Topic 7: Awareness alone is not enough
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Connection with curriculum |
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This topic relates to the concept: cultural safety
Demonstrate cultural humility and explain behaviours and values required to engage in lifelong learning in Intensive Care Medicine; Analyse the limitations of one’s own perspectives and reflect upon the implications of one’s own worldview for delivering culturally safe Intensive Care Medicine to Aboriginal and Torres Strait Islander patients.
Introduction
Having an awareness of “the other” is not enough. The concept of cultural safety has been articulated in the Indigenous health literature and explores the important need for doctors to reflect on their own biases and attitudes to understand how these can impact the care their patients receive.
For example, 'awareness' is acknowledging that having an Aboriginal and /or Torres Strait Islander background increases the risk of cardiovascular disease. However, this is not enough. It is important to understand why this is the case and then adjust behaviour and management accordingly. Reflect on these questions:
Why is the prevalence of risk factors higher in some populations?
Why are interventions aimed at improving risk factors more effective in some settings?
Why do risk factors interact with more deadly effects in certain healthcare settings?
When do people feel able to access healthcare, and why might they not do so?
Citation
Why do some people never make it to ICU for a disease that could be helped in an ICU?
Why might some people not have risks or outcomes known or recorded during an ICU stay?
Why might ICU care be subtly different, and so are its harms and later effects importantly different in hidden ways for some people?
What maintains the structures that sustain all these steps in the path to worse outcomes, and who benefits from them? Cui bono? Is it me?
Social determinants of health and chronic disease compliance
It is important to understand how poverty and difficult living conditions may affect admission patterns and the ability to adhere to difficult medication and treatment regimes.
Take, for example, a person with sleep apnoea, diabetes and some heart failure. The management may include insulin, a CPAP machine, fluid restriction and some heart failure medications.
How does that translate to an Aboriginal person living in a remote community where temperatures often exceed 40 degrees Celsius in summer?
This person may have electricity but possibly pays through a credit system (high prices and runs out if you run out of credit). What do they prioritise being able to run? Some air conditioning or the CPAP machine? Are they likely to drink more than the fluid allowance? Are the fridge and the storage of insulin likely to be kept optimally?
A house with more than ten people (not uncommon for remote houses) may not have a safe place to put the medications, and it may be easy to confuse the webster packs of others in the house.
Only about 30% of the houses have a good working shower, and often the sewerage systems run into problems.
How does this change the causes of what made this person admit?
Is it more likely they deteriorate due to a lack of ability to have treatment adherence?
Is it more likely to be precipitated by an infection?
Is it likely that the drugs have been titrated up when the Aboriginal person is only intermittently taking them?
What then happens when they are given full doses of the drugs when sick in the hospital? |
Activities to facilitate learning |
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The following activities will enhance your learning on this topic.
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Read |
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- Read the article by FitzGerald and Hurst (2017) on implicit bias.
- Read the article by Coombes et al. (2022) regarding take own leave
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Additional recommended resources |
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Reflect on your learningSelect the image to answer the reflection question for this topic. |
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