Native Americans

1
In 2008, 4.9 million people claimed their nationality or race as Native American
or Alaskan Natives(2008). There are atleast 562 federally recognized tribes and over 100
state recognized tribes in America, and over 150 native languages. This group of people
have origins with any of the original people of North America, Central America, or South
America, and still affiliate with the tribe or community practices and their beliefs. Most
American Indians (Native Americans) live in rural areas of the country, a majority of
which live on government provided reservations, in the Great Plains area, the
southwestern United States such as New Mexico, Arizona and the northwest such as
California, Washington and up to Alaska. Most of the healthcare provided to the Native
Americans in these areas is provided by the Indian Health Service (IHS), a government
agency established in 1955, to fix the stifling healthcare system for Aemerican Indians( ).
A majority of American Indians live in poverty, including those who live in larger urban
cities; IHS tries to provide services for these patients who are often living in worse
situations than those living on reservations. Along with providing health services, the IHS
also appropriates funds for educational and social service purposes. Avoiding
stereotyping and making sure not to make judgemental or discriminating comments or
actions is key to providing culturally competent care. To do so, you must first be aware of
some common or generalized knowledge of the culture, family structure, cuisine, and the
beliefs regarding health and illness, and death rituals of the Native Americans. This essay
is intended to explain some of the general culturalistic beliefs and practices of American
Indians, and how they pertain to providing culturally sound care.
Family Structure

Contrary to most European and modern day family structures, Native American
families vary in social structure, and almost always consist of a vast extended family. The
families can consist of blood and non-blood relatives, and often, fictive relations are built.
(BOOK) The nuclear family ( mother, father, brother, sister) , and the extended family
(Grandparents, Aunts and Uncles, nephews and nieces, cousins, second cousins, Tribe
Leaders, elders, family friends, etc.) make the base of the family structure and usually
live in close proximity with one another. These extended families make adoption less
likely to take place within Native American communities or tribes(). Since aboriginal
times Native Americans have valued family as a basic unit of life and tribe. Survival
depended on this close knit family structure, and the elders of the families are often held
in high esteem. (Elrue Potts) They are often looked upon for advice in regards to
children, and are usually the ones responsible for passing down the culture and beliefs of
the specific tribe. Different areas of the country consist of different tribes which consist
of families who follow matrilineal or patrilineal lines of descendants. There are families
that are matrilocal and and patrilocal (meaning they marry and live with the mother or
fathers family). In turn, there are matriarchal tribes like the Navajos of the Southwest
who hold roles in society for women, and mothers are head of the household. Patriarchal
tribes like the Sioux, whom held the majority of roles for males and the husband is the
head of the household. It is important to know as a healthcare provider, that if
hospitalized a Native American patient may have multiple family members who want to
visit and perform healing vituals such as singing, dancing, playing drums, gathering for
prayer circles (all depending on tribe, family, and the beliefs of both groups). In most
cases one or two family members will assert themselves as the patients primary
caregivers, and will act as the voice and decision maker for the patient. As the patients
nurse, it would be wise to build a sound relationship with these family members and
provide them with the guidelines and rules of visitation (Flowers 2005).
Communication
The different aspects of communication of Native American patients, are crucial
in establishing a culturally compentent care plan. Knowing the importance of verbal and
non-verbal communications amongst American Indian tribes, will help the healthcare
provider understand the role it plays in providing respectful and effecient care (Flowers,
2005). Native American speech patterns for one, are usually slower than that of other
cultures, and often the tone of their voice is softer or lower also. The importance of
silence in regard to pain or illness, is especially a key non-verbal communication of
traditional and more modern Native American beliefs. American Indian men are often
very stoic and lack verbal cues or expression of pain or illness. Some communities or
tribes, on the other hand teach their young men it is fine to cry out and express pain. Not
being aware of the reason or meaning for the silence a patient exhibits sometimes leads to
ineffecient care or treatment of pain. Family members and friends who visit the patient,
sometimes show support through silence and prayer. Also, it is important to know many
Native Americans consider it rude to talk in a loud voice, and disrespectful to even make
direct eye contact in some cases(book). Personal space is of great importance to Native
Americans; touching of the patient is sometimes considered unacceptable unless a
relationship has been established between the patient and care giver(Flowers 2005).
Food
The cuisine of most Native Americans consist of a diet high in fat, as well as salty
and sugary dishes(book). One of the staples of the original agricultural tribes of American
Indians, is what is called the Three Sisters; where corn, different types of squash and
beans are grown together, nourishing eachother as they grow, and providing an excellent
source of nutrition for the body. A variety of meats are used by American Indians in their
diets, including buffalo, turkey, squirrel, rabbit, chicken, beef, pork, fish, shellfish, seal,
and whale. In native times these animals were hunted or trapped, and beacause of their
connection with nature and the "Great Spirit", every usable part of the animal was taken
with usually very little to waste or leave behind. Native Americans believe in using the
land and what it offers respectfully, and for centuries have eaten natural growing foods of
America, such as berries, fruits, maple syrup, natural greens, herbs, and few spices. Many
modern American Indians still value many of these beliefs, and tie their diet directly to
their personal health. Ceremonies and rituals held for different reasons, whether health or
illness, birth or death, often include feasts, at which many traditional Native American
dishes may be served. Food to the American Indians is closely related to their religion
and spirituality of each tribe; so as a healthcare provider, consulting the patient and a
Dietrician regarding the diet and care plan of the patient.
American Indian Religion and Spirituality
Native American religion is as broad and varied of a subject as the people
themselves. From the days of their native ancsestors, American Indians generally have
always shared three common beliefs regarding religion and spirituality. One being that
there is an almighty and all-knowing "Great Spirit" or "Master Spirit", who is the creator
of "Mother Earth". This great spirit is worshiped and prayed to, and in most beliefs, is
directly tied to nature and the way an individual is living their life. Most Native American
religions believe that health and unity with nature are closely related. There are also
lesser spirits whom perform tasks for the great spirit, and an evil spirit whom punishes
those with bad behavior(Heyrman). Secondly, all humans are made of a spirit or soul
(sometimes more than one spirit depending on the tribe), and even with death of the
human body, the spirit is to live on in immortality. Or in otherwords the persons spirit or
soul lived on in an afterlife. Third, the beliefs and practices of individual tribal religions
have always been passed down generation to generation through the art of story telling. It
was seldom until the 19th century for tribes to keep written documents regarding their
religious beliefs. Rituals regarding religious beliefs and practices widely vary from tribe
to tribe, and can range from differences in prayer, to sacraficial ceremonies, and the
different items used for ceremonies(food, furs, bones, pottery, amulets, etc.). Suprisingly
enough, these three basic generalizations of Native american religion resemble the basic
premice of most Christian based religions(Heyrman). In healthcare it would be wise to be
open minded to religious beliefs, and if ever any confusion occurs, it is best to ask
questions to get better clarification from the patient or family members about their beliefs
regarding health care practices.
Native American Wellness and Illness Beliefs
The wellness and illness beliefs amongst American Indians are approached in
more of a holistic manner, similar to that of Asian beliefs of the Ying and Yang. Life
itself is made of dualities, hot and cold, day and night, summer and winter and so on
(Abbette). Finding balance to these dualities, along with harmony within nature and mind
and body is the key to wellness in Native American culture. Good health is attained
through balance, and with good health comes the ability to help and provide for others
whether it be family, tribe, or community. American Indians believe in eating wholsome
foods, and that all food is blessed by the "Great Spirit", the creator of life itself. Along
with eating good foods, American Indians also added daily exercise and activities to their
everyday lives. Illness on the other hand was or is caused by a direct imbalance of
everyday life and the lack of harmony between lifes dualities. It is thought by Native
Americans that illness begins with negative thoughts in the head and spreads from there.
So in most cases they believed the thoughts could be rinsed away using water or by other
spiritualistic ceremonies which were usually held by medicine men or medicine women
(Abbette). Illness was also thought to be related to the loss of ones soul because of bad
behaviors, or the acts of another tribes sorcerer performing evil magic on ones
body("medicine men"). Belief and practice in the Medicine men and women throughout
American Indian culture dates back to paleolithic times. They are often thought of as
having supernatural abilities to cure and often inflict pain on people of their tribe.
Medicine men of native culture were believed to secure the hunting season for the tribe,
promote sterility throughout the tribe, as well as do harm to others("medicine men"). The
use of herbs, stones, feathers, amulets forged of metal, wood, or stone, pottery and many
other artifacts were used to perform the rituals and ceremonies held medicine men and
women during times of illness (Falsetto). The medicine men and women are often looked
upon as authority figures, and help in providing input regarding traditional beliefs of the
culture, and the planning and implementation of modern care. It is important to know as
the primary care provider of an American Indian patient, to never touch or move any
sacred objects used or provided by the medicine men, as this is considered extremely
rude and goes against providing the culturally competent care expected of you(book).
Relating back to the family structure and communication of the Native American culture,
in nursing, or healthcare in general, these people would be wise to utilize in maintaing
culturally sound, yet effecient care plans.
Death and Burial Beliefs
Similar to the rituals and ceremonies held for the ill, ceremonies are often held for
those Native Americans who pass away. Rituals and ceremonies vary vastly from tribe to
tribe, and region to region. In most cases, Native Americans believe strongly against
autopsies, and prefer the loved ones body stay as full and intact as possible. The body is
often cleaned or annointed with oils and herbs, by a select group, usually one or two of
the elder women of the tribe or community. The assistance of the medicine men or
women in these ceremonies is often a must for the families of the deceased, in order for
the spirit of thedead to make an easy transition on in life. As far as burial beliefs go, each
tribe has different beliefs as to what or how the service is provided. Furs, clothing, herbs,
amulets, pottery and other keepsakes are often put inside the burial site, either before the
body is placed in, or as the body and items are placed in together. The reason for these
objects are because it is believed in most American Indian cultures, that the soul or spirit
travels on for eternity in some cases, and the momentos help ease the spirits journey.
Many tribal beliefs regarding the dead include taboos against looking directly at the body.