Academic journal article Australian Health Review

Implementing a Working Together Model for Aboriginal Patients with Acute Coronary Syndrome: An Aboriginal Hospital Liaison Officer and a Specialist Cardiac Nurse Working Together to Improve Hospital Care

Academic journal article Australian Health Review

Implementing a Working Together Model for Aboriginal Patients with Acute Coronary Syndrome: An Aboriginal Hospital Liaison Officer and a Specialist Cardiac Nurse Working Together to Improve Hospital Care

Article excerpt

Introduction

Cardiovascular disease is a significant contributor to the difference in life expectancy of 11.5 years for males and 9.7 years for females between Aboriginal and non-Aboriginal Australians.1 In this paper, the term 'Aboriginal' is used to include both Aboriginal and Torres Strait Islander people. Coronary artery disease, the most common form of cardiovascular disease,2 often manifests as acute coronary syndrome (ACS), a spectrum of disorders resulting from the development of thrombus in a coronary artery leading to varying degrees of cardiac muscle damage due to reduced oxygen supply. Advances in acute interventions for ACS and secondary prevention medication strategies have reduced mortality from coronary artery disease2 and improved quality of life.3

The reported health disparities between Aboriginal and nonAboriginal Australians have been linked to systemic and local factors, which impact on Aboriginal patients' experience of and access to care.4-8 Attendance at cardiac rehabilitation services after a cardiac event is associated with a reduction in risk of cardiac mortality.9 Rates of referral to cardiac rehabilitation services in Australia are reported as being between 29% and 45%.10,11 Two studies conducted in remote locations where cardiac rehabilitation services were not readily available reveal low attendance rates for Aboriginal patients.12,13 Attendance rates can be influenced by the strength of the recommendation to attend, distance to service, scheduling of sessions, and work and role conflicts.14,15 For Aboriginal patients, additional barriers include lack of access to culturally appropriate cardiac rehabilitation services.16,17

It has been suggested that, to improve Aboriginal patients' experience, hospitals should provide a culturally safe environment.7 Cultural safety is a subjective experience that is best described by the person experiencing it. Flealth service attempts to provide a culturally safe environment might best be described as a set of practices that aim to ensure awareness and responsiveness to the cultural aspects of health and wellbeing.18,19 The more recent history of Aboriginal Australia has had profound effects on Aboriginal health and wellbeing and it should be recognised that, for many Aboriginal people, hospitals are symbols of the very institutions that had a role in their marginalisation in Australian society. The hospital is a site where Aboriginal and non-Aboriginal Australians meet under circumstances of great stress and hospital staff often lack cultural awareness and understanding. Flospitals are places where Aboriginal people continue to experience poor attitudes, racism and limited cultural understanding.6

The Victorian Government's Improving Care for Aboriginal and Torres Strait Islander Patients framework advocates that Aboriginal Flospital Liaison Officers (AFILO) are fundamental to a system-wide approach to improving hospital care of Aboriginal Australians. AFILOs bring cultural expertise to health services and are key people in the facilitation of communication between Aboriginal and mainstream health services. AFILOs provide reassurance to Aboriginal patients through direct contact and help to provide a culturally safe space.20 They are crucial in supporting the families of Aboriginal patients and play a key role in planning for admission and discharge, especially rural or remote patients admitted to metropolitan hospitals.21

Provision of care by specialist nurses supported by healthcare workers from a similar socioeconomic or cultural background to the patients has been identified as an effective means to improve access to mainstream health and to overcome disparities in health care, including adherence to guideline-based secondary prevention for cardiovascular disease.22,23 Aboriginal Flealth Workers are qualified health professionals who are Aboriginal and provide direct patient care to Aboriginal patients. An Aboriginal Flealth Worker employed in a cardiology ward improved Aboriginal patients' attendance at cardiac rehabilitation. …

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