Nurses' Experiences of Establishing Meaningful and Effective Relationships With American Indian Patients in the Cancer Care Setting

Abstract

Introduction: The establishment of caring relationships with racial and ethnic minority populations is challenging for many cancer care nurses. Nurses serving American Indian (AI) patients frequently encounter population-specific issues, yet their experiences are largely unknown. Objective: The purpose of this study was to describe the meaning of the AI patient-cancer care nurse relationship from nurses' perspectives. The study included three objectives: (a) to describe the immediate experiences of nurses that have engaged in cancer care relationships with AI patients, (b) to identify the underlying structures of the AI patient-cancer care nurse relationship as described by nurses, and (c) to interpret the meaning of the patient-nurse relationship within the context of AI cancer care experiences. Methods: This was an interpretive phenomenological study using a hermeneutical process for data collection and analysis of multiple, exploratory interviews. Thematic reduction was completed to explicate the fundamental structures of this particular relationship. Reduction of individually situated themes resulted in seven shared meta-themes including from task to connection; unnerving messaging; we are one; the freedom of unconditional acceptance; attuning and opening; atoning for the past, one moment at a time; and humanizing the inhumane. Results: Nine cancer care nurses participated. Reconstitution of data and reflective writing suggested that the essential meaning of the AI patient-cancer care nurse relationship was expressed in contradictory yet simultaneous patterns for nurses. Nurses sought synchronicity with their AI patients despite their contextual differences and similarities, yet most lacked adequate cultural safety training. Being in relationship provided nurses great purpose within the universal human context of caring. Conclusions: Results contribute to the development of interventions designed to improve both the AI cancer care experience and the support and training of nurses. The mutually dependent nature of the patient-nurse relationship implies that strengthening and improving support for one entity may in turn positively impact the other.

Health professional perspectives on translation of cultural safety concepts into practice: A scoping study

“…“when you realise whatever it took to get down here [for treatment] or what they've been though before, it's humbling..” ( 34 ).…”

“…“Cultural safety” was defined by four studies and these referred to New Zealand Nursing and Medical Council definitions or literature derived from New Zealand ( 24 – 27 ). The remaining nine studies referred indirectly to cultural safety (4 studies), ( 28 – 31 ) to cultural competence (2 studies) ( 32 , 33 ) or other literature (2 studies) ( 34 , 35 ). Only one study offered a definition of how the authors understood the term “culture” ( 24 ) and all operationalized the notion of culture as related to race or ethnicity.…”

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

“…The establishment of communicative and equitable relationships required for the provision of high‐quality care is known to be distinctly challenging for nurses serving AI/AN populations (Katz, O’Neal, Strickland, & Doutrich, 2010; Pool, 2019). Contributing to this discord is an underlying issue of cultural and racial incongruency between nurses and AI/AN patients.…”

“…Of particular importance to healthcare providers is the capacity to recognize patient behaviors related to historical trauma, which may be mistaken for a lack of investment in their own health and healing (Goodkind et al, 2015; Katz et al., 2010; Pool, 2019). These behaviors may include an aversion to physical touch; non‐adherence to treatment regimens; or apparent hostility toward providers and healthcare systems (Brown‐Rice, 2013; Strickland, Squeoch, & Chrisman, 1999).…”

“…AI/AN nurses may find this additional role to be empowering, and a way to honor their communities and heritage. Yet several preliminary qualitative studies suggest that they also report heightened levels of stress and workload related to these additional duties and may experience feelings of frustration with the comparative cultural ignorance of their colleagues (Katz et al., 2010; Pool, 2019). These stressors should be honored while the unique skill sets of AI/AN nurses are appropriately valued and their often highly effective ideas for improving care are translated into actual policies and protocols.…”