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Cultural Influences on Nursing Care

Native American Middle-Aged Men

Erikson's Midlife Stage

Generativity vs. Stagnation (Ages 45-64)

Cultural competence in nursing improves care quality for diverse populations.

NURS 320 Adult Health II
8 Team Members
2025 AdventHealth University
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Team Members & Research Areas

AnaLucia Diao
Health Disparities in AI/AN Midlife Men
Brooke Thomas
Traditional Healing & CAM Practices
Chanel Campbell
Health Beliefs & Values
Charlene Fana
Family Roles & Decision-Making
Mathew Moslow
Gender Considerations in Care
Matteo Testa
Religious/Spiritual Influences
Melanie Rodriguez
Diet and Nutrition Impacts
Shanique Wilson
Special Considerations & Summary
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Why Culture Matters in Healthcare

Historical Context

  • Centuries of adversity: colonization, forced removal, boarding schools
  • Intergenerational trauma and healthcare mistrust
  • Impact on current healthcare seeking behaviors

Cultural Awareness Need

  • Respect and holistic wellness central to care
  • Non-eye contact = respect, not noncompliance
  • Silence reflects thoughtful communication

"Middle-aged Native American men are in Erikson's 'Generativity' stage, striving to care for family and community despite health challenges. Culturally competent nursing can support their roles and improve outcomes."

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Health Disparities: Where are the Gaps?

5.5 years Shorter life expectancy than U.S. average
3x Higher diabetes incidence vs. whites
#1 Heart disease leading cause of death

Contributing Factors

  • Socio-economic factors: Poverty, limited healthcare access
  • Historical factors: Discrimination, education gaps
  • Lifestyle shifts: Processed foods replacing traditional diets
  • Geographic barriers: Rural isolation, transportation challenges
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Complementary & Traditional Healing: Blending Old & New

Medicine Men & Healers

Tribal healers use rituals, prayer, and herbal remedies alongside Western medicine. Show respect and collaborate when appropriate.

Smudging & Purification

Burning sacred herbs (sage, cedar, sweetgrass) for spiritual cleansing. Many hospitals now accommodate these practices.

Sweat Lodges

Steam bath ceremonies for detoxification and spiritual healing. Consider medical conditions when discussing participation.

Herbal Medicine

Traditional plants for healing. Always ask about herbal supplements to check for drug interactions.

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Health Beliefs & Values: Holistic Worldview

The Medicine Wheel

Balance of Physical • Emotional • Mental • Spiritual

1
Holistic Health: Illness seen as imbalance requiring attention to body, mind, spirit, and community connections.
2
Spiritual Connection: Health tied to relationship with Earth, Creator, and ancestors.
3
Communication Style: Value silence, thoughtful responses, and non-confrontational interaction.
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Family & Decision-Making: It Takes a Village

Extended Family Involvement

  • Health decisions are family affairs
  • Multiple relatives provide input
  • Welcome and involve support system

Elder Hierarchy

  • Elders' opinions carry great weight
  • May need elder approval for procedures
  • Facilitate family consultations

"In a collectivist culture, decisions are made in the context of 'What is best for the family or tribe,' not just the individual."

💡
Nursing Tip: Frame treatment benefits in terms of family support: "This treatment will help you stay strong to continue supporting your family."
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Gender Considerations: Men's Roles & Preferences

Stoicism & Expression

Men may under-report pain as expressing it is seen as weakness. Observe non-verbal cues and explain how pain management aids recovery.

Provider Preferences

Some prefer same-gender providers for intimate care. Offer choices when possible and maintain dignity during procedures.

Role Identity

Illness threatens provider/protector role. Empower through involvement in care decisions and acknowledge their family responsibilities.

Communication Approach

Build rapport through neutral topics first. Be direct yet respectful. Allow time for thoughtful responses.

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Religion & Spirituality: Healing the Spirit

Spiritual Practices in Healthcare

🙏
Syncretism: Many practice both traditional Native spirituality and Christianity
🎵
Ceremonies: Bedside rituals, prayer circles, healing songs, drumming
📿
Sacred Items: Medicine bags, feathers, herbs - never remove without permission
Taboos: Avoid direct death talk; focus on positive outcomes and healing

"Spirituality is a pillar of health. Embracing religious and spiritual needs can transform a clinical encounter into a truly healing experience."

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Diet & Nutrition: You Are What You Eat

Traditional vs. Modern Diet

  • Traditional: Lean proteins, vegetables, fruits, nuts, corn, beans, squash
  • Modern: Processed foods, refined sugars, commodity foods
  • Impact: Spike in diabetes and obesity rates

Culturally Relevant Nutrition

  • Frame as "return to tradition"
  • Respect traditional foods while promoting moderation
  • Acknowledge food desert challenges
  • Involve family in dietary changes
🌽
Food as Medicine: Indigenous cultures view food itself as medicine - berries for immunity, herbal teas for ailments
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Special Considerations: Trust, Communication & Access

Building Trust

  • Acknowledge historical mistrust
  • Be transparent and consistent
  • Keep small promises
  • Own mistakes immediately

Communication Nuances

  • Storytelling as communication
  • Use of humor for coping
  • "Yes" may mean "I hear you"
  • Provide multiple communication avenues

Access Barriers

  • Geographic isolation
  • Limited transportation
  • Financial constraints
  • IHS coverage complexities

Solutions

  • Utilize telehealth when possible
  • Coordinate with local IHS clinics
  • Involve Community Health Reps
  • Connect with cultural liaisons
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References (2019-2025, APA 7th ed.)

  1. Caso Vega, L. E. (2025, Mar 19). From history to healing: A guide for nurses caring for Native Americans. AACN Bold Voices Blog. American Association of Critical-Care Nurses.
  2. AORN. (2021, Dec 3). Native American patients: 6 considerations for culturally sensitive care. Association of periOperative Registered Nurses Journal.
  3. Indian Health Service (IHS). (2019, Oct). Indian health disparities [Fact sheet]. U.S. Department of Health & Human Services.
  4. Office of Minority Health (OMH). (2025, Sep). American Indian/Alaska Native health profile. U.S. Department of Health & Human Services.
  5. San Roman, N. (2024, Nov 25). Native American Heritage Month: UNM Health's commitment to culturally respective care. UNM HSC News.
  6. Furst, J. (2023, Aug 9). Smudging brings comfort to Native American patients at Mayo Clinic. Mayo Clinic News Network.
  7. Cherry, K. (2025, Sep 26). Generativity vs. stagnation in psychosocial development. Verywell Mind. (Reviewed by D. Susman, PhD)
  8. Sturycz, C., et al. (2015). Expression of pain among Mi'kmaq children… (Abstract 292). The Journal of Pain, 16(4), S49.
  9. English, S. (2016). They changed the world! A tribute to the tribal participants of the Diabetes Prevention Program… (Poster). CDC & IHS Native Diabetes Wellness Program.
  10. Sherman, S. (2017, Oct 18). This healthy diet has stood the test of time. Bon Appétit Magazine.