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Thursday, April 6 • 2:30pm - 4:00pm
Supporting Native American Health: Dichotomies Inherent in Nurses’ Perspectives of Leadership and Nursing Care

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Background. The purpose of this study was to examine nurse leadership related to nursing care of Native Americans. The need for nurse leadership development emerged as a priority during the Growing Resilience Phase I Pilot project on Wind River Indian Reservation (WRIR). Institute of Medicine reports have charged health professionals to reduce health disparities through improved cultural competence and have charged nurses specifically with increasing leadership opportunities at all levels of nursing practice. Advances in nursing science and its contribution to eliminating health disparities and improving Native American health hinge on building nurse leadership and improving cultural competency. Nurses are in a unique position to enhance their leadership contributions for the purpose of improving health and healthcare. Nurses serve in a variety of community settings and healthcare facilities and are trained in individual, family and community health, therapeutic relationship development, and leadership. Nurses offer a holistic approach to patient care, focus on wellness rather than illness, and have training in health promotion.

Method. A descriptive-qualitative methodology was used. Phone interviews were conducted with 11 native and non-native nurses employed by public and private agencies that serve Native Americans on WRIR. Participants were asked semi-structured questions regarding perspectives of patient/nurse relationships, attitudes and values, and nurse leadership. A pseudonym was selected by each participant and was used during the interview, data transcription, and data analysis processes. Thematic analysis involved constant-comparison through the examination of (a) similarities and differences and (b) relationships between concepts. Note that Native American perspectives of their relationships with nurses has been sought in a separately-funded project.

Results. Participants were of varying ages, gender, and educational preparation. Two interrelated themes were identified that revealed dichotomies in nurses’ perspectives: (1) Contextual Dichotomy: Shared Patient-Nurse Values versus External Forces and (2) Relational Dichotomy: Patient-Centered versus Stereotype-Driven Care. Theme 1 described the contextual factors that influence patient care. Shared values of Native American patients and nurses (e.g. holism, respect, trust, caring, and family) were discussed as essential to therapeutic relationship development, which is at the heart of effective nursing care and nurse leadership. At the same time, the shared values may contrast with external forces that undermine relationship development. External forces were described as unsupportive work environments within healthcare settings and systems, racial tension, poverty, high rates of chronic disease, and the extent of nurse education and experience in the provision of culturally-competent care. Theme 2 described participant commitment to the therapeutic relationship and patient-centered care. Participants described the importance of understanding and meeting the unique needs of each patient and family, but also advocating on their behalf. Yet, this commitment was challenged by stereotypes of Native Americans exacerbated by the heretofore-mentioned external forces. This was evidenced by a lack of regard for the Native American patient rather than acceptance and appreciation under specific circumstances.

Conclusion. Nurses function in these dichotomous realities, struggling at times to meet personal and professional expectations.

Funding was provided, in part, by INBRE in collaboration with Dr. Porter, PI for the Growing Resilience Phase II project.


Thursday April 6, 2017 2:30pm - 4:00pm
Union 3rd Floor Hallway

Attendees (1)