A phenomenological exploration of the experiences of families of indigenous children hospitalised in the Australian Capital Territory

Abstract

Introduction In this thesis I am seeking to gain an understanding of the experiences of families of Indigenous children hospitalised in the Australian Capital Territory (ACT).

Methods The study is situated within an overall ecological and social determinants framework with phenomenology as its base. It uses mixed data sources comprising: ACT Health hospital separation data for the years 2000-2005 for Indigenous children under five years of age; child/ren s hospital records and clinical notes(n=34); interviews with parents (n=15); and with health professionals (n=13) and feedback two interpretive teams, comprising the local Indigenous Community and health service providers respectively, which guided the study interpreted the findings in order that they inform public health policy and practice (two meetings).

Results Almost 80% of hospitalisations were coded as clinically avoidable: however, the phenomenon of socially avoidable hospitalisations is an emerging theme from the study, underpinned by the fact that health professionals variously employ a `sameness-of-treatment and/or a difference-of-treatment approach in caring for Indigenous patients. There were several limitations of the hospital separation data provided by ACT Health, resulting in an undercount of Indigenous identification for initial and subsequent hospitalisations. Notwithstanding that everyone entering hospital should be asked their Indigenous status, for health professionals, the phenomenon of manifestly Indigenous appears to operate in the conceptual space between ascertaining Indigenous status and knowing that a person is Indigenous. Correcting for any shortfalls in this conceptual space relies heavily on the skills of the Hospital Aboriginal Liaison Officer (HALO). However, the assumption that the HALO is solely responsible for assisting Indigenous patients creates a potential abrogation by the system of its responsibilities towards Indigenous patients. There are gaps in health professionals knowledge about Indigenous-specific services, access to which would not only equip them for referrals, but could also enhance their skills for caring for Indigenous patients. Several sub-ordinate themes arising from the empirical data coalesced towards two super-ordinate themes, The 3 I s: Identification, Identifiability, Identity which explores these separate yet inextricably linked concepts, and Power and control which explores the issues of institutional and personal power within the broader context of the social determinants of Indigenous health.

Conclusions In the context of Indigenous health, good primary health care includes culturally competent health professionals working within the tertiary health care setting. Therefore, understanding of the socio-political context of Indigenous families experiences and the meanings of those experiences is paramount. Further, support for the role of HALOs in negotiating the power differentials between families and the system would greatly enhance families experiences.