A Synopsis of Cree

Culture

With Implications for Nursing Assessments

"ka-kí-kiskéyihtétan óma, namoyakinwés maka aciyowés pohko óma ótaka-hayayak wasétam askihk, ékwa ka-kakwéy miskétankiskéyihtamowin, iyinísiwin, kistéyitowin, mina nánisitotatowin kakiyaayisiniwak, ékosi óma kakiya ka-wahkotowak."

Realize that we as human beings

have been put on this earth for only a

short time and that we must use this

time to gain wisdom, knowledge,

respect and the understanding for all

human beings since we are all

relatives.

http://www.sicc.sk.ca/archive/heritage/sils/ourlanguages/plains/eldersquotes/index.html

A study recently published in the journal Nature reports that present day aboriginal peoples of Canada have clear genetic links to Palaeolithic Europeans.

How that came to be can be debated.

The Nature study argues that ancestral Europeans intermingled as they wandered eastward through Asia and Siberia. Near the end of the last ice age (about 13,000 years ago), successive waves of migrants began to transit the “Bering Land Bridge” to Alaska.

They could be the ancestors of hundreds of aboriginal nations that then spread throughout the Americas.

http://news.nationalpost.com/2013/12/02/surprise-dna-profile-linking-24000-year-old-siberian-skeleton-to-modern-native-americans-could-rewrite-first-nations-story/

A well rounded introduction to the historical presence of First Nations in what would become Canada can be found online at...

http://www.aadnc-aandc.gc.ca/eng/1307460755710/1307460872523#chp2

Aboriginal Affairs and Northern Development Canada is a key player in the wellbeing of First Nations people.

AANDC

Visit the AANDC website and wander through the links “All Topics” and “About AANDC”

The mandate of this governmental department is built on the premise that, “Canada's economic and social well-being benefits from strong, self-sufficient Aboriginal and northern people and communities.”

AANDC

They go on to write – “(AANDC) supports Aboriginal people (First Nations, Inuit and Métis) and Northerners in their efforts to: improve social well-being and economic prosperity; develop healthier, more sustainable communities; and participate more fully in Canada's political, social and economic development - to the benefit of all Canadians.”

AANDC

Reconciliation from our colonial past will likely see an ongoing evolution of terminology.

Language that was regarded as acceptable in previous centuries may be seen as politically incorrect now. The AANDC website provides a brief tutorial on the history and use of some relevant terms.

http://www.aadnc-aandc.gc.ca/eng/1100100014642/1100100014643

No discussion of the history of First Nations in Canada can ignore the tragic legacy of residential schools. It still haunts many individuals and continues to impact their health and the wellbeing of their communities.

“Two primary objectives of the residential school system were to remove and isolate children from the influence of their homes, families, traditions and cultures, and to assimilate them into the dominant culture. These objectives were based on the assumption Aboriginal cultures and spiritual beliefs were inferior and unequal. Indeed, some sought, as it was infamously said, “to kill the Indian in the child.” Today, we recognize that this policy of assimilation was wrong, has caused great harm, and has no place in our country.”

Prime Minister Stephen Harper, official apology, June 11, 2008

The remainder of that website explores the tragedy of residential schools in detail.

http://indigenousfoundations.arts.ubc.ca/home/government-policy/the-residential-school-system.html

In my mind, it would be wise for nursing assessments to routinely ask Native clients if they feel residential schools impact their current health in any way.

If they feel there are residual effects –further exploration can begin. The resulting discussions could, if nothing else, begin a work towards reconciliation.

Religion

Animism - anthropologist Sir Edward Burnett Taylor (1832-1917) defined it as the "theory of the universal animation of nature," from Latin anima "life, breath, soul".

http://www.etymonline.com/index.php?term=animism

Animism is common among many of the world’s hunter-gatherer peoples and is one of the oldest religious beliefs. Its most basic tenet is that all things are endowed with souls or spirits. Subsequent to that central belief some tribes believe certain spirits or characteristics empower particular animals and that those characteristics can be passed on to individuals via totems or fetishes.

http://www.warpaths2peacepipes.com/native-american-culture/fetishism.htm

http://www.warpaths2peacepipes.com/native-american-culture/native-american-religion.htm

Since the earliest European contact there has been a Christian missionary outreach to the native inhabitants found here. Catholic and Anglican powers vied for influence as early factions within Canadian politics waxed and waned. The most profound religious impact would begin in the 19th

century with the indoctrination of children forced to attend residential schools administered by various churches.

The resulting mosaic of religious/cultural beliefs within most Aboriginal people means that no one can assume that a First Nation client must embrace a particular belief. Individual beliefs must be determined on a case by case basis. Even within families belief systems can vary profoundly from simple animism to more formalized traditional ceremonies to “high church” adherence to modern evangelicalism. And even if an individual self-identifies with a particular group they may well embrace aspects of other traditions depending on the circumstance.

Do not make assumptions about what a First Nations client must believe or how they choose to worship...

The participation in “sweats” exemplifies the above polychotomy. For the more traditional participants, led by a ceremonial leader, it invites openness to a spiritual realm where spirits can advise on life choices or facilitate healing. At the other end of the spectrum others may see it as a healthy, social endeavor akin to using a sauna.

http://voices.yahoo.com/inipi-history-meaning-sweatlodge-370823.html?cat=34

Faced with a wide array of traditions it would be wise for institutions to be proactive and enact well conceived policies before they are needed. Issues like allowing pipe ceremonies or smudging in a client’s room ought to be decided ahead of time. At some point someone will ask if we would consider allowing a person’s medicine bag to accompany them into the operating room. If institutions attend to the issues in a culturally safe manner then consistent application can be observed for all clients.

There are many other traditions and observances which also draw in a wide range of religious or cultural beliefs. Interested readers can discover more at the following link.

http://www.rcmp-grc.gc.ca/pubs/abo-aut/spirit-spiritualite-eng.htm

TraditionalMedicine

Holistic health is the foundational understanding of wellbeing among First Nations people. Sickness is rarely viewed as a condition solely of the body – it signals an imbalance among all systems.

The “medicine wheel” is a graphic reminder that balance must be maintained between physical, emotional, mental and spiritual.

Many native people foster abiding ties to their traditional lands, the indigenous foods found there and the herbal medicines gathered from them. Living away from their reserve, eating “white” foods and relying on western medicine are often seen as the root of many problems facing Native people.

During initial nursing assessments clients may deny using any traditional forms of medicine because they have been repeatedly told by non-natives that they are useless, dangerous or sinful. Only a culturally sensitive approach will initiate a helpful discussion.

A non-judgemental focus on whether a treatment is effective rather than a dismissive superiority will promote openness. Asking the client if they are using any traditional medicines that they find helpful comes across as caring and accepting. From there the nurse can reinforce that medicine is medicine and that both traditional and western forms should be used with cautious respect.

“Traditional medicines and practices remain an important part of the lives of Inuit, Métis and First Nations in Canada. A report conducted for the Ontario Women’s Health Council in 2003 indicates that of 276 Aboriginal women respondents, 72.1 per cent reported consulting traditional healers, and 42.0 per cent sought out the services of medicine people. Even in an urban setting, a significant number of Aboriginal Peoples access traditional medicines. According to the 2001 Aboriginal Peoples Survey, about 34 per cent of Aboriginal people living in urban areas had access to traditional medicines.”

“Traditional medicines and practices remain an important part of the lives of Inuit, Métis and First Nations in Canada. A report conducted for the Ontario Women’s Health Council in 2003 indicates that of 276 Aboriginal women respondents, 72.1 per cent reported consulting traditional healers, and 42.0 per cent sought out the services of medicine people. Even in an urban setting, a significant number of Aboriginal Peoples access traditional medicines. According to the 2001 Aboriginal Peoples Survey, about 34 per cent of Aboriginal people living in urban areas had access to traditional medicines.”

http://www.naho.ca/documents/naho/publications/tkOverviewPublicHealth.pdf

It is also important to note here that tobacco is considered a sacred plant. As such it is may be given as a symbolic gift in certain circumstances. Tobacco use remains far more common among Aboriginals than in the broader Canadian population. A dictatorial attitude coming from a health worker will only impinge on any helping relationship

Birth, Deathand Dying

Two influences can profoundly limit discussion of pregnancy or gynecological concerns with a Native client - general taboos against discussing sexuality plus the sacredness of motherhood in general and of the womb specifically. Consequently, the health of aboriginal women and their children can be negatively impacted. Add in the tenuous access to specialists and even physicians in isolated communities and there can be tragic lack of examinations, diagnoses and treatments. Too often a delayed assessment will uncover a health concern that has progressed to dreadful stages

http://www.collectionscanada.gc.ca/obj/s4/f2/dsk4/etd/MQ81349.pdf

A wealth of information related to maternal and child health on First Nations can be found at the following link...

http://www.pwhce.ca/program_aboriginal.htm

“When dying, a traditional person will call for theceremonies, medicine and prayers that will guidehis/her spirit back to the spirit world. A spiritual leader or medicine person close to the dying person will conduct the ceremonies. As many family and clan members as possible will be present...”

http://www.cme.utoronto.ca/endoflife/PPT Indigenous Perspectives.pdf

“Traditionally, it was women who washed and dressed the body in preparation for its burial. Women also made the moccasins which are placed on the feet. Sweetgrass, our sacred and purifying plant is placed in the right hand of the deceased. Tobacco, the instrument to aid communication between the Creator and ourselves, is also placed in the casket. As well, personal property, especially the deceased person's pipe, is left with the body as these articles are, in essence, part of the person.”

www.sicc.sk.ca/archive/saskindian/a89mar11.htm

SocioeconomicFactors

Various social and economic factors directly impact the health of First Nations people...

Overcrowded housing

Various social and economic factors directly impact the health of First Nations people...

Lack of educationalresources

And the underemployment that follows

Various social and economic factors directly impact the health of First Nations people...

Issues of addiction

Various social and economic factors directly impact the health of First Nations people...

Food insecurity

Various social and economic factors directly impact the health of First Nations people...

Health service unavailability...

Various social and economic factors directly impact the health of First Nations people...

All of those issues will have an insidiouseffect on a persons wellbeing

A client assessment on an isolated reserve could uncover circumstances more common to third-world nations.

http://www.nccah-ccnsa.ca/docs/social%20determinates/nccah-loppie-wien_report.pdf

Treaty Entitlements

Specific articles of established treaties – in particular the “medicine chest” clause of treaty number six, extend certain entitlements to some First Nations people.

“To support First Nations people and Inuit in reaching an overall health status that is comparable with other Canadians, Health Canada's Non-Insured Health Benefits (NIHB) Program provides coverage for a limited range of these goods and services when they are not insured elsewhere.”

http://www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/index-eng.php

http://www.pwhce.ca/pdf/entitlementsHealthServices.pdf

Questions about why a status Indian receives some coverage not afforded other Canadians requires extreme tact.

Predominant Present Health

Concerns

“The drastic changes that have occurred over the past 130 years have led to disproportionately high incidences of preventable disease among First Nations...

“For example, some First Nations have diabetes rate 40 percent higher than the rate of the general population...”

“Additionally, First Nations populations have higher levels of injuries such as motor vehicle crashes, as one of the leading causes of injury and death...”

“First Nations peoples have higher rates of arthritis; high blood pressure; diabetes; asthma; heart disease; cataracts and chronic conditions...”

“Food insecurity is a major issue and a precursor to many health problems such as malnutrition, low birth weight babies, unhealthy pregnancies and poor health in seniors...”

“Deaths due to medically treatable diseases are higher among First Nations than the rest of the population, mainly due to untimely access to medical intervention. Deaths for HIV are higher as are rates of HIV per capita.”

All above quotes are from the following link...

http://www.fnhc.ca/index.php/health_actions/primary_care/

Communication

Direct, extended eye-contact could be interpreted as an attempt at intimidation. Similarly, direct questioning (particularly of an elder or someone you do not know well) is rude because it precludes their ability to answer in a roundabout fashion seen by them as respectful of your right to arrive at your own conclusions.

Respect is paramount – they resist telling someone precisely how something is and reject being told an absolute truth. It is expected that everyone will find their own way to the truth.

That poses a particular challenge to any nursing assessment based on direct questions and the expectation of unambiguous responses.

That poses a particular challenge to any nursing assessment based on direct questions and the expectation of unambiguous responses.

Silence truly is golden among many natives. Elders may pause for awkward amounts of time (by Western standards). It ought not to be interpreted as an opportunity for you to speak as they may be using silence to underscore what they just said. When in doubt – just continue to listen quietly.

http://cosmicserpent.org/uploads/downloadables/Communication%20Styles%20of%20Indian%20People.pdf

Suggested Reading List

•A Guide for Health Professionals Working With Aboriginal Peoples - Cross Cultural Understanding

http://www.cfpc.ca/uploadedFiles/Resources/Resource_Items/Health_Professionals/GuideHealthProfessionalsAboriginal.pdf

•From Intercultural Awareness to Intercultural Empathy

http://www.ccsenet.org/journal/index.php/elt/article/viewFile/9671/6919

•Culturally Competent Care for Aboriginal Women

http://www.naho.ca/jah/english/jah04_02/03_V4_I2_Competent03.pdf

•Stories About Cancer From The Woodland Cree Of Northern Saskatchewan

http://www.collectionscanada.gc.ca/obj/s4/f2/dsk3/SSU/TC-SSU-01042006163028.pdf

•Indigenous Perspectives on Death and Dying

http://www.cme.utoronto.ca/endoflife/Slides/PPT%20Indigenous%20Perspectives.pdf

•Health Determinants for First Nations in Alberta 2010

http://publications.gc.ca/site/eng/367385/publication.html

•First Nations And Inuit Regional Health Survey

http://uregina.ca/library/holdings/FN_Inuit_Health_Survey.pdf

•An Overview Of Traditional Knowledge And Medicine And Public Health In Canada

http://www.naho.ca/documents/naho/publications/tkOverviewPublicHealth.pdf

Allwyn Martens