The Use of Talking Circles to Describe a Native American Transcultural Caring Immersion Experience

From a learning opportunity to a conscious multidimensional change: a metasynthesis of transcultural learning experiences among nursing students

BACKGROUND

Several educational activities in nursing schools worldwide have been implemented to promote transcultural nursing and cultural competence. Despite the diversity of their experiences and outcomes, the available evidence has not been systematically reviewed and reinterpreted. This study aimed to review and reinterpret all rigorous qualitative evidence available, providing an opportunity to understand how students learn transcultural nursing and assisting faculties, researchers, managers, and practitioners in designing new interventions to improve transcultural training.

METHODS

A meta-synthesis was conducted to review and integrate qualitative studies of these phenomena. English, Spanish and Portuguese articles were searched in Pubmed and Scopus databases. Only peer-reviewed journals in which qualitative approaches were used were included. Quality was assessed using the CASP qualitative version checklist. The metasynthesis technique proposed by Noblit and Hare was used to analyse the data.

RESULTS

Twenty-nine studies were included in the analysis. Most studies used phenomenological approaches that were conducted in Australia and the United States of America, with international internships being the most popular learning method. The data revealed one central theme, "From learning opportunity to conscious multidimensional change," and six subthemes. The transcultural nursing learning experience is not a simple or linear process. Instead, it appears to be a complex process formed by the interaction between a) self-awareness, b) reflective thinking, c) Cultural Encounters, d) cultural skills, e) Cultural Desire, and f) Cultural Knowledge.

CONCLUSIONS

Transcultural nursing learning is a multifaceted process that arises from specific learning opportunities. This process is still to evolving. Therefore, specific educational strategies should be implemented to encourage attitudinal change and promote reflective thinking.

"Calling the Spirit Back:" Spiritual Needs Among Great Plains American Indians

CONTEXT

American Indians (AIs) are disproportionately affected by serious illness such as cancer. Colonization, cultural genocide, and trauma have adversely affected AIs' ability to attain health and well-being, and in many cases led to the loss of the right to practice traditional ceremonies and rituals. Still many AIs describe well-being as being rooted in spirituality.

OBJECTIVES

The purpose of this project was to learn about the perspectives of AI cancer survivors, caregivers, and Tribal leaders and healers specific to spirituality while on the cancer journey.

METHODS

Qualitative interviews and Indigenous talking circle methodologies were used to explore AIs cancer survivors, caregivers, and Tribal leaders and healers' perspectives on spirituality while on the cancer journey. A data analysis team consisting of AI and non-AI members analyzed the narrative data.

RESULTS

Qualitative analysis of interviews and talking circles revealed 4 major themes related to spirituality: the chasm of colonialism, coexistence of Traditional and Christian religions, calling the Spirit back, and prayer as sacred energy.

CONCLUSION

It is critical that clinicians caring for AIs with serious illness seek to understand their patients' spiritual beliefs about disease treatment and death and work with them and their families to support quality of life throughout their illness journey. In addition, clinicians must recognize the systemic racism inherent in our healthcare systems, and dismantle cultural clashes and bias for all patients, particularly AIs, who have long suffered from poorer health outcomes.

Assessing Social Determinants of Health in a Prenatal and Perinatal Cultural Intervention for American Indians and Alaska Natives

American Indians and Alaska Natives (AIANs) refer to cultural traditions and values to guide resilient and strength-based practices to address maternal and infant health disparities.

METHODS

A case study of a culturally-based educational intervention on AIAN maternal and child health.

RESULTS

Cultural teachings have successfully been applied in AIAN behavioral interventions using talking circles and cradleboards, but maternal and child health interventions are not well-represented in peer-reviewed literature. Zero publications included interventions centered around cradleboards and safe sleep.

DISCUSSION

There is a need for rigorous published research on culturally based interventions and effectiveness on health outcomes for mothers and babies.

CONCLUSIONS

This paper discusses how a cradleboard educational intervention incorporates national guidelines to address maternal and infant health while mediating social determinants of health.

State health disparities research in Rural America: Gaps and future directions in an era of COVID-19

Purpose

In an era of the COVID‐19 pandemic, improving health outcomes for diverse rural communities requires collective and sustained actions across transdisciplinary researchers, intersectoral partners, multilevel government action, and authentic engagement with those who carry the burden—rural communities.

Methods

Drawing from an analysis of transcriptions and documents from a national workshop on the “State of Rural Health Disparities: Research Gaps and Recommendations,” this brief report underscores the gaps and priorities for future strategies for tackling persistent rural health inequities.

Findings

Four overarching recommendations were provided by national thought leaders in rural health: (1) create mechanisms to allow the rural research community time to build sustainable community‐based participatory relationships; (2) support innovative research designs and approaches relevant to rural settings; (3) sustain effective interventions relevant to unique challenges in rural areas; and (4) recognize and identify the diversity within and across rural populations and adapt culturally and language‐appropriate approaches.

Conclusion

The COVID‐19 public health crisis has exacerbated disparities for rural communities and underscored the need for diverse community‐centered approaches in health research and dedicated funding to rural service agencies and populations.

Tangled pasts, healthier futures: Nursing strategies to improve American Indian/Alaska Native health equity

American Indian/Alaska Native (AI/AN) populations in the United States continue to experience overall health inequity, despite significant improvement in health status for nearly all other racial-ethnic groups over the past 30 years. Nurses comprise the bulk of healthcare providers in the U.S. and are in an optimal position to improve AI/AN health by transforming both nursing education and practice. This potential is dependent, however, on nurses' ability to recognize the distinct historical and political conditions through which AI/AN health inequities have been produced and sustained. Nurse providers, educators, and leaders must in turn recognize how the sustained conditions of marginalization and expropriation that underpin current AI/AN health inequities continue to shape contemporary AI/AN health outcomes. This manuscript builds upon the extant literature of AI/AN historical health policy and utilizes decolonial theorizations of nursing and a cultural safety framework to propose a series of immediately actionable steps for nursing intervention into AI/AN health inequity. Ultimately, we suggest that it is crucial for nurses to collaborate with AI/AN individuals and communities across educational and clinical settings to further refine these approaches in alignment with the disciplinary obligation of promoting social justice within healthcare.

Addressing Substance Use Utilizing a Community-Based Program among Urban Native American Youth Living in Florida

This study was conducted in Florida among two urban Native American youth programs that are sponsored by urban Native American community organizations. Convenience and snowballing were used as a sample recruitment strategy. Assignment to the experimental condition (UTC) and the control condition (SE) was established by randomizing the two community youth program sites to the two conditions. Utilization of a culturally relevant theory, Native-Reliance, guided the intervention approach for the prevention of substance use among urban Native American youth. Results of this study provided evidence that a culturally based intervention was significantly more effective for the reduction of substance use interest and general well-being than a non-culturally based intervention for urban Native American youth. Prevention programs for urban Native American early adolescent youth that utilize Native American strengths, values, and beliefs to promote healthy behavior and reduce the harm associated with high-risk behaviors such as substance use are strongly recommended.

Native American adolescent narrative written stories of stress

OBJECTIVE(S)

The purpose of this paper is to report study findings related to themes of stress and coping strategies experienced by non-reservation-based Native American adolescents as expressed by their written stories.

DESIGN

A qualitative descriptive narrative approach was used to capture written stories of stress.

ANALYSIS

Key concepts and themes were identified by using the consensual qualitative research (CQR) approach from the participant's stories of stress.

RESULTS

Written stories of stress were collected and analyzed from a convenience sample of 179 Native American adolescent's ages 13-18-years old. Five major themes related to experiences of stress emerged from the stories including (a) relationships, (b) responsibilities, (c) socioeconomic status, (d) negative coping strategies, and (e) positive coping through Native-Reliance.

CONCLUSION

The findings reveal the importance of understanding the types and response to stress experienced by Native American adolescents.

Experiences and outcomes of health professional students undertaking education on Indigenous health: A systematic integrative literature review

OBJECTIVES

To explore the experiences and outcomes of health professional students when undertaking education on Indigenous health.

DESIGN

An integrative systematic literature review.

DATA SOURCES

The search was undertaken from September 2017-November 2017. Six databases were searched: CINAHL, Scopus, Informit Health Collection, Informit Indigenous Collection, Proquest - Nursing and Allied Health Collection; and Proquest - Health and Medical Collection. Reference lists of all articles were scanned for further relevant articles.

REVIEW METHODS

The search strategy was limited to English articles published in the previous decade. Articles were included if they focused on Indigenous health content provided to health professional university students, with a focus on Indigenous populations of Australia, New Zealand, Canada and the United States of America. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review. Studies were evaluated for methodological rigour using the CASP rating checklist. Both qualitative and quantitative data were coded using thematic qualitative analysis methods and presented as a meta-aggregation.

RESULTS

Twelve articles were included. Synthesis found significant variability in the ways Indigenous health issues were taught and integrated into health programs, particularly with regards to quality, methodological rigour of evaluation, pedagogical approaches and student experiences. Four themes were developed to describe student experiences and learning outcomes. These included: increasing knowledge of Indigenous health; emotional responses to content and teaching processes; perceived value of Indigenous health education; and cultural competence and critical thinking.

CONCLUSIONS

Methodologically sound longitudinal studies are required to test if early changes in student knowledge and attitudes may be sustained. How students' 'increase in knowledge' translates to cultural capability is unclear, and there is a need for validated tools to measure this construct. A more sophisticated critique of how students emotionally engage with Indigenous health content, including understanding the relationships between 'discomfort' and transformative experiences is required.