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Getting good mental health care in Australia has been a big problem in the recent past (Thomson, 1988, p. 158). Many problems relating to clinical practice, consultation of patients, and cultural sensitivity have been a derailment in the provision of effective, mental health care (Willis, 2008, p. 144). The indigenous population in Australia is a special group that needs proper care because of their unique cultural identities. Apart from the difficulty in measuring professional practice and the expected patient service delivery, there are many cultural and ethical concerns that need to be evaluated before mental heath care in Australia is properly streamlined to reflect the needs of the indigenous people (Kirmayer, 2009, p. 401).
Many articles of research have been developed to explain this problem but a conclusive recommendation on how to improve the system is yet to be reached (Happell, 2008, pp. 12-15). This study articulates these findings through the analysis of three articles. The articles chosen are peer reviewed and represent a broad spectrum of conclusions on the topic, with a special recognition of the cultural and ethical issues that affect the indigenous population in Australia. Three articles are chosen to have a wide opinion and conclusion base regarding the research topic.
The first article is titled "An approach to treating defective and psychotic illness in indigenous Communities". The authors are Tricia Nagel, Gary Robinson, Thomas Trauer and John Condon who wrote the article with the aim of developing a range of resources and strategies to increase the value of indigenous health outcomes among the indigenous population. Conclusions were arrived at through interviews based on motivational inspiration; therapy based on the art of solving problems and the art of managing chronic or mental illnesses at individual levels. The study included the participation of two communities comprised of 1500 and 500 participants respectively with a majority of them being from Australia's indigenous population. All participants were suffering from mental illness (Nagel et al., 2008).
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The article had ethical issues well covered because the respondents participated voluntarily with the permission of relevant authorities. Those below the age of 18, had organic mental disability, mental impairment or intellectual disability were excluded from the study. Moreover, various institutions were present to oversee the researchers' ethical conduct. For example, approval was got from the Menzies school of Health research, Health department, and the Joints Ethics Committees. The data was collected through interviews, consultations and development of relationships within a period of one year. Repeated measures were observed after periods of 18 months and other related data was collected in intervals of 6, 12 and 18 months. The historic story of the health community was analyzed in an initial first phase. It was later developed in music and pictorial forms then developed into a video. This was later used to group the participants into two groups of "experimental interventions" and the "treatment as usual" groups.
The study established that there was considerable interest in collaborative planning of care and goal setting. Intervention was advanced as a probable solution to co morbid illnesses in remote settings. There was an underscore of the importance of preventing relapses and an emphasis on the importance of creating culturally sensitive treatment methods. These strategies had been observed to be warmly received by care givers and patients alike, in the remote environments (Nagel et al., 2008).
The second article is titled "Definition of Suicide and Self Harm Behavior in an Australian Aboriginal community". The authors were Terri Farrelly, and Karen Francis who wrote the article with the aim of comprehending the dynamism of suicide and self harm, together with the attitudes of the Aboriginal community residing in the South Wales region of Australia. The research was guided by a qualitative approach and data triangulation technique among the focus groups as the methodology. The study also included 26 participants who were interviewed 21 times (in focus groups) (Farrelly & Francis, 2009).
With regard to present ethical concerns, participants participated voluntarily with freely obtained consents. The identities of the participants were also protected because the findings were purely for research purposes and were never meant to incriminate anyone. Dta was collected through interviews, and participants were categorized into focus groups. Data was analyzed in a triangulated form within the context of the focus groups. This technique was used as a data analysis method and a data collection tool as well.
The interviewed participants admitted that traditional cultural forms of self harm behavior especially to both men and women were as a result of the traditional initiation of community rituals. However, a section of the participants and a section of the aboriginal community said that some of these cultures were not observed in their community. The analysis established that the culture of the aboriginal community influenced the way suicide and self harm behavior was defined. The traditional behavior of self harm was observed to be a continuous occurrence in the aboriginal community because it was viewed as a traditional culture. Most notably, the shaving of women's air was identified as a symbol of the mourning period and also a marker to the community and the individual.
The third article was titled "Culturally specific process measures to improve mental health clinical practice: indigenous focus". The authors were Anthony P. O'Brien, Julie M. Boddy and Derrylea J. Hardy. The article was written with the aim of establishing methods to quantify the outcome of mental health treatment. This came about because of existing studies pitting mental health outcome among Australia's indigenous community, difficult to quantify. The method used in the article established that the process of care delivery was the determining factor in quantifying the effectiveness of treatment and the extent to which treatment either improves or inhibits the mental health of a patient. In addition, the study noted that identifying the underlying factors that contribute to poor achievement of mental health outcomes was eventually bound to affect the occurrence of readmission, shared care initiatives, and the eventual effectiveness of patient care. This emphasis was to be the eventual difference between good and bad quality heath care. The participants included Maori and non Maori nurses who gave their opinion of what constituted the best mental health nursing practices (O'Brien, Boddy, & Hardy, 2007).
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All ethical considerations were factored into the research design and participation of the nurses. Clearance was obtained from participating District health board health committees and Mattex University health committee. Free consent from the participants was also obtained before their contribution was factored into the study. The anonymity of the patients was also preserved as an ethical consideration; exclusively limiting the purposes of the study to research purposes only. Data was collected through a professionally prepared questionnaire for all the participants and constituted items that were not observed from the patients' notes. However, patient notes were used to crosscheck the data given by the participants. Data was analyzed in a four stage research design that included input from the focus groups (nurses), delphi surveys that counterchecked the input of the nurses, pilot studies and a national audit of patient indicators that validated information regarding patient notes.
The results indicated that the quality of determining the outcome of mental health care treatment among patients was hindered by existing monitoring systems. The study also established that New Zealand was on the lead in adopting culturally acceptable health practices when compared to Australia. However, there were indicators that showed inconsistencies in the way both countries treated culturally sensitive or indigenous patients. For the conclusion part, it was established that the process of ordering care to patients directly reflected on the results that were to be achieved as the outcome of the patient. This conclusion was developed from the contribution of results derived from the bicultural health study. The study also contends that accurate and effective cultural measures were derived from cultural sensitivity and the uniqueness of indigenous cultural attributes.
In summary, there ware many similarities and distinctions among the three research studies above. With regard to ethical consideration, the consent of participants was freely obtained in all three studies. Moreover, ethical approval was also obtained from specific committees such as the District health committee for the third article and Menzies school of Health research, Healtth department, and the Joints ethics Committees for the first article. There has however a difference among the selection of participants because patients, general indigenous people and nurses were used differently. For example, in the first article, the participants constituted only the indigenous group population; the second article constituted mental patients while the third article included nurses only. Nonetheless, the selection of the participants depended on the objectives of the study. With regard to the methods used to derive their findings, all the articles outlined that the process of care delivery ultimately determined the outcome and efficiency of the mental health care process. There was however no mention of the limitations and delimitation for all the three articles.
With regard to data collection, questionnaires were used in the third article while the first and second articles relied on interviews as the primary sources of data collection. Interviews were the best data collection tool to use in the first and second articles because of the nature of the participants. Mental patients were best suited for interviews and so were the general indigenous population in the second and first articles respectively. However since professionals (nurses) were used in the third article, questionnaires were best suited for data collection. With regard to analysis of data, different methods were used. However, for the second and third articles, data analysis was done in focused groups. The second article used the triangular technique while the third article was analyzed in a four stage research design. The first article was however developed in two phases; the experimental and intervention group. There were no identifiable omissions.
With regard to the findings and conclusions, the articles identified that cultural sensitivity was a key factor in achieving desirable outcomes in mental healthcare treatment. All the studies also identified that more had to be done to improve the Australian health care system. For example, article two identified that Australia's mental health care system was still lagging behind New Zealand's. Culture also had a huge role to play in defining the expectation of healthcare treatment (Talbot, 2009, p. 23). There were no observable omissions here either.
In general, contributions to these studies relate to the provision of mental health care among indigenous patients. The general nursing fraternity could find this study useful in improving their services to indigenous mental health care patients (Reynolds, 1995, p. 1). Policy formulation could also be improved from adoption of the articles' recommendations. In other words, policies that are culturally sensitive should be formulated, instead of embracing contemporary practices that don't serve the needs of the indigenous population (Organisation for Economic Co-operation and Development, 2003, p. 323).
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Other sectors of the health care system, apart from the mental health care department could also benefit through the understanding of cultural implications of the aboriginal community in healthcare management. This study also acts as a tool for mental health workers to gauge their performance with internationally rated standards of health care treatment (Pillitteri, A. 2009, p. 1617). Areas that seem weak in the provision of effective mental health care treatment were also easily identifiable from the study and therefore represent areas of improvement (Funk, 2003).
The learning outcomes identifiable in the study relate to the comprehension of the dynamics and importance of the aboriginal community in Australia with regard to provision of effective healthcare management. We can also be able to identify the state of health care treatment in Australia and even compare it to other countries (Byrne, 2010, p. 28). For graduates, these studies provide the opportunity to relate theory with practice because the articles are purely based on practical aspects of mental health care treatment.
Graduates can also be oriented with specific local and international standards prevailing in the provision of health care treatment (Elder, 2009, p. 70). The areas that have traditionally contributed to poor effectiveness of health care services can also be easily identified and avoided from the study (World Health Organization, 2004). The gap between case studies and treatment outcomes can also be understood through the study, especially for graduates who studied many process and outcome relations.
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