Cultural Safety: A Culturally Safe Nursing Intervention For Treating Major Depression

Cultural safety is extremely important for maintaining power relationships between nurses and those under their care. The people who are receiving culturally safe nursing practices are given the empowerment of deciding what is considered to be culturally safe rather than just complying in a passive manner with the authority of some of the nurses as well as other healthcare professionals (“Cultural Safety,” 2022). To render culturally safe practices, a certain amount of personal, attitudinal, and cognitive skills will enhance communication between the nurse and the subject, who is the patient. It is a process to develop cultural safety which requires making some adjustments that accommodate different cultural needs. Nurses need to be culturally conscious of the various beliefs and norms of a patient’s culture while appraising them completely. The purpose of this essay is to discuss how a nurse can bring about recovery from major depression using family intervention as a culturally safe intervention and self-assertive training as a psychoeducation therapy in the Aboriginal community of Australia.

The patient who was subject to mental health intervention by the nurse had migrated to Sydney for employment purposes. However, he was subjected to discrimination in the workplace racially, and hence he has started suffering from depression which is becoming chronic. Discrimination at workplace often leads to depression among workers thus weakening their motivation (Garg & Raj, 2019). Hence, he seeks remedy from the same and has hence visited a hospital in Sydney to seek mental support. The patient has been subjected to diagnosis through physical examination, personal interviews, and laboratory tests. He will be subjected to therapies such as family intervention and psychotherapy as per his needs and requirements. The clinician and the appointed nurse shall be providing guidance with care and effectiveness so that the patient can come out of his situation. The cultural identity of the patient says that he is an Aboriginal of Australia and the biggest strength of this community is that they nurture kinship. The reason behind his migration was the scope of employment, as he was not getting a proper job in his native land and was facing difficulty in feeding his family. In his native land, his family lives which consists of the wife of the patient and his son, and his old parents. Recently the patient has suffered from the death of his brother, and hence this is another reason why he is mentally upset. One of the residents of his neighborhood has suggested the patient seek some culturally-safe nursing intervention who being an Aboriginal, had also faced some sort of depression due to racial discrimination. The experience of the patient while traveling to Australia has not been good enough, and hence he is facing problems coping with the culture in Sydney. He will need an interpreter or a Liasion officer who will help make the intervention process faster. This entire cultural formulation will help to understand the treatment measures better.  Importance Of Cultural Safety In Nursing Example Paper

The outcome of mental health among the indigenous people in Australia is more in comparison to the non-indigenous counterparts. The long-term experience of colonization, along with some long-term effects of being colonized, has resulted in a lot of inequalities in the health status of indigenous people (McNamara et al., 2018). This includes social, physical as well as mental health and well-being. The percentage of the Aboriginal community suffering from psychological distress is more than 30%. There has been a reported increase in the mental health conditions of Torres Strait Islanders by a quarter in the year 2018-19. In a report of 2020, it was found that 52% of Aboriginal people are suffering from depression while 59% of the people from the same community suffer from anxiety (Shen et al., 2018). Some of the risk factors which contribute to mental health conditions as major as depression are the grief of the loss of land, culture, connection, and other native aspects, which forms the basis of the history of the invasion of this community (Korff, 2022). People of the Aboriginal community suffer from trauma that remains unsolved and serves as an agent for the health deterioration of the Aboriginals leading to major depression. Subject to racism and discrimination in different settings make the Aboriginal people secluded from the entire society and hence is led to depression eventually. The healthcare sector often treats Aboriginals in a manner that is culturally inappropriate. Domestic violence and substance abuse also contribute to depression among the people of this community (Korff, 2022). It has been found that poor physical health makes the people of this community feel excluded, which makes some Aboriginals feel excluded from society which in turn leads to cause of depression among the Aboriginals.

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Factors Contributing To Mental Health Inequalities Among Aboriginal People

As opined by Jongen, McCalman & Bainbridge (2018), cultural competency in healthcare is considered to be a very popular approach that enhances the provision of healthcare services to the groups who are ethnically minor so that the intended disparities can be resolved. There are different types of culturally safe nursing interventions for treating depressive disorders, and for overcoming the same among Aboriginals, family-based interventions can be an effective way. Family-based interventions include a combination of activities that builds support of families along with health education to uplift the mental condition of patients suffering from depression (Dietz, 2020). This is so because the people belonging to the people of the Aboriginal community hold strong family values. The system of the family has an extended family structure. The child-rearing responsibilities are spread even beyond parents to uncles, aunts, and even brothers or sisters. Hence, nurses as practitioners should understand the concept of extended family when working with this community. The family members in the Aboriginal community have several core functions where the elder ones teach the little ones about anything that is educational and knowledgeable. Kinship relations among Aboriginals are reflective of a very complex and dynamic system that makes a person fit into the community (Queensland Government, 2022). It is believed to structure the obligations and relationships along with the behavior of the people towards each other. Hence, by educating the families of people suffering from major depression using family-based interventions, nurses can easily find positive results in recovery. This is because the patient is bound to actively listen to family members and other close ones for advice. In a culturally safe nursing intervention, the nurse explains the practice care procedures to the family of the patient besides the patient himself. When a patient finds advice coming from one of their close relatives, such as parents, siblings, uncles, or aunts, they rely on the same and follow it for betterment.

The connection between physical and mental health among Aboriginals is a matter of serious concern owing to the increased prevalence of chronic diseases among those people. It has been found that depression increases the risk of comorbid disorders such as diabetes and CVDs. Moreover, people suffering from depression find difficulty in taking self-care if they are ill already, and they are less prone to conducting treatment of their own along with lifestyle changes (Bellamy & Hardy, 2022). To overcome the conditions of depression among the Aboriginals, a lot can be rendered like remaining connected to family and friends, finding people to talk to, taking care of one’s own self, visiting the community or health worker, valuing spirituality as well as culture, remaining connected to the community as well as land, eating food that is healthy and sleeping adequately and always remaining connected to the community and land (Healthdirect, 2022). Rendering mental well-being to the Aboriginals of Australia while helping them overcome major depression can be done using psychoeducation.

Depression is a mood disorder that creates the persistent feeling of loneliness and sadness along with loss of interest. When this persists for over a long time, it is called a major depressive disorder, which needs attention and intervention for cure (Bains & Abdijadid, 2021). Psychoeducation is a systematic intervention that is didactic and structured and transfers knowledge on a particular illness or treatment, thus integrating emotional and motivational aspects, helping patients cope with their illness and improving treatment, and remaining adhered to efficacy and treatment (Koç & Kafa, 2019). The main goal of psychoeducation is to understand people living with mental conditions better so that they can remain accustomed to living. Not only psychoeducation therapy but all other aspects of therapy programs are carried out with the same intention (Christensen, Wong & Baune, 2020). In psychoeducation, the elements of cognitive-behavioral therapy, group therapy, and education are used in combination to render knowledge to the patient and the patient party about the different facets of treatment as well as illness. Through the development of problem-solving skills as well as effective communication skills, the issues faced by the depressed person are given remedy. According to Park & Jung (2019), patients suffering from major depressive disorder suffer from a functional impairment, and the functional abilities of the patient have to be assessed in a multi-dimensional manner. The World Health Organisation has stated that by the year 2030, depression will be one of the major causes of disability among individuals (Funk, 2016). Hence, a person with such a dreadful disease must be helped on an urgent basis to overcome their condition.

Risk Factors For Depression In Aboriginal Communities

Among the various forms of psychoeducation therapy that are provided by mental health experts and nurses, self-assertive training can be one of the effective forms which bring ineffective treatment to the patients (Cuijpers et al., 2020). Self-assertive training, which may also be known as assertiveness training, is based on the thought process that every human being has the right to express their feelings, thoughts, and emotions along with needs to others in a respectful as well as confidential manner. Being not able to express oneself openly will eventually lead to depression and anxiety, along with being angry. This may lead to a condition where the self-worth of a person may suffer. Speed, Goldstein & Goldfried (2018) it has found that assertive training is a factor that gets associated with quite a number of other factors like clinical problems, contexts, and population and that this training is an effective and valuable intervention. Self-assertive training targets individuals with some specific presentations of diagnosis, such as depression and anxiety, and it could also be used for bringing improvement to certain comorbid conditions while increasing general functioning in patients who suffer from some serious mental illness.

Since assertiveness is a communication skill, involving in self-assertive training can also enable individuals to express themselves freely, and a person can stand up for their own point of view. It helps in boosting the self-esteem of an individual, which enables earning respect from other people (Funk, 2016). Self-assertive training helps in the management of stress which is one of the causes as well as impacts of depression in the life of individuals. Self-assertiveness will be inculcated by a person suffering from a major depressive disorder as a result of a continuous and reciprocal interaction between the multi-dimensional skills along with the specific factors which are involved in that situation. It helps in the development of a subjective expectation about the consequences of assertive behavior (Mueen et al., 2022). Self-assertive training should be imparted to a patient with depression in a social and cultural context which would make an evaluation of the same easier. It enables the discrimination and assessment of the behavior much easier and appropriate for a variety of situations in a negative assertion.

It can thus be concluded that major depressive disorders can be treated with the help of family interventions in the case of Aboriginals, and self-assertiveness training can be used as a means of psychoeducation in a very effective manner. When it comes to serving a community with culturally sound practices, there can be no better option than involving the family of the patient. The familial bonding of Aboriginals with their community will build trust and respect among the patients, and this will give a positive growth among patients in overcoming depression. On the other hand, self-assertive training as a psychoeducation therapy will provide self-confidence and self-esteem in patients. These aspects will slowly take all instances of depression and improve the mental health of patients.

Reference List

Bains, N., & Abdijadid, S. (2021). Major depressive disorder. In StatPearls [Internet]. StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK559078/

Bellamy, S., & Hardy, C. (2022). Understanding Depression in Aboriginal Communities and Families. Nccih.ca. Retrieved 2 April 2022, from https://www.nccih.ca/docs/emerging/RPT-UnderstandingDepression-Bellamy-Hardy-EN.pdf.

Christensen, M. C., Wong, C. M. J., & Baune, B. T. (2020). Symptoms of major depressive disorder and their impact on psychosocial functioning in the different phases of the disease: do the perspectives of patients and healthcare providers differ?. Frontiers in Psychiatry, 280. https://doi.org/10.3389/fpsyt.2020.00280

Cuijpers, P., Karyotaki, E., Eckshtain, D., Ng, M. Y., Corteselli, K. A., Noma, H., … & Weisz, J. R. (2020). Psychotherapy for depression across different age groups: a systematic review and meta-analysis. JAMA psychiatry, 77(7), 694-702. doi:10.1001/jamapsychiatry.2020.0164

Cultural Safety. edcan.org.au. (2022). Retrieved 31 March 2022, from

https://www.edcan.org.au/edcan-learning-resources/supporting-resources/aboriginal-and-torres-strait-islander-peoples/cultural-safety/cultural-safety.

Dietz, L. J. (2020). Family-based interpersonal psychotherapy: an intervention for preadolescent depression. American journal of psychotherapy, 73(1), 22-28. https://doi.org/10.1176/appi.psychotherapy.20190028

Funk, M. (2016). Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. Retrieved on, 30. https://apps.who.int/iris/bitstream/handle/10665/23849/B130_R8-en.pdf

Garg, R., & Raj, R. (2019). A cross-sectional study of self-stigma and discrimination among patients with depression. Open Journal of Psychiatry & Allied Sciences, 10(2), 124-127. https://pdfs.semanticscholar.org/c3c4/fb36fec733de6b5266c5243a0a2d32825538.pdf

Healthdirect. (2022). Aboriginal and Torres Strait Islander people and mental health. Healthdirect.gov.au. Retrieved 2 April 2022, from https://www.healthdirect.gov.au/aboriginal-and-torres-strait-islander-peoples-mental-health.

Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: a systematic scoping review. BMC health services research, 18(1), 1-15. https://doi.org/10.1186/s12913-018-3001-5

Koç, V., & Kafa, G. (2019). Cross-cultural research on psychotherapy: the need for a change. Journal of Cross-Cultural Psychology, 50(1), 100-115.  Importance Of Cultural Safety In Nursing Example Paper