The following cultural patterns may represent many American
Indians, but do not represent all people in a community. According to the
University of California School of Nursing, in Culture and Clinical Care, many
aspects of Indian culture today reflect the culture of the general US
population.
Social structure
The American Indian concept of family includes immediate and
extended family members, as well as community and tribal members. Women are the
traditional care givers. Grandparents help counsel and care for their
grandchildren, and children are expected to respect and care for their elders
and take pride in their culture. At powwows, elders are served meals first and
are given special seating areas. Indian communities encourage education with an
emphasis on the unique cultural legacies of the community. Younger people often
leave home to become educated, then return to help their families and tribes.
Diet
The traditional diet of American Indians was generally
nutritious and low in fat, but today a typical diet is similar to that of the
general US population, although it is often poorer in quality, consists of
high-fat, salty, and sugary foods, and lacks sufficient fruit, vegetables,
grains, and dairy products. Indians are more likely to report not having enough
to eat than other US households. Traditionally, the Anishinabe and Dakota ate
fresh or dried wild game and foul and gathered wild rice, berries, acorns,
ginger, and leaves and twigs for teas. They planted potatoes, corn, pumpkins,
squash, and turnips, and made maple syrup. Fish, the principal food of the
Anishinabe, was boiled, cooked over a fire on a stick, or eaten in soup, and
was dried, salted, or frozen in the snow to preserve.
Religion
Spirituality is central to the identity of the American Indian,
and is viewed holistically. People and nature are interconnected. Every animate
and inanimate form of life has a spirit and is considered sacred. For example,
water is viewed as a sacred, life-sustaining source and a way of connecting
with the earth. The head and hair are considered particularly sacred.
Respecting and nurturing life and developing a positive relationship with the
spirits is core to Indian spirituality. Indians nurture that relationship
through prayer and a purification ritual in a sweat lodge. They burn sage and
sweet grass, and smoke a special ceremonial tobacco for cleansing, blessings,
and healing. Drumming, dancing, and singing also are traditional spiritual
expressions associated with healing. American Indians have endured decades of
assimilation policies designed to strip them of their identity and integrate
them into the dominant society. Many Indian people who grew up in the
mid-twentieth century describe a feeling of shame in their heritage during that
time. This was partly due to the fact that it was illegal for Indians to
practice their religious ceremonies until the American Indian Religious Freedom
Act was passed in 1978. As a result, many Indians today have Christian ties or
practice no religion at all.
Medical care
According to the Centers for Disease Control and Prevention,
the top causes of death in the American Indian population are heart disease,
cancer, unintentional injuries, diabetes, and stroke. Also prevalent are
chronic liver disease and cirrhosis, chronic respiratory disease, suicide,
influenza/pneumonia, and kidney disease. Obesity, smoking, and alcohol abuse in
this population are related to many of these diseases. Among racial and ethnic
groups, the prevalence of smoking is highest among American Indians/Alaska
Natives (32 percent). Because their lands are sovereign nations, Indians are
not subject to taxes or to state laws prohibiting the sale and promotion of
tobacco products to minors. Chronic cigarette smoking and spit tobacco used by
this population have increased its risk of developing tobacco-related health
problems, such as heart disease, cancer, and stroke.
Because health is related to spirituality in Indian culture,
sickness may be viewed as a result of disharmony between the sources of life. A
patient may seek western medicine for treatment as well as medicine from a
traditional healer—a medicine man—to address the disharmony that caused the
illness. The medicine man has been given the power to heal through his
relationship with spiritual beings. Spirits work through him, helping him
diagnose and treat physical and spiritual illness. Traditionally, the medicine
man is chosen by the spirits and comes from a specific family lineage. His life
is hard because he cannot deny a request for treatment and never charges for
his services. Indian patients may be reluctant to discuss use of these
traditional practices with a clinician. Indians have been taught to resist any
expression of pain. Although they may not express pain directly, they may
report feeling uncomfortable or may use storytelling or circular conversation
to build trust and describe symptoms. A personal story about a sick neighbor
may be used as a metaphor for the patient’s symptoms. Direct eye contact is
often avoided out of respect or out of concern for soul loss. Time and silence
are often used to prepare to listen, to maintain harmony, and to be
non-confrontational. Patients may occasionally be late or miss appointments
because of a different perception of the concept of time—time orientation for
Indians has been traditionally cyclical and present-oriented compared to the
linear, future-oriented concept of time in Western culture.
Death and dying
Because of the importance of family in American Indian
culture, immediate and extended family members should be informed of an
impending death. A family-centered approach is recommended for conveying
serious medical information and explaining issues such as autopsy and organ
donation. Organ donation may be viewed as a desecration of the body. The entire
family may be included when making decisions and signing documents. Due to the
misuse of signed documents throughout the history of the American Indian, some
Indian patients may be unwilling to sign informed consents, advance directives,
and durable power of attorney forms. Patients may perceive verbal agreement as
sufficient.
Honoring ancestors is especially important in Indian
culture. Several Indian nations across the US are currently in the process of
attempting to retrieve the remains of ancestors that have been unearthed by
archeologists so they can be properly buried.
Culture in context
Culture is essential in assessing a person’s health and
well-being. Understanding a patient’s practice of cultural norms can allow
providers to quickly build rapport and ensure effective patient-provider
communication. Efforts to reduce health disparities must be holistic,
addressing the physical, emotional, and spiritual health of individuals and
families. Also important is making connections with community members and
recognizing conditions in the community. Get to know your patients on an
individual level. Not all patients from diverse populations conform to commonly
known culture-specific behaviors, beliefs, and actions. Generalizations in this
material may not apply to your patients.
Source: www.stratishealth.org
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