Part-A: Gibbs model of reflection
In the RDNS SOUTH SITE in Dandenong, Melbourne community placement was going on. I was practicing my nursing as a wound care nurse in wound management, medication administration and monitoring of blood glucose level. I was attending a 55-year-old patient on wound exudation with surgical wound. The patient was also suffering from dementia and had limited mobility. He was battling through depression.
On knowing about his medical condition, I felt pity for his sufferings and his physical pain. I felt depressed after knowing about his conditions. The care assistants were negligent regarding the old man’s condition. The documentation regarding the healing of the wound was not proper. Still, I felt confident and tried my best to help the old man and relief him from his sufferings. The outcome of the event was good. The old man’s wound healed gradually and he was relieved from the pain.
The whole incident taught me to evaluate my nursing practice and my role in healing a wound of a patient. It helped me to put my basic knowledge about wounds into practice and helped patients to relieve from their physical pain. The incident was challenging as the old man was suffering from loss of memory and communication was a big barrier in managing his wound. The wound healing involves many factors like clinical knowledge, psychological and educational approaches (Baillie, 2014). The altered mood of the man he was suffering from depression and fixed mobility delayed the wound healing. There was also inability to self-care.
The whole incident taught me that the old man was unfortunate and was suffering from lot of physical and mental pain. I was happy that I did my best to help the old man in every possible way. I realized that the wound management requires a lot of patience, skills and communication to deal the patients with surgical wounds (Brooker, & Waugh, 2013). The professionals in wound management have to be more responsible and skilled to deal with difficult situations in their medical practice of wound healing.
Apart from the professional skills in dealing patients with surgical wound healing, there is also requirement of care planning. The old man suffering from dementia needs to be handled patiently apart from his physical pain. The psychological parameters are also important in wound healing (Gillespie et al., 2015). My care plan was successful in healing the old man’s surgical wound. I would also focus on the patient’s measurable needs along with the proper documentation and recording of the healing process. There is also requirement of interpersonal skills in nursing as the care assistants were negligent towards the old man and there was no proper documentation of his wound healing (Huseb?, O'Regan, & Nestel, 2015).
If I encounter this kind of situation further in my nursing career, I will analyze the psychological needs of the patient along with physical pain associated with the wound healing. I will handle the situation patiently and be strong in dealing such situations. I will control my emotions and act professionally and be prepared for the worst situations at the same time (Moon, 2013).
Part-B: SDH assessment circle to assess the health of LGA
The clinical placement was going on in Royal District Nursing Service SOUTH SITE in Dandenong, Melbourne. The placement was going in wound management, medication administration and monitoring of blood glucose level. The Dandenong in Melbourne is a suburb in Victoria, Australia, southeast of the central business district in Melbourne. It is situated at the foothills of ranges of Dandenong. It has 130 kilometers square area and it is a local government area in Victoria having population of 21,911 residents according to 2014 statistics. Dandenong has a diverse culture in Victoria and consist of a high level of migrants including the Albanian and Turkish communities. There are approximately 150 residents from different birthplaces. There are over residents from India, Vietnam, Sri Lanka and Afghanistan.
Assessment of biological and genetic factors
The Dandenong have a mix population that is vibrant in nature. There is multicultural population as there are number of people from overseas. There are people from India, Afghanistan, China, Sri Lanka, New Zealand, Mauritius, England, Croatia and Sudan. About 60 per cent of the population was born overseas in Greater Dandenong and about 33 per cent of the residents of Melbourne metro born overseas. In the year of 2014-2015, there were 2,439 births in Greater Dandenong. There was an increase of 707 per annum in the population of children. The total number of deaths in Greater Dandenong in the year 2014 was 1015. There were 76,180 males in Greater Dandenong and 73,338 females in the year 2014. The median age of the persons in the population is 35. The number of children is born highest among the women who received limited education with no degree qualification aged 25-29. This is highly influenced by the level of education and opportunities for employment. Among the 47,000 households, about 37,000 of them are families, 30% of them are couples and 46% with children, 19% with single parent and 5% other types of families (Beza, & Gollings, 2014).
The general health of the people of Greater Dandenong residing indigenously is considered poor or fair. The life expectancy of the indigenous people is less than the non-indigenous residents. There is prevalence of gonorrhea, syphilis, chronic renal problems, tuberculosis, diabetes and hepatitis B among the indigenous population. Child abuse, disability, suicides, school dropouts and poor health habits are also common in the residents of Greater Dandenong. There are also people reporting asthma, high blood pressure, osteoporosis, heart disease, poor dental health among the people of Greater Dandenong. The Local Government Area reported that there are 33.4% of persons being overweight in which 22% females and 44% males. The incidence of cancer is 440.3% per thousand populations in which the 398.1% are females and 481.1 males. The premature deaths in Dandenong are due to cardiovascular diseases and cancer. The common health conditions and risk factors are the lack of physical exercise, alcohol abuse, smoking and overweight conditions. The population aged 18 years and above reported that they suffer from psychological distress so they are prone to depression and suicides attempts (Gibson-Helm et al., 2014).
Assessment of gender and culture
There is gender inequality prevailing in Australia as there is low number of women participating in jobs, degree education, and wide gender pay gap, involvement of women in media and also high rates of domestic violence. Among the various factors contributing to the violence in women, alcohol is the most significant factor in domestic violence. Psychological illnesses, depression and financial problems are the factors contributing to the increase in violence against women. Childhood abuse is another factor that is not so significant but still a contributing factor to violence against women. Cultural and language disparities also make women vulnerable to violence. The non-Aboriginal Australian women are at high risk to violence because of colonization impacts and that leads to lack of support from support groups. As there is cultural diversity seen in the community of Greater Dandenong, there are various languages spoken by people. The Greater Dandenong has the highest level of cultural diversity among all the Local Government Areas of Melbourne, Victoria. There is about 55% of born non-English speaking residents and 64.5% of people speaking language other than English at home (Ratnayake, 2016). There are other languages that are spoken widely includes Vietnamese, Greek, Khmer, Chinese, Punjabi and Sinhalese. About one out of seven has limited fluency over English language that is 14%, 50% of women and 30% of women. In Dandenong, Albanian and Dari are the most frequent languages.
As there is cultural diversity, there are special needs and services of the residents in the community. The people are diverse in age, gender, color, race, and marital status, physical and political beliefs. There are needs to support the diversity, appropriate needs of the cultural families, disparity in languages and citizenship. The asylum and refugee seeking services, aboriginal community needs, language assistance and translation, citizenship, racism issues, the diversity trends and supporting groups to help the residents with diversity problems. The Bunurong clans form a boundary with the Mayone Bullak and Ngaruk William (Russo et al., 2015). The spiritual needs of these people were dedication to different seasons supporting the sustainability of the natural resources. After years of observation by the Bururong people, they predicted their seasonal resources availability by making certain changes in the plant and animal growth and behavior. There are also scarred trees that are highly valued present on private and public lands. The spiritual needs are addressed by the Councils to help them preserve their cultural and spiritual heritage and help them to meet their needs in the present and preserving for the future. The Baptist Church In Dandenong serves the spiritual needs and expand his services by offering meals to the people, organizing community hub, childcare center, counseling rooms for the people suffering from depression and employment opportunities for people.
Assessing the physical environment
The Greater Dandenong Environmental Group takes care of the environment and creates awareness among the people about the environmental issues. They are responsible for ensuring clean water and air to the people of Greater Dandenong. The schools and local reserves in collaboration with the local council plant indigenous plants and also monitor the bird life and environmental support groups to provide knowledge about the different environmental risks to the people. There are themes reported by the State of Environment Report 2014-2015 in Greater Dandenong. The Government is providing greater protection for the remnant native vegetation and implementation of plans to manage the bush lands, residential and green wedges (King et al., 2016). The integrated water management to implement the water cycle as the draught conditions is prevailing in the area. Water irrigation, alternate use of other sources of water such as storm water and rainwater and increasing the cost of drinking water to reduce the dependency on drinking water are the measures for council use. For the community’s water use, the City of Greater Dandenong has taken steps to create awareness among the residents about issues regarding water and ways to reduce the use of drinking water. The way to improve the water quality is to use the storm water linking to drainage water network. The three bin system is currently employed for waste management; general waste bin, garden waste bin and large recycling (Bishop, Thoms & Mason, 2015).
Assessing the social environment
The people of Greater Dandenong are obese, overweight and are addicted to smoking and alcohol. The Dandenong Community Health Center in collaboration with organizations and communities promote healthy lifestyle and wellbeing to reduce the health risks and prevent illness. There are three different types of housing in Greater Dandenong with 70% of people residing as detached households, 22% flats type and 7% semi detached type (Randolph & Tice, 2013). There are applications of differential residential zones to identify and change the residential developments in Greater Dandenong. The Greater Dandenong Planning Scheme looks after the residential planning according to the local policies, zones and provisions for specific land use. The Residential Growth Zone enables the growth of new housing and diversity. The General Residential Zone respects the existing neighborhood with growth for moderate housing and its diversity (Rahman at al., 2013). The Community Engagement Strategy enables the groups of different communities to support the indigenous groups, special programs to support the Aboriginal and Torres Strait Islander communities.
Assessing child health and development
There is a mortality rate of 6.0 including 600 residents dying in Greater Dandenong. There were around 75,158 births according to the Maternal and Child Health in 2012 that showed an increase of 5,000 in the last five years (Bohensky et al., 2015). The Maternal and Child Health nurse gives visit to the children for the initial consultation. The Integrated Health Promotion Plan works for the priorities of women’s reproductive health in identifying the barriers in the achievement of reproductive health for women and providing them responsive information and related services associated with their reproductive health. It is aimed at improving the reproductive empowerment for women by introducing the strategies like informed consents; advocacy and education, focusing on the reproductive rights of the women. It also promotes gender equality, improving the literacy in women regarding reproductive health and access to information for the linguistically and culturally different women regarding reproductive health. Children were also identified for assistance in disability and depression. The immunization is appreciating in Greater Dandenong for the wellbeing and health of children from many diseases.
The Monash Health is providing integrated hospital and community based services to focus on health improvement in the community. The Greater Dandenong Council provides a free and confidential service called Maternal and Child health (MCH) for the families having children from age of birth to school (Renzaho, & Oldroyd, 2014). This service is also accessible to the parents who come and settle in Greater Dandenong. There are also local services and hospitals for the families and their children. There are programs for pregnant women supporting, educating and providing linkages. The linkage services provide women engagement in services, additional support from the community based programs, and care for the women while collaborating with services for maternal and child health services. There are ongoing child care with long day, occasional, family day care and vacation care. These kinds of care services provide education or care for children based on all day or part time. These services encourage the children to be creative and stimulated while they interact with their friends. They are also encouraged to early learning tailored meeting the needs and care for every child. The neonatal child care is provided by the medical staffs and midwives of Monash Health for babies born in less than 37 weeks of gestation and underweight at the time off birth.
Assessing education and literacy
The literacy rate is one in seven (14%) of the residents having limited English literacy. It is 70% among the aged group of 65 to 74 (Correa-Velez et al., 2016). The women has limited literacy as compared to men among the older Australians and men having less literacy when compared to women in the younger age groups. When limited English literacy is compared to people having English as the second language, it is four times prevalent. The paid employment group is having lowest English literacy and higher in people who are unemployed. It is highest among the people who are not in the labor force having men with limited English literacy when compared to females (de Heer et al., 2016). The young people of Greater Dandenong experience less favorable development of early school, leave school, less attended university and are disengaged from the employment, education and be unemployed in their life.
The Australian Early Development Census (AEDC) measures the development of pupils in school across Australia during their first year. The physical, emotional, social, cognitive and communication, general knowledge is the five domains of development in a child that is assessed by AEDC in Greater Dandenong. The proportion of non-participation of prep school pupils is highest that is 12.1% in Greater Dandenong. According to 2011 census, the early school leaving children before the completion of 11 years was 13% aged 20-24 in Greater Dandenong comprising of mostly young adults of Afghanistan and Burma. 16% of the Greater Dandenong people aged 20-24 were youth disengaged in neither having employment nor educated being the second in the youth disengagement in Melbourne. There are around eight Neighborhood Houses and Learning Centers aimed at providing the caring and safe environment for people belonging to different age groups, backgrounds, culture, interest and abilities to come together as one to participate in different programs and activities that encourage mixing of different cultures and lifelong learning abilities in the community people.
Assessing employment and financial status
The status of unemployment is high among the people of Greater Dandenong especially in local refugees and the occupation is mainly focused on laboring as the local occupation, trading and process work. In March 2015, the unemployment levels have reached to 12.3% that is twice the number of metropolitan and being the highest in Victoria. It is about 22% in Greater Dandenong having more than 54,000 residents in paid employed and manufacturing industry being the most common form of employment (Baum, Mitchell & Flanagan, 2013). The unemployed group experience the high levels of stress, depression and anxiety according to the 2014 Stress and Wellbeing statistics in Australia. This arising depression has a damaging impact on their physical and mental wellbeing. The income levels of males are about 58% higher than females in a week and this disparity is seen in the working age group (Renzaho, & Oldroyd, 2014). The earnings also differed depending upon the birth places that are Australians earn more than the residents from Burma and Iraq. The workers are young engaged in full or part time occupations as labors, trainee or working at structured learning program. There is 17% of injuries and 21% off hospitalization due to occupational hazards. There are occupational health and safety acts for the workers protecting them from occupational risks and hazards. Under the act, they have health and safety representatives and policies assessing them and providing them information regarding the occupational risks.
Assessing social support networks
There is community and disability support groups like aged care services, community legal services, senior clubs, community support grants program, disability services, settlement services, community response grants program, social groups and programs, special needs and disability support groups encouraged to develop respectful relationships, promote gender equity support the migrants and refugees, youth issues and improving the children’s physical and mental health (Best & Savic, 2014).
Assessing health services and resources
The Dandenong hospital provides the acute services in general medicine, surgical, rehabilitation, aged services, intensive and cardiac care unit and children services with orthopedic and rehabilitation services (Kibbey et al., 2013). There are primary health care services for acute post care, community rehabilitation, primary care, alcohol and drug abuse, occupational therapy, pharmacy and labor wards with operating theatres and diagnostic laboratories. There are Greater Dandenong Community Health services for the individuals to ensure health services, wellbeing of most diverse and vulnerable communities and assessing them for health risk factors (Yelland et al., 2015). The Council supports the wide range of projects supporting the refugees, celebrating cultural diversity week, Dandenong film festivals and refugee week to welcome and support the emerging diverse culture of Greater Dandenong. The Disability services aimed to address the issues of exclusion and disadvantage experienced by the disabled persons. It works to create awareness among the community, plan to address the issues and projects to respond to their needs and concerns.
Assessing health practices and coping
The health and wellbeing planning aims to improve the health and promote wellbeing of the residents of Greater Dandenong working in collaboration with government bodies, local communities and agency services (Meadows et al., 2015). The affordable and healthy opportunities like employing physical exercise and recreational activities among the residents of all backgrounds, abilities, coupled with cycling and walking. There are family and youth services to support and manage the families who live, study or work in Greater Dandenong (Advocat, Russell & Mathews, 2016). They focus on family intervention and provide counseling to youths and the families focusing on the connections with the child.
The residents of Greater Dandenong follow a sedentary lifestyle after assessing the health and mental statistics. The health outcomes of the people are poor or fair. They are mostly overweight and suffer from obesity. The main causes of mortality are cardiovascular diseases, diabetes, alcohol consumption, mental disability, unemployment, occupational hazards and lack of balanced diet. The most identified priorities that are needed to be assessed to promote health in the community are the creating awareness among the people regarding the health lifestyle, ill effects of sedentary lifestyle, alcohol abuse; unemployment related depression and stress, lack of physical exercise and balanced diet are the major health concerns among the community people. While focusing on these health concerns of the Greater Dandenong residents, the health and wellbeing would be promoted.
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