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Question
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.
Case Study 1 – Health Promotion  
In this case study, J. R a nurse practitioner is caring for American Indians living in 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 for 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 Indian’s families decisions regarding healthcare are made equally among the family members, while in other families the decisions are made by a specific family member known as a “gatekeeper” (Still & Hodgins, 2013). It is important when caring for these individuals to identify the “gatekeeper” as soon as possible. Failure to do so, may result in delay of care. Traditionally the men are expected to corral the fields and care for the livestock, while the women are expected to stay close to the hogan, are independent and often weave (Still & Hodgins, 2013). 
Alcoholism among Native Indians is very high. Alcohol abuse is the most prevalent substance abuse compared to other chemicals abuse (Still & Hodgins, 2013). High rates of alcohol related health risks 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 of 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 the children, middle age children, and aging family members (DeFrain et al., 2012). These stages are known as the family life cycle.  
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 school age. In this stage the couple encourage the children’s school achievements and they also work to fit in their communities (DeFrain et al., 2012). 
The fifth stage is when the children now become teenagers. In this developmental stage the teenagers are learning to manage responsibility with freedom and establishing post parental interests (DeFrain et al., 2012). The sixth stage is the launching of children stage. This stage involves launching the youth into adulthood, and maintaining a supportive home base (DeFrain et al., 2012). The seventh stage is the middle-aged parents. At this stage the children have grown up and moved out of their family home, now the couple has time to refocus on their marriage (DeFrain et al., 2012). Finally, the eight stage is the aged family members. In this stage the couple now focuses on retirement, and the possibility of selling the family home (DeFrain et al., 2012). 
References 
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. 

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