Understanding the issues
Some of the challenges for Aboriginal people in the rehabilitation environment include:
- Extended time away from family and Country
- Lack of connection and trust
- The history of colonisation and associated traumas may impact on trust in the health system and government 1
- Racism, discrimination and marginalisation in Australia
- The term rehabilitation being associated with alcohol or drug rehabilitation.
Did you know?
- In NSW, Aboriginal people undergo hospitalisations which are potentially avoidable at a rate 2.5 times higher than non-Aboriginal people, and experience unplanned hospital readmissions following an initial hospital admission at a rate 1.3 times higher than non-Aboriginal people.2
- Census data shows that Aboriginal and Torres Strait Islander people have higher rates of disability than non-Indigenous people across all age groups. Aboriginal and Torres Strait Islander people aged 35–54 are 2.7 times as likely to have a disability as non-Indigenous people of the same age.3
- To date, there are few published studies describing the magnitude of injury among Aboriginal people, and no study providing a comprehensive understanding of the impact of injury on their lives. Available evidence suggests that the overall burden of injury for Aboriginal people is 2.8 times greater than for non-Indigenous people. Injury problems in Indigenous communities are complex. They are often interrelated with other chronic health issues, and with socioeconomic and environmental factors.4, 5, 6
Factors to improve the experience
Creating a positive experience for an Aboriginal person undergoing rehabilitation and their families is important to enable them to reach their health goals.
Some of the factors that may improve the experience include:
- Acknowledgement and identification
- All patients should be asked the question about whether they are Aboriginal to allow culturally appropriate care to be provided.
- Access to private spaces for treatment.
- A culturally safe environment
- Access to physical spaces that enhance cultural safety for the patient and family
- Examples of local artwork, flags, acknowledgment, and culturally-adapted resources in the ward area
- Welcome to Country events for patient groups, and recognition of significant cultural days on the ward
- Tea, coffee and a safe space for extended family visits.
- Comfort (care environment)
- Allow flexibility when scheduling therapy and ward activities to allow for family visits
- Understand what’s important to the patient, their rehabilitation goals, and the preferred location for treatment delivery (e.g. outdoor therapy options)
- Allow weekend leave (where possible) for patients to go back to Country.
- Language and communication
- Train staff in clinical yarning
- Identify and promote access to specific services and resources available for Aboriginal people for inpatient and/or discharge management (e.g. involve the Aboriginal liaison officer)
- Use of non-discriminatory language and avoidance of stereotyping.
- Build rapport with Aboriginal people and communities
- Learn about the historical context of your hospital and district and understand the impacts of past injustice and inter-generational trauma
- Learn more about 'Sorry business'.
- Involvement in decision-making
- Take the time to listen to each person
- Involve patients in shared decision-making and goal-setting
- Involve family/parents/carers or contact person in planning discussions.
I’m looking forward to going home. I’ll be followed up by the Chronic Care for Aboriginal people team to make sure I’m getting on okay on my own. I have also been linked with transport and home nursing services.
- Agency for Clinical Innovation. Culturally responsive practice [Internet]. Sydney: Agency for Clinical Innovation; 2021 [cited March 2021].
- Centre for Epidemiology and Evidence. The health of Aboriginal people of NSW: Report of the Chief Health Office. Sydney: NSW Ministry of Health, 2012.
- Australian Bureau of Statistics. 4433.0.55.005 - Aboriginal and Torres Strait Islander People with a Disability, 2012 [Internet]. Australian Bureau of Statistics; 2017 [cited 3 March 2021].
- Helps YLM, Harrison JE. Injury mortality of Aboriginal and Torres Strait Islander peoples in Australia 1997–2000. Canberra: Australian Institute of Health and Welfare, 2004.
- Harrison J, Miller E, Weeramanthri T, et al. Information sources for injury prevention among Indigenous Australians: status and prospects for improvements. Canberra: Australian Institute of Health and Welfare, 2001: 29.
- Moller J, Thompson N, Brooks J. Injury prevention activity among Aboriginal and Torres Strait Islander peoples. Vol. 1. Current status and future directions. Canberra: Australian Government Department of Health and Ageing, 2004. (RFT129/0102.)