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86 LAYING THE FOUNDATION
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UNIT 1
Review of systems
The review of systems (ROS) is the consumer’s subjective response to a series of
body system-related questions and serves as a double check that vital information
is not overlooked. The ROS covers a broad base of clinical states, but it is by no
means exhaustive. The ROS follows a head-to-toe or
includes two types of questions: sign- or symptom-related and disease-related. The
signs or symptoms and diseases are grouped according to physiological body parts
and systems. Some of the diseases may have been discussed earlier in the interview.
Both positive and pertinent negative ndings are documented in the ROS.
When a response is positive, ask the consumer to describe it as completely as
possible. Refer to the 10 characteristics of a chief complaint when gathering more
information about positive responses.
Table 3.1 lists the symptoms and diseases that
can be ascertained during the ROS. Many organisations have pre-printed ROS sheets.
These are convenient to use because positive ndings can be circled and noted.
Negative responses are not circled. As you become more experienced, you can
combine the ROS with the physical examination of the consumer. Thistechnique
often shortens the interview time with the consumer.
Remember to ask the questions in terms that are understood by the consumer.
The following is an appropriate statement to make the transition from the health
management or health promotion to the ROS.
cephalocaudal approach and
EXAMPLES OF QUESTIONS ASSESSING REVIEW OF SYSTEMS (ROS)
> ‘Now I would like to ask you if you have experienced a variety of conditions. Most of the questions
can be answered with “yes” or “no”.’
Pose the same question for each item in the ROS:
> ‘Have you ever had ... ?’
TABLE 3.1 Review of systems
General Consumer’s perception of general state of health at the present, difference from usual state, vitality and energy levels, body odours,
fever, chills, night sweats
Mental status
and neurological
system
Skin
Hair Alopecia, excessive growth of hair or growth of hair in unusual locations (hirsutism), use of chemicals on hair, dandruff, pediculosis,
Eyes Blurred vision, visual acuity, glasses, contact lenses, photophobia, excessive tearing, night blindness, diplopia, drainage, bloodshot eyes,
Ears Cleaning method, hearing decits, hearing aid, pain, phonophobia, discharge, light-headedness (vertigo), ringing in the ears (tinnitus),
Neurological Headache, change in balance, incoordination, loss of movement, change in sensory perception or feeling in an
extremity, change in speech, change in smell, syncope, loss of memory, tremors, involuntary movement, loss of
consciousness, seizures, weakness, head injury, vertigo, tremor, tic, paralysis, stroke, spasm
Psychological Irritability, nervousness, tension, increased stress, difculty concentrating, mood changes, suicidal thoughts,
depression, anxiety, sleep disturbances, eating disorders
Rashes, itching, changes in skin pigmentation, ecchymoses, change in colour or size of mole, sores, lumps, dry or moist skin, pruritus,
change in skin texture, odours, excessive sweating, acne, warts, eczema, psoriasis, amount of time spent in the sun, use of sunscreen,
skin cancer
scalp lesions
pain, blind spots, ashing lights, halos around objects, oaters,
usual noise level, earaches, infection, piercings, use of ear protection, amount of cerumen, insertion of grommets
glaucoma, cataracts, use of sunglasses, use of protective eyewear
Nose and
sinuses
Mouth Dental habits (brushing, ossing, mouth rinses), toothache, tooth abscess, dentures, bleeding or swollen gums, difculty chewing, sore
Throat and neck Hoarseness, change in voice, frequent sore throats, dysphagia, pain or stiffness, enlarged thyroid (goitre), lymphadenopathy,
Lymph nodes Enlargement, tenderness
Number of colds per year, discharge, itching, hay fever, postnasal drip, stufness, sinus pain, sinusitis, polyps, obstruction, epistaxis,
change in sense of smell, allergies, snoring
tongue, change in taste, lesions, change in salivation, bad breath, caries, teeth extractions, orthodontics
tonsillectomy, adenoidectomy
>>
THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION 87
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>>
TABLE 3.1 continued
Musculoskeletal Joint stiffness, muscle pain, cramps, back pain, limitation of movement, redness, swelling, weakness, bony deformity, broken bones,
dislocations, sprains, crepitus, gout, arthritis, osteoporosis, herniated disc
Nails
Respiratory
Breasts and
axilla
Cardiovascular
Haematological Easy bruising or bleeding, anaemia, sickle cell anaemia, blood type, exposure to radiation
Gastrointestinal
Nutrition
Urinary
Endocrine
Female
reproductive
Change in nails, splitting, breaking, thickened, texture change, onychomycosis, use of chemicals, false nails
Dyspnoea on exertion, shortness of breath, sputum, cough, sneezing, wheezing, haemoptysis, frequent upper respiratory tract
infections, pneumonia, emphysema, asthma, tuberculosis, tuberculosis exposure, result of last chest X-ray, Mantoux test
Pain, tenderness, discharge, lumps, change in size, dimpling, rash, benign breast disease, breast cancer, results of recent mammogram
Paroxysmal nocturnal dyspnoea, chest pain, cyanosis, heart murmur, palpitations, syncope, orthopnoea (state number of pillows used),
oedema, cold or discoloured hands or feet, leg cramps, myocardial infarction, hypertension, valvular disease, intermittent claudication,
varicose veins, thrombophlebitis, deep vein thrombosis, use of support hose, result of last ECG
Change in appetite, nausea, vomiting, diarrhoea, constipation, usual bowel habits, melaena, rectal bleeding, haematemesis, change in
stool colour, atulence, belching, regurgitation, heartburn, dysphagia, abdominal pain, jaundice, ascites, haemorrhoids, hepatitis, peptic
ulcers, gallstones, gastro-oesophageal reux disease, appendicitis, ulcerative colitis, Crohn’s disease, diverticulitis, umbilical hernia
Present weight, usual weight, desired weight, food intolerances, food likes and dislikes, where meals are eaten, caffeine intake
Change in urine colour, voiding habits, dysuria, hesitancy, urgency, frequency, nocturia, polyuria, dribbling, loss in force of stream,
bedwetting, change in urine volume, incontinence, urinary retention, suprapubic pain, ank pain, kidney stones, urinary tract infections
Exophthalmos, fatigue, change in size of head, hands or feet, weight change, heat and cold intolerances, excessive sweating,
polydipsia, polyphagia, polyuria, increased hunger, change in body hair distribution, goitre, diabetes mellitus
Vaginal discharge, change in libido, infertility, sterility, pelvic pain, pain during intercourse, postcoital bleeding; menses: last menstrual
period (LMP), menarche, regularity, duration, amount of bleeding, premenstrual symptoms, intermenstrual bleeding, dysmenorrhoea,
menorrhagia, broids; menopause: age of onset, duration, symptoms, bleeding; obstetrical: number of pregnancies, number of
miscarriages or abortions, number of children, type of delivery, complications; type of birth control, hormone replacement therapy
CHAPTER 3
Male
reproductive
Change in libido, infertility, sterility, impotence, pain during intercourse, testicular or penile pain, penile discharge, erections,
emissions, hernias, enlarged prostate, type of birth control
CONCLUDING THE HEALTH HISTORY
After completing the ROS, ask the consumer whether there is any additional
information to discuss. At the conclusion of the interview, thank the consumer
forthe time spent in gathering the health history. Inform the consumer what the
next step will be (e.g. physical examination, diagnostic tests, treatment) and when
to expect it.
Supportive equipment
Some chapters in this text will contain a section on supportive equipment for that
particular body system. It is important to assess the supportive equipment as they
are healthcare extenders for the consumer. Whether the supportive equipment
is supplemental oxygen, a walker or a feeding tube, it needs to be evaluated as
you examine the consumer. Correct use of these devices will help the consumer
maintain a current level of health, whereas incorrect use can harm the consumer.
DOCUMENTATION
The documentation of the health assessment and physical examination is the legal
record of the consumer encounter. It also serves as the medium among health
professionals for communicating about the consumer’s condition. The consumer
record represents a description of the consumer’s status and the care delivered to the
consumer. The documentation may be read by a multitude of professionals: nurses;
doctors; dietitians; physio, speech and occupational therapists; risk managers;
utilisation reviewers; quality assurance personnel; accreditation organisations;
88 LAYING THE FOUNDATION
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lawyers; insurance companies; and, ultimately, the consumer! Because all of these
people have access to the consumer’s chart, you must document everything in a
professional and legally acceptable manner.
UNIT 1
to guide your documentation regardless of whether it is paper-based or electronic
documentation.
Table 3.3 provides specic assessment-oriented ‘dos’ and ‘don’ts’ for
documentation. Each organisation also has its own documentation system. If you
perform computerised charting in your workplace, always safeguard your access
code to protect yourself.
TABLE 3.2 General documentation guidelines
IF USING ELECTRONIC MEDICAL RECORDS, PROTECT YOUR ACCESS CODE AND ELECTRONIC SIGNATURE.
Ensure that you have the correct consumer record or chart and that the consumer’s name and identifying information are on every page of the record.
1
Document as soon as the consumer encounter is concluded to ensure accurate recall of data (follow organisation’s guidelines on frequency of charting).
2
3
Avoid distractions while documenting. This is frequently when errors are made.
If interrupted while documenting, reread what you wrote to ensure accuracy.
4
5
Record date and time of each entry. (This may be a forced function in electronic documentation.)
Sign each entry with your full legal name and with your professional credentials, or per your organisation’s policy (for paper-based documentation;
6
electronic documentation will bear your access code, so ensure you protect this).
Table 3.2 outlines general principles
7
Do not sign a note that you did not write (for paper-based documentation; electronic documentation will bear your access code, so ensure you
protect this).
8
Do not leave space between entries (for paper-based documentation).
Do not insert information between lines (for paper-based documentation).
9
10
If an error is made while documenting, use a single line to cross out the error, then date, time and sign the correction (check organisational policy); avoid
erasing, crossing out, or using correction uid (for paper-based documentation).
11
Never correct another person’s entry, even if it is incorrect (for paper-based documentation).
Use quotes to indicate direct consumer responses (e.g. ‘I feel lousy’).
12
13
Document in chronological order; if chronological order is not used, state why.
14
Use legible writing (for paper-based documentation).
Use a permanent ink pen (for paper-based documentation. Black is usually preferable because of its ability to photocopy well).
15
16
Document in a complete but concise manner by using phrases and abbreviations as appropriate. Avoid using dangerous abbreviations, acronyms and
symbols as specied by your healthcare organisation.
17 When writing numbers less than 1, write a zero to the left of the decimal point; this avoids confusion as to the use of a decimal point.
Document telephone calls that relate to the consumer’s case.
18
19
Always reread your notes for accuracy.
20 Record the name of the interpreter if one is used.
21 Avoid using words that have more than one meaning.
22 Remember, from a legal standpoint, if you didn’t document it, it wasn’t done.
Electronic medical records (EMRs) create a paperless system that can reduce
charting/documentation time once the clinician is familiar with the system. EMRs
enable the nurse to use voice recognition, narrative writing, and/or check boxes
with drop-down menus to record consumers’ histories and examination ndings.
Other advantages of EMRs are their legibility, easy accessibility, ability to be accessed
by multiple users simultaneously at different work stations in different areas in real
time, and capability of accessing real-time laboratory and diagnostic studies.
THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION 89
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TABLE 3.3 Examination-specic documentation guidelines
DO DON’T
DO record all data that contributes directly to the examination (i.e. positive
examination ndings and pertinent negatives).
DO document any parts of the examination that are omitted or refused by
the consumer.
DO state time intervals precisely (e.g. ‘every 4 hours’, ‘B
‘seldom’, ‘occasionally’).
DO draw pictures when appropriate (e.g. location of scar, masses, skin lesion,
ulcers, deep tendon reex, etc.).
DO refer to ndings using anatomic landmarks (e.g. left upper quadrant
[of abdomen], left lower lobe [of lung], midclavicular line, etc.).
DO document any change in the consumer’s condition during a visit or from
previous visits.
DO describe what you observed.
D’ instead of
DON’T use judgemental language such as ‘good’, ‘poor’, ‘bad’, ‘normal’,
‘abnormal’, ‘decreased’, ‘appears to be’ and ‘seems’.
DON’T use evaluative statements (e.g. ‘
‘Consumer is lazy’); cite instead specic statements or actions that you
observe (e.g. ‘consumer said, “I hate this place” and kicked a chair’).
DON’T make relative statements about ndings (e.g. ‘mass the size of an egg’);
use specic measurements (e.g. ‘mass 3 cm by 5 cm’).
DON’T describe what you did.
Documentation should also reect information that is relayed verbally, and is
the standing record of consumer care (which is based on your assessment of the
consumer). Documentation is one of the most important aspects of care as:
The written patient record survives far into the future and should serve to
give a clinical picture of the patient that is accurate, legible, clear and precise.
Continuity of care and avoidance of errors depend on this.
Calleja, Aitken & Cooke, 2011, p. 15.
CHAPTER 3
Consumer is uncooperative,’
Many health organisations are building structure into all forms of clinical
communication, and handover structures are being developed and implemented
as a way of improving communication. Calleja et al. (2011) also identify a gap
in linking documentation to information that is handed over. To reduce the
incidence of this issue, some clinicians are using handover structures to guide any
documentation that may usually be unstructured (e.g. nurse’s progress notes). One
such structure to support this is the SBAR structure (Figure 3.11) (Haig, Sutton &
Whittington, 2006). Please note there are other similar structures such as ISBAR and
ISOBAR. Regardless of the one used in your environment, ensure you understand
the structure and what the aim of using it is.
REFLECTION IN PRACTICE
Assessing your documentation
After completing the health history, reect on the techniques you used to elicit the history.
Did you rush the consumer? Did you use too many open-ended or closed questions?
Wasyour documentation concise? What could you have done better?
Many healthcare facilities have pre-printed health history forms that are
checklists and require few narrative notes. Other facilities require the nurse to
document the health history in its entirety. The health histories that follow
throughout the text illustrate how to document the complete health history of an
ill consumer and a well consumer.
Chapter 22 gives examples of documentation of a comprehensive and focused
health assessment and physical examination.
90 LAYING THE FOUNDATION
Many health organisations are building structure into all forms of clinical
communication and handover structures are being developed and implemented
as a way of improving communication. Calleja et al. (2011) also identify a gap
in linking documentation to information that is handed over. To reduce the
incidence of this issue, some clinicians are using handover structures to guide any
documentation that may usually be unstructured (e.g. nurse’s progress notes). One
such structure to support this is the SBAR structure (Figure 3.11) (Haig, Sutton &
Whittington, 2006).
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
SBAR Communication
UNIT 1
Use the following SBAR steps to communicate issues, problems or
opportunities for improvement to coworkers or supervisors. SBAR can be
applied to both written and verbal communications.
SITUATION – State what is happening at the present time that has warranted
the SBAR communication. Example: Patients and visitors are entering the
medical centre through the wrong doors and getting lost trying to find their
destination.
BACKGROUND – Explain circumstances leading up to this situation. Put the
situation into context for the reader/listener. Example: The campus has many
buildings and is accessible from both E. Washington St. and Eastland Dr. Other
entrances are more noticeable than the hospital’s main entrance. MD offices do not
have good maps to mark and hand to patients when sending them to our campus,
and they often misdirect patients.
ASSESSMENT – What do you think the problem is? Example: People need
something that they can carry with them when they are coming to the hospital so
they park outside the appropriate entrance.
RECOMMENDATION – What would you do to correct the problem?
Example: Create a campus visitor guide that includes an “aerial” map of the campus
as well as a community map and floor by floor maps. Distribute widely, including
to physician offices. Make them available to visitors in admission packets and at all
entrances.
FIGURE 3.11 SBAR communication
SOURCE: REPRINTED FROM THE JOINT COMMISSION JO URNAL ON QUALITY AND PATIENT SAFETY, VOL 32/ISS UE 3, K HAIG, S S UTTON A ND J WHIT TINGTON , SBAR: A SH ARED MEN TAL
MODEL F OR IMPRO VING COMM UNICATIO N BETWE EN CLINIC IANS, CO PYRIGH T 2006, W ITH PERM ISSION FR OM ELSEV IER.
CHAPTER RESOURCES
REVIEW QUESTIONS
For answers to these questions, see Answer section at the end
ofthis book.
1. A consumer at the clinic is complaining of feeling tired for
thepast few months. What type of health history should the
nurse use?
a. Complete health history
b. Focused health history
c. Both a and b
d. Emergency health history
2. A consumer tells you that she has bloating and increased
abdominal sounds, and diarrhoea along with her abdominal
pain. What characteristic of a chief complaint do the vomiting
and nausea represent?
a. Location
b. Radiation
c. Aggravating factors
d. Associated manifestations
3. The nurse is conducting a family health history on a consumer
who says that he was adopted as a baby. What would be the
nurse’s next best step?
a. Ask the consumer to contact the adoption agency to learn
his biological parents’ health conditions
b. Continue the health history with the social history
c. Inquire about medical conditions of his adopted family,
asthey can affect the consumer’s health
d. Tell the consumer that he has no concerns because he
ishealthy
4. A consumer reports that he has had increased illicit drug
use in the last month. What would be the next appropriate
response for the nurse to make?
a. ‘Oh OK, do you like taking drugs?’
b. ‘Well no wonder you have abdominal pain, your liver must
be terrible.’
c. ‘Are you quitting any time soon?’
d. ‘How do you view your drug taking? Have you ever
considered quitting or reducing your intake?’
THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION 91
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5. The nurse documents that the consumer’s back pain is 9/10
in the left side of her lower back radiating to the left ank.
The consumer reports feeling a stabbing sensation that is
accompanied by nausea and vomiting. Which characteristics
of a chief complaint are described in this statement?
Select all that apply.
a. Location
b. Radiation
c. Quality
d. Quantity
e. Setting
f. Associated manifestations
6. Which of the following statements is true about the review
ofsystems?
a. It is performed at the beginning of the health history.
b. It usually follows a cephalocaudal approach.
c. It is based on a functional assessment.
d. It is a summary formed by the nurse at the end of the
health history.
7. Which of the following chart entries is documented correctly?
a. The mass is egg-sized.
b. The mass appears to be smaller than last week.
c. The mass is located in the left lower quadrant.
d. The mass does not seem to bother the consumer.
8. Which of the following situations warrants more investigation
for possible domestic and intimate partner violence? Select all
that apply.
a. Small oval bruises around the throat of the consumer
b. A blister on the consumer’s lip consistent with a history
ofcold sores
c. Frequent urinary tract infections
d. Consumer refusal to answer questions about
past injuries
e. Vague symptoms such as fatigue, headaches, that have
‘caused’ clumsiness or small injuries or nonattendance
ofappointments
f. A signicant other who will not allow the consumer to
answer questions
9. Which of the following statements reect objective
documentation? Select all that apply.
a. Consumer has a poor attitude about losing weight.
b. Abdominal pain is elicited by palpation in the right
upperquadrant.
c. White nipple discharge is noted bilaterally.
d. Consumer is uncooperative in taking medications
asdirected.
e. Consumer performs ve deep breaths every hour.
f. Swelling of the legs has decreased since yesterday.
10. When undertaking an emergency assessment for the
consumer with chest pain, which of the following statements
best describes priority of assessment?
a. Asking the consumer about their lifestyle
b. Advising the consumer to quit smoking
c. Assisting the consumer to identify the medications
theyare on
d. Asking the consumer questions about their pain, while
conducting a physical examination including Airway,
Breathing, Circulation and Disability.
CLINICAL SKILLS
The following Clinical Skills are relevant to this chapter and
can be found in Tollefson & Hillman, Clinical Psychomotor
Skills 8th edition:
> 25 Clinical handover
> 26 Documentation.
CHAPTER 3
FURTHER RESOURCES
Advance directives
> Advance Care Planning Australia:
https://www.advancecareplanning.org.au/
> Advance Directives & Enduring Powers of Attorney:
https://www.hdc.org.nz/your-rights/about-the-code/advancedirectives-enduring-powers-of-attorney/
Intimate partner violence
> Care directives for clinicians, Australia: https://www.racgp.org.
au/clinical-resources/clinical-guidelines/key-racgp-guidelines/
view-all-racgp-guidelines/abuse-and-violence/preamble
> New Zealand: http://www.health.govt.nz/our-work/
preventative-health-wellness/family-violence
Smoking cessation
> QUITnow: http://www.quitnow.gov.au
> RACGP guidelines for smoking cessation for health
professionals: http://www.racgp.org.au/your-practice/
guidelines/smoking-cessation
> QUIT New Zealand: http://www.quit.org.nz
Immunisation schedule
> Australia: https://beta.health.gov.au/health-topics/
immunisation
> Australian Immunisation Register for health professionals:
https://www.humanservices.gov.au/organisations/healthprofessionals/services/medicare/australian-immunisationregister-health-professionals?utm_id=9
> National Centre for Immunisation Research:
http://www.ncirs.edu.au
> New Zealand’s Immunisation Schedule: https://www.health.
govt.nz/our-work/preventative-health-wellness/immunisation/
new-zealand-immunisation-schedule
Travel immunisations
> Australia: Smart Traveller http://smartraveller.gov.au/guide/
all-travellers/health/Pages/health-checks-and-vaccinations.aspx
> New Zealand: The Immunisation Advisory Centre http://www.
immune.org.nz
> Safetravel: https://www.safetravel.govt.nz/you-go
92 LAYING THE FOUNDATION
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Exercise guidelines
> Australia: https://www.health.gov.au/health-topics/physical-
activity-and-exercise
> New Zealand: https://www.health.govt.nz/our-work/
UNIT 1
preventative-health-wellness/physical-activity
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Australian Government Department of Health and Aged Care. (2022).
Australian Immunisation Handbook. Retrieved from
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Australian Institute of Health and Welfare (AIHW). (2019). Family, domestic
and sexual violence in Australia, 2019. Cat. No. FDV 3. Canberra:
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Boxall, H., & Morgan, A. (2021). Intimate partner violence during the
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Calleja, P., Aitken, L. M., & Cooke, M. L. (2011). Information transfer for
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New Zealand Ministry of Justice. (2020). The New Zealand crime and
victims survey. Key ndings. Cycle 2, October 2018–September 2019.
https://www.justice.govt.nz/assets/NZCVS-Y2-core-report-v1.1-forrelease.pdf
NSW Health. (2020). Prevention and response to violence, abuse and
neglect. https://www.health.nsw.gov.au/parvan/Pages/default.aspx
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O’Connor, D. B., Thayer, J. F., & Vedhara, K. (2021). Stress and health: a
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(n.d.). DFV common risk and safety framework. https://www.justice.
qld.gov.au/initiatives/end-domestic-family-violence/our-progress/
enhancing-service-responses/dfv-common-risk-safety-framework
RACGP. (2021). Guidelines for preventative activities in general practice
(9th ed.). https://www.racgp.org.au/clinical-resources/clinical-guidelines/
key-racgp-guidelines/view-all-racgp-guidelines/guidelines-for-preventiveactivities-in-general-pr/psychosocial/intimate-partner-violence
Services Australia. (2022). What is family and domestic violence?
https://www.servicesaustralia.gov.au/what-family-and-domesticviolence?context=60033#a1
Special Taskforce on Domestic and Family Violence in Queensland. (2015).
Not now, not ever report. Retrieved from https://www.publications.qld.
gov.au/dataset/not-now-not-ever/resource/533db62b-b2c9-43cc-a5fff9e1bc95c7c7
CHAPTER
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4
ABORIGINAL AND TORRES STRAIT ISLANDER
PEOPLES’ HEALTH
LEARNING OUTCOMES
By the end of this chapter you should be able to:
1 describe the identity of Aboriginal and Torres Strait Islander peoples of Australia
2 discuss culturally safe and responsive nursing practice in the context of health assessment
and physical examination using the concepts of reexivity, cultural strengths and
intercultural communication
3 reect on the importance of continually developing self-knowledge, including
understanding personal beliefs, privileges, assumptions, values, perceptions, attitudes
and expectations, and how these impact on relationships with Aboriginal and Torres Strait
Islander peoples
4 discuss the ongoing impacts of colonisation on Aboriginal and Torres Strait Islander
peoples in Australian health care, which is evident in forms of racism, internalised racism
and resultant systemic barriers to healthcare access for Aboriginal and Torres Strait
Islander peoples
5 describe the critical role nurses play in breaking down barriers and enabling equitable and
safe access to health care for Aboriginal and Torres Strait Islander peoples
6 improve communication in clinical practice during health assessment and physical
examination by engaging with Aboriginal and Torres Strait Islander peoples’ ways of
‘knowing, being and doing’ that can be embedded into health practice as a pathway to
building trust and access.
93
My name is Nicole Hewlett, and I am a proud palawa woman from lutruwita
(Tasmania). I would like to acknowledge that we all stand in footsteps millennia old.
May we acknowledge the Traditional Custodians of the lands and waterways we
breathe on, whose cultures and customs have nurtured and continue to nurture this
land since men and women awoke from the great Dream. We honour the presence
of these ancestors who reside in the imagination of this land and whose irrepressible
spirituality ows through all creation.
I have been offered the privilege of helping to write this chapter while on Turrbul
and Yuggera Country of meeanjin (Brisbane) and would also like to respectfully
acknowledge the ancestral spirits that have inuenced the Aboriginal wisdom
shared with you in this chapter. If you are reading this, then the moment has
come for you to learn the lessons that will unfold in these pages. I am not a nurse,
sothischapter has been co-authored with nurses to contextualise the learnings to
your profession.
>>
94 LAYING THE FOUNDATION
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UNIT 1
>>
The spirit of this chapter is to take you on a journey in whichever role you take.
All peoples in Australia should have equitable access to healthcare knowledge,
resources and services, and to thrive with dignity, authority and respect. However,
it takes all of us, especially you, as healthcare professionals, to work in solidarity to
achieve this reality.
All the authors invite you to take a personal inward journey to the rivers of your
mind, which will require your openness and courage to sit with some uncomfortable
currents. This journey may produce debris of its own. It is not an easy journey, but
one that is powerful, and one which can bring an unimaginable richness to your
life. Let us begin to walk together, you have the opportunity to start here and now,
pulingina karati (welcome, friend).
Nicole Hewlett (2023)
BACKGROUND
In every role a health professional undertakes, whether this is in gathering
information to develop care plans and undertaking interventions to help improve
the health of consumers, practising in ways that make our consumers feel
culturally safe is paramount. If we are unable to provide culturally safe care, the
ability of the health professional to gather health and personal information on
which care decisions are based, can be reduced, or even completely blocked by the
misunderstandings, or inability to uncover the correct information at the right
time. Therefore, this journey is vitally important to both your consumers and to
you and the healthcare team.
In this chapter, you will encounter many different concepts about health care
related to Aboriginal and Torres Strait Islander peoples’ cultures when performing
health assessment and physical examination: cultural humility, cultural awareness,
cultural sensitivity, cultural capability, cultural security, cultural learning and
cultural respect. In nursing and midwifery, in other allied health professions,
in health education curriculums, and in Australian health policy, these are key
concepts when caring for people of a differing culture than your own. In the
nursing and midwifery profession, you will see these concepts in the codes of
practice, in the professional standards (NMBA, 2016), in curriculums (AGDH, 2014;
CATSINaM, 2017a), and in nursing academic literature (Cusack, Kinnear, Ward,
Mohamed & Butler, 2018). This section combines the concepts of ‘cultural safety’
and ‘cultural responsiveness’.
Please note that the focus of the chapter is specically on First Nations people
in Australia. Content related to Ma¯ori peoples of Aotearoa/New Zealand is referred
to throughout the textbook in context of particular health assessments. For further
information about Ma¯ori peoples in Aotearoa/New Zealand, we recommend that
you visit https://www.futureofhealth.govt.nz/maori-health-authority/ as well as
https://www.teakawhaiora.nz/, where you will nd up-to-date information, policy
documents and guidelines for conducting health assessments in a culturally
safe context.
INTRODUCTION TO CULTURALLY SAFE AND
RESPONSIVE PRACTICE
Cultural safety
Cultural safety uses a broad denition of culture that does not reduce it to
ethnicity, but includes age/generation, sexual orientation, socioeconomic status,
religious or spiritual belief, ethnic origin, gender and ability. It also recognises
ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES’ HEALTH 95
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that professions and work places have cultures, and cultural safety is as applicable
to working with colleagues in providing health care as it is to working with health
service users.
CATSINaM (2017a, p. 10)
The concept of culture is a component of nursing and midwifery accreditation,
standards, and conduct and practice (NMBA, 2016; ANMAC, 2019) in hospital
accreditation and registration (ACSQHC, 2017), allied health professions (IAHA,
2019), health policy (AGDH, 2021), and in the national strategy of Closing the Gap
(JCCTG, 2020). As you will read later in this chapter, culture and communication
are extremely important in clinical practice.
There are many denitions of culture; one is ‘… a set of meanings, behavioural
norms, and values used by members of a particular society, as they construct their
unique view of the world’ (Alarcon, Foulks & Vakkur, 1998, p. 6). In Australia,
racism has its roots in the colonial view of ‘an empty land’, denying the existence
of the original peoples of the land. This racism is evident as late as 50 years ago;
evident in the history of the ‘White Australia policy’ period from 1901–73. This
policy informed the development of health professions, including nursing, to
see non-white people (especially Aboriginal and Torres Strait Islander peoples) as
‘a reservoir of disease that would degenerate and erode the tness of the white
European’ (Mayes, 2020, p. 292). However, it is important to recognise that many
non-Indigenous peoples have been allies in antiracism and of the human rights of
Aboriginal and Torres Strait Islander peoples. Nevertheless, the nursing profession
and the healthcare systems need to be further educated and sensitised to create a
safe space for Aboriginal and Torres Strait Islander peoples.
CHAPTER 4
Cultural safety describes a state, where people are enabled and feel they can access
services that suits their needs, are able to challenge personal or institutional
racism levels (when they experience it), establish trust in services and expect
effective, quality care.
IAHA (2019, p. 4)
The Australian Health Practitioner Regulation Agency’s (Ahpra) denition of
‘cultural safety’ is:
Cultural safety is determined by Aboriginal and Torres Strait Islander individuals,
families and communities. Culturally safe practise [sic] is the ongoing critical
reection of health practitioner knowledge, skills, attitudes, practising behaviours
and power differentials in delivering safe, accessible and responsive health care
free of racism.
Ahpra (2020)
Cultural safety is central to Aboriginal and Torres Strait Islander peoples’
relationships with organisations and service systems: healthy relationships are
grounded in trust.
The health care system and the hospitals within it have historically eroded the
trust of Aboriginal and Torres Strait Islander people, leading to feelings of being
culturally unsafe, which is ‘any actions that diminish, demean or disempower the
cultural identity and wellbeing of an individual’.
NCNZ (2011, p. 7)
Nurses may have the best of intentions when providing culturally respectful
care; however, it is critical to note that experiences of cultural safety can only be
determined by Aboriginal and Torres Strait Islander peoples receiving care. Therefore
cultural safety does not necessarily require the study of any other cultures. It is
largely an inwards journey about landscaping our hearts and attitudes to be open
and exible towards others (see the ‘Reexivity’ section below).
The process of seeking cultural safety, like most forms of study and development,
is lifelong and it is the receiver of services who determines whether the service
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