Ch25.ppt - Transcultural Health Care A Culturally Competent Approach 4th Edition American Indians Alaskan Natives(AI\/ANs Larry Purnell PhD RN FAAN

Ch25.ppt - Transcultural Health Care A Culturally Competent...

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Unformatted text preview: Transcultural Health Care: A Culturally Competent Approach, 4th Edition American Indians Alaskan Natives (AI/ANs) Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage Amount of Indian blood necessary to be considered a tribal member varies among the tribes—¼ to be a Navajo, which is the largest tribe in United States and live in the Southwest 556 different tribes in the United States and Canada Each tribe unique but share similar views regarding cosmology, medicine, and family organization Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Heritage Forced migration by United States government Life on MOST reservations is hard with high poverty and high unemployment although a few have significant money due to oil, land leases, gambling casinos, etc. Children were taken from them and placed in “White Man’s Schools” Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition AI/AN Cultural Values Group, clan, or tribal emphasis Present oriented Time is always with us Age Cooperation Harmony with nature Giving/sharing Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition AI/AN Cultural Values Pragmatic Mythology Patience Mystical Shame Permissiveness Extended family and clan Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition AI/AN Cultural Values Non-aggressiveness Modesty Silence Respect other’s religion Religion is a way of life Land, water, forest belong to all Beneficial, reasonable use of resources Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage Continued Low educational levels for most tribes, preferring children to remain at home and learn Indian ways For the traditional, health care is an undesirable profession because one should not work with the dead or ill Navajo sometimes have a special cleansing ceremony to allow them to work in a hospital Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition AI/AN Communication Language and dialect vary by tribe, but most speak English and in the southwest many speak Spanish instead of English Minor variations in pronunciation can change the meaning of the word Talking loudly or interrupting someone is considered rude Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition AI/AN Communication Navajos generally do not share thoughts and feelings easily outside family and friends, making it difficult to obtain trust in the healthcare setting Comfortable with long periods of silence Touch is unacceptable unless you know the person very well Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition AI/AN Communication No set pattern for willingness to share tribal ceremonies Pueblo groups usually do not share any tribal ceremonies Light passing of the hands for a handshake Considered rude to point with the finger; instead shift your lips in the desired direction Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition AI/AN Communication Direct eye contact is rude and confrontational —deadpan facial expression Proximity for conversations usually greater than 24 inches Time sequence is present, past, and future Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition AI/AN Communication The future is out of one’s control. Very few are future oriented and for the Navajo there is no future verb tense Time is not something that can be controlled, nor should time control the person; events start when the people arrive Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization Navajo, like most Native Indian tribes, is matrilineal in decision-making and land rights Relationship between brother and sister is more important than that between husband and wife Children's names are not revealed at birth Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization Older people are addressed as grandmother, grandfather, mother, father, or a nickname. Algonquin are egalitarian society Dene and Athabascan are patriarchal Navajo, Iroquois, Pueblos, and Haida are matriarchial societies Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization AI/AN naming traditions vary greatly from tribe to tribe and are frequently determined by nature, animals, or character. In the past, AI/AN women practiced breastfeeding exclusively. Since the early to mid-1980s, the use of formula has become popular. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization A primary social premise is that no person has the right to speak for another. Parents are permissive in childrearing practices and may allow a child decide whether if not go to school or take medicine. Ceremony plays a vital, essential role in AI/ANs everyday life. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization When a couple marries in the Pueblo tribes, the man goes to live in the woman’s house. In Navajo tradition, families have separate dwellings but are grouped by familial relationships. The Navajo family unit consists of the nuclear family and relatives such as sisters, aunts, and their female descendants. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization In all American Indian and Alaska Natives extended family members play an important role in the infants’ life. Older adults are looked on with clear deference Elders play an important role in keeping rituals and in instructing children and grandchildren. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization Social status is determined by age and life experiences. Among the Pueblos governors are chosen from a particular clan; unless one is born in the clan they cannot run for tribal governor. Generally, individuals are discouraged from having more possessions than their peers, and those who display more material wealth are ignored. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization Standing out is not encouraged among the different tribal groups. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues Many AI/ANs remain traditional in their practice of religious activities. Family matters are more important than work, resulting in high rates of absenteeism. In addition, tribal ceremonies are seen as necessary and they often must take time from work or school. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues Tribal members in the community function informally as cultural brokers and assist by helping non– American Indian staff to understand important cultural issues. Conflict is addressed indirectly through third parties in some tribes Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues Group activities are an important norm in AI/AN cultures. One individual should not be singled out to answer a question because the student’s mistakes are generally not forgotten by the group. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues Issues of superior-subordinate roles exist and are related to age. IHS is the only organization allowed to discriminate in hiring practices; it is required to hire an AI/AN when possible. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck AI/AN tribes and clans are a. Patriarchal. b.Matriarchal. c. Egalitarian. d.Depends on the tribe and clan. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D Some tribes and clans are patriarchal, some are matriarchal, and some are more egalitarian. Variations exist within the tribe and clan as well. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Skin color among AI/ANs varies from light to very dark brown, depending on the tribe. Each of the American Indian tribes vary in terms of facial features and height. Never assume that an AI/AN patient is from a particular tribe, if wrong, he or she will be offended. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Historically, most diseases affecting AI/ANs were infectious such as tuberculosis, smallpox, and influenza. Diseases of the heart, malignant neoplasm, unintentional injuries, diabetes mellitus, and cerebrovascular disease are the top five leading causes of AI/AN deaths Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Type 1 diabetes mellitus is almost nonexistent in AI/ANs but type 2 diabetes mellitus is the third most prevalent chronic disease affecting all AI/AN tribes. The incidence of diabetes varies among tribes has steadily increased and is approaching 30 percent. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Albinism occurs in the Navajo and Pueblo tribes. Navajos who lived in Rainbow Grand Canyon are genetically prone to blindness that develops in individuals during their late teens and early 20s. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology The Zunis have an incidence of cystic fibrosis seven and one-half times that found for Caucasians. Methamphetamine (meth) abuse and suicide are two top concerns in Indian country. Suicide rates among American Indians and Alaska Natives (AI/ANs) are 1.7 times higher than the national average. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Alcohol use is more prevalent than any other form of chemical misuse. Many accidents are attributed to driving while under the influence of alcohol. Spousal abuse is common and frequently related to alcohol use. The wife is the usual recipient of the abuse, but occasionally, the husband is abused. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition Food has major significance beyond nourishment in AI/AN populations. Food is offered to family and friends or may be burned to feed higher powers and those who have died. Life events, dances, healing, and religious ceremonies evolve around food. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition Corn is an important staple in the diet of American Indians. Rituals such as the green corn dance of the Cherokees and harvest-time rituals for the Zuni surround the use of corn. Corn pollen is used in the Blessingway and many other ceremonies by the Navajo. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition Each tribe has its own version of fry bread. Access to fresh fruits and vegetables is minimal during wintertime. AI/AN diets may be deficient in vitamin D because many members suffer from lactose intolerance or do not drink milk. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Family Traditional AI/ANs do not practice birth control and often do not limit family size. In Apache and Navajo tribes, twins are not looked on favorably and are frequently believed to be the work of a witch. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Family Some want their blood and urine specimens returned to them upon discharge. Many use herbs during labor and delivery. A ceremony may be performed by the medicine man during labor and delivery. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Family Be flexible with positioning for delivery. Some may want the umbilical cord, meconium, and afterbirth. Some may use peyote during labor and delivery. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The most common form of substance abuse among AI/ANs is a. Alcohol. b.Peyote. c. Marijuana. d.Methamphetamine. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer The most common substance abuse among AI/AN tribes is alcohol which is 1.7 times higher than other groups who have been studied. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Most AI/AN tribes believe that the souls of the dead pass into a spirit world and became part of the spiritual forces that influenced every aspect of their lives. Today some tribes maintain their traditional practices but use a mortuary or use the IHS morgue to prepare their dead. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals The Pueblo tribes prepare their own dead and only certain family members are allowed to prepare the body. Hopis bury their dead before the next setting of the sun and bury them in upright sitting positions with food and goods in the grave with the person. After the Zuni burial, the members must take off three days from work for a cleansing ceremony. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals The body must go into the afterlife as whole as possible. In some tribes, amputated limbs are given to the family for a separate burial and later the limb is buried with the body. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals In some tribes, family members are reluctant to deal with the body because those who work with the dead must have a ceremony to protect them from the deceased’s spirit. In the Navajo, if the person dies at home, the body must be taken out of the north side of the hogan and a ceremony conducted to cleanse the Hogan or it must be abandoned. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Older adults are reluctant to discuss advance directives once they discover what it means. Effective discussions require that the issue be discussed in the third person, as if the illness or disorder is happening to someone else. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals If a provider makes a statement such as “if you don’t get medical care, you will die,” this implies that the provider wishes the client dead. If the patient does die or is extremely ill, the provider might be considered a witch. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals The Navajo are not generally open in their expression of grief; they often will not touch or pick up the body or prepare the body for burial. Grief among the Pueblo and Plains Tribes are expressed openly and involves much crying among extended family members Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality AI/AN religion predominates in many tribes. When illnesses are severe, consultations with appropriate religious organizations are sought. Sometimes, hospital admissions are accompanied by traditional ceremonies and consultation with a pastor. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality AI/AN tribal traditional members start the day with prayer, meditation, and corn pollen. Prayers ask for harmony with nature and for health and invite blessings to help the person exist in harmony with the earth and sky. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality The meaning of life for AI/ANs is derived from being in harmony with nature. The individual’s source of strength comes from the inner self and depends on being in harmony with one’s surroundings. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality Spirituality cannot be separated from the healing process in ceremonies. Illnesses, especially mental illnesses, result from not being in harmony with nature, from the spirits of evil persons such as a witch, or through violation of taboos. Healing ceremonies restore an individual’s balance mentally, physically, and spiritually. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices Traditional AI/AN beliefs influence biomedical healthcare decisions. asking patients questions to make a diagnosis fosters mistrust. This approach is in conflict with the practice of traditional medicine men, who tell people their problem without their having to say anything. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices IHS has attempted to shift its focus from acute care to health promotion, disease prevention, and chronic health conditions. Wellness-promotion activities include a return to past traditions such as running for health, avoiding alcohol, and using purification ceremonies. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices Medicine men, diagnosticians, crystal gazers, and shamans tell them how to restore harmony. Many families do not have adequate transportation and must wait for others to transport them to their appointments. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices Frequently, pain control is ineffective because the intensity of their pain is not obvious to the health-care provider because patients do not request pain medication. Herbal medicines may be preferred and used without the knowledge of the health-care provider. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices Mental illness is perceived as resulting from witches or witching (placing a curse) on a person. In these instances, a healer who deals with dreams or a crystal gazer is consulted. Individuals may wear turquoise or other items such as a medicine bag to ward off evil. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-ca...
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