Cultural ProjectNATIVE

AMERICANS

The red feather of hope and healing is the symbol used by the National Indian Health Board NIHB.org

Family Nursing Diagnosis

Interrupted family processes related to

scattered family members, secondary to

ineligibility for financial assistance for

medical services and the complexity of

coping in an alien culture as evidenced by

Mrs. D’s sudden right sided hemiparesis

while staying with one of her sons in

Pennsylvania. 

Physical Assessment

Is Mrs. D physically strong enough to do everyday activities such as:• Grooming• Toileting• Bathing herself• Brushing her own teeth• Dressing herself• Caring for her own clothes and

environment

Is Mrs. D mobile? • Does Mrs. D need a walker or wheel chair

at home, or are any special aids needed to help her remain mobile?

• Daily physical activity• Walking- lack of strength due to right-sided

hemiparesis• Will Mrs. D need 24 hour care• To help her in and out of bed?• Is her environment safe?• Will she receive the needed care?

Physical Assessment

Is Mrs. D eating healthy? Can she drink?• Is Mrs. D able to chew and swallow?• Is she able to cook for herself?• Does she need supplemental nutrition?• Is she compliant with her medication?

Physical Assessment

Cognitive Assessment

• Assess Mrs. D’s thought process. Is she alert and oriented?

• Does Mrs. D understand what has happened to her?

• How has the stroke affected Mrs. D’s memory?

• Is she able to think clearly, enough to care for herself?

• Is she able to speak? • Can she communicate ie. understand what

is being said to her?

• Severity of depression• Due to stroke• Lack of family support• Loss of independence

• Family support• Lack of support from her tribe if she is off-

reservation for more than 180 days• A stable environment for her to stay

Mental Health Assessment

• Since nurses encounter patients of different ages, socio-economic statuses, and cultures on a daily basis, it is necessary for nurses to be knowledgeable and culturally competent.

• In our culturally diverse world nurses must be aware and informed about sensitive spiritual and religious influences during health and illness.

Culturally Appropriate Care

• It is especially important to establish a good rapport with with the client in order to develop a trusting relationship• Many elders distrust of the Western health care

based on historical abuses and beliefs

• Native Americans are a cultural group that nurses encounter often, especially in the Western United States and Alaska.

Culturally Appropriate Care

• Most Native Americans prefer to be called Indian.

• Life, modesty and privacy are highly valued

• Hand shakes are often viewed inappropriate • Direct eye contact is also avoided.• Avoidance of direct eye contact is a sign of respect.

Culturally Appropriate Care

Patient specific interventions

In order for the nurse to provide culturally competent

care to Mrs. D, the nurse should:

• Adapt questions to age and acculturation level.

• Slow down when communicating with Mrs. D

especially during initial encounter and when

explanations of treatments, medications and health

care decisions are given.

• Frame questions carefully to convey the message of

caring and not indicate idle curiosity about culture

or cultural practices.

Patient specific interventions

• Use an adult same gender interpreter if need be for an

interpreter

• Utilize indirect discussion over direct questioning.

• Request and obtain permission from Mrs. D before

physical examination and it should be accompanied by

explanation in a quiet, calm and pleasant manner.

• Remember that Mrs. D might under report her pain, due

to her believe that this is not a western disease.

Patient specific interventions

• Avoid direct eye contact as a sign of respect. Gaze may

be directed over the shoulder.

• Maintain a healthy physical distance; several feet is

usually a comfort zone.

• Minimize or avoid interruptions when Mrs. D is speaking

and respect her lengthy pauses.

• Know that time is non-linear to Mrs. D when doing

medication teaching regiments.

Family and Community Members

• Traditionally, Native Americans look to medicine people, elders, clan leaders, spiritual leaders, or a cultural guide for treatment.

• It is critical for health care professionals to work collaboratively with the family, as well as tribal leaders.

• Unless every member of the healthcare team understands not only the role of families, but also the extent of family systems, there may be misunderstandings.

Family and Community Members

• In some situations it is possible to have the traditional healer participate as a member of the interdisciplinary team.

• In some tribal groups, clan members are considered extended family.

• It is important to acknowledge and include family, community, and traditions in the care plan.

Family and Community Members

• The connection of heritage helps in the nursing process.

• Cultural values include:• Indian Medicines• Old ways• Ceremonies• Rituals

Evaluate Plan of Care

• Mrs D is able to understand the healthcare provider because they were able to speak slowly when talking to her.

• Mrs. D was given her space as the healthcare provider respectfully maintained at least several feet distance.

• Questions were framed in an age sensitive nature to make Mrs. D comfortable.

• Only female age appropriate interpreters were used to put Mrs. D at ease so she could open up with her answers.

Evaluate Plan of Care

• Mrs. D was given enough time to say what she had to say with minimal interruptions and her long pauses were respected.

• Indirect discussions were used instead of direct questioning when Mrs. D was being assessed and when instructions were given regarding her medications and her plan of care.

• The health care provider gained Mrs. D’s trust and she could comfortably report her pain and discomfort.

Evaluate Plan of Care

• After obtaining permission from Mrs. D, the nurse was able to do a comprehensive physical assessment, respecting her boundaries in a calm and reassuring manner.

• Mrs. D was able to have members of her family and clan participates in her plan of care which made her more comfortable.

• Mrs. D was able to have her medicine pouches which are very important to her at her bedside at all times as she requested.

Tribal governments have played a central role in advocating for the improvement of health care among American Indians and Alaska Natives. This partnership with Tribal governments is key and a foundation of the National Indian Health Board.  With 565 federally recognized tribes, each tribe is represented by Area Health Boards or when there is an area without an Area Health Board, a NIHB representative is chosen which communicates with the tribes of that area.  The mission of the NIHB is to advocate on behalf of all Tribal governments and American Indians/Alaska Natives in their efforts to provide quality health care. As part of this advocacy, we are committed to providing timely, factual, and valuable information on the Indian health care system to AI/AN, tribes, tribal governments and policy makers. This tribal resource center has been established to provide tribes with the resources and tools to effectively engage in fulfilling the mission of NIHB.

Tribal Resources – NIHB.org

References

Hendrix, L. R. (2010). Health and healthcare for american indian and alaska native elders. Retrieved from Website:http://www.stanford.edu/group/ethnoger/americanindian.html

Horowitz, S. M. (2012). American indian health. Integrating traditional native healing practices with western medicine, 18(1), 24-30. doihttp://web.ebscohost.com/ehost/detail?vid=5&sid=44ec09fa-820d-451d-b785-6f11c9271cd7@sessionmgr114&hid=113&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ

Blais , K. K., & Hayes, J. S. (2011). Professional nursing practice: Concepts and perspectives . (6th ed.). Saddle River: Pearson Eduction.