Discharge Against Medical Advice (DAMA) among Aboriginal and Torres Strait Islanders

According to Shaw (2016), most people Aboriginal and Torres Strait Islanders (ATSI) have a poor healthcare outcome and access compared to the non-Indigenous population. The reason for this health gap is due to the social, economic, political and cultural factors. Furthermore, the people of ATSI suffers from higher rates of chronic diseases which include diabetes, kidney diseases, and cancer. Also, they get hospitalized at a rate that is higher than that of the non-Indigenous population. These are some of the factors that have caused the rate of the DAMA to be high in the ATSI people compared to that of the non-Indigenous population. Moreover, the access to healthcare services is a serious issue especially for the ATSI people living in the rural areas (Shaw, 2016). This article aims to address the health factors that have contributed to the ATSI peoples’ rate of DAMA. Also, the article has identified a health system improvement strategy that could reduce the incidences of ATSI peoples’ rate of DAMA. The importance of managing the DAMA is because it is the primary cause of readmissions and it poses a severe problem for patients in care continuity.

Cross-cultural Communication and Linguistic Issues

Some of the Aboriginal and Torres Strait Islanders (ATSI) have an issue with communication especially between the staff and the ATSI patients which raised concerns. The hospital staff admitted that the ATSI people have a different understanding when it familiar with the disease process, medical treatment and hospital routine must be followed by all patients (Holmes, 2017). Moreover, the use of medical language was often not understood by the patients, and this contributed to the ATSI people lack understanding of their sickness and the procedure of treatment. An Indigenous patient said that the hospital staff had a mindset that urban Indigenous patients were the ones that could understand what the nurse or doctor said (Emma, 2011). It is because most of the medical staff communicated in English and assumed that the ATSI patients from the rural areas could not understand what they were saying which was not always the case. According to Holmes (2017), this got noted across the various ATSI language groups which were worrying and frustrating because assumptions were being made by the hospital staff concerning medication administrations. Furthermore, the ATSI people made it difficult to administer treatment because there were cases that some of the Indigenous patients had a fear of needles and instruments. Moreover, the Indigenous people made it difficult for the nurse to carry out procedures such as x-rays, ultra-sounds, and they also found it challenging to complete antibiotics before they got officially discharged from the hospital. Furthermore, ATSI patients who required long-term treatment made it difficult for the nurses to carry out their nursing responsibilities because some of them were quick to leave the hospital even before they fully recovered. These communication difficulties contributed to the high DAMA in the ATSI people.

Factors affecting healthcare system and DAMA in ATSI patients

Social and Cultural Issues

The hospital staff also identified that various cultural and social issues that contributed to the high rate of self-discharge in ATSI people. Also, women especially mothers left their children under the care of relatives back home because they were anxious for them to get well (Emma, 2011). The reason for this is that the mothers got increasingly worried when they heard children carry in the Children’s Ward who made the ATSI mothers feel the sense of taking their children back home. Furthermore, the ATSI mothers thought that the nurses never had an understanding of the need for them to be close to their children because it was cultural for them. Also, mothers who had sick or premature babies often faced pressure from their family to go back home which led to the high DAMA of the ATSI.  Some of the mothers were pressured by their families to go back home and take care of their older children which resulted to them leaving the newborns in the hospital without them knowing if the needs of the newborn got catered. Moreover, the isolation and loneliness that some ATSI patients went through especially those who were from rural areas preferred self-discharging themselves from the hospital without the proper recommendation from the doctors. The nurses in the hospital facility also noted that even when the ward was predominant with ATSI patients, they never supported each other because there was no common language in which they could communicate. It further increased the self-discharge that is often experienced by the ATSI people thus the high rate in the DAMA.

Hospital Environment

Though some of the hospitals in the region were considered appropriate by the ATSI people, some complained that other hospital facilities had no air-conditioning and high-raised buildings. Moreover, some ATSI complained that some facilities did not have outdoor space where they could sit and their family members which also contributed to the high level of DAMA. Some Indigenous people said that the wards were either cold or hot and the spacing of the hospital beds was inappropriate. Furthermore, some of the toilets were unisex which also was disturbing to some of the ATSI patients, and even they complained that some of them got placed in the same ward with people they had an avoidance relationship. Another issue that nurses said was that some of the male ATSI patients were difficult to care for because some did not like being spoken to by female staff while some were intimidated by the female medical staff.

Communication difficulties contributing to high DAMA

Medical Staff Skills, Attitude, Ability, and Awareness.

According to Durey (2012), some of the ATSI patients complained that there were racist attitudes and insensitive behaviors that the hospital staff had towards them. The reason for this was because some of the hospital staff had no experience in caring for the Indigenous patients. Furthermore, the some of the nurses had little knowledge and understanding of the social, cultural and emotional issues that the ATSI patients and families faced. This situation often led to assumptions got made on why the ATSI patient left without completion of their treatment.

Cultural Safety

Cultural safety is intended to construct effective clinical care and health system administrations that are focused on providing the ATSI people with health and wellbeing system that values the culture of the Aboriginal people (Framework, 2015). Furthermore, providing cultural safety in offering health service is identified as an effective way to minimize cost which improves outcomes in the healthcare assessment on the ATSI people (Australian Government, 2010). Moreover, cultural safety enriches the provision of healthcare services by competent health care practitioners. Also, the purpose of the cultural security is to ensure that the building designs can accommodate the needs of the ATSI people which will improve their wellbeing.

Conclusion

The article addresses the essential factors that affect the healthcare system which has caused an increase in the DAMA of the Aboriginal and Torres Strait Islanders. Some of the critical issues identified include social and cultural factors where the family puts pressure on ATSI mothers to go back home and take care of their older babies. Furthermore, there have been complaining that some of the medical staff assume that the ATSI people are not used in English which results in neglect of healthcare of the ATSI people. It puts the ATSI patients in a situation where they have to self-discharge themselves from the hospital because they not being taken care. Also, the lack of experience from the nurses proved a vital issue why the ATSI people prefer discharging themselves from the hospital which increases the DAMA level.

References

Australian Government, (2010). Aboriginal and Torres Strait Islander Health Performance Framework. Retrieved from: https://www.health.gov.au/internet/publications/publishing.nsf/Content/health-oatsih-pubs-framereport-to 

Dudgeon, P., Milroy, H. & Walker, R. (2014). Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principle and Practice Retrieved from: https://www.mhcc.org.au/media/80434/working-together-aboriginal-and-wellbeing-2014.pdf 

Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous Australians: time to change focus. BMC health services research, 12(1), 151.

Emma, K. (2011). Who Cares? Aboriginal and Torres Strait Islander Health Care Choices and Access Barriers in Mount Isa. Retrieved from: https://researchonline.jcu.edu.au/31287/1/31287_McBainRigg_2011_thesis.pdf 

Framework, (2015). Implementation Guide For the WA Aboriginal Health and Wellbeing Framework 2015-2030. Retrieved from: https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Aboriginal%20health/PDF/1 

Holmes, J., & Wilson, N. (2017). An introduction to sociolinguistics. Routledge. Retrieved from: file:///C:/Users/My/Downloads/9781317542919_googlepreview.pdf 

Shaw, C., (2016). An Evidence-based Approach to Reducing Discharge Against Medical Advice Amongst Aboriginal and Torres Strait Islander patients. Retrieved from: https://ahha.asn.au/system/files/docs/publications/deeble_institute_issues_brief_caitlin_shaw_2_1.pdf