Dr. Gloria Craig Introduces Section 2 Concepts As we enter the 21st Century, it is impossible to ignore the number of elderly that will need health care.

In September 1990, the U.S. Secretary of Health and Human Services released a report to the United States entitled "Healthy People 2000." This was a cooperative effort involving the government, private businesses, voluntary and professional associations, and concerned individual citizens. "Healthy People 2000" was designed to stimulate initiatives to improve significantly the health of ALL Americans. Three broad goals were identified with measurable objectives under the broad categories of:

• Health Promotion
• Health Protection
• Preventive Services

The United States has been a "melting pot" for many years as cultures tried to fit into the American way of life but this is no longer the case. The United States is now more like a "vegetable stew" where each culture is attempting to maintain their "own flavor" of values and beliefs. 

By the year 2080, minorities will compose 51.1% of the total population. Multiculturalism now exists and nurses need to develop a sensitivity to and appreciation for the differences among cultures. 

Cultural assessment, awareness, and sensitivity help nurses to develop the learned objectivity and sensitivity needed to give culturally congruent care, not only within the United States but also on an international level.

The current challenge to health care practitioners is to integrate Western medicine with traditional non-Western medicine to provide culturally congruent educational methods for people from other cultures. Although each Native American tribe has its own belief system regarding health and illness, there are some general beliefs and practices that can be identified.

Let's listen to Madonna Blue Horse Beard as she describes healing and the role of medicine people and food.

Thank you, Madonna for helping us to understand the Native American perspective on traditional non-Western medicine and food. Remember, this is a reflection of the Folk System of care in Leininger's Sunrise Model.

The World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity". Wellness is more than being in good health or the absence of disease, wellness must be defined from a holistic perspective and include the whole being - physical, emotional, mental, and spiritual or from the Native American perspective - heart, body, mind, and spirit. 

Wellness differs for each person. The traditional Native American belief about health is that it reflects living in total harmony with nature and having the ability to survive under difficult circumstances (Spector, 2000). The earth is considered to be a living organism. 

According to the Native American belief system, a person should treat his/her body with respect, just as the earth should be treated with respect. The earth gives food, shelter, and medicine to humankind, and for this reason, all things of the earth belong to human beings and nature. "Mother Earth" is the friend of the Indian, and the land belongs to the Indian (Spector, 2000). These cultural values will be manifested in the Action Modes found in Leininger's Sunrise Model within the Native American culture. 

Let's listen to Madonna Blue Horse Beard as she describes the relationship between the Native American and Mother Earth. 

As you can tell by the description from Madonna, Native Americans have a unique relationship with Mother Earth and they strive to find harmony and balance.

The wellness continuum recognizes that each person has an optimal level of functioning regardless of whether at the healthy end of the continuum or progressing towards the illness and death end of the continuum. Wellness is a balance between environment (internal and external), emotional, spiritual, social, cultural, and physical components. 

Today people are living longer and living with chronic illnesses that may not have a single cause or cure. Instead the progression of the illness depends on the risk factors that may begin and remain undetected for years until a serious condition surfaces like diseases of the heart, malignant neoplasms, or diabetes mellitus. 

The wellness continuum offers a more positive view of aging in that an elderly person may have a chronic condition and remain able to function in the environment. This person may experience periods of remission and periods of exacerbation but remain active in the environment. Wellness is a state that each person must strive to attain despite age and/or illness.

There are five dimensions that must be considered to achieve wellness or when assisting an individual to achieve wellness (Ebersole & Hess, 1994). Let's examine these five dimensions in the PowerPoint presentation. 

Let's listen to Madonna Blue Horse Beard as she discusses stress and how it has affected Native Americans.

Let's listen again to Madonna Blue Horse Beard as she explains how the changes in their way of life and diet have affected Native Americans.

Thank you, Madonna for that explanation. Let's listen to Madonna again as she explains another problem for the Native American regarding food and a sedentary lifestyle. 

Thank you, Madonna. Inactivity is a serious problem for both the young and the elderly especially as we move into a "Technological 21st Century." Society has not been able to successfully make the transition from the Agricultural Age when "work was exercise" to the Technological Age when "exercise is work." In the Agricultural Age, work involved a lot of physical exercise but in the Technological Age, work involves a lot of mental exercise. 

Dr. Madeleine Leininger, a visionary nurse anthropologist, founded the field of transcultural nursing and the Transcultural Nursing Society.  She defines transcultural nursing as "humanistic and scientific area of formal study and practice in nursing which is focused upon differences and similarities among cultures with respect to human care, health (or well being), and illness based upon the people's cultural values, beliefs, and practices" (Leininger, 1991).

Health is affected by health beliefs and health behaviors. Health behaviors include choices and actions. Health beliefs are related to culture and values.

Values are the social principles, or ideals, or standards held by an individual, class, or group that give meaning and direction to life. Valuing is the process by which values are determined through choosing, prizing, and acting.

"Healthy People 2000" offered an alternative to treatment of disease with a focus on empowerment of the individual, prevention, and health promotion. The goals set forth included:

• Increasing the span of healthy life for Americans
• Reducing health disparities among Americans
• Achieving access to preventive services for ALL Americans through health promotion, protection, and preventive services.

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

Other online resources regarding Native American Elders and Health and Wellness:

Healthy People 2010

Medline: Native American Health

Native American Healing: Special Sites and Links

Native American: Years to Your Health

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

Section 3 of Module 2 will address Teaching and Learning Approaches for the Native American elder.

Proceed to Section 3