My report on cultural awareness in tennant creek

The town of Tennant Creek, has a population of 6307 people,  84.6% were born in

Australia, 51% identify as Aboriginal, 35.2 % speak a language other than English at home

(www.nt.gov.au/ntt/financial/budget). Tennant Creek is a multilingual community (Aboriginal

child language acquisition project, 2008).  There are other minority groups residing in


Tennant Creek and often overseas tourists pass through during the summer months.  It is the

only town of any size in the Barkly Tablelands. It lies on the Stuart Highway 510 kilometres

North of Alice Springs and 670 kilometres South of Katherine. The Barkly tablelands covers

an area of 240,000 square kilometres between the tropical 'Top End' and the arid 'Red Centre’,

approximately the size of New Zealand (www.ntgov.com.au).

The health status and health services needs of Aboriginal people, and Aboriginal concepts of health and illness, differ from those of the general population in many ways. Therefore the development of policies, programs, and resources that affect Aboriginal people must take these differences into account.  Cultural Security is about ensuring that the delivery of health services is such that no one person is afforded a less favourable outcome simply because she or he holds a different cultural outlook (reference).  The aboriginal definition of health is “Health does not mean the physical well-being of the individual but refers to the social, emotional, spiritual and cultural well-being of the community.  This is a whole of life view and includes the cyclical concept of life death-life” (Stout & Downy, 2009).   

Cultural safety was a concept developed in New Zealand; the following is the definition of cultural safety

“The effective nursing practice of a person or family from another culture,

and is determined by that person or family. Culture includes, but is not

restricted to, age or generation; gender; sexual orientation; occupation

and socioeconomic status; ethnic origin or migrant experience; religious

or spiritual belief; and disability.

The nurse delivering the nursing service will have undertaken a process

of reflection on his or her own cultural identity and will recognise the

impact that his or her personal culture has on his or her professional

practice. Unsafe cultural practice comprises any action which

diminishes, demeans or disempowers the cultural identity and wellbeing”

(Guidelines for cultural safety, the treaty of Waitangi and Maori Health in nursing education and practice, march 2005).

Cultural Awareness Is a beginning step toward understanding that there is difference. Many people undergo courses designed to sensitise them to formal ritual and practice rather than the emotional, social, economic and political context in which people exist as an individual (guidelines for cultural safety the treaty of Waitangi and Maori Health in Nursing education and practice, 2005).

Cultural Sensitivity can alert health professionals to the legitimacy of difference between their culture and their client’s culture, and begins a process of self-exploration as the powerful bearers of their own realities and the impact this may have on others. (Guidelines for cultural safety the treaty of Waitangi and Maori Health in Nursing education and practice, 2005).  Cultural Safety is an outcome of nursing education that enables safe service to be defined by those who receive the service (guidelines for cultural safety the treaty of Waitangi and Maori Health in Nursing education and practice, 2005). Unsafe cultural practices are any action that diminishes, demeans or disempowers the cultural identity and wellbeing of an individual (The Royal Australasian college of Physicians, 2004).

Policies

The Northern Territory government has recently developed a policy for Aboriginal Cultural Security, the policy states that by providing culturally secure services all Territorians can have access to safe and effective services (Aboriginal Cultural Security, 2009 pg3). The Northern Territory’s population is 215000, 30% identify as being Aboriginal and Torres Strait Islanders, the Department of  health and Families employs over 5,000 people with only 10% being Aboriginal and Torres Strait Islanders (Aboriginal Cultural Security, 2009) The policy requires health services to identify the elements of Aboriginal culture that affect the delivery of health and community services in the Northern Territory, to review service delivery practices to ensure they do not unnecessarily offend Aboriginal peoples culture and values, change service delivery practices where necessary and to monitor service activity to ensure that the services continue to meet culturally safe standards (Aboriginal Cultural Security, 2009 pg2).  It is a strategy to improve services to Aboriginal people by making sure the way health services are delivered takes important cultural matters that may have a bearing on health and community outcomes into account (Aboriginal Cultural Security, 2009 pg2).  The Department of health and community services will work closely with Aboriginal communities, some changes to services provided; include the number of Aboriginal people employed and the way quality is assessed in the workplace (Aboriginal Cultural Security, 2009).This policy of cultural security is a commitment to further strengthen Aboriginal people’s access to health and community services.  Ideally this policy would see health services develop partnerships with aboriginal peoples to better improve the way they view and access health services (Aboriginal Cultural Security, 2009).  Fostering cultural security by engaging the community in service planning develop and monitor standards of practice relating to cultural competence for the organisation, system and individual staff, develop training programs going beyond awareness to develop skills and knowledge, effective implementation and assessment strategies (Aboriginal Cultural Security, 2009).   The implementation of the cultural safety policy will include workforce development by improving the knowledge base of all staff employed by the hospital workforce reform, changing the public health, clinical and administrative practices, monitoring and accountability developing measures and indicators of success.  Community engagement involving the wider community in developing and monitoring policy and its functioning (Aboriginal Cultural Security, 2009).

 

The Northern Territories Department of health and families corporate plan 2009-2012 recognises that developing and delivering a system of services that is underpinned by cultural security, safety and quality is essential for the effective delivery of health services.  The department of health and families Aboriginal and Torres Strait Islander Strategic workforce plan 2008-2011 recognises strengthen the Aboriginal and Torres Strait Islander workforce is a priority to help and improve the economic and social health and well being of  Aboriginal and Torres Strait Islander people, building a sustainable Aboriginal and Torres Strait Islander workforce, strengthening a capable Aboriginal and Torres Strait Islander workforce, attraction and retention of Aboriginal and Torres Strait Islander talent and optimizing the Aboriginal and Torres Strait Islander workforce (pg 1). Interestingly gainful employment is one of the key social determinants of health, strengthen employment could potentially influence the health and well being of the entire community (Aboriginal and Torres Strait Islander Workforce, 2009).

The Australian nursing and Midwifery council was established in 1992 to facilitate a national approach to nursing and midwifery regulation.  The code of Professional Conduct for Nurses in Australia, the Code of Ethics for Nurses in Australia and the Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse, The National Competency Standards for the Enrolled Nurse and the National Competency Standards for the Nurse Practitioner, “provide a framework for accountable and responsible nursing practice in all clinical management, education and research areas” (Code of Ethics, 2008).  The Australian and Midwifery Council sets out national standards to assist nurses and midwifes to deliver safe and competent care these standards are the core competency standards on which nurses and midwifes are assessed on in order to obtain a practicing certificate (National Competency Standards for Registered Nurses, 2008).

Australian Nursing and Midwifery Council Code of Professional Conduct for Nurses in Australia (2008 pg 1) “sets the minimum standards for practice a professional person is expected to up hold both within and outside of professional domains in order to ensure the ‘good standing’ of the nursing profession” .  Standard 4 of the code states “Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment and of their colleagues” (pg 1).  Nurses should uphold the standards of culturally informed and competent care, ensure the safety and quality of care is not compromised because of harmful prejudicial attitudes about race, culture, ethnicity, gender, sexuality, age, religion, spiritually, political, social or health status (Code of Conduct, 2008, pg4).  The Code of Ethics for nurses in Australia outlines the nursing professions commitment to respect, promote, protect and uphold the fundamental rights of people who are both recipients and providers of nursing and health care. Value statement 3 of the code states “Nurses value the diversity of people” (pg6).  In other words the nurse must acknowledge the similarities and differences between their culture and others and appreciate how different cultural backgrounds may influence the provision of health care and how it is received (code of ethics, 2008).

Gastroenteritis - some facts, not for those with a weak stomach !

Well for those who read my last post -- will know I was very sick with gastro!!!

I'm still not 100% and have just started a course of antibiotics to reduce the length of time I'm sick or contagious 


So I had shigella - a nasty bacterial little bugger and one of the worst types


After several days of going to the toilet about every two hours, vomiting, fevers, headaches, nasty stomach cramps, and lethargy, I'm now only going to the toilet a couple of times a day. I'm buggered, but happily I've lost 4 kg ! 
So there are a few things that can cause gastroenteritis 

Firstly gastroenteritis is a medical condition characterized by inflammation ("-itis") of the gastrointestinal tract that involves both the stomach ("gastro"-) and the small intestine("entero"-), resulting in some combination of diarrhea, vomiting, and abdominal

 pain and cramping.

(Wickpedia, 2013)

The various germs and parasites that cause gastro are found worldwide. It is estimated that gastro causes between 3-5 million deaths per year worldwide, most of which occur in developing countries.

There are many things that can cause gastroenteritis, including:

Viruses – such as norovirus, calicivirus, rotavirus, astrovirus and adenovirus. Rota virus was so prevalent in central Australia before the vaccine the very young and very old would sometimes die due to complications, usually severe dehydration. Anyone in the medical profession prior to the vaccination being developed would remember it well !

Bacteria – such as the Campylobacter bacterium, Shigella, and Campylobacter, E coli.is contracted by ingesting the bacteria in contaminated food or water, and by handling poultry or reptiles such as turtles that carry the germs.

• Campylobacter occurs by the consumption of raw or undercooked poultry meat and cross-contamination with other foods. Infants may acquire the infection by contact with poultry packages in shopping carts. Campylobacter is also associated with unpasteurized milk or contaminated water. The infection can be spread to humans by contact with infected stool of an ill pet (for example, cats or dogs). It is generally not passed from human to human.
• Shigella bacteria generally spreads from an infected person to another person. Shigella are present in diarrheal stools of infected individuals while they are ill, and for up to one to two weeks after contracting the infection. Shigella infection also may be contracted by eating contaminated food, drinking contaminated water, or swimming or playing in contaminated water (for example, wading pools, shallow play fountains)

Parasites – such as Entamoeba histolytica, Giardia lamblia and Cryptosporidium,
these little "worms" are usually ingested, usually via contaminated water.  Giardia for example is spread via cow poop, so Ive often seen Giardia infections in communities and on cattle stations where people go swimming in dams ect

Bacterial toxins – the bacteria themselves don’t cause illness, but their poisonous by-products can contaminate food. Some strains of staphylococcal bacteria produce toxins that can cause gastroenteritis

Chemicals – lead poisoning, for example, can trigger gastroenteritis

Medications – certain medications, such as antibiotics, can cause gastroenteritis in susceptible people. Chemotherapy can induce diarrhoea in some people as well

Radiation poisoning - Smaller doses of radiation poisoning can cause gastroenteritis, fortunately I've never sen this


Germs that cause gastro may be passed from person to person, as well as in contaminated food and water. Specific ways in which a person may become infected include:


• Kissing or other close personal contact.
• Coming into contact with an infected person's faeces (shit).
• Touching surfaces such as tap handles or items like toys which have been contaminated with germs from infected people who have not washed their hands after going to the toilet etc.
• Eating contaminated food. Food can become contaminated if a person does not wash their hands before handling food, or if safe food handling practices are not followed.
• Drinking contaminated water. Water supplies may contain germs from fecal pollution, or germs like Giardia Lamblia can be present naturally in untreated water sources.
• Inhaling germs released into the air by a sick person vomiting, coughing or sneezing.
• Failing to wash hands after handling pets or other animals.

In most cases it is difficult or impossible to determine how a person became ill.

Bacteria multiplying


Sources
Wikepedia, 2013
Better Health Channel, 2013
emedicine, 2013
my personal experiences and knowledge

Paplau's interpersonal theory and how it relates to my nursing practice in the emergency department of a rural hospital

This assignment will address reflection on self awareness and skills in the counselling role, I will look at the ethical aspects of private and confidential information that a client shares with the counsellor.   The importance of self understanding and reflection, in the role of counselling and how it aids the counsellor as well as the client. I will discuss Paplau’s interpersonal theory and how it relates to my nursing practice in the emergency department of a rural hospital, how culture impacts on communication using my experiences with the local Indigenous culture and how I will continue to develop counselling skills in the future using skills gained from this course. In the geographical location I live in and consequently my workplace there is a large indigenous population.  I am from an Anglo Australian back ground, and have had to learn some of the local culture in order to practice culturally safe nursing and communicate effectively.

Firstly counselling can be defined as a process in which the counsellor helps the client understand the causes of problems and helps them develop a process of learning to make good life decisions (Counselling Services, 2006).   It is usually a theory-based process that helps clients resolve everyday life issues and concerns, each process is tailored to meet the client’s needs and help enable the client to be more self aware to understand why and make positive changes (Ivey, Ivey & Zalaquett, 2010).  Counsellors are good listeners, they are neutral and non-judgemental, and they are there to help their clients explore alternatives in order to make positives changes rather than giving out advice (Counselling Services, 2006).

Each counsellor must follow a code of ethics and code of practice.  In Australia the Australian Counselling Association (ACA) has a code of conduct which includes a code of ethics and code of practice, this code also covers the counselling environment, including physical and emotional factors (section 2.7) (www.aca.com.au).  See appendix one.  Ethical practice codes are in every major helping profession worldwide and could be summed up as “Keep the best interest of your clients in mind; do no harm to your clients; treat them responsibly with full awareness of the social context of helping” (Ivey, Ivey & Zalaquett, 2010, p35).  It is suggested that the counsellor and client discuss and set up a contract, at the beginning of the relationship, the counsellor should discuss elements of the counselling sessions, the goals, risks and benefits with the client,  a written contract can then be initiated including  confidentiality surrounding the discussions between the counsellor and client (Ivey et al, 2010; www.aca.com.au).  Section 2.4.3 Contracting with clients, of the ASA code of conduct (appendix one, p10), talks about counsellors contracting with their clients and the counsellors responsibilities.  All of this is important in protecting the client and ensuring a safe environment for them, as well as allowing them some autonomy.  Clients entering a helping relationship with a counsellor or other helping professional such as a nurse are usually in a vulnerable state, it is the counsellors ethical duty to protect their client from harm, this would include informed consent, in terms of written consent such as a contract where the counsellor outlines their role and discusses what the client wants from counselling, what their goals might be and any procedures, benefits and risks counselling may cause (Ivey et al, 2010).  Setting boundaries with the client is also important and would include defining the professional relationship at the beginning and not taking advantage of a client who is in a valuable state by entering into other relationships such as sexual or financial (www.aca.com.au).

The ACA code of conduct states under section 1. Code of ethics, p3

“Ensure client understanding of the purpose process and boundaries of the counselling relationship, offer a promise of confidentiality and explain limits of duty of care, for the purpose of advocacy receive written permission from the client before divulging any information or contacting other patients”

The ACA code of conduct also discusses confidentiality regarding information received during verbal discussions with clients and their written records see section 2.3 confidentiality, which ensures client safety and privacy as well as offering client autonomy, any breech in confidentiality will likely decrease any benefits of the counselling experience for the client (www.aca.com.au).  See also section 2.3.4 exceptional circumstances. Exceptional circumstances are those in which the counsellor believes that serious harm may occur to the client or others (for example - suicidal ideation or planning physical violence towards others), even then, where possible the counsellor should endeavour to discuss changes to the confidentiality agreement – or contract with the client (www.aca.com.au).  See also Section 2.3.5 management and confidentiality.  (www.aca.com.au).  Other principles counsellors as well as anyone in the medical profession such as nurses should follow include 1) Do no harm – to the client physically, emotionally or mentally; 2) beneficence – where the counsellor acts to promote well being; 3)non-maleficence – where the counsellor is committed to avoiding harming the client; 4) Justice – the fair and impartial treatment of the client and the provision of services (The ethical framework for good practice in counselling and psychotherapy within the NHS, 2004).  As nurses we are also bound by the Australian Nursing Midwifery Council Code of Conduct and Code of Ethics, The Code of Conduct states “Nurses treat personal information obtained in a professional capacity as private and confidential” (www.anmc.com.au).  Nursing in an emergency department is no exception.  According to the code of ethics, we – as nurses are required to value confidential and private information as well as our role in providing health counselling and education to broader community (code of ethics,2010, www.anmc.com.au).  

As a nurse working in the emergency department and having studied nursing theory recently as part of my masters degree at the University of Queensland I can relate to Hildegard Paplau’s  – Theory of interpersonal relations, which was developed for psychiatric nursing but can and has been applied to many other areas (Tomey & Alligood, 2006; Pearson & Vaughan 1986). The interpersonal approach is different to other counselling and psychotherapy theories as it emphasises the growth of both the counsellor or health professional and the client (NUR 5520 Introduction to counselling, study book, 2010).  The purpose of this theory is to facilitate the development of problem solving skills within the context of the interpersonal relationship between the nurse and the client using education and therapeutic interrelations (Pearson et al, 1986). Stress cannot be avoided however, “nurses can help patients to use stress situations as learning experiences through which they can acquire new patterns of behaviour and thus change” (Pearson et al, 1986 p143). This interpersonal approach works well in the emergency department as client counselling enables the client to develop realistic expectations and to have the knowledge available to prepare them for future events such as managing at home after a stroke or fractured limb (Paaviliainen, Salmimen-Tuomaala, Kurikka and Paussu, 2009).  Paplau’s interpersonal theory has four stages of overlapping nurse-client relationship, firstly orientation, where a client seeks out professional help and the nurse helps the client identify and understand the problem and establish what help is needed (Comley, 1994). Secondly identification where a nurse helps the client explore and express their feelings during the illness allowing the client to re evaluate and strengthen positive forces in their personality (Comley, 1994).  Thirdly exploration where the client uses the interpersonal relationship with the nurse to develop and work towards new goals, the client gradually becomes independent from the nurse (Comley, 1994). Fourthly and lastly the resolution phase where old goals are disregarded and forgotten and new goals are adopted (Comley, 1994).  In Paplau’s interpersonal theory the function of the nurse –client relationship is to promote growth and development of both parties (Tomey & Alligood, 2006; Pearson & Vaughan 1986).  A patient presenting to the emergency department with a fractured leg, once the pain is under control and the leg is immobilised in plaster will be thinking or worrying about how they are going to get their children ready for school, or negotiate a flight of stairs. The nurse can counsel the client; draw out their fears and concerns and offer information and education.  This occurs on a regular basis with many clients and illnesses while talking with the client about their illness or injury I as the nurse often also learn and grow professionally as I expand my medical knowledge, gain an understanding of the recourses available in terms of allied health team members and continue to develop my counselling skills, as I counsel more clients.

Reflection can be defined as the consideration of personal actions with the ability to review those actions and analyse the situation and evaluate the events, it is the basis for insight learning and self discovery (Martin, 2003).  Self-reflection, the practice of inspecting and evaluating one’s own thoughts, feelings and behaviour, and insight, the ability to understand one’s own thoughts, feelings and behaviour are important to learning. “Self awareness is the broad concept of the knowledge of one’s self” (Ivey, Ivey & Zalaquett, 2010, p6).  Self understanding is the ability to understand one’s own actions (Martin, 2003).

Reflection can occur in different ways with different purposes.  Reflection in action occurs while the individual is participating, they watch, review and adjust to their surroundings, reflection on action occurs afterwards, where the individual recalls the event and reviews what happened and why and gains new insights and is able to make adjustments in the future if necessary (Lian, 2001).  “Reflection identifies one’s professional capabilities, increases knowledge of self and improves understanding and management of patients. Conducting reflective practice is conducive to professional development and growth.”(Lian, 2001, p217).  Reflection should be used as a learning tool and teaching tool for professional growth as well as improving professional standing, reflection can help with self understanding by allowing the professional to develop new insight (Lian, 2001). It’s by participating in reflection that professionals can learn their limitations as well as their capabilities, this will help the counsellor interact with their clients and allow the counsellor to refer the client if they are no longer able to help the client (Lian, 2001) Self evaluation and self understanding promotes professional growth.  Reflection was introduced to me when I first started nursing it is often used in the emergency department as a debriefing tool after major trauma, by talking about the incident and reviewing our actions we can come to terms with the outcome – Reflection allows us to have insight into our actions, review the event and see if anything could have been done differently, it helps us come to terms with our actions particularly if there is an undesirable outcome such as death.  By reflecting on the events we often see our limitations or inexperience in a particular area, this allows us to seek further education or request in-services on particular procedures such as arterial line monitoring, by doing this reflection has served to increase professional growth.

Culture impacts on communication, people of different cultures can often have to deal with communication barriers.  Culture can include religion, class, ethnic background, gender and lifestyle (Reid & Trompf, 1991).  People with differing cultural backgrounds will have different communication patterns (Reid & Trompf, 1991).   This assignment will show some of these difficulties between Anglo Australian and indigenous peoples.  There are several barriers to cross communication including stereotyping, as counsellors and nurses we have to be aware of our beliefs about groups or individuals, perceptions and attitudes by reflecting and having a good self understanding we can know our limitations and barriers for example if as an atheist you can’t relate to someone with strict christen views then counselling will be limited and it might be wise to refer the client (Ivey et al, 2010; Kelsey, 2010).

When communicating with indigenous persons it is important to remember men’s and women’s business are separate and discrete issues where disclosure is set by strict social rules and breeches are punished (Reid and Trompf, 1998). Health professionals should be mindful of this when treating members of the opposite sex. Most indigenous groups have complex avoidance relationships, including not using the name of a deceased person (Reid and Trompf, 1998).  Transfer or evacuation to hospital can mean a person is away from their family group, this can be extremely distressing (Reid and Trompf, 1998).  Indigenous people don’t generally like to tell their name immediately which in Anglo Australian culture is a normal way of meeting or introducing people (Reid and Trompf, 1998).  In indigenous culture, social relationships always take priority overriding medical appointments and even the illness itself (Reid and Trompf, 1998). indigenous people don’t make eye contact, and generally feel more comfortable sitting side by side rather than face to face, they have no obligation to answer a question, and like to take time to think about a question before answering, meaning there could be long pauses in the conversation, indigenous people prefer one question at a time and find it difficult when peppered with multiple questions regarding their health, they often use hand signals as a way of answering (Reid and Trompf, 1998).  Indigenous groups have their own culturally determined and socially structured health care systems and in some cases have little faith in the Anglo Australian health care system (Reid & Trompf, 1991).   In indigenous health, bush medicines and traditional healers (medicine man or witch doctor) play important roles in health care (Reid and Trompf, 1998).  This is very different to my culture; I would generally make eye contact, introduce myself, and answer questions promptly, rapidly and with much information.  It can be difficult to keep in mind the cultural differences and practice culturally safe nursing; it is easy to revert to my natural communication style.  With this in mind I am learning through this course to develop good communication skills as previously mentioned.  Self reflection and listening are important communication tools (Ivey, etal, 2010; Kelsey, 2010). 

I work in a relatively small but busy emergency department, since starting this course I have noticed that I am listening more closely to what client’s are saying.  I am watching for cues such as body language that may suggest distress or anger, a person may cross their arms and turn away when a subject comes up they don’t want to discuss, facial expressions such as a frown or pursed lips may indicated worry. Non verbal communication is an important tool for a counsellor as discussed throughout Ivey et al, 2010.  It is also important to remember different cultures have different communication styles which can hinder communication, if a client feels unsafe they will not take in the information they are given nor will they return to the emergency department in the future (Reid & Trompf, 1991).  If in doubt ask a college who may have more experience with that culture or seek out interpreting services. When Clients arrive at the emergency department they are usually acutely ill or injured giving rise to feelings of fear and helplessness adding to their stress and causing unpredictable responses such as anger and lashing out either verbally or physically (Paaviliainen et al, 2009).  Nurses working in the emergency department need to be able to provide effective counselling it should “ foster optimal coping and independent living ability of patients so as to help them identify their own resources and strengths and see new possibilities in their life situation marked by acute illness” (Paaviliainen et al, 2009, p18).  talking to clients, and listening to what they are saying, either verbally or non-verbally, practicing paraphrasing their comments as discussed in Ivey et al, 2010, as well as using open ended questions to draw the client out has been particularly helpful in determining what the client understands of the illness and medical treatment required. I have discovered since starting this course and by using these skills I am becoming better at communicating with my patients.  Ongoing development of these skills would allow me to continue to grow professionally and provide more effective aid to my clients.  In order to do this – practice is the key I need to keep referring back to Ivey et al, 2010, attending in-services around counselling and communication, discussing these skills with colleges.  Practice with colleges the role of a counsellor. Use counselling contracts with colleges and clients and counselling sessions to continue to develop my listening and observation skills in both verbal and non-verbal communication.

In conclusion counselling is a skill that requires practice, it requires good listening and communication skills, and it is a valuable tool in the emergency department which can help the nurse provide effective nursing care.  Counselling people with different cultural backgrounds requires the counsellor to have good communication, reflection skills and a self understanding.  This course has given me a good knowledge and skill base from which I can develop further in the future.

Living in remote Australia: Living in remote Australia: What was the one baby ...

Living in remote Australia: Living in remote Australia: What was the one baby ...: Living in remote Australia: What was the one baby item you couldn't live witho... : What was the one baby item you couldn't live wit...

medical help

The fat loss factor

<a href="http://5503dquzod09qm41oetapgknmr.hop.clickbank.net/" target="_top">Click Here!</a>

Heart Health Made Easy: How To Lower Blood Pressure & Cholesterol (view mobile)

Easy To Understand, Practical Take Action Guide Takes You Step By Step To Lower Cholesterol And Blood Pressure Naturally. Everything You Need To Know In One Convenient Easy To Follow Guide So You Can Stop Searching For The Answers You Seek.

 <a href="http://a9252pybu8nkg0ad14c2e23l5u.hop.clickbank.net/" target="_top">Click Here!</a>

Worst gastro ever !!!!! Just when I thought I was immune !

This of course is just life, there is no use complaining - no one would listen anyway :)

Well one Thing I mentioned before was if you get really sick out in the bush then you have to hope RFDS gets to you in time !!

Well I wasn't that sick but there were a couple of moments when it felt like it !
Two days with no food
Two trips to the hospital for a drip
7 days of non stop diarrhoea !!
And 9 days without leaving the house ( except two trips to hospital )

Still not feeling the best,
I've got a few more days off before returning to work

The poor kids, after not seeing me for a couple of days, the both caught a mild dose ( thankfully mild) of what I had

A nasty bacterial gastro and viral infection all rolled into one !
after living in remote Australia I thought I was immune to most things by now.
The health of a rather large part of the population out here is very poor and the sanitation conditions are not the best, deasese and illness are rife through the communities .  So I was rather shocked when I got so sick
Having nursed in outback QLD, WA and the NT, including living and working on some remote communities, I've come in contact with all manner illness and infections. I've had coughs and colds, gastro, and other viral illnesses, but I've also built up an immunity to most of them.

Unfortunately the Australian indigenous population has a significantly poorer health than the non indigenous population

Overall, Indigenous Australians experience lower levels of access to health services than the general population, attributed to factors such as proximity, availability and cultural appropriateness of health services, transport availability, health insurance and health services affordability proficiency in English. 

The social determinants of health include if a person:

• is working
• feels safe in their community (no discrimination).   
• has a good education
• has enough money
• feels connected to friends and family.

Social determinants that are particularly important to many Indigenous people are:

• their connection to land
• a historical past that took people from their traditional lands and away from their families.

If a person feels safe, has a job that earns enough money, and feels connected to their family and friends, they will generally be healthier. Indigenous people are generally worse off than non-Indigenous people when it comes to the social determinants of health.

Infants	High rates of low birth weight, high rates of growth faltering (or failure-to-thrive), high rates of infections (particularly respiratory and gastrointestinal)
Young children (3-8 yrs)	Repeated and/or chronic infections (particularly of the skin, ears/nose/throat, eye, respiratory system, gastrointestinal and genitourinary), under nutrition, anaemia, intestinal parasites
Older children 9-14 (yrs)	Repeated infections, growth retardation, accidents, alcohol and drug abuse
Youth (15-20 yrs)	Communicable disease, incarceration, suicide, self harm, injury, poisonings, alcohol and drug abuse
Adults (21-40 yrs)	Respiratory diseases, digestive system disorders, obesity, hypertension, cardiovascular disease, diabetes (type 2), complications of pregnancy; chronic renal diseases and renal failure, alcohol-related disorders, psychosocial stress and mental disorders, accidents and violence
Elderly (>40 yrs)	Disabilities, immobility, chronic diseases requiring regular clinical care and supervision, provision of adequate and culturally appropriate services and facilities

(West Australian Department of Health, 2013) 

In my experience - and of course this is just my observations over the years, the poor health of the indiginous population is determined in part by the history - at least since Captin Cook landed, and by the social determinants of health - its complicated thats for sure.

The poor immunity, poor sanitation, lack of housing, fresh foods ect leads to increase spread of infection through the communities. which of course in turn leads to poorer health and an increase in mortality and morbidity.

Then there is me ----- The nurse/person that constantly comes into contact with "bugs" that would proably send most city doctors running for their text books !!

And of course occassionally i manage to pick up a really nasty gastro and viral illness!!

 

Bloody boils -- please help

My 3.5 year old fell over at child care about 6 weeks ago, and grazed his knee, a few days later it turned into a boil. 4 lots of antibiotics later it still won't heal!!
He's been off his food, grizzly, having the odd day of temperatures and the odd vomit, he keeps getting swollen lymph nodes in his groin, he was completely toilet trained but he's wet the bed a few times, just in such a deep sleep I think

I've been nursing a long time and I've  seen plenty of boils, but not one in the same spot that keeps popping up for several weeks straight

Any ideas anyone ?

I've tried pentavite vitamins
And I've just resorted to sustagen so he's at least getting some nutrients

Anyone else had the same problem ?? 

I hate flying!

Wow, I really hate flying !!!

We were off to my brothers wedding, since its a three day drive from his house , I reluctantly decided to fly, it's only 500 Km's to the airport about 4.5 hrs drive if the kids don't play up too much.
We almost always get a few Kms down the road and one of them decides to poo!!

Anyway off we go, we arrive in Alice Springs, do some shopping, have the mandatory feed of MacDonald's
and take my Daughter to the ENT to check her ears - still a mild hearing loss.

having been up since 0430 we are already tired and the kids are cranky!. we wake up early on Sunday morning having had a horrible night in the motel as the air con didn't work properly and it was too hot and my Daughter grizzled on and off all night with a??mild ear ache or ?? teething

As we go to the airport i swallow a bunch of my air sick pills in hopes they work!

it was a Quantas link flight so no in air entertainment :(
I felt miserable and the kids wanted to run up and down the isles!

Then the landing into Brisbane was rough due to the weather , we had to bank around and the planes engines kept speeding up and slowing down until i was convinced we were going to crash!

after a torturous landing i was finally on safe ground.
Then we had to find the hire car and get ourselves of to dads house , but not after we discover one of our bags had been lost !! it was one with the toiletries in it too

after an eventful week of dress and shoe shopping, as well as eating every take out and junk food available, we were up at 6.30,  we packed up, we had to buy another suitcase to get back on the plane !! we had brought all the kids winter clothes lol.

I swolled a bunch of air sick pills and gritted my teeth as i got back on the plane!
This time there was in air entertainment and i watched life of PI in between trying to ignore the fact i was on a plane and dealing with two restless kids
about 30 mins prior to landing both kids pitched a fit and about 15 mins prior to landing they were fast asleep - un bloody believable!!  We were desperately trying to shush them so the other passengers didn't get upset it was horrible !

Finally we land - bundle everyone and everything off the plane
race off to woolies, grab a few bits and pieces and start the 4.5 hour journey home finally arriving home just before 7 pm .

Overcome the fear of flying

<a href="http://f4383cqzs0ydtoiawc0w6s7tav.hop.clickbank.net/" target="_top">Click Here!</a>

 

Learn How To Overcome Fear Of Flying In As Little As :60 Minutes With My Special Techniques And Strategies,even While Waiting For A Flight.

<a href="http://bd978lz8u3ujnp9ps2nt09ut2o.hop.clickbank.net/" target="_top">Click Here!</a>

Why not fly for free!!!

<a href="http://f3e4aiuyt9n7tti8spic5clybg.hop.clickbank.net/" target="_top">Click Here!</a>

 

 

 

The Ultimate Games Guide Teaches You How To Play Dozens Of The Best Party Games, Only The Very Best Group Games, Beer Games And Card Games Around!!!

 

 

<a href="http://8b1b8brai6vbiud9t8ongw0n1q.hop.clickbank.net/" target="_top">Click Here!</a>

 

 

 

A 10 hr round trip for a 45 min appointment !!!

Living remotely has its perks ! medical care is not one of them.
No offence to the serives provided - I myself am a nurse and the care that can be provided in a small town is often great. its the extra requirements not so much

Well after a 5 hr drive and getting up at 4 am - we made it to Alice springs , We took Temperance to the ENT , still has slight hearing loss( we know that!) one pink ear and no we won't give her grommets come back for a review in 4 months time !! - all of which took about 45 min
Well a night at a hotel and some nice food, a bit of shopping and another 5 hour trip home
About$400 in petrol
$180 for hotel room
Plus food and shopping, which we always buy more than we need lol, can't pass up all the specials !

One of the many challenges of living in the bush

thinking about moving to Australia ?

Hi,  
Ive put a few recommendations for some resources and intersting reading on my blog for those of you who want to know more about Oz


The Book Is Aimed To All Those Who Are Considering The Idea Of Moving To Australia, Or Those Who Are Already In The Middle Of It. It Is Aiming To Make You Think About It Better And It Acts As A Facilitator Of Thoughts. Have A Good Trip.

<a href="http://8e10ab20s30bgzhepb8qfe2x4y.hop.clickbank.net/" target="_top">Click Here!</a>


____________________________________________________________________________


A Step-by-step Guide To Getting A Visa, Job And Registration & Relocating And Settling In Australia. In 3 Parts, An Invaluable, User-friendly Guide For Overseas Nurses, Midwives And International Nursing Students Wanting To Work, Study & Live In Australia

<a href="http://4efafhu1s4sdlvab7n399shy33.hop.clickbank.net/" target="_top">Click Here!</a>



________________________________________________________________________________

Everything You Need To Know Before Travelling Around Australia. Packed Into This Ebook Is Guidance On Where To Go, Choosing The Right Rig, Vehicle Preparation, Communication Equipment, Gps Navigation, Digital Mapping, Travelling With Kids, First Aid...

<a href="http://1c55fg28xz0kpz9adg8bshck1e.hop.clickbank.net/" target="_top">Click Here!</a>