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Family and Cultural Care of the Critically Ill Patient 169

have never left their original community or land. The Aboriginal Health Workers
ties Aboriginal people have to their people and land Aboriginal people access health care in two ways: through
are so strong that, rather than receiving lifesaving care, Aboriginal Community Controlled Health Services and
many prefer to refuse the treatment and die on the land through mainstream health services. There are many
that they belong in, with their family and community reasons why Aboriginal people do not access mainstream
present.
health services. Some of these barriers are related to
There are members (elders) of the community who often transport, fear of institutions, or culturally inappropriate
speak on behalf of that community and its people. A healthcare services. Anecdotally, Aboriginal people are
similar approach occurs within families, where spokes- more likely to access mainstream health services if there
people speak on behalf of the family and its members. is an Aboriginal person employed in the services.
These spokespeople could be either male or female There have been efforts to increase the number of Aborig-
(brothers, sisters, ‘Aunties’ or ‘Uncles’), and spokesper- inal registered nurses to improve the competency of the
sons differ from community to community. Some Aborig- Australian nursing workforce in delivering appropriate
inal communities have lores that dictate that only women care to Aboriginal people. 126 This move is supported by
talk (women’s business) or only men talk (men’s busi- the ‘getting ’em ‘n’ keeping ’em’ report of the Indigenous
ness). It is important that critical care nurses identify who Nursing Education Working Group, 128 the Common-
is the spokesperson of the patient from the outset and wealth Department of Health and Ageing and the Office
who is the right person to talk to about all aspects of the for Aboriginal and Torres Strait Islander Health. 128
patient’s care.
Issues around death and dying
Often, Aboriginal people are transferred from remote or
rural areas to major hospitals for specialist services. This There are a number of important cultural factors sur-
can cause great anxiety for the patient, family and com- rounding death and dying relating to Aboriginal patients
munity and can often lead to the patient refusing care or and families. Aboriginal people have a deep spiritual con-
transfer. It is important that the family be informed about nection to the land, the country; this is part of their
the potential for relocation, that it is important and that dreaming. The most important factor will be the need for
the family be given time to talk it over. In reality, the the Aboriginal patient to go ‘back to country’, back to
importance of the family being able to spend as much their traditional lands to die or to heal. The critical care
time as possible with the patient cannot be underesti- nurse should allow time and facilitate discussion with the
mated. Having the opportunity to pass on knowledge team around these issues and to also make sure that the
through stories to family members is important for relevant family or community member is present.
Aboriginal people. The critical care nurse can facilitate However, many times the Aboriginal patient will die in
this by allowing the time and the space for this impor- the critical care setting. If this happens there are certain
tant storytelling to occur. However, financial constraints protocols that need to be considered. Gender-appropriate
and geographical distance may make family visiting care may be needed, as often male elders will not allow
difficult.
women into their room, and will request a male nurse to
The interface between critical care, the hospital and care for them. It is important to note that some Aborigi-
primary health care is a critical part of the patient’s nal communities do not allow health professionals to
journey. It is important that critical care teams have part- handle the body after death. The critical care nurse needs
nerships with their local Aboriginal Community Con- to discuss with the family issues that relate to handling
trolled Health Services. This enables planning of care of the body. Some Aboriginal communities do not allow
across the continuum, as Aboriginal people will often the body to be cremated.
have follow-up visits with their local Aboriginal health- Aboriginal people have a distinct culture and health
care services.
beliefs that can interfere with the Western view of medi-
cine and health. It cannot be stressed enough that the
Communication integration of the patient’s culture into the critical care
Aboriginal culture is one of the oldest living cultures, one setting is important to achieving health gains. The critical
that is based on a deep sense of spirituality and oral care nurse needs to know the Aboriginal community or
history. Traditionally, knowledge has been passed down communities and develop relationships in order to
from generation to generation through storytelling and improve the health experience of Aboriginal people.
yarning. In some communities traditional languages are This section has highlighted the importance of consider-
still being used, and English may be a second or third ation of cultural differences in nursing care of the criti-
language for many Aboriginal people. Critical care nurses cally ill Aboriginal person, with important points
may need to identify interpreters to optimise communi- summarised in Table 8.3. Some important cultural aspects
cation with patient and family. Interpreters can be family that need to be taken into account are:
members, Aboriginal Health Workers or Aboriginal
Liaison Officers. Health information and health literacy ● Each Aboriginal community is different and has dif-
is a vital part of communicating with Aboriginal people. ferent lores; these need to be considered on a one-to-
It is important to identify the need for culturally appro- one basis.
priate resources, including visual aids, and to take steps ● Aboriginal health is holistic, and the community and
to access these. family are central to health.