Formative Research and Cultural Tailoring of a Substance Abuse Prevention Program for American Indian Youth: Findings From the Intertribal Talking Circle Intervention.

Background. Substance use among American Indians (AIs) is a critical health issue and accounts for many health problems such as chronic liver disease, cirrhosis, behavioral health conditions, homicide, suicide, and motor vehicle accidents. In 2013, the highest rates of substance use and dependence were seen among AIs when compared to all other population groups, although these rates vary across different tribes. Among AI adolescents, high rates of substance use have been associated with environmental and historical factors, including poverty, historical trauma, bicultural stress, and changing tribal/familial roles. Our project, the Intertribal Talking Circle intervention, involved adapting, tailoring, implementing, and evaluating an existing intervention for AI youth of three tribal communities in the United States. Formative Results. Community partnership committees (CPCs) identified alcohol, marijuana, and prescription medications as high priority substances. CPC concerns focused on the increasing substance use in their communities and the corresponding negative impacts on families, stating a lack of coping skills, positive role models, and hope for the future as concerns for youth. Cultural Tailoring Process Results. Each site formed a CPC that culturally tailored the intervention for their tribal community. This included translating Keetoowah-Cherokee language, cultural practices, and symbolism into the local tribal customs for relevance. The CPCs were essential for incorporating local context and perceived concerns around AI adolescent substance use. These results may be helpful to other tribal communities developing/implementing substance use prevention interventions for AI youth. It is critical that Indigenous cultures and local context be factored into such programs.

A traditional American Indian death ritual: Developing nursing knowledge through aesthetic exposure.

The theoretical and practical application of Boykin and Schoenhofer's Nursing as Caring: A Model for Transforming Practice (2001) provided a framework for the exploration of an aesthetic project of quilting, which was undertaken in order to explain the death journey for a cherished mentor of American Indian nursing students. In particular, the nursing situation was used to guide the making of the quilt sampler. Aesthetics nested into the teaching-learning process became another way to help students solidify their professional self-identity as caring persons. This research has implications for the intentional development of studying quilting as an aesthetic way to express valuable lessons learned while caring for patients and telling stories. This idea of quilting opens up a line of enquiry into caring that can be expressed through a new and creative medium.

Quilting a Field Pattern Portrait Using Butcher's Methodology.

The nursing profession acknowledges Martha Rogers to the foundation of nursing theory as a true visionary. Butcher developed a method that ensures scientific rigor in the application of Rogerian theory, unitary field pattern portrait (UFPP), which was used to explore new phenomenon of inquiry resulting in insights into Rogerian pandimensionality. In this intervention, an American Indian tradition, quilting, became a culturally appropriate way for a nurse to facilitate healing through the application of Rogerian theory. In Rogers's theory of the science of unitary human beings, pattern unfolding becomes a way of knowing through expansion, evolving, blossoming, revealing, and openness. Rogers's theory was used to encourage healing as an American Indian mother and deeply depressed daughter created a quilting story based on Rogerian principles: resonancy, helicy, and integrality. This aesthetic field patterning modality using Butcher's UFPP captured the intervention as clients were engaged in health patterning through the American Indian tradition of quilting. Field notes with reflective journaling as recommended by Butcher assisted in the crystallization of a UFPP drawn from Rogerian nursing theory.