In the NT, staffing arrangements for delivery of health services in communities vary from place to place. In general, Aboriginal Health Workers (AHWs) and Remote Area Nurses (RANs) are the resident, full-time primary health care providers. In communities that do not have resident nursing or medical staff, AHWs provide the primary health care services.
Other resident members of the multidisciplinary team may include:
Non resident members of the multidisciplinary team may include:
The title 'Aboriginal Health Worker' refers to an Aboriginal person who has undertaken specific education and training. Aboriginal Health Workers are recognised as a professional group and are required to be registered by the Aboriginal Health Worker Registration Board (NT). Aboriginal Health Worker training started formally in 1976 when Health Department staff provided basic skills training.
AHW education and training has evolved into accredited courses at various levels. It is offered through Batchelor College and other organisations including Anyinginyi Congress in Tennant Creek and Central Australian Aboriginal Congress in Alice Springs.
The 'National Competency Standards for Aboriginal Health Workers and Torres Strait Islander Health Workers' are used as a guide to develop training, to assess staff and to promote quality service delivery. These have been customised for the NT. In 1997, THS introduced a revised AHW career structure classification system. It is linked to competency levels, education and experience.
| Working Together I have been a health worker off and on for over ten years. When I started in 1984, it was under the supervision of the missionaries at Ntaria (Hermannsburg). I began as a cleaner at the community hospital and the nurse asked me if I would go to Darwin and train as a nurses' aide. I agreed because I wanted to help people and learn about Western medicine. The nurses at Ntaria were good to work with. They realised how much we could teach each other and were always willing to listen to advice from Aboriginal Health Workers(AHW). I felt I was trusted by the nurse I worked with and in 1986 I did my training to become a health worker. Often in the past, the non Aboriginal nurse had been in charge and the health workers have not been in the role of decision makers. We usually worked under the supervision of the non Aboriginal nurse. In my experience, the best nurses I have worked with have been those who are willing to work in partnership with AHWs. Today I work as a member of a team, not as an assistant. Although there is a nurse in the charge position, myself and the other AHWs are very much involved in the decisions, planning and running of our health centre. I feel we help each other by acting like a bridge between cultures. Non Aboriginal staff who do not work in partnership can find that they have a lot of misunderstandings and not achieve very much with Aboriginal people. Napanangka Susan Abbott, Senior AHW, |
Community health teams also work with traditional healers who are respected for their knowledge of traditional medicines and healing techniques. Talk with the Aboriginal Health Workers about referring to and working with the traditional healers. Many people will choose to use a combination of traditional healing methods and western medicine.
It is essential that all members of the multidisciplinary team work together to provide a comprehensive and responsive primary health care service to the community.
AHWs bring a range of skills, knowledge and understanding to the health team. They uphold traditional and cultural values within the local health service. The role of the AHW can promote and support traditional healing methods.
In general the role of the AHW is to:
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For more information see local Aboriginal Health Worker Person and Position Profiles |
The role of an AHW is often challenging. AHWs have multiple priorities and obligations. Much has been written on the subject.
See Josif and Elderton 1992, Franks and Curr 1992 and Tregenza and Abbott 1995 in the
Bibliography.
(Note: Josif and Elderton and Franks and Curr have been published together as a report
titled Final Report to Rural Health Support Education and Training (RHSET) Program on the
Recruitment, Retention and Education of Aboriginal Health Workers in the Northern
Territory by Northern Territory Department of Health and Community Services 1994).
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Check the library for copies of Aboriginal & Islander Health Worker Journal | |
| Aboriginal Health Workers: another co-worker or the most important member of
the team? We have all heard it many times, that nurses come and go and that Aboriginal Health Workers (AHWs) have to live in the communities for the rest of their lives. We have to remember this is true and that most AHWs accept quite a lot of flack for the behaviours and attitudes of nurses. Personally I believe that AHWs are the most important member[s] of the health team. They are the health care providers, co-workers, cultural brokers and the link to the community for the rest of the team. ... My real cultural training came from the AHWs. They were always willing to teach me. As long as nurses show interest, respect and are willing to listen, in my experience, the AHWs are always prepared to teach staff about cultural issues... Brycen Brook, RAN, in Franks and Curr 1996:146 |
A RAN is an advanced nurse practitioner who works as a primary health care provider. RANs either live in or visit communities that are isolated from hospitals, main town centres and other medical facilities.
As a member of a multidisciplinary team, their role is to:
The role of the RAN is often challenging. Some of the challenges of working as a RAN include the following:
THS has a 'critical incident policy' to guide action and clarify responsibility during times of crisis and critical incidents. Remote area staff are supported formally and informally during these times. They may be referred to counselling services within THS or to external service providers. Counselling is often backed up by peer support.
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Think about talking with other team members about your concerns. They may well have experienced similar problems and worries | |
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As a member of a multidisciplinary team, you will have a network of people outside the community you can talk to as well |
The Council for Remote Area Nurses of Australia (CRANA) has set up a 24 hour Bush Crisis Line to support remote area health practitioners.
Bush Crisis Line : 1800 805 391 (Free call from anywhere in Australia)
CRANA has also produced a booklet called 'Surviving Traumatic Stress: A guide for remote area health practitioners and their families'.
For a copy call 8953 5244 or fax 8953 5245.
The health centre can help the community to access information and a range of specialist and public health services. Some members of the multidisciplinary team have been visiting communities for a long time and have developed close relationships with local people. They are a valuable resource.
The resident team members are a valuable resource to visiting team members in providing local information, expertise and community links. It is important that the health centre is seen by the community as a resource centre which has strong links to other THS programs and services.
Part of the resident health team's role is to negotiate with visiting staff and organise visiting times. Visits have to be convenient for the community, for resident staff and for visitors. In order to make the most of community visits:
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obtain information about the programs and services that visitors represent | |
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find out what can be expected from the visit | |
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ask for written objectives before the visit | |
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organise a debriefing meeting with visiting staff before they leave the community. You can talk about what happened, what was achieved, what needs to be followed up, what problems came up, if any |
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Talk to the council or other relevant groups about forthcoming visits and the results of visits | |
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As soon as you know when visiting staff are coming, consider putting posters or fliers around the community | |
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Consider using local media to broadcast the messages. See 'Using Media' in the chapter 'Strategies for Health Promotion' | |
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Write up a schedule of visits on the health centre whiteboard |
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Keep in mind that visiting staff such as Environmental Health Officers and Family and Children's Services Officers have to meet certain legislative requirements | |
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Talk together about whether there needs to be a regular 'visitor free' time | |
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Consider how visits fit with local health priorities and health centre plans |
A team approach will benefit your work with individuals, groups and communities. 'Teamwork' is the process whereby the talents and resources of various people (service providers) are coordinated to achieve a common goal. The concept is "that collaborative, cooperative efforts can achieve more than the sum of the individual efforts" (Foundation for Multi-disciplinary Education in Community Health 1980:13).
| Through team planning the day-to-day responsibilities of each member
of the team should be clearly defined. In turn each member reports back to the team on
their accomplishments. AHWs, nurses and medical officers all have a clinical, health
promotion and public health role, the exact nature of which is negotiated locally so that
local needs are met. Freeman and Rotem 1999:54 |
An effective team is one that has:
Team members need to meet regularly to:
| A health team exercise: Think together about how well you are operating as a team. Talk about the following questions: Are you all aware of the health centre's goals? Based on Northern Territory Bush Book, |
There are various team building exercises and resources which are recommended by THS
Staff Development Branch. Check your current staff development program or contact:
Top End: 8922 8715 or 8922 8747
Central Australia: 8951 7722 or 8951 7735
If you look at well functioning community health teams, they are likely to have worked at developing flexibility, especially with regard to roles and responsibilities. They make the most of 'what they have and who they are'. Roles and responsibilities that team members take on (or are delegated) depend on :
In order to make the most of the skills and experience of each team member:
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review each other's strengths, interests, roles and responsibilities | |
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invite your THS manager/s to a meeting to discuss changes in roles and responsibilities | |