When caring for a Native American patient, it is imperative that the nurse provide culturally competent care. In this scenario, there are two main dimensions along which cultural tensions between the patient and the nurse can arise. The first pertains to the actual practices and values of Native American culture, which may be at odds with the practices and values of dominant healthcare institutions.
The second is both broader and more subtle: it pertains to the historical relationship of the Native American people and the mainstream U. S. society.After addressing both of these dimensions, suggestions will be made with respect to how a nurse could bridge this gap and provide culturally competent care for the Native American patient. To start with, it is important for the nurse to acknowledge that the Native American perspective on health may simply diverge from the default culture's perspective in some significant ways. For example, BigFoot and Funderburk (2011) have discussed how Native American conceptions of family are different from the contemporary norm, and how this results in the need to adapt nursing interventions in this sphere to the cultural context of Native Americans.
Further, these alternative conceptions are often supported by a whole alternate philosophy of life: for example, while Native American culture certainly doesn't advocate passivity "in the face of grave potential harm," there is a pronounced emphasis on "noninterference" and "letting things happen the way they are meant to be" (BigFoot & Funderburk, 2011, p. 312). This may sound somewhat jarring to the ear of the modern nurse. But then, we must remember that the modern obsession with dominating nature may sound just as jarring to the Native American patient.Nurses must thus negotiate differences not only at the level of concrete practice but also at the level of considerably more abstract ideas and values.
However, the nurse's relationship with a Native American patient must be understood not as an interaction occurring between two equal but different cultures, but rather as an interaction between a historically dominating culture and a historically subordinated culture. It cannot be forgotten than the U. S. nation is guilty of what could only be called genocide against the Native American peoples.As such, it is perfectly reasonable for a Native American to view a representative of mainstream society (that is, the nurse) with the utmost suspicion.
For example, Native Americans may be strongly inclined to view "cultural adaptation" of evidence-based practices as "simply another strategy of oppression by the dominant culture" (p. 316). In the same vein, Larios, Wright, Jernstrom, Lebron, and Sorensen (2011) have noted that "researchers [or nurses] today, to work successfully with tribal people, must listen to the needs of the community and maintain respect for tribal priorities in order for partnerships to develop trust" (p. 358).
The value of listening is absolutely crucial in this situation, because listening implies respect and equality: in a hierarchical relationship, the dominant party never has any need to listen to the subordinate party. In order to provide a Native American patient with culturally competent care, the nurse must take efforts to enfranchise and empower the patient as a "co-owner" of the nursing intervention (Lowe, Riggs, ; Henson, 2011): this is partly a form of cultural atonement, and partly just good nursing practice.With regard to adapting care to the cultural context of a Native American patient, two theoretical nursing perspectives would be useful. The first is the meta-theory of critical theory, which is concerned with addressing and overcoming unethical power relations in the nursing situation (Oudshoorn, Ward-Griffin, ; McWilliam, (2008); and under this umbrella, the second is Leininger's middle-range theory of cultural care, which is specifically concerned with surmounting cultural barriers in the nursing situation (McFarland & Eipperle, 2008).
The critical theory perspective would help the nurse remain attuned to power discrepancies in her relationship with the Native American patient; this is absolutely crucial, because a Native American patient may be far more sensitive to what he perceives as acts of domination than patients from the dominant culture.Complementing this broad view, Leininger's theory provides a more specific framework which the nurse can use to assess her patient in order to make sure that she is taking a full holistic account of the patient and refraining from imputing her own cultural views onto the patient. This theory isn't predictive in nature, but it will help the nurse develop the frame of mind necessary for providing "culturally congruent care" (McFarland & Eipperle, 2008, p. 48) for the Native American patient.The middle-range theory can help the nurse bridge the simple social-cultural gap, while the meta-theory can help her bridge the broader political-historical gap. In conclusion, in order to provide culturally competent care to a Native American patient, nurses must navigate cultural tension at two levels: first, there's the relatively general level of the differences in practices and values which exist between any two cultures; but also, there's the specific history of domination, oppression, and genocide between U.
S. society and the Native American peoples.In order to overcome the first valence of tension, the nurse should practice in accordance with Leininger's middle-range theory, which assists with developing a holistic and culturally sensitive understanding of the patient; and in order to overcome the second valence, nurses should practice in accordance with the meta-theory of critical theory, which promotes sensitive to issues of power in all its forms.
