Past experiences enhance the future. Health care providers gaining expertise in creative thinking, traditional medicine, spirituality, and cultural sensitivity is an essential requirement for 21st century health care. We must stay mindful that poverty, isolation, and rural living may create new forms of social exclusion because of lack of communication and rapidly changing technology. Conversely, sensory overload resulting from a faster paced lifestyle and rapid enhancements in technology may cause increased tension and stress. This article reviews successes that may offer the reader ideas on coping with the provision of health care services in such a volatile changing environment, while honoring tradition and cultural competency.
This off-reservation boarding school serves over 600 students in grades 4-12; approximately 85% of the students reside in campus dormitories. After having documented significant improvement on a number of outcomes during a previous High Risk Youth Prevention demonstration grant, the site submitted a Therapeutic Residential Model proposal, requesting funding to continue successful elements developed under the demonstration grant and to expand mental health services. The site received Therapeutic Residential Model funding for school year 2001-2002. Once funds were received, the site chose to shift Therapeutic Residential Model funds to an intensive academic enhancement effort. While not in compliance with the Therapeutic Residential Model initiative and therefore not funded in subsequent years, this site created the opportunity to enhance the research design by providing a naturally occurring placebo condition at a site with extensive cross-sectional data baselines that addressed issues related to current federal educational policies.
Although the health of Indigenous peoples is affected by structural inequities, interventions to address health inequities are often focused locally rather than at a structural level where they could play a transformative role. Addressing structural health inequities by involving Indigenous peoples in health-policy discourses can serve to address power imbalances that are implicit in policymaking processes. Using an analytical framework based on interdisciplinary perspectives rooted in critical and decolonizing approaches, the author presents a discussion of theoretical considerations for including Indigenous peoples in policy discourses as a means of addressing health inequities. She argues that the involvement of Indigenous peoples in health-policy discourses has the potential to mitigate epistemological colonialism, push forward an agenda of decolonization, and address health inequities caused by inequitable systems of power. The article concludes with suggestions for future research and implications for nursing and health professionals of addressing structural inequities through attention to policy discourses.
Although HIV/AIDS prevention has presented challenges over the past 25 years, prevention does work! To be most effective, however, prevention must be specific to the culture and the nature of the community. Building the capacity of a community for prevention efforts is not an easy process. If capacity is to be sustained, it must be practical and utilize the resources that already exist in the community. Attitudes vary across communities; resources vary, political climates are constantly varied and changing. Communities are fluid-always changing, adapting, growing. They are "ready" for different things at different times. Readiness is a key issue! This article presents a model that has experienced a high level of success in building community capacity for effective prevention/intervention for HIV/AIDS and offers case studies for review. The Community Readiness Model provides both quantitative and qualitative information in a user-friendly structure that guides a community through the process of understanding the importance of the measure of readiness. The model identifies readiness- appropriate strategies, provides readiness scores for evaluation, and most important, involves community stakeholders in the process. The article will demonstrate the importance of developing strategies consistent with readiness levels for more cost-effective and successful prevention efforts.
Nurses are key providers of health care in remote Indigenous communities throughout Australia. Evidence of nurses' actual practice and the outcomes of their care for clients in this context, however, is lacking. This exploratory research describes how nursing is practised in a remote Aboriginal community and reveals many anomalies. The overall theme, termed amorphous practice, defines the changeable character of practice from nurse to nurse and from situation to situation. The themes underlying amorphous practice are termed detachment, diffusion, and beyond the nursing domain. Each theme is described by way of its characteristics, the strategies nurses use to deal with the situation, and the consequences. The significance of these findings raise concerns for the accountability of nursing and most of all for the rights of Indigenous people in remote areas to basic standards of safe health care.
In this article we critically analyze the disconnect between much of the contemporary discourse and practice in Canadian community health nursing (CHN) that has contributed to the slow progress of strengths-based, health-promoting nursing practice. Appreciative inquiry philosophy and methods are introduced as a bridge to traverse this disciplinary gap. Two exemplars show how appreciative, strengths-based CHN research and action can move policies and programs toward more socially just practices congruent with CHN values. Exciting potential for nursing knowledge may arise from incorporating more strengths-based approaches into practice, education, policy, and research.