Note: This section about Native American cultures is abbreviated and does not provide comprehensive information about all Native Americans. In Nebraska the Santee Indian Reservation is located in Knox County; the Winnebago Indian Reservation is in Thurston and Dakota Counties; and the Omaha Indian Reservation is in Thurston County.

1. Value Orientations (Seidel, Ball, Dains, & Benedict, 1995, p. 39; Wilson, 1983, pp. 276-277):
   1. Time: Present oriented; lives day by day.
   2. Activity: Engages in self-expression; doing for others valued
   3. Human Nature: Views individuals neutrally, in harmony with nature.
   4. Relation: Group goals more important than individual goals; competition is discouraged; respect grows with age
2. Health Beliefs (Seidel et al., p. 50; Wilson, pp. 281-282)
   1. Health is a state of harmony with nature and illness has a basis in the supernatural. The human body should be respected.
   2. Illness may result from violation of some restricted behavior and is related to the supernatural (e.g., witchcraft, taboos, intrusion by spirits, loss of the soul).
   3. Objects may be used to ward off witchcraft.
   4. Religious practices are important in maintaining health and warding off illness.
   5. Hospitalization is used for illness only therefore, no prenatal care may be sought since pregnancy is viewed as a normal phenomenon.
      

3. Health Practices (Seidel et al., p. 50; Wilson, pp. 279-282)

   1. Medicine persons, diviners, specialists, and singers may be utilized. These individuals use powers against enemies, herbs, rituals, and songs to cure.
   2. More information on herbal remedies may be found by clicking onto this website.
   3. Tribal healers may focus on prevention, treatment, and health maintenance. They may use witchcraft to ward off evil and restore balance in efforts to prevent disease/illness. Treatment regimes deal the illness as well as the mind and spirit. Motivation of the client to recover is considered important. Health maintenance may take the form of rituals to restore balance to the body.
   4. Several medicine healers exist. They include those who have only altruistic purposes and play a positive role. Another type of healer is capable of both good and evil. Diviners are diagnosticians who may use herbs and other interventions to treat the illness. The fourth type of healer are those concerned about the restoration of souls. Lastly, singers, cure by the power of song, laying on of the hands, and other nontraditional techniques.
4. Dietary Considerations (Wilson, pp. 283-285)
   1. Lactose intolerance is prevalent. Papago and Pima Indians drink undiluted cow's milk which may make them ill. This may be related to lactose intolerance rather than other factors.
   2. Food restrictions may be followed in certain Indian ceremonies.
      • Navajo: Ill person may be restricted from certain proteins (e.g., organ meat, chicken, eggs) for the remaining life span.
      • Yuma: Pork, fish, chicken, birds and eggs are forbidden. Delaware: People with fever cannot eat meat
      • Yuma, Papago, Navajo, Delaware, and Yokut women cannot eat salt for one year postpartum.
      • Some other American Indians have restrictions on liver, rabbit, milk, and cabbage.
5. Family Aspects (Seidel et al., p. 51)
   1. Extended families are important.
   2. Elders assume leadership.
6. Communication Practices (Seidel et al., p.51; Wilson, pp. 277- 278)
   1. English and the native tongue are important.
   2. Much nonverbal communication is utilized; this varies by tribe.
   3. Silence is valued as it helps to form thoughts before speaking. Those who interrupt are seen as being immature.
   4. Eye contact is accepted with a handshake but continued contact may be seen as disrespectful.
7. Physical Assessment (Jarvis, 1996, pp. 217, 356, 391, 468, 655, 778; Wilson, p. 290)
   (Note: The following characteristics may be found more frequently in individuals of this minority group.)
   1. Skin/Hair: Melanin causes darker skin pigmentation especially noticeable in the perineal and nipple regions. Cyanosis and jaundice are more difficult to detect. Little to no body odor is present.
   2. Ears: Dry cerumen.
   3. Nose/Mouth/Throat: Partially or totally split uvula, cleft lip /palate, torus palatinus. Eskimos may have long, narrow noses.
   4. Thorax/Lungs: Smaller chest volume than Blacks, Caucasians, and Asians.
   5. Musculoskeletal: Femurs have convex shaped anterior femurs. May have 25 vertebrae.
   6. Genitalia: No tradition to practice circumcision.
   7. Height and weight, especially for children, may vary from the norm of the general U. S. populatio
8. Common Health Conditions
   1. Extra vertebrae may cause low back pain (Jarvis, p. 655).
   2. Adults under 35 have high degree of mortality from cardiac disease. (Interestingly, Native Americans have a lower incidence of high blood pressure and lower serum cholesterol levels.) (Jarvis, pp. 526-527).
   3. Diabetes and its associated complications are prevalent (Jarvis, p. 527).
   4. Traumatic injuries (see web site bibliography)
   5. Strep throat is prevalent (Wilson, p. 291).
   6. Gastroenteritis is prevalent (Wilson, p. 291).
   7. Trachoma associated conjunctivitis (Wilson, p. 291).
   8. Children: Otitis media with associated hearing impairment (Jarvis, p. 356; Wilson, p. 290), gastroenteritis, bacillary dysentery, impetigo, respiratory disease sometimes associated with influenza (Wilson, p. 291).
   9. Note that the pain threshold is generally high. Some may not be able to distinguish the site of pain because of the cultural belief in the mind and body as a whole. It may be helpful to ask a client to point to the site of the pain (Wilson, p. 289) for a more accurate assessment.
9. "Culture-Bound Syndromes" (Jarvis, p. 55)
   1. "Ghost" resulting in terror and feeling of danger.
10. Genetic Disorders (Jarvis, pp. 56-57)
    1. Hopi: Tyrosinase positive albinism.
    2. Navajo: Ear anomalies.
    3. Zuni: Tyrosinase positive albinism.
11. Pharmacological Considerations
    1. Alcohol metabolism rate may be more rapid than in Caucasians but this finding is controversial (Kalow as cited in Levy, 1993, p. 9). Less tolerance for alcohol is exhibited (Levy, p. 26).

References

• Jarvis, C. (1996). Physical examination and health assessment (2nd ed.). Philadelphia, PA: W. B. Saunders.
• Levy, R. (1993). Ethnic and racial differences in response to medicines. Reston, VA: National Pharmaceutical Council.
• Seidel, H. M., Ball, J. W., Dains, J. E., & Benedict, G. W. (1995). Mosby's guide to physical examination (3rd ed.). St. Louis, MO: Mosby.
• Wilson, U. M. (1983). Nursing care of American Indian patients. In M. S. Orque, B. Bloch, & L. S. A. Monrroy. Ethnic Nursing Care (pp. 271-295). St. Louis, MO: C. V. Mosby.

Photo Credits

• Photographs courtesy of Mobile Nursing Center and N. Rheiner, College of Nursing, UNMC.

Bibliography

• Dempsey, P., & Gesse, T. (1995). Beliefs, values, and practices of Navajo childbearing women. Western Journal of Nursing Research, 17, 591-604.
  
  The results of an exploratory, descriptive study are reported. Twenty women were interviewed. The purpose of the research was to determine the beliefs and practices of childbearing Navajo women. The cause of labor is believed to be the baby's need to come out". The women believed it was important to be near a hospital. Some desired to have an elder nearby and a chant being performed at the same time. There were no food restrictions but most women avoided drugs and alcohol. Women felt they should be awake during the labor process. Some expressed a wish not to be touched during labor. Some had no restrictions are who was with them during labor and delivery. The biggest fear during labor and delivery was pain. Most women had no unique cultural beliefs about lochia flow, the exposure to hot or cold, or bathing. The majority did not express any special dietary preferences. Breast-feeding immediately following birth was desired by all but one woman. Most had no specific practices to be followed for the newborn. Some however, referred to baptism and the Blessingway Ceremony thanking God for a healthy infant. The majority of women felt the infant should be wrapped with no freedom to move.
  
  
• Iris, M.  (August/September 1998).  Life in balance.  The Park Ridge Center Bulletin,  15, 17.
  
  The Navajo Nation is among the largest in the U.S.  They practice many native healing ceremonies which link patients, ceremonial singers, and other participants to the holy people and sacred past.  Healing ceremonies, "hataal" (sings) involve many rituals and intersect religion, health, and traditional medical practices.  Many rely on these rituals for healing.   However, many individuals may seek the assistance of western medicine and use it, in conjunction with their traditional cultural rituals. 
  
  
• Mercer, S. O. (1996). Navajo elderly people in a reservation nursing home: Admission predictors and culture care practices. Journal of the National Association of Social Workers, 41, 181-189.

  An overview of the Navajo culture is provided. Religion plays an important role in the culture. The supernatural plays a large role in religious beliefs. Living a harmonious life with a natural death from old age is important to the culture. Talking about death may cause death to occur. Dying persons are removed from the home (hogan) to avoid death in the house. There are certain practices followed when preparing the body. Jewelry may be buried as well and a four day ritual may follow for the family. Names of the dead are not used again because it may cause death to the one speaking the name. Ceremonies are performed for numerous reasons and individuals also turn to " tremblers, star gazers, crystal gazers, and water gazers for diagnosis and treatment" (p. 183). Preventive ceremonies also play a large role in the society (e.g., Blessingway for pregnant women). These ceremonies are performed by medicine men/women. Family life and structure is important to the Navajo. Many have difficulty adjusting to unfamiliar settings with personal space, privacy, and cleanliness being very important. Preferred foods include mutton, breads, corn, potatoes, and coffee.

• Sanchez, T. R., Plawecki, J. A., & Plawecki, H. M. (1996). The delivery of culturally sensitive health care to Native Americans. Journal of Holistic Nursing, 14, 295-307.

  This article reviews the health beliefs of both the Navajo and Sioux. The role of traditional healers is described. Traditional remedies are listed, including, among others, the use of wild hydrangea bark for an upset stomach; black-eyed Susan root for earaches, cuts, and enemas; tulip tree leaves in paste form for headaches, and catnip for gastritis. Tobacco is considered sacred. Tule powder is often sprinkled on the floor of hospitals provides curative powers for the sick. Five values of the Sioux are reported as generosity/sharing, respect for elders, respecting nature, freedom to choose (the right thing), and courage.

• Phillips, S., & Lobar, S. (1995). Navajo child health beliefs and rearing practices within a transcultural nursing framework: Literature review. In M. Leininger. Transcultural Nursing Concepts, Theories, Research & Practices (pp. 485-500). New York, NY: McGraw-Hill.

The Navajo culture is examined including caring behaviors, tribal themes, health and illness beliefs, prenatal, postpartum, neonatal, and childbearing practices. Pregnancy is accompanied by various ceremonies and taboos. Since pregnancy is viewed as a normal and healthy process prenatal care may be limited. During the pre-Cradleboard phase the hogan (house) is prepared for delivery. The newly delivered infant is washed in herbal soap. The placenta is placed in the hogan fire or buried. Emetic juniper bark tea may be fed to help the infant rid itself of mucus. Corn pollen and water is then fed as part of a ceremony. Breast feeding is preferred. The Cradleboard phase is celebrated with the infant's first laugh indicating that the child has matured and has a self-identity. Ceremonies accompany this phase as well. The infant is placed on a permanent cradleboard. This protects the baby and is convenient for the mother. Digestion is aided when placed in an upright following feedings. The board also provides an eyeshade against the harmful effects of the sun. The post Cradleboard phase include weaning, training, and discipline.

Web Addresses:

• Brief overview regarding Native American Aids Prevention Center
• Native American Women's Health Education Resource Center
• Native American and Asian Women's issues

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