Good article: http://www.minoritynurse.com/america...g-wounded-past

“Just being born American Indian brought me into the legacy of harm and poor health,” asserts Roxanne Struthers, RN, PhD, CTN, assistant professor at the University of Minnesota School of Nursing in Minneapolis and president-elect of the National Alaska Native American Indian Nurses Association (NANAINA). “I have seen in my family the effects of disease--TB and other epidemics with no resistance and little or no treatment. And not only disease [but also cultural loss]. My mother’s first language was Ojibwe; she was beaten when she spoke it, then her only language, at a rural reservation school. Later, she would not allow us to speak it at home. Now as a nurse, all the diseases I encounter every day [in Indian patients]--alcoholism, drug dependence, diabetes, overeating--I see as parallel to my own life. Some younger nurses may not be as aware of this at first, but it will resonate when they hear the history.”

“That’s when I started to see--and later I started to hear more,” recollects Lillian Rice, a Forest County Potawotami Tribe Native practitioner and alcohol/drug counselor, born in backwoods Star Lake, Wisc., and now living in Minneapolis. Then only 17 years old (in 1949), she linked the negative behavior of a close family member sinking into alcoholism with what she had heard earlier as a child from her grandmother. The grandmother had told of TB epidemics and children’s deaths, of scarlet fever quarantining with confiscation of Native ceremonial paraphernalia, of relocation without treatment or recompense, of going back home and finding the old estate burnt down by the U.S. government. Other family members brought forth painful memories from boarding school days of horsewhipping and humiliation.

“That’s when I decided to become a healer,” says Rice, who leads women’s sweat lodges and women’s spiritual gatherings. “After raising my five children and getting into chemical dependency work, I made a decision with a promise to the Great Spirit to be there for [Indian] women in honor of my grandmother.”

“If you are Native and born into a Native family, your community’s past is a part of who you are,” attests John Lowe, RN, PhD, a faculty member at Florida Atlantic University’s College of Nursing in Boca Raton and a researcher/designer of Native American teen interventions to prevent and reverse substance abuse and reduce HIV/AIDS risk. “I was raised in a Cherokee farming community in the Southeast and went to school there,” he says. “My father, now 80, would have had to go to boarding school, so he didn’t go to any school. He was needed on the farm and his parents did not want their kids taken away. [I used to wonder,] why didn’t my father have the problems we see so often [in Indian communities], such as alcoholism and diabetes? Why was he OK? When I went away to attend a college nursing program in the 1970s, I took with me that vision of my father. He knew who he was: Cherokee, with traditions, values and beliefs. He faced many barriers, but something within him was very grounded and centered, and that kept him OK. If we [as nurses] could understand it, that is what we should promote.”

These Native American health practitioners are describing historical trauma. Although of recent coinage as a term, its devastating effects on the physical and mental health of American Indians and Alaska Natives have been documented for decades. Native healers, with their feeling for root causes, have tapped traditional spiritual resources to help put their families and communities back on a path to recovery. Now, working right in the mainstream of Western health science, leading Indian health professionals and researchers have given the concept a scientific name and a place for testing in their disciplines. The literature is now packed with empirical clinical evidence and qualitative data. Promising new models of care are emerging.

And today at the front lines, strategically positioned to put these models into practice, are Indian nurses. Their recognition of who they are and what they do has inspired a call to action for Native nurses: to recognize the critical role they can play in helping their people begin the process of healing from the harms of historical trauma.

Connecting, Listening, Empowering

How does the healing start? For Native nurses, it begins with knowing yourself, your community and your common past.

“First, heal yourself,” urges Struthers. “The healing of one is the healing of all. Then you can share [with patients]. It does ripple out. You can reassure your patients by saying, ‘You are not unusual, you are not alone.’ History lessons are OK, too.”

Rachel Wright, RN, BSN, a master’s student in the nurse practitioner program at the University of Oklahoma College of Nursing in Oklahoma City, talks in terms of empowering patients.

“In fact, I think that’s the main thing nurses can do,” says Wright, whose father is Cherokee. “I agree that I see many Native American patients with social problems associated with physiological problems, but I believe that some of those are related to the self-esteem issue, lack of knowledge and lack of confidence to make lifestyle/behavioral changes that impact their health status. Any patient who feels like a failure and does not understand the problem most likely will not comply with the treatment plan. The nurse or nurse practitioner must help patients learn appropriate knowledge and skills to help themselves.”

To get compliance and accurate information from your patients, make sure the communication connection is two way, advises Lea Warrington, RN, BSN, manager of the Gerald L. Ignace Indian Health Center, an urban Indian Health Service facility in Milwaukee. Warrington, who is of Menominee Indian heritage and visits the reservation frequently, often finds out what’s really going on with her patients--as opposed to what’s in the clinic record--when she encounters them on their own “turf.”

Communication failure may come from passivity or not wanting to cause conflict, Warrington warns. Take the case of a 72-year-old patient whose daughter found all his medication bottles unopened in his medicine cabinet. The patient’s record at the clinic showed that he had very literally answered “yes” when asked whether he had filled his prescriptions and “no” as to whether he “had any problems with them.”

Often, after patients leave the facility, Warrington hears complaints about the way the clinic works, or about problems with service, that never showed up on the returned patient satisfaction surveys (usually checked off as “excellent”). “Outside the clinic, even though I work there, patients open up because we are in our own common setting, such as the elderly center, the school or on the street,” she explains.

Native nurses who work within the mainstream Western health care system face a paradoxical challenge, Warrington adds. “I believe that Native patients appreciate that Natives work in health care centers,” she says. “But I think, though, that sometimes we end up having to prove that we can provide as good service as non-Natives. It’s an odd situation to be in, because of the way Native people perceive the overall health care system as not being Native-friendly.”