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Thread: Guidelines for interacting with Native Americans and their families

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    Guidelines for interacting with Native Americans and their families

    This is a must read for everyone. You never know when it might come in handy: http://info.kyha.com/documents/CG-Native_American.pdf

    BACKGROUND & INTRODUCTION
    Health care providers need to have an understanding of and respect for a wide spectrum of
    beliefs and religious preferences of their Native American patients in order to provide optimal
    care for them. As the population of Native American increases, health care workers including
    physicians, nurses and chaplains will more frequently encounter Native American patients who
    require contact with the health care system. The information in this document is general and is
    applicable to all communities of Native Americans. In the United States, there are more than
    500 nations of Native Americans, each having their own separate customs, language, culture,
    set of beliefs and religious practices. There is no single “Native American Religion”, or church
    hierarchy. There is no central figure like Moses, Jesus, Muhammad or Buddha, nor is there a
    central holy book in Native American Religious tradition. It is an oral tradition that is passed
    down from generation to generation, based on certain guiding principles that are internalized
    from childhood and are an integrated part of each person’s life. Following the sacred way does
    not separate life into segments, it is seen as one.


    There are two and half million Native Americans living in the United States and Canada with
    over 100,000 residing in the metropolitan Chicago area. There are many Native Americans
    who follow traditional customs and spiritual beliefs. There are also many Native Americans
    who combine their traditional set of beliefs and religious practices within the framework of
    Christianity and would want both traditional and Christian religious traditions while in the
    hospital. Chief Seattle said,
    “Our religion is the tradition of our ancestors—the dreams of our

    old men and women, given them in the solemn hours of the night by the Great Spirit, and the


    visions of our tribal chiefs—and is within the heart of our people”
    .



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    The Creator’s Spirit is alive and in all things in the universe. Everything that can be seen or
    touched is “alive” with the spirit, or breath. The Creator’s Spirit actively affects human lives
    in ways that can be both good and bad. Mother or Grandmother Earth’s spirit nourishes
    and sustains life, and it is there that people return after death. Mother or Grandmother
    Earth is to be respected and given thanks for the life it gives to sustain creation. All forms
    of life depend on all others. The words Mitakuye’ Oyasin expresses this thought which
    means all of creation are my relatives, we are all one,
    “we are all connected and whatever
    happens to the Earth it will happen to the children of the Earth.”
    (Chief Seattle). Lakota
    Holy Man Black Elk states,
    “Peace…comes within the souls of men and women when they
    realize their relationship, their oneness, with the Universe and all its powers, and when they
    realize that at the center of the Universe dwells Wakan Tanka, and that this center is really
    everywhere. It is within each of us.”

    Each individual is called to “walk in the sacred way or to walk in beauty”. This means to
    live in balance and harmony with the universe and spirit world. Each person finds their own
    sacred way by seeking the sacred through traditional teachings, prayer, vision quests and
    or dreams.

    Morals, ethics, values, beliefs, culture, customs, religious and sacred traditions are passed
    on through an oral tradition and through ceremonies. Cultural identity, understanding and
    bonding takes place through rituals developed by tribes over many centuries. Some of
    these may include dancing, singing, drumming, prayer, worship, feasting, purification rites,
    fasting and physical ordeals. An example of this would be a singer coming to the hospital
    with a hand drum in order to sing a prayer song.

    There are medicine men and women, singers, shamans, and healers who have been given
    a special gift by the Great Spirit to help mediate between the spirit world and the earthly
    world for healing, spiritual renewal and for the good of the community.

    Humor is an important part of the sacred way because two-leggeds (people) need to be
    reminded of their own foolishness.

    The theme of “One Mind” is one that runs through many Native American tribes.

    Decisions will be put off if agreement cannot be reached. Dissention will dictate that one
    needs to proceed with caution and take time to reflect in order for everyone to come to “one
    mind”, “one accord” and/or “one decision”.

    Community and relationships are important. Family includes many extended family
    members and friends and/or an entire clan. Elders are respected and listened to when

    decisions are being made.

    Balance is an important concept. Illness occurs when life is out of balance.

    “Koyaanisquatsi”—life is out of balance.

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    To Walk in Beauty, a concept from the Navajo tradition is an important phrase. It is included in prayers as well as using it as an honored phrase in parting. It does not mean that you
    should see beautiful things around you. Beauty means to live in balance. This balance
    includes a circle containing our parts – body, mind, heart and soul. Another circle of Beauty

    would be community, family, plants and animal, brother & sisters. And yet another circle
    includes earth (mineral) air, water and fire. There must be a balance…a oneness with all parts,
    the ones listed above and our traditional spiritual self with the universe. This is a must. Picture
    a perfectly weighted mobile. That will represent all parts walking in beauty. Now place a
    weight on one of the strings. The mobile is out of balance. This could represent our lives
    during an illness or crisis. The doctor may remove or fix that problem. But still we shake as
    the mobile does. We need the spiritual person to make everything right to restore the oneness

    with all so we may Walk in Beauty again.


    Most Nations allow blood transfusions. In general, Navajos do not.

    Organ transplantation, both donating and receiving, is generally allowed. There is a special
    effort to get Native Americans to sign up as donors due to difficulty in matching tissue. In

    general, Navajos do not allow organ donation.




    Circumcision of male infants is infrequent.

    Sanctity of life is a high value but abortion practices vary.

    Maintaining a terminal patient on artificial life support for a prolonged period in a vegetative
    state is not encouraged. At the end of life, prayers may be said and family is encouraged to

    be present.




    Autopsy is not encouraged among traditional people. However, it is permitted if required by
    law. Modern families may desire autopsy for health care information.

    MEDICAL & NURSING CARE



    Respecting Traditions


    Greet with a gentle handshake. Do not look straight in the eyes, especially Elders. Hugs

    and touching are rarely done. Do not initiate.




    At the time of admission ask the person about their tradition and do not be in a hurry.

    Listen to the patient as they explain about their tradition and their needs. Look for ways to
    be sensitized to their beliefs.
    For those who speak their traditional language, ask if they need a translator.




    Native Americans are a modest people. Try to be sure their bodies are not exposed to

    others.
    When possible, provide male doctors and nurses for male patients and female doctors and
    nurses for female patients.




    Show respect for all family members. Treat all with kindness.


    In most native societies “intelligence” is measured by one’s ability to listen and hear and

    understand rather than one’s ability to ask “smart” questions. Do not interrupt…your
    question may well be answered if you listen. If someone shares personal stories etc. with
    you – they are for you and you alone. Do not speak about these to others.




    Many people have items that they consider sacred. They may be stones, feathers, antlers,

    fur, claws, or pouches of cloth or leather. Do not touch sacred items. In an emergency,
    keep sacred items with the patient when at all possible.


    A woman’s moon time (menstrual cycle) is considered an important time of power.

    A woman may not participate in some ceremonies “on her moon.”




    When a family is having a ceremony performed – leave the room and provide privacy

    unless the family asks you to stay. Providing a room for ceremonial purposes would be
    helpful and afford families with their needed privacy.




    Ask permission before taking any photographs. If taking X-Rays, CT-Scans, MRI’s or any

    other type of imagery take time and explain the procedure.




    If the person is in need of an amputation of a body part, ask what their tradition is and what

    they may require afterwards for the body part that is removed. Some may request that the
    body part be blessed and then followed by cremation in order to be buried with them at the
    time of death or they may need it to be buried soon after the surgery if the body part is not
    being cremated.



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    Pain Management
    Patients may deny their pain, or decide not to talk about it because it is hard to accept that
    their bodies are failing them.

    Patients may also be afraid of becoming addicted or be sensitive to medicines. Take time
    to explain healing can be quickened if pain is managed.

    Talk with the patient to find out their preference for managing their pain; pain management
    can be managed at the hospital and/or at home.

    If the patient is dying they may want to go to the Creator with a clear and open mind.

    Patients may not believe in medication due to their belief that the Creator will heal them
    through traditional healing practices.

    Care of The Elderly
    Elders are respected and treated with honor within the Native American society. They are
    respected as teachers, the purveyors of tribal history and lore, and for their advice. They are
    seen as people who have a great amount of wisdom and knowledge, which they share with
    others of all ages. Their presence is not taken for granted or just tolerated but relished and
    enjoyed. This is a natural part in all Societies. The Native Americans take this special attitude
    and use it to its fullest extent. Caring for the elderly in their homes is seen as important and as
    a necessary part of life. The children are then given a gift of wisdom, love and the freedom to
    play and dream with a person who does not care how foolish they act for only they can see
    how wonderful and sometimes short life can be. Children and Elders are supposed to be
    together. It is through our Elders that individuals are taught the full circle of life, which includes
    death.
    If the patient needs care at home after being in the hospital, family members should be trained
    to take care of the patient. Time should be taken to explain the procedures, utilizing hands-on
    experience in order for the family member to make sure they fully understand the process.
    SPIRITUAL CARE/PRAYERS
    Sacred Objects/Healing Rituals
    A Medicine bundle, medicine bag
    is a collection of objects with sacred meaning and spirit
    power, which is wrapped in an animal skin or in a cloth. All of the items are in some way
    connected to the creation; these items may include shells, stones, crystals, feathers, and/or
    tobacco. The medicine bundle/bag may belong to an individual, the family or it may be the
    sacred object of a tribe or clan. These bundles are to be treated with great respect. If given a
    bundle for safekeeping it is both a great honor and a grave responsibility.
    Other sacred objects from tribes have significant spiritual significance. Examples of these are:
    the sacred pipe of the Lakota; the Pueblo peoples of the Southwest prepare paho, sacred
    prayer sticks that are carved and decorated with stones, shells, and feather; the Huron and
    Hopi use masks and these are worn in sacred dances; tobacco, sage, sweet grass for
    purification; feathers and medicine wheel for lifting up of prayers; and medicinal plants and
    herbs are gifts from the spirit world to be used in healing. There are over 400 species of wild

    plants, which can be used for medicinal use.

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    Smudging with sage, cedar, and sweet grass
    may be desired. To smudge is to spread the
    smoke of burning herbs over a person, space, or object for purification. The smoke carries
    prayers to Creator. This ceremony usually involves a feather or fan. If smoke is not allowed,
    smudging the oils for sage, cedar and sweet grass may be used as a substitute.

    Tobacco ties
    are small cloth bundles that contain tobacco, which can be given as a sign of
    friendship, tied on a string, or tied on a branch to carry prayers. The making of these prayer
    ties is an act of prayer.

    Feather ceremonies
    might involve the sweeping of a person or body with feathers, the tying
    on of feathers, or the handling of feathers in prayer.

    Face painting
    may be a part of a ceremony to prepare a person for surgery or death, or may
    be a part of the care of the body after death.

    Healing herbs, oils, roots
    are often used for spiritual and emotional healing as well as a part
    of the treatment of the physical condition. Physicians are encouraged to consult with the
    Native American practitioner to integrate these treatments.

    Fetishes
    are objects representing the power of animal spirits, which can assist in healing.
    Many persons find special strength from a particular animal or their “totem.”

    Pipe ceremony
    may be performed by a spiritual leader either in the hospital or outside on
    behalf of the patient. When possible, arrangements should be made for the pipe to be smoked
    with the patient. If the patient can be moved out of doors this is preferable. When conditions
    do not allow smoke near a patient, the spiritual leader may have the patient pray with the
    tobacco and the pipe before going to smoke it elsewhere.

    Chantways and songs with drum or rattle
    are a daily part of healing for many Native
    Americans. The visit by tribal singers is emotionally very healing for the patient. A patient may
    have an audiotape of a prayer song they will want to hear regularly. The drum represents the
    heartbeat of mother earth. The sound of the heartbeat is the first sound that people hear when
    he or she is in their mother’s womb. The shaker or rattle is associated with medicine
    ceremonies. When patients are in coma or near death, hearing is often the one sense that
    remains. The sound of the drum or shaker is associated with healing prayers and will reassure
    the patient that they are not alone, nor forgotten.

    Medicine lodge or inipi lodge
    is a purification ceremony that takes place in a special “sweat
    lodge.” It involves prayers and the calling of spiritual ancestors for help. This ceremony may be
    requested before a medical treatment such as surgery. If the patient is unable to participate,
    the spiritual leader may perform this ceremony on their behalf.

    Crystals and sacred stones
    may be used as part of healing. Crystals may be laid on a
    person’s body, or may be held for prayer. Sometimes a crystal is prayed with in the four

    directions in place of the pipe. Sacred stones may be held in prayer.

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    DIET/FOOD PREFERENCE & PRACTICES
    Fasting is a traditional part of preparation for rite of passage ceremonies and for spiritual
    discernment. Although a person who is ill should be encouraged to eat, family members and
    others may be fasting on behalf of the person. Sometimes fasting is a part of body healing, as
    a cleansing of toxins.
    Native Americans have preference for certain traditional foods during ceremonial times. These
    may be requested, especially particular teas. When preparing a special diet, (such as for
    diabetics or heart conditions), utilize traditional food recipes and then adapt or change recipes
    to fit the dietary requirements.
    BEGINNING OF LIFE CARE
    As children come into this world it is recognized that this is the beginning of the cycle of life.
    Throughout the child’s life each will go through the cycle of life, such as: birth, naming,
    childhood, adolescence, marriage, child rearing, old age, and death. All stages of life are
    valuable. There are a vast number of rituals that mark the passages from one stage of life to
    another help to keep the individual on the path and to bind them to their family and their
    community. The path of life is a spiritual journey, not just a physical one. The ceremonies
    marking life’s passages vary widely from tribe to tribe, however most groups value each stage
    of life and mark it with ritual and celebration. At the beginning of life there are a variety of
    traditions and these may include:
    The use of herbs and teas during labor.

    The help of a midwife.

    The presence of family members, spiritual leaders.

    The saving of a length of the umbilical cord, which is then added to a sacred bundle. This
    bundle is kept by the child for a lifetime as a connection to the mother and to mother earth.

    Saving of the placenta.

    Singing a special song to the child at time of birth.

    Burning incense and smudging the newborn.

    END OF LIFE CARE
    Native Americans do believe that death is natural and necessary in the circle of life. They may
    vary the beliefs as to how long it may take for ones souls to travel from ones body here on
    earth to the final joyous reunion with our Creator. There may also be various beliefs as to what
    if any objects are needed to make ones Spirit journey and what needs to be done to the body
    left behind.
    A patient who is nearing death often reports visits and conversations with deceased relatives.
    Usually the patient will request traditional foods and it is very important that the family obtain
    these foods for the patient so that they are ready for their journey. Native Americans use food
    to honor the dying and deceased where other people may use flowers. Patients may also
    request special prayers from their tradition and if they are Christian they may also want to have
    their pastor or priest present.

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    DIET/FOOD PREFERENCE & PRACTICES
    Fasting is a traditional part of preparation for rite of passage ceremonies and for spiritual
    discernment. Although a person who is ill should be encouraged to eat, family members and
    others may be fasting on behalf of the person. Sometimes fasting is a part of body healing, as
    a cleansing of toxins.
    Native Americans have preference for certain traditional foods during ceremonial times. These
    may be requested, especially particular teas. When preparing a special diet, (such as for
    diabetics or heart conditions), utilize traditional food recipes and then adapt or change recipes
    to fit the dietary requirements.
    BEGINNING OF LIFE CARE
    As children come into this world it is recognized that this is the beginning of the cycle of life.
    Throughout the child’s life each will go through the cycle of life, such as: birth, naming,
    childhood, adolescence, marriage, child rearing, old age, and death. All stages of life are
    valuable. There are a vast number of rituals that mark the passages from one stage of life to
    another help to keep the individual on the path and to bind them to their family and their
    community. The path of life is a spiritual journey, not just a physical one. The ceremonies
    marking life’s passages vary widely from tribe to tribe, however most groups value each stage
    of life and mark it with ritual and celebration. At the beginning of life there are a variety of
    traditions and these may include:
    The use of herbs and teas during labor.

    The help of a midwife.

    The presence of family members, spiritual leaders.

    The saving of a length of the umbilical cord, which is then added to a sacred bundle. This
    bundle is kept by the child for a lifetime as a connection to the mother and to mother earth.

    Saving of the placenta.

    Singing a special song to the child at time of birth.

    Burning incense and smudging the newborn.

    END OF LIFE CARE
    Native Americans do believe that death is natural and necessary in the circle of life. They may
    vary the beliefs as to how long it may take for ones souls to travel from ones body here on
    earth to the final joyous reunion with our Creator. There may also be various beliefs as to what
    if any objects are needed to make ones Spirit journey and what needs to be done to the body
    left behind.
    A patient who is nearing death often reports visits and conversations with deceased relatives.
    Usually the patient will request traditional foods and it is very important that the family obtain
    these foods for the patient so that they are ready for their journey. Native Americans use food
    to honor the dying and deceased where other people may use flowers. Patients may also
    request special prayers from their tradition and if they are Christian they may also want to have
    their pastor or priest present.

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    The body should not be moved until the family has been consulted about their particular
    tradition. Special clothing may be brought to dress the body in before it leaves the hospital, or
    the family may request that their loved one be covered at the time of death by a blanket.
    Particular ceremonial objects may be placed on the body. It is often customary for a family
    member or the spiritual leader to cut a piece of hair from the deceased. This is for some tribes
    especially important at the death of a child.
    Traditional persons do not generally desire embalming, and may require significant lengths of
    time to be with the body. Traditional families may wish to have the body near them for as long
    as 4 days.
    It is critical to talk to the family about their particular tribal tradition. For example, Navajo
    people destroy the clothes and possessions of the dead person and are careful never to speak
    the person’s name because to do so might attract his/her wandering ghost or spirit. On the
    other hand, some tribes will make special ceremonies of giving away the deceased persons
    possessions and will repeatedly speak the name of the person after death as part of ceremony.
    RESOURCES/REFERENCES
    A Native American Theology. Kidwell and Tinker. Orbis books, 2001.
    Coyote Medicine. Lewis Mehl-Madrona, MD. Scribner, 1997.
    God is Red. Vine Deloria, Jr. Fulcrum Publishing, 1994.
    Gospel of the Red Man. Complied by Ernest Thompson Seton and Julia M. Seton. Nature
    Graph, 1937.
    Green Grass Pipe Dancers. Lionel Little Eagle. Nature Graph, 2000.
    Native American Religions


    . Sam D. Gill. Wadsworth Publishing Co., 1982.
    Native American Religious Identity, Unforgotten Gods. Jace Weaver, Ed. Orbis Books, 1998.
    Native American Religions. Paula R. Hartz. Facts on File Inc., 1997.
    One Church Many Tribes. Richard Twiss. Regal Pub., 2000.
    Scalpel and the Silver Bear. Lori Arviso Alvord, MD. Phantom, 1999.
    For further assistance, contact:
    Sr. Patricia Mulkey
    Anawim Center
    4750 N. Sheridan
    Chicago, IL 60640
    Ph. and Fax 773-561-6155
    Email:

    mulkepa@yahoo.com
    Rev. Michelle Oberwise Lacock
    Advocate Health Care
    Guidelines-Native American/9
    2025 Windsor Drive
    Oak Brook, Ill. 60523
    Ph 630-990-5637
    Fax 630-990-4759
    Email:

    michelle.lacock@advocatehealth.com
    Ken Scott, Executive Director
    American Indian Health Service of Chicago, Inc.
    4081 N. Broadway
    Chicago, Illinois 60613
    Ph. 773-883-9100
    Ph. 773-883-0005
    Email:

    scottaihsc@aol.com

    The Metropolitan Chicago Healthcare Council wishes to acknowledge the technical assistance
    of Rev. Carol Lakota Eastin, Joan Resitich, Phyllis Ballard, Starr Bressette, Sister Pat Mulkey,
    Rev. Michelle Oberwise Lacock and the many Elders that have assisted in the preparation of
    this document. A deep heart felt thank you goes out to them. They are the greatest resource.
    Approved by the Committee on Clinical, Administrative, Professional & Emergency Services – 11/04/2004

    © Copyright 2004 Metropolitan Chicago Healthcare Council

    Last edited by cougarnurse; 06-14-2013 at 09:57 AM.

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