Integrative Approaches

LEARN Model

&

Native American Teachings/Medicine

LEARN MODEL

• Most powerful transcultural barriers are different explanatory models of disease/illness

• Providers must first become aware of their own cultural biases

Starts in communication …

• Verbal• Non-verbal• Handshakes & smiles

– Signs of warmth and caring to a Hispanic patient

– Indication of frivolity and immaturity to Soviet emigres

LEARN Model

• L - Listen with empathy & understanding (active listening)

LEARN Model

• L – Listen with empathy & understanding

• E – Explain your perception of the problem/need

LEARN Model

• L – Listen with empathy & understanding

• E – Explain your perception of the problem/need

• A – Acknowledge & discuss differences in client/provider perceptions

LEARN Model

• L – Listen with empathy & understanding

• E – Explain your perception of the problem/need

• A – Acknowledge & discuss differences as well as similarities in client/provider perceptions

• R – Recommend treatment or action plans

LEARN Model

• L – Listen with empathy & understanding• E – Explain your perception of the problem/need• A – Acknowledge & discuss

differences/similarities in client/provider perceptions

• R – Recommend treatment or action plans• N – Negotiate treatment or action plans

(Involvement = Action)

Berlin & Fowkes (1983); Modified Tafoya & Wirth (1992)

… the disconnect

“Patients ask why they’re ill, and having told them how they became ill, physicians

think they’ve answered the question.”

Dr Margaret Clark

… mending/preventing the disconnect …

“Because of alternate views of the causative factors of disease, there are also alternative methods of treatment.

Asian & Latino American Cultures

• Believe in a humoral concept of disease and treatment

• Based upon opposition or balance of hot & cold qualities

What happens to clients?

Integrating Native American Teaching

• … to develop effective, culturally relevant approaches to HIV/AIDS treatment, services, case mgt, and prevention programs.

Smudging & Sacred Smokes

• To cleanse and purify both the physical and spiritual bodies with smoke from sacred herbs

• Sage & Cedar• Every Nation has its

own specific teachings & practices

Sweat Lodge

• Ceremony of preparation

• Means of physical and/or spiritual renewal

• No fire – hot rocks produce heat & create steamy mist

Apache Tears

• Obsidian

• Smoking Mirror

• Knives, spearpoints & arrowheads

• Paul Ortega, Apache Medicine Man

• Put “sorrow” in stone

• Once you’ve learned what you needed to know, release it / let it go

Storytelling

• Internalization of the meaning of the story

• Telling elaborating stories as opposed to telling directly … “this is what the story means”

Talking Circles

• Provide group members w/ structure and support

• Help to deal with “pause time” issues

• 1st generation responsibilities of “teaching” & “sharing”

Drumming & Dancing

Drumming & Dancing

• Entire cosmos moves in constant rhythm

• All of life pulses to the cosmic dance

• Music is a healing force – all living spirits sing

Drumming & Dancing

• Drumming & dancing are expressions of:– inter-dependence,

– healing,

– medicine &

– rebalances energy

Drumming & Dancing

• Can be a holy act, a religious act or an act of great power

Sacred Herbs

Medicine People