You are working in a large regional hospital, and have been rostered to work an afternoon shift in the surgical ward as they are short staffed. There has been an orthopaedic list that morning, with several patients recovering from knee and hip replacements. Your handover has been straightforward, everyone is doing well and there have been no post-surgery complications reported. You are looking forward to a great shift

You perform the post op checks and observations, and ask everyone if they have had adequate pain relief. The last name on the handover list is a very elderly Aboriginal lady from a remote community; you decide that you will see her last as she may need some extra time spent with her – she has had a complicated procedure. Her name is Margaret, and she smiles when she sees you, shakes her head and points to the floor. She then pushes the bedcovers away and tries to get out of bed, so you gently push her back down on to the pillows, and draw the covers up around her, explaining that she can’t get out of bed just yet.

Margaret doesn’t appear to hear you as she is still shaking her head, so you nod and ask her loudly if she has hearing aids. As there is no response, you start going through the locker to find Margaret’s bag. There is no sign of hearing aids, however Margaret is looking extremely distressed and grabs your arm. She is shaking her head and pulls her bag away from you then leans forward to push the bed covers away. Your dream shift is fast becoming a nightmare. You are wrestling Margaret for the bed covers again when you realise you are not alone.

A young lady is standing in the doorway. She tells you she is Margaret’s granddaughter May. After a swift conversation (that you don’t understand) she tells you that Margaret wants to go to the toilet – urgently. You assist Margaret with a bed pan, and when she is comfortable again ask the granddaughter to go through the patient information leaflet that was sent to Margaret before surgery. You tell them the leaflet explains why Margaret cannot get out of bed, and what to expect following surgery. Both women look at you, and begin a conversation between themselves. Margaret’s granddaughter tells you that she has come to interpret for her grandmother as she speaks little English but can understand quite well. You are also informed Margaret is not deaf, and did not understand why a nurse would need to go through her personal belongings without permission. If you had read the notes, you would have seen an entry that advised Margaret’s granddaughter would be interpreting for all communications while Margaret was inpatient. You apologise to both, and realise you have a lot to think about

q) Outline strategies that may encourage self-determination and community control of the services and programs available