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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