Negotiating three worlds: academia, nursing science, and tribal communities.

PURPOSE: The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams. METHOD: Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages. RESULTS: Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities. DISCUSSION: Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities.

Drawing on wisdom from the past: an elder abuse intervention with tribal communities.

PURPOSE: The Family Care Conference (FCC) is an elder-focused, family-centered, community-based intervention for the prevention and mitigation of elder abuse. It is based on a family conference intervention developed by the Maori people of New Zealand, who determined that Western European ways of working with child welfare issues were undermining such family values as the definition and meaning of family, the importance of spirituality, the use of ritual, and the value of non-interference. The FCC provides the opportunity for family members to come together to discuss and develop a plan for the well-being of their elders. DESIGN AND METHODS: Using a community-based participatory research approach, investigators piloted and implemented the FCC in one northwestern Native American community. The delivery of the FCC intervention has grown from having been introduced and facilitated by the researchers, to training community members to facilitate the family meetings, to becoming incorporated into a Tribal agency, which will oversee the implementation of the FCC. RESULTS: To date, families have accepted and appreciated the FCC intervention. The constructive approach of the FCC process helps to bring focus to families' concerns and aligns their efforts toward positive action. IMPLICATIONS: The strength-based FCC provides a culturally anchored and individualized means of identifying frail Native American elders' needs and finding solutions from family and available community resources.

Research as spiritual covenant.

Conducting research with Native American communities poses special challenges from misunderstandings that may arise from the interface of differing cultural worldviews held by the scientific and the Native communities. Although the community-based participatory research approach shows promise for conducting research that can maximize benefits and minimize the risks of harm to Native American people, there is little information related to the practical implementation of culturally appropriate research practices when working with Native American communities. Drawing on the authors' research with three Native American communities in the Northwest, this article describes culturally appropriate processes for engaging Native American communities. The first section identifies and describes the principles that provide the foundation for the authors' research activity as a spiritual covenant and guides the authors' research with the three communities. The second section describes the project phase matrix that was used to organize the approaches employed in this work.

Community-based participatory research: an approach to intervention research with a Native American community.

Community-based participatory research (CBPR), with its emphasis on joining with the community as full and equal partners in all phases of the research process, makes it an appealing model for research with vulnerable populations. However, the CBPR approach is not without special challenges relating to ethical, cultural, and scientific issues. In this article, we describe how we managed the challenges we encountered while conducting a CBPR project with a Native American community. We also suggest criteria that will enable evaluation of the project.

Big changes in the Indian Health Service: are nurses aware?

Unparalleled challenges currently face the Native American health care system. These challenges are a result of several factors, including (a) external pressures to reduce the overall cost of health care in the United States, (b) increased assumption of responsibility for delivery of health care by tribal governments, (c) decreased direct supervision by the Indian Health Service (IHS), (d) insufficient funding for Indian health care, and (e) increased interest of managed care to contract with tribal service units for health care. This article explores the opportunities and challenges facing Native American health care delivery and examines nursing policy issues pertinent to the current state of the IHS.