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Research studies have indicated many benefits of providing culturally competent care. CampinhaBacote and Munoz1 state that a direct relationship exists between culture and health and that of the many variables known to influence health beliefs and practices, culture is the most influential. In addition, patients who are less dissatisfied with their care are less likely to discontinue their treatment, particularly if their cultural beliefs are taken into account.2 Although cultural traditions and practices vary greatly among and within the approximately 500 different American Indian tribes, some similarities do exist.
In this article, I provide nurses who work with American Indian clients in critical care situations information needed to facilitate administration of culturally competent care. The focus of the article is similarities among the different tribes.
Demographics
The terms American Indian, Native American, and Alaska Native refer to one of the smallest racial minority groups in the United States, a group that consists of descendants of the original people indigenous to the North American continent.3 The US Census Bureau4 defines American Indians and Alaska Natives as "people having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment." Of the 281.1 million persons included in the 2000 US census, 4.1 million reported they were American Indian or Alaska Native. This number included 2.5 million who reported they were solely American Indian or Alaska Native and 1.6 million who reported they were American Indian or Alaska Native as well as one or more other races. Within this last group, the most common races included with American Indian and Alaska Native were white (66%), black or African American (11%), and white and black (6.8%); "some other race" accounted for 5.7%.4 The approximately 4.1 million persons who identify themselves as American Indian make up more than 500 different tribes.5 Among these tribes are Plains Indians, such as the Apache, Comanche, and Sioux; the Five Civilized Tribes, such as the Cherokee, Choctaw, and Seminole; Pueblos, such as the Navajo and Zuni; and Alaska Natives, which include Eskimos, Aleuts, and other Indians in Alaska. ' Since 1970 the Native American population has increased by 140%, because more and more persons are claiming Indian heritage.6 Table 1 lists...