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Kenny Pitcher, Jenny Harrison, Kymbre Governson, Ashley Soni, & Allison Fostveit
Introduction and Overview
Implications for practice
Plan of care
1. Animation/emotion: The preferred communication style is restrained. Indians will speak dispassionately about something very meaningful and important to them so that they do not "impose one's energy or emotion on others".
. Directness/Indirectness: Indirectness within the Native American culture is usually preferable, giving others a chance to refuse a request without directly saying no, or to evade a question that is felt to be too personal or simply a subject the listener does not want to discuss.
Elders with high status may sometimes be very direct with those younger.
An untrue accusation will result in no response from an Indian person; to reply is seen as lowering oneself to the level of ignorance or over-emotionality of the other person, leading to the entrance of the negative energy space of the accuser and may be interpreted by other Indians as a sign of guilt.
3. Eye Contact: Direct prolonged eye contact is seen as invasive. It's avoidance is practiced to "protect the personal autonomy of the interactors". Eye contact is usually fleeting, and the gaze of listener and speaker will often remain around the forehead, mouth, ear
or throat area.
Direct gaze to an elder or very respected person is seen as especially rude, unless one is in a formal listening/storytelling situation, in which case listeners may look at the speaker more directly without violating his or her personal space by eye contact.
4. Gestures: Storytellers or elders may often use gestures, which are larger and more frequent than those found in usual conversation, Typically, a restrained use of gestures is normal for conversation.
5. Identity orientation: Traditional American Indians have a lineal orientation meaning their identity is spread vertically over time. Ancestors, the present tribe, and those potential people not yet born are all part of a person's identity and will be considered when making important decisions.
6. Turn taking and pause time: In formal group speaking situations, turns are usually taken by everyone present, and no one else speaks until the previous speaker is completely through and a few moments of silence have passed. Speaking too quickly after the first speaker indicates disrespect for the importance of what the other person was discussing.
Interrupting another speaker is an absolute rudeness, and may lead to social consequences especially if the person interuppted was an elder.
7. Touch: Usually reserved for friends or intimates. Many Indians, however, have adopted the European American custom of handshaking. The Indian handshake is very light, to avoid imposing energy on the other person or receiving energy one does not want.
8. Vocal Patterns: A narrow, quiet range of pitch, tone, and volume is the normal adult communication pattern, especially when non-Indians or elders are present. Talking too quickly, loudly, and very animatedly may be viewed by some as disapproval.
Use of Time and Space
1. Time: For the American Indian raised in a traditional environment, "clock" time carries a much different meaning. The "right time" for something is when everything and everyone comes together, resulting in the appropriate activity ensuing. Time is felt to be more of a matter of season, general time of day, or when the person is internally ready for a particular activity. This mentality is viewed by other cultures as arrogant, uncaring, or oppressive behavior. Indian parents tend to not worry if their child is "not developing on time".
2. Space: Side-by-side meetings is more comfortable than a face-to-face orientation, especially in a 2-person conversation. If interacting with someone they are not familiar with, a PCP for example, Native Americans prefer a slighlty larger distance-more than arm's length-for conversation.
Psychological Space: This is maintained by silence and is used if a question is asked that he or she feels is inappropriate or feels that subject should not be addressed, especially if an intimate friend or relative is not present.
Elliott, C. (2010). . Retrieved from www.awesomelibrary.org multiculturaltoolkit-patterns.html
Opportunities for change: Improving the health of American Indians/Alaskan Natives in Washington state. (2010). Retrieved from http://www.doh.wa.gov/Portals/1/Documents/1200/phsd-AIHCHealthCare.pdf
Sanchez, T., Plawecki, J., & Plawecki, H. (1996, December). The delievery of culturally sensitive health care to Native Americans. Journal of Holistic Nursing, 14, 295-307.
Wikipedia. (2013). Native American cuisine. Retrieved from http://en.wikipedia.org/wiki/Native.American.cuisiene
Dream-catcher.org. (2013). What is a dream catcher? Retrieved from http://www.dream-catchers.org/dream-catchers-faq.php
Gille, M. (2013). The role of culture in Native American food choices and perceptions of physical activity. Seven directions Native American health center. Retrieved from http://www.thecmafoundation.org/projects/ObesityGeneralPDFs/Meriah%20Gille.pdf
Native American peace pipe. (2013). Indians.org. Retrieved from http://www.indians.org/articles/native-american-peace-pipe.html
Medicine ways: traditional healers and healing. (2013). Native voices: native peoples' concept of health and illness. Retrieved from http://www.nlm.nih.gov/nativevoices/exhibition/healing-ways/medicine-ways/medicine-wheel.html
Wikipedia. (2013). Sweat lodge. Retrieved from http://en.wikipedia.org/wiki/Sweat_lodge
Moulton, P., McDonald, L., Muus, K., Knudson, A., Wakefield, M. & Ludtke, R. (2005). Prevalence of chronic disease among American Indian and Alaska native elders. Center for rural health: University of North Dakota school of medicin & health sciences. Retrieved from http://ruralhealth.und.edu/projects/nrcnaa/pdf/chronic_disease1005.pdf
Family and home
Government, Authority, and Law
Respect for aged and elder as authority. Often the shaman or medicine person was consulted for important personal matters.
Until european settlers came, there was no concept of "ownership". The pervasive ideology was stewardship.
Distrust of government/conventional U.S, authority as treaties have been repeatedly broken.
Native American resources available by law can be found at: http://www.usa.gov/Government/Tribal.shtml
Health and Healthcare
traditional healing practices were extensive and unique to each tribe, and may involve use of ceremony, herbs, symbols, earth or animal spirits
Pervasive mistrust and skepticism of western medical system
Marked by holism. often illness indicated a personal or communal imbalance requiring healing.
Earth centered. Tribes had unique "creation stories", involving a divine force/spirit/ or creator.
Spirit communicated with individuals through symbols, animals, natural phenomena (drought, etc), and life events.
Illness was generally viewed as a spiritual crises or imbalance needing care.
Spirit was the source of healing and restoration of balance
Interconnectedness of spirit and matter
Rites of passage and rituals were considered very important, and vary among tribes. These may surround birth, puberty, death, and other significant life events.
Marriage--Polyandry was common among some tribes. Homosexuality was not uncommon
Separation of couples was not uncommon, but no often no formal ceremony for marriage or divorce
Gender roles--Generally clear gender roles held. Both were equal, but roles were clearly defined.
childbirth and child rearing--Often a private or Woman centered event. Women were the primary caretakers of children
family structure--Respect for elders. Extended families not necessarily blood related may live and function as a family together. Often non-traditional family structure, such as multiple women with a single man.
Original tribes were based on trading, hunting and gathering.
Until contact with settlers, land ownership was a foreign concept.
Material necessities (Food, Shelter, harvest, meat, clothing) were seen as gifts from Spirit for survival and sustanence.
Government "settlements" and economic relations have drastically altered this original relationship with money.
limit physical touch
keep conversation low and calm
respect the flow of the conversation
traditional healing practices
may take longer to establish trust
respect rituals and rights of passage
respect the strong belief in ceremony and artifacts
respect that the patient believes these have power
education on maintaining a healthy diet
decreasing processed foods
screening for the diseases that Ashley mentioned
education on those diseases
Point of Care
majority of Native Americans are living in urban areas thus making them more isolated and removed from their tribes but still suffering from low incomes, poverty, and illness
Point of Care
Health care includes the tribe
tribal council identifies the priorities of health issues
policy and treatment needs are determined by the tribal council
often recommendations need to be a joint venture with the patient, provider, and tribal council
Implications for practice: the tribe
honor the inherent sovereign rights of the tribe
realized that diagnosis, treatment plans, and implementation may take longer
The APN can most effectively help Native American clients by demonstrating understanding, respect, and sensitivity to their culture and belief systems. By valuing and appreciating the Native American culture and utilizing appropriate interactions and techniques, the APN can help integrate western medicine and improve health care outcomes, while honoring and including the patients' culture and beliefs.
Implications for Practice: privacy
Often the primary person to talk to regarding health care decisions is not the parent/spouse/HPOA but rather a tribal council member/s
Brings on a HIPPA conundrum of weighing legal permission with emotional permission
Implications for practice: communication
Implications for practice: social institutions
Implications for practice: artifacts
Implications for practice: diet
Implications for practice: disease prevention
Hunter gatherer and some agriculture (Three sisters)
Feast and famine cycles
Salt free, natural sugars (i.e. honey, stevia)
Convenience stores in isolated communities
Food banks or supplemental programs
Low in fiber, non-starchy vegetables, fruit, and dairy
Most Prevalent Chronic Diseases
High blood pressure
Congestive heart failure
Drumming and chanting
2005 - Center for Rural Health:
University of North Dakota school of Medicine
of Native American history
Definition: peoples who occupied North America before the arrival of the Europeans in the 15th century.
Many Native Americans refer to themselves as American Indians or simply "INDIANS"
Origin of Native Americans
Native Americans came into the Western Hemisphere from Asia via the Bering Straight or along the N.Pacific coast in a series of migrations
Native American existence in the Americas
Some scholars believe that their existence goes back 25,000 years
Others believe as recent as 12,000 years.
In Pre-Columbian times (prior to 1492) conservative numbers reached 1.8 million
other estimates reached numbers of 10 million+
Europeans created most of the of the early historical record about Native Americans after the colonists' immigration to America
Commmon origin is used to explain the physical Characteristics that Native American have in common (considerable variation)
Mongolic features, coarse straight black hair, dark eyes, sparse body hair and skin color ranging from yellow brown to reddish brown
Native Americans lived in a hunter-gatherer society
women carried out sophisticated cultivation of numerous varieties of staple crops: maize, beans, and squash
Culture was Matrilineal: the peole occupied lands for use of the entire community, for hunting or agriculture
Arrival of Europeans
At first Native Americans found Europeans intriguing and interesting, almost worshipping them
As time passed it became apparent that the white man was greedy, cruel, and materialistic.
Emergence of Disease
Europeans brought diseases (small pox, influenza, measles, and other disease that they had not previously been exposed)
Epidemics after European contact caused the greatest loss of life for indigenous people.
Forced off their land
Native americans were forced off their land and pushed further and further west with promises that were never kept.
Conflict arose leading to indian wars
massacres drastically reduced numbers and only small reservations were left
1830: Congress passed the Indian Removal Act (relocating to lands west of the Mississippi to accomodate European-American expansion
U.S forced a series of treaties and land cessions by the tribes and established reservations in many western states
Native Americans ere encouraged to adopt European American farming and pursuits
American agriculture technology was inadequate for dry reservation lands
In 1924 Native Americans were granted citizenship
Contemporary Native Americans
Since the 1960's NAI activism has led to the building of cultural infrastructure and wider recognition (independant newspapers, online media, community schools, tribal colleges, tribal museums and language programs)
Native American authors are increasingly published; they work as academics, policy makers, doctors, and a wide variety of occupations
Activism has led to expansion efforts to teach and preserve indigenous languages for younger generations