Assessment Task 3: Case Study Analysis

Weight: 50%
Due date: Week 5 – 9am Friday 2nd September.
Aboriginal and Torres Strait Islander people are advised that this assessment contains
images and stories of people who have passed.

Intent: Through the examination of a case study, explore Aboriginal and Torres Strait
Islander People’s experiences of healthcare and the impact this has on their health and
wellbeing.

Acknowledgement of Country:

I would like to acknowledge the Gadigal of the Eora Nation, the traditional custodians of this
land in which we stand, and pay my respects to the Elders both past, present, and emerging.

Using ‘Gibb’s Reflective Cycle’, write a reflection on your response to the story of Naomi
Williams. (Approximately 300 words).

Experience:
In the case of Naomi Williams, racial bias in healthcare settings saw fatal impacts regarding
her care. Naomi Williams, at the time, was a pregnant 27-year-old Wiradjuri woman. She
presented at Tumut hospital on the 1st of January 2016, and later that day passed away due to
sepsis, associated with the bacterium Neisseria meningitidis.

Feelings:
In reading this article, watching the video, and through my exploration of other sources
regarding this case, I was overwhelmed by the blatant disregard for Naomi and her holistic
wellbeing. The way in which she was neglected while at her most vulnerable was disturbing. I
felt embarrassed to be associated with any treatment like this and am compelled to always act
and promote culturally safe practices to ensure something like this doesn’t occur again.

Evaluation/Analysis:
Value from this article comes in many forms, but the explicit nature and language used to
describe the drastically flawed treatment in which Naomi received demonstrates how such a
potent change in needed within the healthcare system to allow Aboriginal and Torres Strait
Islander People to feel safe in healthcare environments. This is seen through the description of
Naomi’s treatment as “below any acceptable standard”. Additionally, in providing nine
recommendations for improvement he Murrumbidgee Local Health District, direction is given,
prompting actual change to be implemented, rather than having no tangible positive outcomes
from the situation. However, a potential fallback with some ideas is the practicality and overall
benefit that the implantation would have. While strengthening the Aboriginal liaison health
worker program so that they were available 24 hours a day is fundamental to improving cultural

Elizabeth McGrory Student Number: 14267710

safety, it may not be feasible at times and thus not to be solely relied upon. Education needs to
be provided to all health workers on culturally safe practices, while also the identification of
risk factors for certain demographics. Complacency can also be attributed to Naomi’s situation,
along with lack of awareness, demonstrated through unconscious bias, hence the utter
importance of education and spreading awareness of how bias detrimentally impacts care and
patient outcomes.

Conclusion/Action Plan:
By educating ourselves as well, we are taking ownership of our own ability to care for a holistic
patient – something I hope to have been able to do if in a similar situation. The choice to not
conduct any formal pain assessments, or physical examinations paved the way for errors to
occur. Naomi was not treated the same way as other patients, and while prejudicial, allows
proper awareness for students, such as myself, to take away the utter importance of culturally
safe care, and equity of care to all.

Analyse and discuss the care that Naomi Williams received at Tumut hospital in relation
to the Australian Registered Nurse Standards for Practice and the International Council
of Nurses (ICN) Code of Ethics for Nurses.

The ICN Code of Ethics for Nurses governs the care that is provided to all patients. It is (or
should be) at the forefront of your mind when providing care. The ‘endemic racism’ seen in
Naomi’s case through undisputed ‘unconscious bias’ provided a legitimate ‘barrier to
treatment’ (Newhouse & Hawtrey, 2021). With the ICN Code of Ethics for Nurses providing
a foundation for ‘ethical guidance in relation to nurses’ roles, duties, responsibilities,
behaviours, professional judgement, and relationships with patients’, it is disturbing how
mistreated a patient can be (ICN, 2021). The ICN code was not translated into the care of
Naomi – she was disregarded which is evident enough in the 34-minutes she spent at the
hospital with the failure for a physical examination or formal pain assessment to be completed.
Through this, the Australian Registered Nurse Standards for Practice 4 of Comprehensively
Conducts Assessments, was forfeited and not considered being a catalyst for Naomi’s future
decline (Nursing and Midwifery Board of Australia, 2017). Racism and implicit bias has
pervaded the healthcare system, ‘allowing mistreatment, discrimination and disempowerment’
among vulnerable populations. (National Justice Project, 2021). This treatment, which
progressed and worsened over time, is what lead to Naomi putting of obtaining forms of
healthcare due to the discrimination she felt, ‘delaying going to a hospital until she was very
sick’ (Jackson, 2019).

In applying the elements of the ICN Code of Ethics for Nurses, we can understand and identify
how all four principal elements – nurses and patients or other person receiving care, nurses and
practice, nurses and profession, and nurses and global health – interrelate and how they should
look when enacted. In reading the State Coroners of NSW Inquest into the Death of Naomi
Williams, more light is shed into the structure and preceding’s of the night Namoi attended
Tumut Hospital, where more in depth discussion in relation to the ICN Code of Ethics can be
drawn. Various evidence reflects the inadequacy Naomi felt when regarding her care, and that
she continually informed friends and family over multiple years leading up to her death that
she “didn’t feel comfortable going back [to Tumut Hospital]”, as they didn’t “hear what she
was saying” (Inquest into the Death of Naomi Williams, 2019).

Elizabeth McGrory Student Number: 14267710

Describe what implicit bias or racism is and explain how implicit bias or racism at both
individual and systemic levels may have impacted on Naomi Williams and her family.

Implicit bias describes our attitudes towards people or the association of stereotypes of certain
population groups without conscious knowing, being negative and based on irrelevant
characteristics such as race or gender (FitzGerald & Hurst, 2017). Where individual and
systemic racism differ if that individual forms from the basis of that person’s views and
feelings, and systemic racism occurs across society or large organisations – both of which
Naomi experienced. Implicit racial bias interferes with treatment, where stereotyping
influences healthcare disparities, causing distrust of medical professionals, hindering the ability
to have equitable access to healthcare and treatment for those enduring mistreatment (Quigley
et al., 2020).

Naomi repeatedly made known her dissatisfaction with the care she was receiving at Tumut
Hospital, going as far to consider having her baby in Canberra as she believed she would be
more equitably treated, with the Inquest finding she believed she would have access to a local
Aboriginal Medical Service, where she felt more comfortable and where they would “hear what
she was saying”. Implicit bias and/or racism in healthcare influences diagnosis of the patient,
treatment decisions, and the level of care (FitzGerald & Hurst, 2017). The effect this has on
Naomi is explicit, seen through her many hospital visits and her later passing. Her family is
also just as impacted, as implicit bias inhibits family engagement. In alienating Naomi in her
own care and removing her autonomy, consequently, other stakeholders such as family or
friends are detached also. In this case, Naomi’s passing left many questions unanswered, and
the preventability of her cause of death further illuminates the fundamental issues of individual
and systemic bias at hand, further traumatizing those close to her.

Analyse the ongoing implications of implicit bias, or racism, in healthcare for the health
and wellbeing of Aboriginal and Torres Strait Islander people.

Implicit bias or racism is recognised as a significant health determinant, responsible for much
of Australia’s health inequity (Kairuz et al., 2021). Despite efforts that have been made to
bridge the gap between Aboriginal and Torres Strait Islander people and other Australians, the
disparity of care due to implicit bias has still significantly permeated the healthcare system.
The RACGP found evidence to suggest stereotyping to influence they type of treatment
provided to Aboriginal and Torres Strait Islander patients (RACGP, 2018). Institutional racism
creates conditions in which Aboriginal and Torres Strait Islander patients do not receive
appropriate, timely and respectful care. As seen in Naomi’s case, this can have fatal
implications.

One step to reduce Indigenous Australian’s health inequity is improving the cultural safety and
responsiveness of the healthcare system. This in turn improves access to, and the quality of
health care for Aboriginal and Torres Strait Islander People (AIHW, 2022). Westernised forms
of medicine subdue the integration of other cultures and backgrounds when regarding the care
of Indigenous patients, endorsing a culturally unsafe environment as Indigenous values,
strengths and difference in beliefs are not acknowledged. To counter this inequity, health

Elizabeth McGrory Student Number: 14267710

professionals and services need to be compelled to be culturally responsive, regaining
autonomy to overcome individual and systemic racism so that we can see an active engagement
of Indigenous Australians in a culturally safe manner where their needs are met (Closing the
Gap, 2020).

As a future Registered Nurse, discuss how you could address implicit bias or racism, at
an individual or systemic level, to improve the health care and outcomes for Aboriginal
and Torres Strait Islander people.

As a future Registered Nurse (RN), it is my duty to act in a culturally safe and responsible
manner. Addressing implicit bias is inevitable in my time as a future RN, however taking steps
at an individual level are key to ensure I am equipped to stop racism within a healthcare setting
from occurring. Education is key and maintaining and continuing my education on Aboriginal
and Torres Strait Islander patients’ determinants of health will allow me to identify risk factors
that are prevalent in this population group. These Indigenous health outcomes are linked to the
social determinants of health and can be influenced by institutional racism (AIHW, 2022).

Moreover, working in alignment with Aboriginal Liaison Officers (ALO) will not only allow
me to continue self-education, but also provide culturally safe environments for the patients,
and allow for a more holistic understanding of the patients needs. By ensuring I am familiar
with the ALO, how to reach the ALO and the best ways to incorporate the ALO into the
patient’s care will aid the health outcomes for Indigenous patients (Mackean et al., 2020).

Systemic change is more of a challenge, however ensuring I commit to my own responsibility

of not acting with implicit bias, we will be able to improve how Aboriginal and Torres Strait
Islander People are treated in all environments through our advocation. Even through the
completion of this subject at university, demonstrates the progress in eliminating systemic bias
in healthcare, as undergoing compulsory Indigenous subjects to ensure respect and education
on Indigenous individuals and their treatment is given. With the National Aboriginal and Torres
Strait Islander Health Plan 2021–2031 seeking to "change the way governments work with
Aboriginal and Torres Strait Islander people to achieve better health outcomes" (2021), the
needs of Indigenous People in the healthcare setting are identified, enhancing their holistic
health outcomes.

Reference List:

A. Quigley., J. Hutton., G. Phillips., D. Dreise., T. Mason., G. Garvey., & Y. Paradies.

(2020). Implicit bias towards Aboriginal and Torres Strait Islander patients within
Australian emergency departments. Emergency Medicine Australasia, 33(1), 9-18.
https://doi.org/10.1111/1742-6723.13691
Australian Government (2022) The new National Aboriginal and Torres Strait Islander
Health Plan 2021–2031 https://www.health.gov.au/health-topics/aboriginal-and-
torres-strait-islander-health/how-we-support-health/health-plan

Elizabeth McGrory Student Number: 14267710

Australian Institute of Health and Welfare. (2022). Indigenous Australians and the health
system. Retrieved from https://www.aihw.gov.au/reports/australias-health/indigenous-
australians-use-of-health-services
C, Kairuz., Casanelia, L., Bennett-Brook, K., Coombes, J., & Narayan Yadav, U. (2021).
Impact of racism and discrimination on physical and mental health among Aboriginal
and Torres Strait islander peoples living in Australia: a systematic scoping review.
BCM Public Health, 21(1). https://doi.org/10.1186/s12889-021-11363-x
C. FitzGerald., & S. Hurst. (2017). Implicit bias in healthcare professionals: a systematic
review. BMC Medical Ethics, 19
https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-017-0179-8
G. Newhouse., & L. Hawtrey. (2021, April 08). Fighting Racism in the Healthcare system.
Australian Lawyers Alliance. https://www.lawyersalliance.com.au/opinion/fighting-
racism-in-the-healthcare-system
Inquest into the death of Naomi Williams (2020) Coroners Court
https://coroners.nsw.gov.au/coronerscourt/download.html/documents/findings/2019/N
aomi%20Williims%20findings.pdf
International Council of Nurses (ICN) (2021), The ICN Code of Ethics for Nurses
https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdf
Jackson G. (2019, July 29), Naomi Williams inquest: coroner finds bias in way hospital
treated Aboriginal woman. The Guardian. https://www.theguardian.com/australia-
news/2019/jul/29/naomi-williams-inquest-coroner-finds-bias-in-way-hospital-treated-
aboriginal-woman
Mackean T, Withall E, Dwyer J, Wilson A. Role of Aboriginal Health Workers and Liaison
Officers in quality care in the Australian acute care setting: a systematic review.
(2020) Aust Health Rev. https://pubmed.ncbi.nlm.nih.gov/31931950/
National Justice Project (2021). Inquiry to health outcomes and access to health and hospital
services in rural, regional, and remote NSW.
https://www.parliament.nsw.gov.au/lcdocs/submissions/70322/0628%20National%20
Justice%20Project.pdf
Nursing and Midwifery Board of Australia (2017), Registered Nurse Standards for Practice
https://www.nursingmidwiferyboard.gov.au/codes-guidelines-
statements/professional-standards/registered-nurse-standards-for-practice.aspx
RACGP National Faculty of Aboriginal and Torres Strait Islander Health. (2018). RACGP
Racism in the healthcare system Position statement.
https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20stateme
nts/Racism-in-the-healthcare-sector.pdf

Elizabeth McGrory Student Number: 14267710