Dr. Tish Smyer Introduces Section 2 Concepts We are going to be reviewing key concepts related to Leininger's theory in this section.

• Care Expressions
• Care Patterns
• Care Practices
• Holistic Care

Thank you Madonna.  I would like to examine the concepts of care expressions, care patterns, and care practices as it relates to health care of the Native American Elder.

This is important because cultural care differences between the Native American Elder and the nurse can contribute to:

• stress
• noncompliance
• slow client recovery

It is also important for the nurse to reflect on their own cultural care values.  Leininger believes that without self-awareness the nurse cannot recognize differences in cultural care values and practices.  This could lead to conflicts and frustration for both the nurse and client.

Listen now to Madonna Blue Horse Beard as she speaks of care expression toward Native American Children.  The circle of life is illustrated very overtly in this summary from Madonna and can be related to the Native American Elder.

Thank you Madonna.  Once again, as care providers, exploring and finding the "conflict in" or "compatibility of" care expressions or practices leads to better nursing care.  Exploring differences in cultural values and cultural meanings and action modes can help us identify these conflict or compatibility. 

Leininger (1991) refers to these concepts in the following definitions:
Cultural care diversity:
"refers to the variabilities and/or differences in meanings, patterns, values, lifeways, or symbols of care within or between collectivities that are related to assistive, supportive, or enabling human care expressions."

Cultural care universality:
"refers to the common, similar, or dominant uniform care meanings, patterns, values, lifeways or symbols that are manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people."

The next PowerPoint presentation is on culture values and reviews the cultural values, meanings and action modes from Section 1 related to the Native American Culture and introduces the cultural values, meanings and action modes for the dominant western culture.  As you read through these,  identify if these concepts have been evident in your nursing practice or in your Native American Elder client.  Keep in mind that Leininger defines culture values as:

"The powerful, persistent, and directive forces that give meaning, order, and direction to the individual or group's thinking, actions, decisions, and lifeways, and usually over a span of time" (Leininger, 1991).

Now listen to Madonna Blue Horse Beard as she describes differences between the concept of wealth in the Native American community and the Anglo-American community.

It is appropriate to highlight some differences in cultural values to better understand the conflicts which may arise.  Cancer, as a concept, is an area in which a difference in cultural understanding can occur.
Cancer strikes fear in the hearts of most individuals.  There is no word for cancer in Indian languages.  It is often seen as a "white disease".  Cultural taboos related to modesty and not brining attention to oneself may add to the misperceptions about this disease in the Native American Elder.  The negative connotations must be addressed in a culturally sensitive way (Kline & Huff, 1999).

Listen to Madonna Blue Horse Beard as she explores the concepts of Pain and Death as it relates to the Native American Elder.  "How you meet your death" becomes particularly important.  Try to identify how these concepts may differ from the dominant western culture.

Madonna eloquently explains the values related to Native American Culture.  It is also important to recognize the diversity of cultural beliefs and practices in the many distinct tribal communities.  Additionally, there is likely to be a range of acculturation levels from the very traditional to the fully acculturated. 

Another concept that we wish to address in this section is "Holism" and its relationship to health and wellbeing to the Native American Elder.  Leininger (1991) defines health as:  "a state of well being that is culturally defined, valued, and practiced, and which reflects the ability of the individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways. "

Lets listen to Madonna as she elaborates on the theme of Holism and health. 

Thank you Madonna.  To conclude this section, I wish to identify some of the practices common to many of the cultures of Native Americans.  Incorporation of these practices into nursing care will strengthen the relationship with the client.

Listen to Madonna relate a short story about growing up Native American.

This ends Section 2 of Module 1.  To review, we have
defined and elaborated on the following concepts. 
 

Thank you for your time and attention.  Please be sure
to take the Post-Test for Section 2.

Proceed to Section 3