Caution: These are broad generalizations and should not be used to stereotype any individuals.
Communication
Anecdotes or metaphors may be used; for example, a story about an ill
neighbor may be a way of saying the individual is experiencing the same
symptoms.
Long pauses generally indicate that careful consideration is being given to a question. Do not rush patient.
Direct eye contact may be avoided out of respect and/or concern for soul loss/theft.
Loudness is often associated with aggressiveness and should be avoided.
Due to history of misuse of signed documents, some may be unwilling to sign informed consent or advanced directives. Some may display hostility toward healthcare providers due to history of treatment of Native Americans by whites.
Older adults may prefer the term "American Indians" over "Native Americans."
Family/Gender
Issues
Extended family important, and any illness concerns the entire family.
Decision-making varies with kinship structure. Patients will generally make their own decisions. In tribes that are matrilineal (descent reckoned through the female line), women and/or their brothers may make important decisions. Navajo, Hopi, and Zuni tribes are among those that are matrilineal.
Time
orientation
Generally flexible, oriented to activities, rather than the clock. "Indian
time" may run very late.
Expression
of Pain
Stoicism is highly valued, and patients may not express their pain, other
than by mentioning "I don't feel so good" or "Something doesn't feel right."
If patient reports feeling "uncomfortable" and is not given pain relief,
s/he generally won't ask again. Offer pain medication when the condition
warrants it, even if patient does not appear to be in pain.
Pregnancy
& Birth
Female relative may be birth attendant.
Stoicism encouraged during labor & delivery.
Mother & infant may stay inside and rest for 20 days post partum, or until the umbilical cord falls off, depending upon custom. May want to save umbilical cord, since it may be seen as having spiritual value.
End
of Life Issues
Names of deceased relatives may be avoided, but relationship term (e.g.,
brother, father, sister) may be used.
Some tribes may prefer to avoid discussion of terminal prognosis or DNR since negative thoughts are believed to hasten death. Others will use the information to make appropriate preparations.
Some tribes may avoid contact with the dying, while others will want to be at the bedside 24 hours a day. Visitors may display a jovial attitude so as not to demoralize patient. Mourning is done in private, away from the patient.
After death, wailing and shrieking may occur.
Some may want to leave a window open for the soul to leave at death; others may orient the patient's body to a cardinal direction before death.
Health
Related Practices
Before cutting or shaving hair, check to see if patient or family wants
to keep it. Realize that in some tribes, cutting hair is associated with
mourning.
A medicine bag may be worn. Do not treat it casually or remove it without discussing it with the patient. If absolutely necessary to remove it, allow a family member to do so, keep it as close to the patient as possible, and return it as soon as possible.
Food which is blessed (traditional religion or Christianity) may be thought to be devoid of harm. Nutritional guidance should take this into account. Many traditional foods are high in fat.
Traditional healers may be combined with use of Western medicine. Allow traditional healers to perform rituals whenever possible. Do not touch or casually admire ritual objects.
Note: the material contained in this profile is adapted from Kramer, J. (1996) American Indians. In JG Lipson, SL Dibble, and PA Minarik (Eds.), Culture and Nursing Care: A Pocket Guide (pp. 11-22). San Francisco: UCSF Nursing Press.
