Exploring Aboriginal patients’ experiences of cardiac care at a major metropolitan hospital in Melbourne
Linda Worrall-Carter A B C D J , Karen Daws D , Muhammad Aziz Rahman B C E , Sarah MacLean F G , Kevin Rowley F , Shawana Andrews H , Andrew MacIsaac C D , Phyllis M. Lau I , Samantha McEvedy B E , John Willis D and Kerry Arabena FA Her Heart Ltd, PO Box 2525, Melbourne, Vic. 3001, Australia.
B St. Vincent’s Centre for Nursing Research, Australian Catholic University, East Melbourne, Vic. 3002, Australia. Email: samantha.mcevedy@acu.edu.au
C The Cardiovascular Research Centre, Australian Catholic University, East Melbourne, Vic. 3002, Australia.
D St. Vincent’s Hospital Melbourne, Fitzroy, Vic. 3065, Australia. Email: karen.daws@svha.org.au; andrew.macisaac@svha.org.au; john.willis@svha.org.au
E Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic. 3000, Australia. Email: aziz.rahman@acu.edu.au
F Indigenous Health Equity Unit, The University of Melbourne, Carlton South, Vic. 3053, Australia. Email: smaclean@unimelb.edu.au; rowleyk@unimelb.edu.au; kerry.arabena@unimelb.edu.au
G Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Vic. 3000, Australia. Email: shawanaa@unimelb.edu.au
H School of Health Sciences, The University of Melbourne, Carlton South, Vic. 3053, Australia.
I Department of General Practice, The University of Melbourne, Carlton, Vic. 3053, Australia. Email: plau@unimelb.edu.au
J Corresponding author. Email: lindaworrallcarter@herheart.org.au
Australian Health Review 40(6) 696-704 https://doi.org/10.1071/AH15175
Submitted: 23 September 2015 Accepted: 8 January 2016 Published: 9 March 2016
Abstract
Objectives The aim of the present study was to explore Aboriginal patients’ lived experiences of cardiac care at a major metropolitan hospital in Melbourne.
Methods The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012–13. A phenomenological approach was used to analyse the data.
Results Eight themes emerged from the data, each concerning various aspects of participants’ experiences: ‘dislike of hospitals’, ‘system failures’, ‘engagement with hospital staff’, ‘experiences of racism’, ‘health literacy and information needs’, ‘self-identifying as Aboriginal’, ‘family involvement in care’ and ‘going home and difficulties adapting’. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences.
Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community.
What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system.
What does this paper add? Aboriginal patients’ lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care.
What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.
Additional keywords: heart diseases, hospital–patient relationships, hospitalisation, Indigenous.
References
[1] Australian Bureau of Statistics. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. 2010. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter100Oct+2010 [ verified 4 September 2014].[2] Brown A. Bridging the survival gap between Indigenous and non-Indigenous Australians: priorities for the road ahead. Heart Lung Circ 2009; 18 96–100.
| Bridging the survival gap between Indigenous and non-Indigenous Australians: priorities for the road ahead.Crossref | GoogleScholarGoogle Scholar | 19264549PubMed |
[3] Australian Institute of Health and Welfare (AIHW). Australia’s health 2012. Australia’s Health Series. Canberra: AIHW; 2012.
[4] Mathur S, Moon L, Leigh S, editors. Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment. Canberra: Australian Institute of Health and Welfare; 2006.
[5] Randall DA, Jorm LR, Lujic S, Eades SJ, Churches TR, O’Loughlin AJ, Leyland AH. Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: roles of age, gender, geography and area-level disadvantage. Health Place 2014; 28 58–66.
| Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: roles of age, gender, geography and area-level disadvantage.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2cnltlCrug%3D%3D&md5=e5d5e0c0973e0492a773a56c7a8478eaCAS | 24751666PubMed |
[6] Brown A. Acute coronary syndromes in Indigenous Australians: opportunities for improving outcomes across the continuum of care. Heart Lung Circ 2010; 19 325–36.
| Acute coronary syndromes in Indigenous Australians: opportunities for improving outcomes across the continuum of care.Crossref | GoogleScholarGoogle Scholar | 20363187PubMed |
[7] Ilton MK, Walsh WF, Brown AD, Tideman PA, Zeitz CJ, Wilson J. A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population. A consensus statement from the National Heart Foundation of Australia. Med J Aust 2014; 200 639–43.
| A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population. A consensus statement from the National Heart Foundation of Australia.Crossref | GoogleScholarGoogle Scholar | 24938344PubMed |
[8] Lopez D, Katzenellenbogen JM, Sanfilippo FM, Woods JA, Hobbs MS, Knuiman MW, Briffa TG, Thompson PL, Thompson SC. Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non-Aboriginal patients with acute ischaemic heart disease in Western Australia. BMC Cardiovasc Disord 2014; 14 58
| Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non-Aboriginal patients with acute ischaemic heart disease in Western Australia.Crossref | GoogleScholarGoogle Scholar | 24886321PubMed |
[9] Randall DA, Jorm LR, Lujic S, O’Loughlin AJ, Eades SJ, Leyland AH. Disparities in revascularization rates after acute myocardial infarction between aboriginal and non-aboriginal people in Australia. Circulation 2013; 127 811–19.
| Disparities in revascularization rates after acute myocardial infarction between aboriginal and non-aboriginal people in Australia.Crossref | GoogleScholarGoogle Scholar | 23319820PubMed |
[10] Digiacomo M, Davidson PM, Taylor KP, Smith JS, Dimer L, Ali M, et al Health information system linkage and coordination are critical for increasing access to secondary prevention in Aboriginal health: a qualitative study. Qual Prim Care 2010; 18 17–26.
| 20359409PubMed |
[11] Artuso S, Cargo M, Brown A, Daniel M. Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study. BMC Health Serv Res 2013; 13 83
| Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 23497140PubMed |
[12] Roberts L, Power P. Better hospital care for Aboriginal and Torres Strait Islander people experiencing heart attack. Heart Foundation and Australian Healthcare and Hospitals Association; 2010.
[13] Dwyer J, Kelly J, Willis E, Glover J, Mackean T, Pekarsky B, Battersby M. Managing two worlds together: city hospital care for country Aboriginal people – project report. Melbourne: The Lowitja Institute; 2011.
[14] Kingsley J, Townsend M, Henderson-Wilson C, Bolam B. Developing an exploratory framework linking Australian aboriginal peoples’ connection to country and concepts of wellbeing. Int J Environ Res Public Health 2013; 10 678–98.
| Developing an exploratory framework linking Australian aboriginal peoples’ connection to country and concepts of wellbeing.Crossref | GoogleScholarGoogle Scholar | 23435590PubMed |
[15] McGrath P. Exploring Aboriginal peoples’ experience of relocation for treatment during end-of-life care. Int J Palliat Nurs 2006; 12 102–8.
| Exploring Aboriginal peoples’ experience of relocation for treatment during end-of-life care.Crossref | GoogleScholarGoogle Scholar | 16628174PubMed |
[16] Collins HP, Kalisch D, editors. The health and welfare of Australia’s Aboriginal and Torres Strait Islander people: an overview 2011. Canberra: Australian Institute of Health and Welfare; 2011.
[17] Department of Health. Koori health counts! Victorian Aboriginal hospital data 2009–2010, Melbourne: Department of Health; 2011.
[18] Gray C, Brown A, Thomson N. Review of cardiovascular health among Indigenous Australians. Available at: from http://www.healthinfonet.ecu.edu.au/chronic-conditions/cvd/reviews/heart_review. [verified 3 February 2016].
[19] Holland C. Shadow report on Australian governments’ progress towards closing the gap in life expectancy between Indigenous and non-Indigenous Australians. In: Meehan A, editor. A Close The Gap Steering Committee for Indigenous Health Equality report. Canberra: Close the Gap Steering Committee for Indigenous Health Equality; 2013.
[20] Mackean T, Adams M, Goold S, Bourke C, Calma T. Partnerships in action: addressing the health challenge for Aboriginal and Torres Strait Islander peoples. Med J Aust 2008; 188 554
| 18484923PubMed |
[21] AustralianIndigenousHealthInfoNet. Overview of Australian Indigenous health status, 2014. Available at: http://www.healthinfonet.ecu.edu.au/health-facts/overviews. [verified 3 February 2016].
[22] Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: advancing the humanistic imperative. Philadelphia: Lippincott Williams & Wilkins; 2011.
[23] Davidson PM, Jiwa M, DiGiacomo ML, McGrath SJ, Newton PJ, Durey AJ, Bessarab DC, Thompson SC. The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery. Aust Health Rev 2012; 37 70–8.
| The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery.Crossref | GoogleScholarGoogle Scholar |
[24] Durey A, Wynaden D, Thompson SC, Davidson PM, Bessarab D, Katzenellenbogen JM. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nurs Inq 2012; 19 144–52.
| Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians.Crossref | GoogleScholarGoogle Scholar | 22530862PubMed |
[25] Lau P, Pyett P, Burchill M, Furler J, Tynan M, Kelaher M, Liaw S-T. Factors influencing access to urban general practices and primary health care by aboriginal Australians: a qualitative study. AlterNative: Int J Indig Peoples 2012; 8 66
[26] Shahid S, Finn LD, Thompson SC. Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting. Med J Aust 2009; 190 574–9.
| 19450207PubMed |
[27] Garvey G, Towney P, McPhee JR, Little M, Kerridge IH. Is there an Aboriginal bioethic? J Med Ethics 2004; 30 570–5.
| Is there an Aboriginal bioethic?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2cngsFaltg%3D%3D&md5=bc7240962d29dd14848d66695f0fb0b3CAS | 15574447PubMed |
[28] Taylor KP, Thompson SC, Smith JS, Dimer L, Ali M, Wood MM. Exploring the impact of an Aboriginal health worker on hospitalised Aboriginal experiences: lessons from cardiology. Aust Health Rev 2009; 33 549–57.
| Exploring the impact of an Aboriginal health worker on hospitalised Aboriginal experiences: lessons from cardiology.Crossref | GoogleScholarGoogle Scholar | 20166903PubMed |
[29] Renhard R, Anderson I. Summary of findings from hospital case studies and recommendations for accreditation. Melbourne: VicHealth Koori Health Research and Community Development; 2004.
[30] Aspin C, Brown N, Jowsey T, Yen L, Leeder S. Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC Health Serv Res 2012; 12 143–51.
| Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 22682035PubMed |
[31] Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Intern Med J 2012; 42 17–22.
| Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC387nsFShsQ%3D%3D&md5=ad6eabc124c591dee4c8c7547b36f320CAS | 22032537PubMed |
[32] Taylor K, Guerin P. Health care and Indigenous Australians: cultural safety in practice. Melbourne: Palgrave Macmillan; 2010.
[33] Medved MI, Brockmeier J, Morach J, Chartier-Courchene L. Broken heart stories: understanding Aboriginal women’s cardiac problems. Qual Health Res 2013; 23 1613–25.
| Broken heart stories: understanding Aboriginal women’s cardiac problems.Crossref | GoogleScholarGoogle Scholar | 24172021PubMed |
[34] Taylor KP, Smith JS, Dimer L, Ali M, Wilson N, Thomas TR, Thompson SC. ‘You’re always hearing about the stats…death happens so often’: new perspectives on barriers to Aboriginal participation in cardiac rehabilitation. Med J Aust 2010; 192 602
| 20477740PubMed |
[35] Prior D. The meaning of cancer for Australian Aboriginal women; changing the focus of cancer nursing. Eur J Oncol Nurs 2009; 13 280–6.
| The meaning of cancer for Australian Aboriginal women; changing the focus of cancer nursing.Crossref | GoogleScholarGoogle Scholar | 19282240PubMed |
[36] Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: AIHW; 2013.
[37] Stoner L, Stoner KR, Young JM, Fryer S. Preventing a cardiovascular disease epidemic among Indigenous populations through lifestyle changes. Int J Prev Med 2012; 3 230–40.
| 22624079PubMed |
[38] Australian Institute of Health and Welfare (AIHW). Coronary heart disease and chronic obstructive pulmonary disease in Indigenous Australians. Canberra: AIHW; 2014.
[39] Abbott P, Davison J, Moore L. Too many of us have gone early: priorities in heart health education for Aboriginal people. Aust Fam Physician 2008; 37 266–8.
| 18398527PubMed |
[40] Liaw ST, Lau P, Pyett P, Furler J, Burchill M, Rowley K, Kelaher M. Successful chronic disease care for Aboriginal Australians requires cultural competence. Aust N Z J Public Health 2011; 35 238–48.
| Successful chronic disease care for Aboriginal Australians requires cultural competence.Crossref | GoogleScholarGoogle Scholar | 21627724PubMed |
[41] Downing R, Kowal E. Putting Indigenous cultural training into nursing practice. Contemp Nurse 2010; 37 10–20.
| Putting Indigenous cultural training into nursing practice.Crossref | GoogleScholarGoogle Scholar | 21591822PubMed |
[42] Williamson M, Harrison L. Providing culturally appropriate care: a literature review. Int J Nurs Stud 2010; 47 761–9.
| Providing culturally appropriate care: a literature review.Crossref | GoogleScholarGoogle Scholar | 20138275PubMed |
[43] Grieves V. Aboriginal spirituality: Aboriginal philosophy, the basis of Aboriginal social and emotional wellbeing. Discussion paper no. 9. Darwin: Cooperative Research Centre for Aboriginal Health; 2009.
[44] Daws K, Punch A, Winters M, Posenelli S, Willis J, MacIsaac A, Rahman MA, Worrall-Carter L. Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal hospital liaison officer and a specialist cardiac nurse working together to improve hospital care. Aust Health Rev 2014; 38 552–6.
| Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal hospital liaison officer and a specialist cardiac nurse working together to improve hospital care.Crossref | GoogleScholarGoogle Scholar | 25200319PubMed |
[45] Hayman NE, Wenitong M, Zangger JA, Hall EM. Strengthening cardiac rehabilitation and secondary prevention for Aboriginal and Torres Strait Islander peoples. Med J Aust 2006; 184 485
| 16719743PubMed |
