Case 1
Cases J.R. is a nurse practitioner in a clinic on a large, isolated Indian reservation. The clients in his community have a disproportionately high rate of alcoholism and suicide. Poverty is widespread.
He believes the most important component of his job is to promote wellness among his clients. J.R. reaches out to the people of the community by providing wellness clinics and educational forums. He uses a holistic approach to health care, incorporating traditional Indian healing practices along with Western medicine.
Questions for the case Do you think is appropriate that J.R. is adapting his practice incorporating traditional Indian healing practices along with Western medicine? Support your answer with evidence base practice recommendation.
Once you received your case number; answer the specific question on the table above. Then, continue to discuss the 3 topics listed below for your case:
1. An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.
2. Name the different family developmental stages and give examples of each one.
3. Describe family structure and function and the relationship with health care.
Case 1: J.R., Nurse Practitioner on an Indian Reservation
Question: Do you think it is appropriate that J.R. is adapting his practice incorporating traditional Indian healing practices along with Western medicine? Support your answer with evidence-based practice recommendation.
Answer: Yes, it is absolutely appropriate and, in fact, highly commendable that J.R. is adapting his practice to incorporate traditional Indian healing practices alongside Western medicine. This approach is a cornerstone of
culturally congruent care, which is essential for effective healthcare delivery, particularly in Indigenous communities.
Indigenous populations often experience deep historical trauma, cultural disenfranchisement, and significant health disparities, including high rates of alcoholism and suicide as noted in the case. A purely Western biomedical approach can be perceived as alienating, disrespectful, and may not fully address the holistic needs or belief systems of the community.
Evidence-Based Practice Recommendation: Evidence-based practice strongly supports the integration of traditional healing practices when appropriate and culturally sanctioned.
The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements emphasizes the nurse's responsibility to provide culturally respectful and sensitive care, acknowledging the diverse cultural beliefs and practices of patients (ANA, 2015). Furthermore, research consistently shows that culturally adapted interventions lead to improved health outcomes, increased patient engagement, higher rates of treatment adherence, and greater patient satisfaction, especially in Indigenous populations (Gone & Calf Looking, 2015; National Academies of Sciences, Engineering, and Medicine, 2017). By incorporating traditional healing, J.R. builds trust, validates the community's cultural heritage, reduces perceived power imbalances, and provides care that is relevant and meaningful to his clients.
This holistic integration respects the client's spiritual, emotional, and social dimensions, which are often central to Indigenous understandings of health and healing, leading to more comprehensive and effective wellness promotion.
Discussion Topics for Case 1
1. An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.
To achieve maximal health potential, a truly effective health assessment must extend far beyond basic physiological parameters (e.g., vital signs, lab results, physical exam findings). It requires a comprehensive, holistic approach that considers the individual within their unique life context. Key additional parameters that should be considered and included are:
- Social Determinants of Health (SDOH): This crucial category encompasses factors like socioeconomic status (income, education level, employment status), housing stability and quality, food security, access to safe transportation, neighborhood safety, and exposure to environmental hazards. These external factors profoundly influence an individual's health behaviors, disease risk, and access to care.
- Psychological and Mental Health Status: Assessment should include screening for common mental health conditions (depression, anxiety, PTSD), stress levels, coping mechanisms, history of trauma, and overall emotional well-being. Given the case context, specific screening for historical and intergenerational trauma pertinent to Indigenous communities would be vital.
- Cultural and Spiritual Beliefs: Understanding a patient's cultural background, health beliefs, preferred language, traditional healing practices, and spiritual practices is paramount. This ensures care is respectful, congruent, and tailored to their worldview, influencing everything from dietary choices to end-of-life decisions and treatment adherence.