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J.R. is a nurse practitioner in a clinic on a large, isolated Indian reservation.

J.R. is a nurse practitioner in a clinic on a large, isolated Indian reservation.

J.R. is a nurse practitioner in a clinic on a large, isolated Indian reservation.


Case Study 1 – Health Promotion

In this case study, J. R a nurse practitioner is caring for American Indians living on a reservation where the rates of alcoholism, suicide, and poverty are very high. J. R believes in health promotion and works to provide it by using wellness clinics and education forums. He also uses a holistic approach to healthcare by incorporating both western practices along with traditional Indian practices of medicine.  Patient-centered care should be the primary focus of care given to any group of people. J. R’s holistic approach to providing care ensures his patients receive patient-centered care.

In some Native American families, healthcare choices are decided equally among family members, and in others, decisions are made by a designated family member known as a “gatekeeper” (Still & Hodgins, 2013). When caring for these people, it is critical to identify the “gatekeeper” as soon as possible. Failure to do so may result in care being delayed. Men are traditionally supposed to corral the fields and care for the animals, while women are expected to stay close to the hogan, be independent, and often weave (Still & Hodgins, 2013).

Alcoholism is quite common among Native Americans. Alcohol abuse is the most common type of substance addiction when compared to other types of chemical misuse (Still & Hodgins, 2013). A high prevalence of alcohol-related health hazards, such as cirrhosis, motor vehicle accidents, homicides, and suicides are also prevalent among Native Indian communities (Still & Hodgins, 2013). J. R’s focus should be on educating the Native Indians about the risks associated with alcoholism, and possibly start a support group for those recovering from alcoholism.

Family structures can be complex; however, the developmental family theory helps to explain the various stages that families go through. According to the Duvall family theory, there are 8 different stages to the family developmental cycle (DeFrain et al., 2012). The 8 stages include the married couple, childbearing, preschool-age children, school-age children, teenage children, launching children, middle-age children, and aging family members (DeFrain et al., 2012). These stages are known as the family life cycle.  J.R. is a nurse practitioner in a clinic on a large, isolated Indian reservation.


The first stage of the married couple is when a wife and a husband establish their own family. In this stage the new couple start planning for childbearing, and establish a mutually satisfying marriage (DeFrain et al., 2012). The second stage is when the couple has their first child. In this stage the couple have a child and adjust to raising the child together, they also work to establish a satisfying home for their small family (DeFrain et al., 2012). The third stage is when the couple now have a child or children that are in the preschool age. In this stage the couple adapts to the needs of their child/children and they cope with lack of energy and lack of privacy (DeFrain et al., 2012). In the fourth stage the children are now..

The fifth stage occurs when the youngsters reach the age of adolescence. Teenagers are learning to balance responsibility and independence while creating post-parental interests throughout this developmental period (DeFrain et al., 2012). The sixth stage is the introduction of children. This stage entails transitioning the youngster into adulthood while still keeping a supporting home base (DeFrain et al., 2012). The seventh stage is the parents in their forties and fifties. The children have grown up and moved out of the family home at this point, so the couple may be focused on their marriage (DeFrain et al., 2012). Finally, the old family members are the eighth stage. At this point, the couple is contemplating retirement and the prospect of selling the family home (DeFrain et al., 2012)


.J.R. is a nurse practitioner in a clinic on a large, isolated Indian reservation.



DeFrain, J. D., Brand, G. L., Burson, M. H., Fenton, A. M., Friesen, J. L., Hanna,, J. S., . . . Werth, L. A. (2012, September). Getting Connected, Staying Connected. Families Across the Lifespan: The Normal, To-Be-Expected, Satisfactions and Challenges Couples and Families Experience.

Still, O., & Hodgins, D. (2013). Navajo Indians. In 920022124 722549842 L. D. Purnell (Author), Transcultural health care: A culturally competent approach (pp. 279-293). Philadelphia, PA: F.A. Davis.


J.R. is a nurse practitioner in a clinic on a large, isolated Indian reservation. The clients in his community have a disproportionately high rate of alcoholism and suicide. Poverty is widespread.

He believes the most important component of his job is to promote wellness among his clients. J.R. reaches out to the people of the community by providing wellness clinics and educational forums. He uses a holistic approach to health care, incorporating traditional Indian healing practices along with Western medicine.

Questions for the case

Do you think is appropriate that J.R. is adapting his practice incorporating traditional Indian healing practices along with Western medicine? Support your answer with evidence base practice recommendation.

Once you received your case number; answer the specific question on the table above. Then, continue to discuss the 3 topics listed below for your case:

  1. An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.
  2. Name the different family developmental stages and give examples of each one.
  3. Describe family structure and function and the relationship with health care.

Your initial post should be at least 550 words, formatted and cited in current APA style with support from at least 3 academic sources.

J.R. is a nurse practitioner in a clinic on a large, isolated Indian reservation.

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