Importance of Cultural Competence
Nurses need to understand the attitudes, traditions and values of the group in their service area. Cultural beliefs can impact the patients healthcare choices. When you are aware of how culture can influence behavior and thinking you will be able to provide the best care to your patients. It is also important to be aware of your own stereotypes and attitudes towards different cultures in order to avoid them.
The Native American Culture
Beliefs and Values
- Respect the unique individual differences among people.
- Quietness or silence is valued and is a form of etiquette.
The virtue of patience is based on the belief that all things unfold in time.
- Time should be given to make decisions.
Only that which is actually needed is accumulated through work.
- Work must be shown to have an immediate and authentic purpose.
As a value, attitude, and behavior, mutualism permeates everything in the traditional social fabric.
- Mutualism promotes a sense of belonging and solidarity with group members cooperating to gain group security and consensus.
- Prefer listening rather than speaking. Talk, just as work, must have a purpose.
- Storytelling, oratory, and experiential and observational learning are all highly developed.
Time is relatively flexible and generally not structured into compartments as it is in modern society
- Things happen when they are ready to happen.
- Present needs and desires tend to take precedence over vague future rewards.
- Tend to be practical minded. Many have less difficulty comprehending educational materials and approaches that are concrete or experiential rather than abstract and theoretical.
- Religious thought and action are integrated into every aspect of the socio-cultural fabric.
- Spirituality is considered a natural component of everything.
Some Native American communities believe that the body must be whole in order to “cross over” into the next world, and some believe that body products could be used to cause the individual or his family harm if they are used in casting spells.
To meet the expectations of the Native Americans, health care workers need to understand and integrate into treatment and procedures the beliefs of the patients’ tribes. They do not expect for the nurse to be able to perform the rituals and traditional methods of healing, but they do expect respect for their beliefs and a balance to be achieved between the two cultures in treatment.
How Health Care May Differ for Native Americans
- Need to give plenty of time to obtain informed consent.
- May request removed body tissues to be returned to them including hair, nail clippings, tonsils, organs surgically removed, and amputated limbs or digits.
- Sharing of medicines is common within clan groups and extended families.
Overt expression of pain (verbal or non-verbal) is unacceptable in many cultures today.
- Native Americans are generally under-treated for chronic and acute pain.
- A request for assistance may not be repeated, or may be told to a family member who will relay the request.
- Potential barriers in acceptability of medical services include cultural differences in concepts of modesty and propriety; lack of respect; long clinic waits; and, staff turnover.
- Many elders will not apply for Medicaid benefits for which they are eligible as a matter of pride, or because it is believed that medical care was assured by treaty, or because the system is too complicated.
May have a “fatalistic attitude” toward health also making care seem less acceptable.
Ways to individualize and optimize health care for Native Americans
Health care providers must be attentive to cultural and social norms of this group in order to provide the best possible care. An understanding and willingness to accept the differences in culture on the part of the health care provider will improve care. Common sense and flexibility in dealing with other cultural groups is of great importance.
- Direct eye contact may be avoided out of respect and concern for “soul loss”
- Long pauses generally indicate careful consideration. Do not rush the patient
- Loudness can be associated with aggressiveness and should be avoided
- Some patients in this group may be unwilling to sign documents, consent forms, etc. due to a history of misused documents
- Native Americans can be oriented to activities, rather than the clock. They may run late.
- Extended family is important. Be sure to include the entire family.
- Decision-making varies. Usually the patient will make their own decisions, but sometimes a woman and/or brothers will make important decisions.
Expressions of pain
- Stoicism is highly valued and patients may not express pain. Patient reports of pain may be understated. Offer pain medication when appropriate, even if the patient does not appear to be in pain.
Pregnancy and Birth
- The mother may request a female relative as a birth attendant
- Mother and infant may stay inside and rest 20 days post partum, or until the umbilical cord falls off. They may want to save the umbilical cord for spiritual reasons.
- Stoicism is sometimes expected during labor and delivery
- Patients may use traditional healers. Allow them to perform rituals. Do not casually touch or inspect ritual items.
- Medicine bags should be handled carefully and only when necessary.
- Food that is blessed may be considered devoid of harm. Use common sense when determining diets.
Death and End of Life Issues
- Native Americans may avoid talking about terminal prognosis and DNR issues, as this is believed to hasten death.