1. Sense of Belonging as Connectedness to Selected Areas of Health and Traditional Practices in American Indians Doris M. Hill, PhD, RN, CNOR SAMSHA MFP FELLOWSHIP NANAINA SUMMIT XI This research was supported by The Substance Abuse and Mental Health Services Administration (SAMSHA). Data was provided by a grant from the National Institute for Nursing Research, NIH, R01 NR04528, called Wellness Circles, An American Indian Approach. (Felicia Hodge, Principal Investigator).

2. Purpose Describe and examine sense of belonging as connectedness in relationship to selected areas of health and traditional practices in the American Indian (AI) population under the framework of a cultural worldview.

3. Background 4.1 million American Indians live in the United States and represent approx. 1.5% of the total U.S. population. (U.S. Bureau of the Census, 2000). There are over 500 federally recognized tribes in the United States with Alaska, Arizona, California, Michigan, New Mexico, New York, North Carolina, Oklahoma Texas, and Washington having the largest populations. (U.S. Bureau of the Census, 2000). In 2000, 24.9% of American Indians lived on reservations or trust lands, with the remaining population 75.1% residing in urban, suburban or rural non-reservation communities. (Kaiser Family foundation, 2001; USDHHS, 2001).

4. Background Historical Events Historical events and their disruption of sense of belonging within American Indian communities are enmeshed with the survival of the culture Attempted eradication of the American Indian way of life, traditions and family impacted: –Connectedness of the community –Balance and harmony of American Indian health It’s possible historical disruption to sense of belonging and health plays a role in the current health disparities in the American Indian population.

5. General Health Status Life expectancy is 70.6 years compared to the U.S. general population of 76.5 years. (Indian Health Service [IHS], 2002; USDDHS, 2003). Ten leading causes of death for American Indians in 2002: 1.Heart disease 2.Cancer 3.Unintentional injuries 4.Diabetes 5.Stroke 6.Chronic liver & cirrhosis 7.Chronic respiratory disease 8.Suicide 9.Influenza and pneumonia 10.Homicide (Center for Disease Control [CDC], 2004).

6. Factors Which Impact Health Access to health care and cultural barriers are factors that impact health particularly in rural, remote tribal communities (Parker, Haldane, Keltner, Strickland, & Tom-Orme, 2002). The mental health system is not able to meet the needs of racial and ethnic minority populations. (USDHHS, 1999). In the report titled: Achieving the Promise: Transforming Mental Health Care in America recognizes the lack of information concerning culturally diverse populations histories, traditions, beliefs, languages, and value system. (New Freedom Commission on Mental Health, 2003).

7. American Indian Worldview Totality of the personality, mind, body and spirit, being part of all creation and living life as one system (Duran & Duran, 1995). Cultural values of living in connectedness is a worldview perspective of the American Indian population and reflects a connection with nature and their spirituality. This relationship is a “sense of place, belonging and connectedness with life [sic]” (Burkhardt & Nagai-Jacobson, 2002, p. 20). Artist: Roy Thomas“Native Artist”

8. Theoretical Framework Theory of Relatedness –Developed by Hagerty, Lynch-Saucer, Patusky, & Bouwsema, (1993). States of Relatedness –Connectedness –Disconnectedness Competencies –Establish and promotes the states of relatedness e.g. sense of belonging Domains of Interest in Nursing –Human and environment (philosophical assumptions). –Health

9. Methods Descriptive-correlational design using secondary analysis. Data for this dissertation was provided by a grant from the National Institute for Nursing Research, NIH, R01 NR04528, called Wellness Circles, An American Indian Approach. (Felicia Hodge, Principle Investigator).

10. Methods Sample –Randomized sample –453 American Indian adults –Age 18 years and over Setting –Rural American Indian health clinics in California Tule River, Lassen, Karuk, Hoopa, Round Valley, Tuolumne, South Indian, Santa Ynez, Toyiabe, Consolidated, Pit River, and Trinidad.

11. Methods Inclusion Criteria –American Indian (self-identified). –Living in the state of California in either a rural or reservation setting. –Persons age 18 years of age or older. Exclusion Criteria –Persons not utilizing a rural Indian Health clinic for medical care. –Persons not identified as American Indian.

12. Characteristic n( % )_______ Gender males 117(25.8) female 336(74.2) Enrolled in a Tribe Yes376(87.2) No 55(12.8) Blood Quantum Level 100% 48 (15.7) (µ=55.8%)75% 34(11.1) 50% 57(18.7) 25% 58(19.0) <25%108(35.5) Age (yr) 18-24 50(11.6) 25-44199(46.2) 45-64134(31.1) 65+ 48(11.1) Mean age of all participants = 41.2 years of age males = 40.1 years of age females = 42.0 years of age SOCIODEMOGRAPHIC CHARACTERISTICS

13. Able to Speak Tribal Indian Language (n = 406) n(%) Yes105(25.9) No301(74.1) Sense of Belonging (Connectedness) to Community and Satisfaction with Life (n = 411) n(%) Yes329(80.1) No 65(15.8) Other 17 (4.1)

16. Limitations Limited due to its specific focus on California American Indians. Results are generalizable only to this population. Further research is needed with the remaining 500+ American Indian communities. Information gathered was obtained for another purpose in the original study.

17. Significance for Nursing Practice Understanding the AI worldview can assist the professional nurse in understanding how AI might interpret their health and illness along with their use of cultural practices. Improve cultural competence by enhancing cultural awareness and cultural knowledge. Supports the American Nurses Association’s position statement, Cultural Diversity in Nursing Practice,1991.