regarding care before care is given, refer the client and family to help groups in the community, assess what spiritual practices have offered comfort and meaning to the client’s life in the past, assess for the presence of culture-bound
anxiety states, assess for the influence of cultural beliefs, norms, and values, assess physical reactions to anxiety, determine the client’s sleep and activity pattern, provide measures to take before bedtime to assist with sleep.

8. Read the 1:1 intervention notes and identify the communication skills/strategies that are allowing the health professional to talk with Justin in a culturally safe and recovery focused manner.

Therapeutic communication is defined as communication strategies that support a patient’s feeling of well-being, with goals that help a patient feel cared for and understood. It establishes a relationship in which the patient feels free to express any concerns to the healthcare professional without the fear of judegment. Active listening is the act of mindfully hearing and attempting to comprehend the meaning behind the words spoken by another in a conversation (Klagsbrun, 2012). Active listening uses various techniques including demonstrating concern, building trust and establishing a rapport, paraphrasing to show clear understanding, using non-verbal cues which show understanding such as nodding, eye contact and leaning forward.

9. Review the discharge plan and 3-month review and consider how Justin can be supported to continue on his path to recovery and maintain his well-being when he returns to his family and community.

There are many ways to help indigenous people deal with their feelings, loss, and grief in a healthy traditional manner. Reconnecting with culture by going back to the country (community), attending ceremonies, going camping, gathering bush food or hunting, attending cultural events or learning about things such as family history, language, art, craft or music, may significantly help the grieving person cope and manage with their pain/grief. (Parenting SA, Grief and Loss: 2016). Indigenous people experience limited access to mental and physical health services (Dudgeon et al. 2012). Some of this can be attributed to the lack of access to culturally appropriate health services within the mainstream and community-controlled mental health sector (Reibel & Walker 2009). Justin can be supported at home on his path to recovery and to maintain his well being by participating in and getting help from the following;

* Community Mental Health Nurse visits *Family Support *Joining a local support group
*Australian Unity’s Aboriginal Home Care Service (culturally appropriate home and community services)
*Social and Emotional Well-being and Mental Health Services on Aboriginal Australia *Aboriginal Social Services/Health Worker *Aboriginal Health GP *Relapse Prevention Plan ; Recovery Plans

10. After considering the issues for Justin, reflect on your own experiences of relating to people from different cultures. Consider what you have learned from Justin’s story and how your new knowledge might influence your practice.

When working with mental health consumers I have learned that demonstrating clear boundaries is essential to protect both the patient and the mental health professional. It is a vital component to maintaining a functional therapeutic relationship. That nurses use therapeutic communication techniques to provide support and information to patients whilst promoting a patient long-term recovery. That you need to have an open, understanding and patient approach to people from other cultures so that as a nurse I can uphold a professional standard and provide non-judgemental nursing care.

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