Native American Culture in Nursing Practices
American Indians, also known as Native Americans, have a long history and culture that they hold in very high esteem, and rightfully so. In the nursing field you must learn to respect and acknowledge all cultures and rituals. Native Americans are no exception. Understanding culture and practices help us as nurses better care for and treat our patients. Information such as healthcare practices, and high-risk health factors are pertinent knowledge to care for any Native American patient. Knowing their feelings on personal space and touch can help smooth the healing process. Having a base information on their culture such as naming rituals, diet and religious practices will help you better understand how to properly care for your patient with respect and ensuring their dignity and culture are respected.
Native American Culture in Nursing Practices
Native American Religious Preferences
The term Native American encompasses a much larger group of indigenous peoples that occupy Canada, Mexico, Central and South America. However, “Native American” has been widely accepted to describe the Indians of North America, individuals need to be aware that there are differences in geographic locations of these populations and their religions, even though they do share some broad similarities (Answers.com-Health). There are currently 569 federally recognized tribes in the United States and still many more tribal nations striving for federal recognition to this day (CDC). If a tribe becomes federally recognized it greatly increases their ability to function, receive much needed benefits and the ability to practice their beliefs without being criminally prosecuted. Due to the extensive oppression of this population over the past four decades much of their cultural beliefs, religion, and genealogy has been either destroyed or lost. Their cultural beliefs, religions, history and genealogy have been handed down from one generation to the other by the aid of the story tellers and through petroglyphs or ceremonies.
Native Americans are the only ethnic group required to carry a federally issued permit to practice their own religion which encompasses the use of hallucinogens (peyote) (Indians.org). Native Americans don’t have a true religion. They follow a spiritual path and of truths and lessons with their environment, land, community, and spirits with the goal of harmony, peace, and love. It encompasses ceremonial dance, practices and symbolism to depict events and gain a sense of true connectedness, insight and communication with their gods. Ceremonies and practices may include herbs, music, dance, and hallucinogens. The use of symbolism, especially the use of animals, depicts and explains creation, certain ideas, concepts and spirits. To completely understand their spirituality of their culture you would almost have to grow up in the culture (Indians.org).
The American Indians have taken many of their cultural beliefs that have been handed down to them from previous generations and have incorporated it in with western religions. The most popular or widely accepted is the Native American Church. To have a better understanding of the church one will have to first know a little history on the use of peyote for ceremonial purposes. Peyote use among Indians has been radiocarbon back 5000BC and found in caves in Texas and down through Mexico into Central America (Fikes). Peyote is a cactus that grows low to the ground in little mounds and when cut and consumed as a fruit; it has hallucinogenic qualities. The AI’s use it as a sacrament in much the same way as Christianity uses wine and wafers as a sacrament of Christ. The Native American Church is the first church based on Christianity; accepted by native Americans ( it was started by a native American!) Today, for many chapters of the American Church, services begin on Saturday evening and go into the night and ending with a feast the following Sunday morning. It a service involving the use of prayer, song, gourds, rattles, drums, tribal costumes, peyote, and meditation, It is not uncommon to hear songs in their native languages praising Jesus Christ and the He’s the Savior. Peyote is regarded as a gift from God and not be abused. The Church has no paid clergy, members freely interpret Bible passages according to their understanding. Morality is the foundation and stresses the abstinence of alcohol, faithfulness to one’s spouse, fulfillment of family obligations, truthfulness, self-sufficiency, praying for the sick and for peace (Fikes).
The American Indians of the Southwest (Pueblo Indians) practiced an ancient religion of Kiva. It is a class system that connects all peoples to one another. The main Kiva is the Katchina and then all smaller kivas are interconnected. The best way to describe it is to imagine a wheel with lots of spokes and a central hub. A community have a subterranean “kiva” (church). Only the Chief Kachina and his assistants may sit in the center and only those invited may join into their Kiva. Not much is known about Kiva because it is held so sacred that outsiders are not permitted in. Today, there are public performances that generally follow Catholic holidays but are laced with aboriginal elements of their culture. There are a host of animistic spirits including prominently Father Sun, Mother Earth, and the cloud spirits. Except for the publicly performed ceremonials, the activities of the kiva societies are poorly described. Prayer sticks, corn meal, pollen, and other standard Pueblo ritual equipment, often referred to as “Medicine,” are used, but little is known of their true role and significance (World Culture Encyclopedia)
Many American Indian tribes use the Sacred Pipe for ceremonial purposes. It was later confused by the white man as the “peace pipe”. The Sacred Pipe in Indian culture was the heart of their culture as they travel the red road. The red road of balance and the way of the Wanan-Tanka, the creator, the way of Tunkashila, the living breath of the Great Spirit Mystery, and the way of the helpers, the way of love and freedom on the back of mother earth (Warrior). The Sacred Pipe represents: “ the smoke coming from the pipe represents the spoken truth, the plumes of spoke then represent the pathway to the which there prayers and words reach the Great Spirit, and also a pathway for the Great Spirit to reach Mother Earth.” ( Windtalker). The Sacred Pipe ceremony involves a series of prayers in the directions of east-south-west-north and it is then lit and passed to the individuals who then speak in prayer. Once the ceremony is completed the pipe stem and the pipe are stored in separate pouches in a bad and not reunited until the next use. The Sacred Pipe is also used in marriage. It binds a man and women together in a circle of love. It is the one holy object in the making of which both man and woman create. The man carves the bowl and makes the stem and the woman decorates the stem. When they are joined in marriage the man and women assemble the pipe together and a red ribbons are wrapped around their hands thus symbolizing their bonds for life (Windtalker).
Many American Indians were forced live on reservations sanctioned by the federal government and sent to boarding schools in the early parts of the 1900’s in an attempt to control them and to live by the western ways; which resulted in many of the Indians converting to the religions taught to them by the missionaries in charge of the reservations or the boarding schools. The religions practiced by these tribes are Catholic or Protestant and they also have incorporated song and dance from their native cultural tradition into their new religion.
High Risk Health Behaviors
The constant geographic relocation and oppression of these peoples beliefs and traditions have all made an impact on the health behavior of the populations ( MSH ). There intense will to survive has taken them through many years of change. They hold onto what is important and toss what is not important to them, or is not conducive to their cultural norms, and understanding (MSH). They are people that are not driven by the western ways of money, novelty, and individuality. As a result they are often misunderstood. According to the U.S. Department of Health and Human Services, “inadequate treatment and misdiagnosis occurs much more often in minority communities, usually due to such factors as: a general mistrust of medical health experts; cultural barriers; socioeconomic factors; and reliance on the religious community and family during times of distress” (Widby)
The high risk behaviors of the American Indian is described as: a sedentary life style, smoking, alcohol abuse, drug abuse, poor dietary practices and suicide. As a result of these behaviors they have the highest incidence of liver disease, diabetes, obesity, pulmonary disease, alcoholism, drug abuse, depression, suicide and accidental deaths (CDC). Also, only 30% of the American Indian population has adequate access to health care. Many are unemployed and do not live on reservations; thus making it even harder to acquire aid. For many American Indians – Western Medicine is very foreign and confusing to them – it lacks the spirit. However, an effort has been made to change many of the clinical settings and to train healthcare providers on a better understanding of the cultures and traditions. Much information is available on the internet on how to address the cultural differences. www.tribalconnections.org is an excellent source for the general public and for healthcare providers to utilize a tool in their practices. Also for further learning you may contact:
US Dept. of Health and Human Services, under Indian Health Services and then the Clinical Support Center at: 1616 East Indian School Road, Suite 375, Phoenix, AZ 85016. (tribalconnections).
Native Americans find touch very personal. The head and the hair may be considered particularly sacred. Before touching, always explain what will be done and why. Hair, jewelry, ornaments, or other regalia may have a spiritual meaning. Ask your patient if they have any spiritual objects with them. If it is necessary to remove an object, have the patient or family member remove the item. The item can be placed in a sterile bag and taped to the patient. Physical distance should be several feet for their comfort zone. (Ask.com)
Direct eye contact can be a sign of disrespect. Instead, keep eye contact to a minimum and try looking over their shoulder while speaking. Touch in general is not acceptable. Handshaking is allowed, but some Native American women will only shake with their fingertips. When doing a physical examination, modesty and privacy are valued, as with all cultures. Requests should be accompanied with an explanation in a calm, quiet manner. Loudness and brusque manner are associated with aggression. Touching of the body in some Indian cultures is inappropriate; therefore, permission should always be obtained before starting, and with each area. In some reservations clothes are removed only if absolutely necessary. (Kumey)
The formation of the American Indian boarding school during the late 1800’s and into the mid 1900’s has left a long lasting and far reaching impact on the education of the American Indian people. The American Indian boarding school was designed to suppress the culture, language, and spirituality of the American Indian nations throughout the U.S. These institutions were built and operated by non-American Indian government agents and churches. Attendance was mandated. Thus, from the age of 5 through 18, American Indian children were removed from their families, for months or years at a time, placed in boarding school where a harsh indoctrination occurred. A systematic suppression occurred during this era in which banning of thier spiritual practices and the speaking of the native language held severe punitive repercussions. (Sharp)
The boarding school served as a means to assimilate American Indian children and to train them as laborers. For the most part, the level of education and training prepared them for menial vocations. As a result, most American Indian students today do not have several generations of professionals, such as doctors, lawyers, or bankers to emulate.
Due to the remembrance of past education experiences, many elders in the Native American culture still lack trust in the education system, and continue this mistrust onto the younger generation. However, about 90 percent of all American Indian students attend regular public schools, and 7 percent attend schools administered by the U.S. governments Bureau of Indian Affairs (BIA) (U.S. Dept of Education, 2005).
Studies indicate that American Indian students often experience difficulty-establishing relationships with their teachers and other students; additionally, they are often subject to racist threats and frequent suspension. The national graduation rate for American Indian high school students was 49.3 percent in 2004 (EPE Research Center 2007). The National Assessment of Education Progress (NAEP) reports that 83 (EPE Research Center 2007). The National Assessment of Education Progress (NAEP) reports that 83 percent of American Indian eighth graders read below grade level.
Under current federal laws, tribes can control tribal schools and some aspects of federal schools. Under current federal law, tribes have poorly defined rights with state public schools. Tribes may have some input, but tribes have no final decision –making authority. “With little funding and authority, we are unable to get Native American culture taught in the school systems” (Tabitha Whipple, San Diego State). Among the haves, those with casino money, it is hard for a child to stay in school when they know they will be getting money and working for the tribe once they are of age. And for the have-nots, poverty remains along with the deep mistrust of schools passed down form grandparents.
Native Americans are well known for being resourceful people, and when it comes to Native American food, there is no difference. They were knowledgeable at using the ingredients that were readily available to them, and for making many different foods with them. Corn and various corn products are plentiful in Native American food recipes.
Corn is such a big staple in Native American culture that not only do they frequently cook with corn, but they also use what’s known as Harinilla, or Blue Corn Meal. Harnilla can be ground into flour and used for baking tortillas and other starches. Some Native American food also consists of the use of many different meats. Besides deer, Native Americans frequently eat Salmon, Beaver, Lamb, Buffalo, and Pork. Using grains and vegetables are also common in the Native American diet, along with squash; sage, wild onions, cabbage, pumpkins, and cactus plays a vital role in Native American food.
Along with the staples and animal sources, herbs also played a vital role in early Native American food. Many of the earliest forms of medicine were derived from these food sources as well. The Native Americans were masters at making poultices, teas, and herbal remedies. They used herbs and plants such as Peppermint, Spearmint, Clover, Sage, and Rosehips to make teas and other foods. Today’s society and culture owes much of what it has learned about food and the natural American resources to the early Native Americans
Effective Communication Techniques
Although there are many different tribal entities and various degrees of transition into mainstream culture, Native American’s share a unique heritage, and many traditions that are often similar enough to employ some common communication techniques. The Native American’s nomadic, semi-nomadic or small village existence depends on hunting and fishing and perhaps limited agriculture. Knowledge is passed on verbally through tradition. Effective communication requires an appreciation, as well as an understanding of these values and this different perspective.
When greeting a Native American, a smile and a patient, positive attitude will make up for almost any intercultural faux pas you may make. A sullen, unhappy demeanor is easily construed as prejudice. Unless you are certain and are fluent in their language, an attempt at greeting in their tongue will look silly and perhaps demeaning. Addressing as Mr., Mrs., or Miss shows respect and is always safe. It is important to greet everyone in the room, and establish relationships. Extended family relationships with cousins, aunts and uncles are often as close as immediate family and their role in the patient encounter should be treated accordingly. Most importantly, treat everyone with the respect.
Some Native American’s believe words have great power and should be respected. Slowness of speech does not indicate slowness of mind, but respect for speech. Rapid-fire questions and pressure to respond are particularly offensive. Eye contact with the individual conveys an understanding of what is said. Be patient and make a point of listening and pausing before your response. Humor is appropriate only after significant rapport is established.
Among the Native American tribes of the United States, all individual names have a distinct significance. When considering Native American rituals as a whole, individual names fall generally into two classes: those which refer to sacred rites, and those which commemorate a personal achievement.
A Native American tribe is composed of a number of kinship groups or clans. To each one of these belongs the traditional duty of completing a certain custom and also the concern of the sacred items connected with that custom. Each clan has a set of personal names, all of which refer to the custom specific to the clan, or to the sacred objects or to the symbols connected with the custom, and one of these names is given to each person born within the clan. Names of this category are generally maintained by men and women throughout life and are regarded as sacred. These names have also a social significance, as they always indicate the birth status of the person, for the name at once shows which clan the person belongs to. No one can exchange his birth name, any more than he can change his gender.
The names that belong to the second class are those which are taken by an adult to mark an accomplishment. This must be an act in which he has shown special ability or courage in successfully defending his people from danger. Such a name marks a period in a man’s life and is individual to the man and, to a degree, signifies his quality or achievements. It sometimes happens that a man on such a time may decide to take the name of a celebrated ancestor rather than attain a completely new name, but the nature of the act of taking a new name is not changed in doing so.
The assignment of a name, whether the name is of the first or of the second class, is always given with rituals. It is a widespread custom observed among Native Americans to never address men or women by their individual names or use those names in their company. To do so is a violation of good manners. The individual name stands for something that is too closely connected with the life of the person to be used in an ordinary setting.
Native Americans are known for their historical use of herbs and roots as their traditional form of medicine and wellness practice. Native American medicine is very similar to medicinal approaches used by the Chinese. Both value the treatment of the mind, body, and spirit, and uses the natural elements to cure illnesses. Each tribe has its own unique medicinal practices. Common among these practices are the Medicine Wheel, the sweat lodge, and the vision quest.
The Medicine Wheel is an ancient symbol used by almost all of the Native American peoples of North and South America. Like a mirror can be used to see things not normally visible (behind us or around a corner), the medicine wheel can be used to help us see or understand things we can’t quite understand because they are ideas and not physical objects. The Medicine Wheel is created utilizing the power of four – four seasons, four directions on a compass, four elements, and four races of human beings. The Medicine Wheel uses growth and change principles (mental, physical, emotional and spiritual). Symbolically, it teaches wholeness, protection, nutrient, and growth.
A sweat lodge is a physical and spiritual self-purifying ritual that accentuates the connection of the human being to all creation. The use of the sweat lodge to cleanse and purify someone has long been a custom among many tribes, and is presently being used in alcohol treatment programs among both native and nonnative practitioners.
A vision quest is the traditional cultural answer to a personal crisis of meaning. It is a rite of passage and prepares individuals to receive the spirit powers of healing. A vision quest can from one to four days. During this time, the seeker of the vision does not eat or drink, but only sits in silence and listens to the voices of nature. The idea of a vision quest is for the seeker to pray hard and listen to the world around him, so that messages of the spirits of nature will come to him.
Native American medicine offers the power of choice and individual involvement in the pursuit of health, happiness, and well being. Some consult modern counselors for some types of concerns and local healers or medicine people in their village for other concerns. For broken bones and illnesses that are clearly more physical than emotional or mental, most Native Americans utilize modern medical practices where they are available.
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