'Gettin Em N Keepin Em': Indigenous Issues in Nursing Education
Goold, Sally, Australian Aboriginal Studies
Abstract: The health of Indigenous Australians has been unacceptable for many years. Generations have never recovered from the effects of colonisation, genocide, and attempted assimilation. Introduced diseases, poor nutrition, dislocation of families and clans from traditional lands, poverty, and human rights issues have historically combined to impact on Indigenous health and wellbeing. Vast distances, lack of educational opportunities, and reduced access to higher education have contributed to serious under-representation of Indigenous persons in the health professions, including nursing, a profession that, along with other health disciplines, has not always welcomed Indigenous persons nor been inclusive of Indigenous health issues in its educational curricula.
In 2000 four nurse leaders collaborated to become the Indigenous Nursing Education Working Group. In 2003 INEWG released the 'gettin em n keepin em' report, which made 32 recommendations aimed at encouraging universities to recruit and retain more Indigenous persons in nursing. Strategies to increase the awareness, knowledge and skills of nurses to care for Indigenous people can be incorporated into nursing curricula. Better cultural acceptance of Indigenous people in the university sector has been emphasised.
On many indices, the health of Indigenous Australians is worse than that of non-Indigenous Australians (Ring & Brown 2002). Although there have been recent gains in reduced infant and maternal morbidity and mortality rates, the gap in life expectancy between Indigenous and non-Indigenous people stands around 18-19 years (Goold et al. 2002a). Major causes of early Indigenous death include endocrine, nutritional and metabolic diseases, with some Indigenous groups having up to 40 times the rate of Type 2 diabetes as non-Indigenous persons. Indigenous Australians in the 25-54 years age group are hospitalised at 15-18 times the rate of other Australians for diabetic complications; they suffer infectious and chronic diseases at higher rates than the rest of Australian population, are more likely to be hospitalised, suffer higher rates of injury from accidents, and have a higher rate of death from accidents and suicides (ABS & AIHW 2003).
Strategies implemented thus far to reduce the morbidity and mortality rates of Indigenous Australians largely have not succeeded. Action is needed to ensure that there is a competent health workforce with the capacity to provide appropriate care in both mainstream and Indigenous health services (SCATSIH 2002). This is important as Australian health services continue to be attuned to Western cultural values and modes of delivery and are often seen by Indigenous persons as inappropriate, unresponsive or exclusionary to their needs (Turale 1990).
Trends in improving the health status of Indigenous Australians have not mirrored international experiences in improving Indigenous health in other countries that have been colonised in recent centuries (Goold et al. 2002b:39):
A key difference between Australia, North America and New Zealand is the relative failure to reduce the gap in Indigenous peoples' life expectancy in Australia, which is still 18 to 19 years less than the non-Indigenous population. In the United States this gap has been progressively reduced from 13 to three years and in New Zealand it has been reduced to five to six years.
International experiences show that Indigenous health status can be improved by using culturally appropriate recruitment, retention and support strategies to increase the involvement of Indigenous peoples in education programs and health care delivery. Overseas experience has also shown that strategies to provide non-Indigenous health professionals with appropriate education about Indigenous issues and health care contribute positively to Indigenous peoples' health. It has been shown that Indigenous health professionals placed in the broader health system contribute to improvements in their own health and in the health of their families and communities (Mathews 1997; Schwab & Anderson 1999). …