John is 56 years old, and a member of the Oglala Lakota (Sioux) nation in South Dakota.

He lives with his grandson Taylor in a mobile home on the Pine Ridge Indian Reservation.

Today he arrives at the Indian Health Service Pine Ridge Hospital emergency room with shortness of breath. John walked to the emergency room after attending a traditional sweat lodge, where he became short of breath. The shortness of breath seemed to lessen somewhat after leaving the lodge, but he became concerned as this was the first time this occurred for him during the ceremony.

John has a past medical history of type 2 diabetes and hypertension. He is of normal weight, checks his blood sugar once a week with a glucometer and the readings show he is maintaining control of his blood sugars through his diet. He has been self-employed for most of his life making traditional beadwork and dance regalia for pow-wow dancers, and peace pipes that he sells at pow-wows.

There is high unemployment and a high level of poverty on the Pine Ridge Reservation:         

Key demographic and economic indicators

John is thankful for the traditional Lakota life skills his uncle taught him as he was growing up. While he has no health insurance, he has access to Indian Health Service (IHS) health insurance benefits because he is a resident of the Pine Ridge Reservation and is an enrolled tribal member.

John stays active by attending a senior men’s group for coffee once a week and often attends community lunches at the senior center that are available at no cost for Pine Ridge elders. He has four children who he and his wife of 40 years raised on the reservation. John is grieving the loss of his wife who passed away due to breast cancer one year ago. Two of his children have moved to Sioux Falls, South Dakota, and one to Minneapolis, Minnesota.  He misses his wife greatly as together they were committed to raising their 10-year-old grandson Taylor after his mother, their youngest daughter, died from suicide. John is now raising his grandson alone. Taylor is at home today while John visits the emergency room. He does not own a car and walks to his destinations on the reservation.    

You are the nurse preparing to meet and assess John in the emergency room consultation area.   

Before meeting John, answer the following questions:

1. Describe the Native American sweat lodge and ceremony. What are some health considerations a participant should be aware of before participating in a sweat lodge?
2. John is seeking emergency room (ER) care at the Pine Ridge hospital today. Describe and discuss the IHS health insurance benefits for Native elders.
3. Discuss what you have learned about poverty on this reservation and its likely influence on John’s lifestyle and choices.
4. Describe what you know of the health status of the Pine Ridge Oglala Lakota (Sioux) tribe.  What are primary health concerns and what do you propose could be discussed with John during his visit at the ER today to promote greater health and well-being for him? Where would you go to learn more on these areas of discussion?
5. There is a long tradition of grand families or kinship care in Native America. In this type of care, many potential caregivers and supports in a nurturing network share responsibility for child rearing.  American Indian and Alaska Native children are more likely to live in grand families – families where grandparent/s are raising children without parents in the home, than any other racial or ethnic group. Over two hundred years of US federal policy has threatened this natural kinship structure to assimilate Native Americans into the White culture. The effects persist today as unresolved grief, also referred to as historical trauma. Knowing this background, what would you like to discuss with John and his grandson Taylor who he is raising?
6. After your health assessment you would like to highlight and support John’s strengths towards his future health and well-being. What are areas of strength from what you have learned today?  Give specific examples on dialogue you would choose and what questions you would ask in this conversation. 

Root cause of health inequity

Centuries of US federal policy that has threatened natural Native American kinship and family structure and forced assimilation of Native Americans into the White culture. Also, “…health outcomes for Native Americans are adversely impacted by wholly inadequate access to comprehensive health services.” (Smith, 2022)

Policy Considerations

1. Ensure there are strong caregiver voices in shaping programs, policies, and strategies that result in better outcomes for American Indian and Alaska Native children and their families.
2. Advocate on behalf of Native American grand families and kinship caregivers at the federal, state, and local levels.
3. Seek out Native American caregiver input on draft publications and other materials for grand families and kinship families.
4. Model the value of caregiver engagement – (e.g., more internet content to deliver needed communication with response to all questions and comments)
5. Foster leadership development

Calls to Action

• Begin action in areas of critical aid (e.g., food, critical supplies), empower tribal members, and support sustainable infrastructure.
• Develop new pathways with large organizations and develop volunteer networks to bring people together.

References

Smith, M. (2022). Native Americans: A crises in health equity. In American Bar Association’s Human Rights Magazine, 43(3). https://www.americanbar.org/groups/crsj/publications/human_rights_
magazine_home/the-state-of-healthcare-in-the-united-states/native-american-crisis-in-health-equity/

True Sioux Help Foundation (2022). https://www.truesiouxhope.org

W.K. Kellogg Foundation (2020). American Indian & Alaska Native grandfamilies: Helping children thrive though connection to family and cultural identity tool kit.  Grandfamilies.org Michigan: Battle Creek. https://www.gu.org/resources/american-indian-alaska-native-grandfamilies-helping-children-thrive-through-connection-to-family-and-cultural-identity/