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General Health and Healthcare of Native Hawaiians the Culture of Western Health Care Providers and Native Hawaiian Culture Education

GeneralHealth and Healthcare of Native Hawaiians: the Culture of WesternHealth Care Providers and Native Hawaiian Culture Education

Tableof Contents

Purposeand Goal 3

Demographics 3

Background 3

TheoreticalFramework 5

LearningObjectives 7

LearningModules 8

References 11

Appendix 12

Purposeand Goal

Thepurpose of this teaching plan is to provide an educational module fornursing students about culturally competent nurses and other healthcare professionals working in a culturally diverse place.


Most of theNative Hawaiians currently live in Hawaii while others live in theWestern states, notably Washington, Oregon and California. Accordingto the latest Census report, there are approximately 400,000residents of the United States who were identified as being NativeHawaiians (U.S. Census Bureau, 2002). In addition, approximately480,000 others said that they were from the combination of theHawaiian background with another racial group.


Hawaii isone of the U.S states with the longest life expectancy. However,people with the Native Hawaiian culture make up only 20% of thepopulation and they have the shortest life expectancy in this state,almost equal to the average life expectancy of the United States.Before the contact of the Western health culture with the Hawaiiannative culture, it is estimated that there was approximately 300,000.Some of other estimates of the total Hawaiian were greater. Thecontact with Western diseases with the native Hawaiian people had noimmunity, for instance, the native Hawaiian population were nearlyextinguished by Western diseases such as measles, venereal diseasesand chicken pox. Other diseases that came from other continents suchas Asia, such as leprosy also caused more deaths.

The rapidmigration of people to U.S has brought new diseases, unfamiliardiseases, new treatment, and medicine and this has posed a challengeto the health care professionals who are required to quickly learn toaccurately diagnose and treat patients, and also prevent the spreadof such diseases. For instance, a nurse who is not familiar with acertain disease may be suddenly faced with a client from Hawaii whorequires treatment for that particular disease. Some Treatments andmedicines which are being considered as complementary or alternativein the Western health culture may be considered as routine in theHawaiian health culture. On the other hand, medicines and treatmentswhich are considered as routine in the Western health culture mayhave different and adverse effects on the Hawaiian culture due todifferent genetic body processes and health beliefs.

Differencesin the expected nursing roles may differ from the Western healthculture with that of Hawaiian culture, therefore, there is need toeducate people on the expected nurse-nurse interaction,client-therapeutic nurse interaction, nurse-family interaction andphysician-nurse interaction. The inconsistencies in nursing practicesin the different cultures will highly influence the way they viewpower and make clinical judgments (Sherman &amp Eggenberger, 2009).This takes even if the nurse is viewed as a well-educated andparaprofessional or as a person who is not educated. Also, thenurse-patient relationship and nurse-family interaction will beaffected if the nurse is viewed to be an outsider (Leininger, 2002).

The rolesand perceptions that are expected from nurses vary from the Westernheath culture to the Hawaiian culture and, therefore, it is necessaryto accurately appraise the knowledge, expectations and beliefs of theclient if the culturally congruent healthcare is to be achieved bythe healthcare teams. The roles of gender and the way people expectfrom the nurses greatly vary. Nurses and other professionals inhealthcare can be greatly transformed through transcultural nursingeducation (Andrews, 1995 Leininger, 1995a Leininger &amp, 2002).

Nurses andother healthcare providers should be culturally competent for them toeliminate disparities in different healthcare cultures. In theHawaiian culture, native Hawaiians face a lot of suffering due todisparities in the health culture. Healthcare professional shouldhence undertake some training in cultural competency. Currently,Hawaii has the highest age-adjusted death rates as the cause of deathand also deaths caused by cardiovascular diseases, cancer anddiabetes.


Thetheoretical framework of the teaching-learning process of healthcareprofessionals to be culturally competent is Madeleine Leininger’sTheory of Cultural Care Diversity and University. This theoryfocuses on ways of discovering care diversities and universalities tobe able to provide culturally congruent health care (Leininger, 19821991).

When thistheory is put into practice, it will be highly instrumental in thepreparation of nursing students to be able to deliver congruentcultural care to all people. Since most nursing theories are expectedto influence all phases of the nursing curriculum, the adoption ofLeininger’s nursing theory of cultural care diversity anduniversity should, therefore, result in a more congruent culturalnursing education to the multicultural student population.

Nurses areexpected to provide respectful, compassionate, individualized,thoughtful and holistic care to the patience and this approach needsto be adopted in the culturally diverse world. Due to difference incultures, the mortality rate is higher in culturally diversesocieties as the existing healthcare systems do not address the needsof the patients fully. This is due to language barriers, economicfactors, different expectations, and inadequate knowledge of thelocal healthcare system.

Figure1. Culture Care theory.


Atthe end of this lesson, the learner should be able to:

  1. Name one similarity between the Native Americans and Native Hawaiians.

  2. Discuss the general health of Native Hawaiians.

  3. List 8 risk factors for Native Hawaiians.

  4. Discuss the genesis of Hawaiian identity.

  5. Define the Hawaiian term for harmony.

  6. Name for common Native herbs that may be used by Native Hawaiians.

  7. Define the word “Kahuna”.

  8. Describe the consequence of the western culture on Hawaiian people

  9. Describe eight ways to work effectively with Native Hawaiians

  10. Name four Hawaiian organizations where you can access Native Hawaiians


Thefollowing learning modules are based on information from the UnitedStates Department of Health and Human Services, the U.S. DHHSNational Institutes of Health (NIH) (2012) Centers for DiseaseControl and Prevention (CDC) (2011). The main teaching methods willinclude teaching aids and class manipulatives class demonstrationwritten assignments discussions and handouts. In order to preventfatigue and increase interest and student participation, there willbe only one class per week. Each lesson will begin with a 20-minutediscussion then followed by a 30-minute interactive lesson. Thelesson will then end with an optional 30 minutes period for questionsor consultation.

Introductionto class: Hello, my name is …and I am a student at the Universityof …here in …earning my masters degree in nursing, I am here tohelp you to learn more about the Native Hawaii people and how you canbecome culturally competent in caring for the Native Hawaiians. Thisis a series of five, 1 hour lessons- one each week over the course ofthe next five weeks. Welcome to your first class, and let us getstarted.

Pre-Testand Post-Test

Thelearners are provided with a Pre-Test before Module one Begins. Thesame test is also given to the learners at the end of the lesson.This test is meant to assess and introduce them to the NativeHawaiian culture.

Moduleone: Native Americans and Native Hawaiians and then genesis ofHawaiian identity

Ask thelearners to give a similarity between the Native Americans and NativeHawaiians. Facilitate the discussion by stating it to them that thesimilarity of the two native cultures is that they experienced aninvasion of their homeland by Westerners.

Proceed todiscuss the genesis of the Hawaiian identity, state to them that theKumulipo is on a chant that refer to the inter-relationships of lifeand cosmos. Also let the learners to note down that nurses and otherhealth care professionals should understand the way the Hawaiiansview themselves as part of continuum and not individuals.

ClassClosure: Thank you for your attendance to today’s class and greatwork. I look forward to next week’s class.

Module2: Risk Factors for Native Hawaiians

Ask thelearners to state any risk factors that they are aware of. Proceedand list them 8 high risk factors for the Hawaiians, these are

  1. Diabetes

  2. Hyperlipidemia

  3. Hypercholesterolemia

  4. High blood pressure

  5. Cigarette smoking

  6. Alcohol intake

  7. High dietary fat

  8. Obesity

Display avariety of pictures of people suffering from these high risk factorsas visual aids.


Module3: Native Hawaiian herbs and Terms

Ask thestudents to name any native herb that may be used by NativeHawaiians. List four native herbs on the board.

  1. ‘awa, a mild narcotic

  2. Kukui nut, a cathartic

  3. Popolo berries, antidiarrhoea agent

  4. Guava shoots, antidiarrhea agent

Proceed andgive definitions of the term “Kahuna”.

Module4: Consequence of Western Culture on Hawaiian people

Ask thelearners to give any changes that were brought to the Hawaiian peopleby the western culture. Introduce to them the western beliefs andthen provide them with the consequence of the western culture onHawaiian people.

Module5: Ways to work effectively with the Native Hawaiians andOrganization to access them.

Ask thelearners to give ways in which they can work with the NativeHawaiians. Proceed and state eight ways to them in which they canwork with Hawaiians and then list for Hawaiian organization where onecan access Native Hawaiians. Finish the lesson by providing thestudents with a Handout on cultural communication.

Seriesclosure: Thank you all for your excellent participation in the fiveweeks course. I enjoyed your company and learned a lot from you.Pleasure stay in touch.


AndrewsM. M. (2002) Trans-cultural concepts in nursing care. Journal ofTranscultural Nursing.

Centersfor Disease Control and Prevention website (Updated November 2011).

Retrievedfrom http://www.cdc.gov

Leininger,M. (1982).Transcultural Nursing: Concepts, theories and Practices.New York: Wiley

Leininger,M. (1991). Culture Care Diversity and A theory ofnursing. New York:

NationalLeague of Nursing Press.

Leininger,M. (1994). Transcultural Nursing Education: A worldwide imperative.Nursing &amp


Leininger,M. (1995). Transcultural Nursing: Concepts, theories, research andpractices. 2nded.

New York:McGraw-Hill

Leininger,M. (2002). Culture Care Theory: A major contribution to advancetranscultural

nursingknowledge and practices. Journal of Transcultural Nursing.

Sherman,R. &amp Eggenberger, T. (2009). Taking Charge: What every chargenurse needs to know.



Handout 1

Attachment1: Pre-Test and Post-Test

Handout 2

Chapter 3:Theoretical Basis for Transcultural Care

Handout 3

Chapter 4:Cross-Cultural Communication

Handout 4

Attachment2 Picture of people with major risk factors