Within the African American community two social structures seem to influence the well-being of the community. Those two social structures include human care by friends, kin, and family, and spiritual and religious practices to help promote health and well-being. It is within these two social structures where the community seems to get the majority of their information regarding health and health care practices. Understanding the African American culture and what is comprised in that culture will help develop a better plan of care. Efficient and effective care is the ultimate goal as nurse practitioners. Developing a plan of care that encompasses all aspects of a community will likely give the patient better outcomes.
African American's (AA) have many aspects that are consistent across their culture. They share a sense of community, a sense of hospitality, a sacredness of life, respect and authority of elders, and a sacredness of religion (African Cultureal Values). A popular proverb sums up the African sense of community "go the way that many people go; if you go alone, you will have reason to lament" (ACV). The community offers the person the psychological and ultimate security as it gives its members both physical and ideological identity (ACV). When it comes to AA being part of a community is better than being alone and they value life above all other. Any form of materialism which ultimately leads to the destruction of life is alien and destructive of the culture (ACV). This explains why the AA community underutilizes services such as hospice or palliative care it is against their culture.
Spirituality and religion have historically played important roles in the lives of AA (Chavis, 2004). In the AA culture, religious denominations and groups provide frameworks from which to practice specific beliefs, rituals, and rites (Chavis, 2004). Religious institutions in the AA community provide much more than a spiritual foundation. It offers a context for living, and offers a means of coping with adversity and preserving family patterns (Chavis, 2004).
To understand the AA community means to understand the strength of the family. Family strengths are those "traits that facilitate the ability of the family to meet the needs of its members and the demands made upon it by systems outside the family unit" (Hill, 1997, p. 50). For the AA community family strengths are necessary for maintenance, survival, and advancement of family network, dynamics, and family functioning (Chavis, 2004). Recognizing and making use of the family strengths of the AA community can help practitioners understand and help solve many problems that the families present. The AA community also has and extended kinship network. This kinship network goes beyond extended families and often includes significant people not related by blood or marriage. "Kinship is the mechanism which regulates social relationships between people and almost all of the concepts pertaining to and connected to human relationships can be understood and interpreted through the kinship systems" (Chavis, 2004). This family kinship can be a remarkable adaptive strength that practitioners can utilize to help families function and change (Chavis, 2004). With this extended family and kinship network practitioners have many people that will be involved in change. This can either work for the patient or against the patient depending on the feeling of the network.
Leininger identified three nursing decisions and actions that achieve culturally friendly care for the patient. They are: cultural preservation or maintenance, cultural care accommodation or negotiation, and cultural care restructuring. Leininger’s sunrise model can apply to AA women in many ways. When developing a plan to increase cervical cancer screening we can use this theory on many different levels.

Cultural and Structural Dimensions Interventions Technological | Lack of awareness of cervical cancer deaths and screening available. Educate AA women on Pap tests and HPV screening guidelines. | Religious | Use Churches and Community groups as forums to increase awareness of Cervical Cancer screenings and HPV virus. | Kinship and Social | Women are always the caregivers of this community therefore putting their own health last. Educate women on need for routine screening and educate them to educate their family and kin. | Cultural Values | Understanding that health is a lesser priority but preservation of life is extremely important Practitioners can use this to educate on Cervical Cancer deaths and risk of death if not treated or caught soon enough. | Political and Legal | Lack of outpatient services for this group of women. Increasing the outpatient services and the free screening for the disease is necessary. | Economic | Increasing free screening services is necessary. Understanding that HPV and Cervical Cancer are higher in poverty stricken areas can help understand the need in these areas. Setting up traveling clinics and going into communities that are poverty stricken can help increase awareness and early detection in these communities. | Educational | Understanding that the lower the education level the increase in cervical cancer cases can help practitioners be aware of the need for more education. Educating women on the need to get screened and the s/sx of cervical cancer is a must. Not only educating the patient but any family, kin, or community members she may bring with her. |

In today's healthcare field, it is required for nurses to be sensitive to their patients' cultural backgrounds when creating a nursing plan. Understanding that a person’s culture is so integral in whom they are as individuals, and it is that culture that can greatly affect their health, as well as their reactions to treatments and care. Practitioners can use the knowledge gained about an individual’s culture to create a nursing plan that will help the patient get healthy quickly while still being sensitive to his or her cultural background. This can also help not only the individual but the community as a whole change their outlook and their behavior about cervical cancer screening, HPV, and cervical cancer.