The ACPE Research Network

Back to the Articles of the Month Index Page ]


December 2007 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.


Walton, J. "Prayer warriors: a grounded theory study of American Indians receiving hemodialysis." Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association 34, no. 4 (July/August 2007): 377-386.


COMMENT and SUMMARY: This month’s article touches on two topics of potential interest: Native American spirituality and patients receiving hemodialysis. Its primary research questions are: "[W]hat is spirituality to people who are American Indians receiving hemodialysis, and how does spirituality influence the lives of those individuals receiving hemodialysys therapy?" [p. 378]. This is a good example of qualitative research, and includes a special section explaining "grounded theory" [p. 379] in addition to the obligatory description of the study’s design and method [p. 378-379], though it should be noted that the actual questions used in interviews are unfortunately not given. Results are illustrated with quotes from participants, and tables and figures offer a significant amount of explanatory and supplemental information. Students should find it thought-provoking, and researchers may see here a number of possibilities for further investigation.

Dr. Joni Walton, a Clinical Nurse Specialist and Assistant Professor at Carroll College in Helena, Montana, recruited 21 "English-speaking American Indians" [p. 378] from two different dialysis units: 9 men and 12 women, aged 24-62 years, who had been receiving hemodialysis from 1 month to 10 years. They are reported to have been from "a variety of tribes" [p. 378], yet while the author in her Summary states that "[e]ach tribe, community, and individual is unique" [p. 385], she does not make particular distinctions in the presentation of her findings but speaks generally of the population and gives a single conceptual model of Native American spirituality in a figure on p. 382 and a "Prayer to the Great Spirit" on p. 384. The study's validation process involved "2 nurses who were American Indians" [p. 383].

The author focuses on the participants’ sense of prayer and on prayer activity as "the source of hope, cleansing, and inner peace" [p. 383] in addressing separately 4 themes from patient interviews: "(a) honoring spirit, (b) resisting hemodialysis, (c) healing old wounds, and (d) connecting with family and community" [p. 380]. To summarize sub-themes identified in the interviews: For honoring spirit, they are "cherishing the old ways, …rejecting the old ways, and ...finding peace with the old and new ways" [p. 381]. An example of the "old ways" is given as the burning of cedar, the smoke from which "carried...prayers up to the Great Spirit" [p. 381]. A table on p. 380 lists 11 other such practices. For connecting with family and community, they are "nurturing family, ...being with family and friends, ...belonging, and ...helping others" [p. 383]. For healing wounds, they are "[b]uilding esteem and respect, feeling loved, fighting addictions, setting limits, and caring for self" [p. 382]. Finally, the theme of healing and suffering through illness is explained as a process by which patients reversed an initial resistance to dialysis because of pleading from family, thereby "enduring hemodialysis for the family" [p. 382]. These patients who reluctantly agreed to treatment are said to have "expressed feelings of despair, depression, and anxiety" [p. 382].

Walton points out that her finding that "[m]ost participants never did come to the point of accepting dialysis, but tolerated it 'for the family,'" stands in contrast to previous research with Caucasians, which has indicated a tendency to accept dialysis "as a gift of life or a miracle" [p. 385]. She also points out the potential dissonance between the culture of technology in US healthcare and the traditional culture of many in her sample. She relates:
Individuals in this study requested that the culture of the dialysis unit be set up according to their individual preferences and practices. One husband and wife recommended a prayer for the initiation of dialysis. Another recommended the burning of sweet grass or cedar to carry prayers to Grandfather and create a sacred space while on dialysis. It was recommended that each individual have a colorful handmade tote bag in a locker at the dialysis unit. The bag would be filled with items that are dear to the individual so he or she could have it at the bedside. The tote would carry personal items such as a prayer wheel, sweet grass, photos of family, music CD, and food for snacking. Some participants in this study said that they play bingo as a unit during dialysis and share fun and laughter. These interventions would make dialysis more tolerable for many American Indians who honor the old ways. [pp. 383-384]
The author exhorts: "Researchers must listen to the voices of individuals to discover experiences and build a body of evidence related to spirituality" [p 377]. It is apparent that she has tried to do this in her work, though the tone of the article seems--to this reader--to convey the sense of an outsider, and her discussion is less about spirituality per se than about clinical implications. CPE students may appreciate the attention given to clinical practice in Tables 2-6 on pp. 380-381: "Considerations When Developing an Individual Care plan," "Recommendation to Ease Transition into Hemodialysis," "Recommendations to Decrease Boredom, Sadness, and Depression," "Interventions to Facilitate Healing of Old Wounds," and "Facilitating Relationships with Family and Friends." However, chaplain researchers may want to think about how to delve more deeply into the spiritual side of the experience of dialysis in future studies, along with the number of questions for further research suggested by the author [--see p. 383].


Suggestions for the Use of the Article for Discussion in CPE: 

This month’s article offers a great many ideas for how to support patients through the personal and clinical experience of hemodialysis, based upon findings from the study’s sample. [See the lists in Tables 2-6 on pp. 380-381.] Some of these suggestions seem quite particular to the potential needs of Native Americans, while some seem to be helpful ideas for any patients. Discussing this with students could raise important research issues of the translation of research findings into clinical practice, and the question of generalizing findings beyond a s specific study population. Another use of the article could be to ask students to think about the value of the quotes illustrating the various identified themes. What would this article be like without those quotes? What did students learn from the quotes? Such a discussion addresses the dynamics of presentation and the richness of qualitative methodology. Of course, the article could be used to open up discussion about Native American spirituality or hemodialysis, and other articles on either of those subjects--see Related Items of Interest (below)--could come into play. Students may want to read Walton’s other recent article on hemodialysis, "Finding a balance: a grounded theory study of spirituality in hemodialysis patients" (below), though only one of her subjects in that earlier study was an American Indian.


Related Items of Interest:

I. The following articles look at spirituality and hemodialysis per se. Note especially the one by Walton (i.e., the author of this month's featured article).:

Al-Arabi, S. [University of Texas Medical Branch, School of Nursing, Galveston, TX]. "Quality of life: subjective descriptions of challenges to patients with end stage renal disease." Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association 33, no. 3 (May-June 2006): 285-292. [This qualitative study of 80 patients with end stage renal disease (ESRD) from an outpatient hemodialysis center found (from the abstract:) ...The three emergent conceptual categories that describe the quality of everyday life among the study group were: 1) Life Restricted, with sub-themes "tied down," "left out," and "doing without," 2) Staying Alive, with sub-themes "love from others," "accept it as part of life," and "trust in God," and 3) Feeling Good, with sub-themes "personal satisfaction" and "being happy."]

Berman, E., Merz, J. F., Rudnick, M., Snyder, R. W., Rogers, K. K., Lee, J., Johnson, D., Mosenkis, A., Israni, A., Wolpe, P. R. and Lipschutz, J. H. [Department of Medical Ethics, University of Pennsylvania, Philadelphia, PA]. "Religiosity in a hemodialysis population and its relationship to satisfaction with medical care, satisfaction with life, and adherence." American Journal of Kidney Diseases 44, no. 3 (September 2004): 488-497. [(Abstract:) BACKGROUND: The religious beliefs and spirituality of patients on hemodialysis (HD) therapy have not been studied extensively. Studies of the dialysis population seem to indicate that religion may be associated with increased patient satisfaction with life and increased levels of social support. METHODS: Using multiple religiosity scales and scales to assess patient satisfaction with life and social support, we studied the relationship between religiosity and medical and/or social factors and adherence to treatment in 74 HD patients. RESULTS: High scores on the Intrinsic Religiosity Scale were associated strongly with high scores on the Satisfaction With Life Scale, whereas age and high Organizational Religious Activity Scale scores were associated strongly with high scores on the Satisfaction With Medical Care Scale. Older age was associated strongly with increased adherence. No relationship existed between religiosity and adherence in our population. CONCLUSION: Religious beliefs are related strongly to measures of satisfaction with life, whereas religious behaviors are related to satisfaction with medical care. Age is the single most important demographic factor associated with adherence. Because of the complex nature of religiosity, additional investigation is in order.]

Carosella J. [Gambro Healthcare-Hartford, Hartford]. "Incorporating spirituality into the delivery of dialysis care: one team's perspective." Advances in Renal Replacement Therapy 9, no. 2 (April 2002): 149-51. [(Abstract:) The importance of spirituality and organized religion in coping with chronic kidney disease (CKD) and other medical illnesses has been cited in the literature in recent years. This article describes how one dialysis unit recognized the importance of spiritual resources for patients and incorporated the role of chaplain into its interdisciplinary health care team. The resulting enhancement of team functioning and sensitivity to patients' spiritual needs is discussed.]

Finkelstein, F. O., West, W., Gobin, J., Finkelstein, S. H. and Wuerth, D. "Spirituality, quality of life and the dialysis patient." Nephrology Dialysis Transplantation 22, no. 9 (September 2007): 2432-2434. [The authors look briefly at the potential importance of spirituality for quality of life in End Stage Renal Disease patients and report preliminary results supporting this from their own study 200 ESRD patients on both hemodialysis and peritoneal dialysis. (From pp. 2432-2433:) "The preliminary results of this study have suggested that there is a strong correlation between spirituality scores on the SWBQ(Spiritual Well being Questionnaire) and several quality of life domains, including: (a) depressive symptoms as assessed by the Beck Depression Inventory (BDI), (b) the mental composite score (MCS) of the SF-36 and (c) the global assessment of the patients’ quality of life. These correlations were strongest for the existential component of the spirituality questionnaire. …It was of interest that there was no relationship between spirituality scores and comorbidity (as assessed by the Charlson Co-morbidity Index) and patient age. And, there was no relationship between spirituality scores and patients’ compliance, as clinically assessed by various members of the dialysis units’ staff (physician, primary nurse, dietician and social worker). Spirituality scores for PD and HD patients were similar]

Kimmel, P. L., Emont, S. L., Newmann, J. M., Danko, H. and Moss, A. H. [Department of Medicine, Division of Renal Diseases and Hypertension, George Washington University, Washington, DC]. "ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity." American Journal of Kidney Diseases 42, no. 4 (October 2003): 713-721. [(Abstract:) BACKGROUND: Recent research suggests that patients' perceptions may be more important than objective clinical assessments in determining quality of life (QOL) for patients with end-stage renal disease (ESRD). METHODS: We interviewed 165 hemodialysis patients from 3 sites using a QOL questionnaire that included the Satisfaction With Life Scale (SWLS) and the McGill QOL (MQOL) scale, which includes a single-item global measure of QOL (Single-Item QOL Scale [SIS]). The MQOL scale asks patients to report their most troublesome symptoms. We also initiated the use of a Support Network Scale and a Spiritual Beliefs Scale. RESULTS: Mean patient age was 60.9 years, 52% were men, 63% were white, and 33% were African American. Patients had a mean treatment time for ESRD of 44 months, mean hemoglobin level of 11.8 g/dL (118 g/L), mean albumin level of 3.7 g/dL (37 g/L), and mean Kt/V of 1.6. Forty-five percent of patients reported symptoms. Pain was the most common symptom (21% of patients). There was an inverse relationship between reported number of symptoms and SWLS (P < 0.01), MQOL scale score (P < 0.001), and SIS (P < 0.001). The Spiritual Beliefs Scale correlated with the MQOL scale score, SWLS (both P < 0.01), and SIS (P < 0.05). The Support Network Scale score correlated with the MQOL Existential (P = 0.01) and MQOL Support (P < 0.01) subscales. No clinical parameter correlated with any measure of QOL, spiritual beliefs, or social support. CONCLUSION: Symptoms, especially pain, along with psychosocial and spiritual factors, are important determinants of QOL of patients with ESRD. Additional studies, particularly a longitudinal trial, are needed to determine the reproducibility and utility of these QOL measures in assessing patient long-term outcome and their association with other QOL indices in larger and more diverse patient populations.]

Ko, B., Khurana, A., Spencer, J., Scott, B., Hahn, M. and Hammes, M. [Department of Medicine, University of Chicago Hospitals, Chicago, IL]. "Religious beliefs and quality of life in an American inner-city haemodialysis population." Nephrology Dialysis Transplantation 22, no. 10 (October 2007): 2985-2990. [(Abstract:) Background: The ability to adapt to the long-term aspects of chronic haemodialysis is multifactorial and poorly understood. Given the many comorbidities of a patient on haemodialysis, religious beliefs may be an important factor in the patient's ability to cope. Methods: End-stage renal disease patients in an inner-city American in-center haemodialysis unit were given two surveys to quantify their quality of life (KDQOL) and beliefs (Royal Free Score). The population studied included 97% African Americans. The demographics were collected and recorded. The relationship between religious/spiritual beliefs, demographic variables, and how quality of life (QOL) is viewed was analyzed. Results: The vast majority of patients considered themselves religious, spiritual or both. KDQOL scores did not correlate with belief in a higher power, but the non-religious group demonstrated a significantly lower blood urea nitrogen (BUN) and creatinine as compared with the religious group. There was a negative correlation with age and physical function as reported by KDQOL and physical health composite. Conclusion: As physical function declines, religious and spiritual beliefs are stronger in the haemodialysis population studied. Given the overwhelming prevalence of religious and spiritual beliefs in this population, further study is needed as acknowledging and incorporating these beliefs into patient treatment plans may be warranted.]

Lai, C. F., Kao, T. W., Wu, M. S., Chiang, S. S., Chang, C. H., Lu, C. S., Yang, C. S., Yang, C. C., Chang, H. W., Lin, S. L., Chang, C. J., Chen, P. Y., Wu, K. D., Tsai, T. J. and Chen, W. Y. [Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan]. "Impact of near-death experiences on dialysis patients: a multicenter collaborative study." American Journal of Kidney Diseases 50, no. 1 (July 2007): 124-132, +132.e1-2 (supplementary data). [This is a cross-sectional study of 710 dialysis patients at 7 centers in Taiwan. (From the abstract:) MEASUREMENTS: Greyson's NDE scale, Royal Free Questionnaire, 10-Question Survey, Ring's Weighted Core Experience Index, and Beck Depression Inventory. RESULTS: 45 patients had 51 NDEs. Mean NDE score was 11.9 (95% confidence interval, 11.0 to 12.9). Out-of-body experience was found in 51.0% of NDEs. Purported precognitive visions, awareness of being dead, and "tunnel experience" were uncommon (<10%). Compared with the no-NDE group, subjects in the NDE group were more likely to be women and younger at life-threatening events. Both frequency of participation in religious ceremonies and pious religious activity correlated significantly with NDE score in patients with NDEs (P < 0.01 and P = 0.01, respectively). The NDE group reported being kinder to others (P = 0.04) and more motivated (P = 0.02) after their life-threatening events than the no-NDE group. …CONCLUSIONS: NDE is not uncommon in the dialysis population and is associated with positive aftereffects. Nephrology care providers should be aware of the occurrence and aftereffects of NDEs. The high occurrence of life-threatening events, availability of medical records, and accessibility and cooperativeness of patients make the dialysis population very suitable for NDE research. (This article is also cited as a Related Item of Interest for the May 2006 Article-of-the-Month.)]

Mattison, D. [St. Joseph Mercy Hospital Cancer Care Center, University of Michigan School of Social Work, Ann Arbor, MI]. "The forgotten spirit: integration of spirituality in health care." Nephrology News & Issues 20, no. 2 (February 2006): 30-32. [(Abstract:) Health care technology has witnessed incredible advances and increasingly effective treatments for physical and psychological disorders, but the spiritual component of care is an intervention resource that often goes unseen, unaddressed, and underused for patients facing multiple challenges. State-of-the-art services must take a perspective that expands beyond a focus on the biological and psychological needs of patients to also integrate practice skills to address spiritual needs. Spirituality can provide valuable interventions to help maintain hope and stability in times of turbulence. If health care providers are to offer holistic care to patients, we must create an environment in which spirituality is competently explored and addressed. What do health care providers have to lose by integrating the spiritual, dimension into care delivery and accessing a powerful intervention that can make a positive difference to patients? How might patients benefit and what might we learn by asking a few simple, but profound, spiritual questions? What gives your life meaning? What is your greatest hope? What do you fear? What comforts or encourages you most? As you consider how spirituality fits into and benefits your practice you might find meaning in Viktor Frankl's words, "No cure that fails to engage our spirit can make us well." (Also note: this issue of Nephrology News & Issues contains a brief "cover story" article on p. 34: Straveler, R., "Meditation in the dialysis clinic.")]

Patel, S. S., Shah, V. S., Peterson, R. A. and Kimmel, P. L. [Department of Medicine, George Washington University, Washington, DC]. "Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis." American Journal of Kidney Diseases [Online] 40, no. 5 (November 2002): 1013-1022. [(Abstract:) BACKGROUND: Religious and spiritual aspects of quality of life (QOL) have not been fully assessed in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD), but psychosocial factors are associated with patient survival. METHODS: To investigate interrelationships between religious beliefs and psychosocial and medical factors, we studied 53 HD patients. Psychosocial and medical variables included perception of importance of faith (spirituality), attendance at religious services (religious involvement), the Beck Depression Inventory, Illness Effects Questionnaire, Multidimensional Scale of Perceived Social Support, McGill QOL Questionnaire scores, Karnofsky scores, dialysis dose, and predialysis hemoglobin and albumin levels. RESULTS: Eighty-seven percent of participants were African-American. Men had higher depression scores, perceived lower social support, and had higher religious involvement scores than women. No other parameters differed between sexes. Perception of spirituality and religiosity did not correlate with age, Karnofsky score, dialysis dose, or hemoglobin or albumin level. Greater perception of spirituality and religiosity correlated with increased perception of social support and QOL and less negative perception of illness effects and depression. A one-question global QOL measure correlated with depression, life satisfaction, perception of burden of illness, social support, and satisfaction with nephrologist scores, but not with age or Karnofsky score. CONCLUSION: Religious beliefs are related to perception of depression, illness effects, social support, and QOL independently of medical aspects of illness. Religious beliefs may act as coping mechanisms for patients with ESRD. The relationship between religious beliefs and clinical outcomes should be investigated further in patients with ESRD.]

Pruchno, R. A., Lemay, E. P. Jr., Field, L. and Levinsky, N. G. [Boston College and Boston University Medical Center, and University of Medicine & Dentistry of New Jersey, New Jersey Institute for Successful Aging;]. "Predictors of patient treatment preferences and spouse substituted judgments: the case of dialysis continuation." Medical Decision Making 26, no. 2 (March-April 2006): 112-121. [This descriptive, cross-sectional study of 291 hemodialysis patients, aged 55 years and older, and their spouses found (from the abstract:) ...Patients' preferences and spouses' judgments were only moderately correlated (r = 0.33). Multiple regression analyses revealed that patients' preferences to continue dialysis were positively related to education, subjective quality of life, and religious participation and negatively related to months of ESRD treatment and fear of end-of-life suffering (R(2) = 0.15). Spouses ' substituted judgments regarding patients' dialysis continuation preferences were positively related to African American race and spouses' perceptions of patients ' quality of life and negatively related to months of ESRD treatment, spouses' perception of patients' negative affect, and spouses' own fear of end-of-life suffering....]

Tanyi, R. A. and Werner, J. S. [Department of Family Practice, Allina Medical Clinic, Coon Rapids, MN]. "Adjustment, spirituality, and health in women on hemodialysis." Clinical Nursing Research 12, no. 3 (August 2003): 229-45. [(From the abstract:)) This descriptive correlational study examined levels of and relationships between adjustment, spiritual well-being, and self-perceived health in women with ESRD. The sample included 65 women aged 24 to 82 receiving hemodialysis at five outpatient centers in a large metropolitan area. ...Overall, these women were fairly well adjusted as measured by the Psychosocial Adjustment to Illness Scale-Self-Report. They demonstrated fairly high levels of religious, existential, and overall spiritual well-being. Self-perceived health was good Spiritual well-being variables were all positively and significantly related to overall psychosocial adjustment and psychological distress adjustment. Self-perceived health variables were all positively and significantly related to overall psychosocial adjustment. Few significant relationships were found between spiritual well-being and other adjustment domains and between self-perceived health and other types of adjustment.]

[ADDED 1/12/08]: Tanyi, R. A. and Werner, J. S. "Women's experience of spirituality within end-stage renal disease and hemodialysis." Clinical Nursing Research 17, no. 1 (February 2008): 32-49. [(From the abstract:) ...The purposive volunteer sample of 16 women regularly attended two outpatient dialysis centers in a large Midwestern city. ...These women affirmed that spirituality was extremely important in living with their illness and necessary treatment regime. Four major clusters of themes pertaining to the women's spiritual experience within their illness emerged: acceptance, understanding, fortification, and emotion modulation. Findings show that spirituality is of great importance in living with ESRD while receiving hemodialysis and suggest that spirituality may be a significant consideration in nursing and interdisciplinary health care....]

Tanyi, R. A., Werner, J. S., Recine, A. C. and Sperstad, R. A. [Loma Linda University, School of Public Health, CA]. "Perceptions of incorporating spirituality into their care: a phenomenological study of female patients on hemodialysis." Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association 33, no. 5 (September-October 2006): 532-538. [(Abstract:) This phenomenological study was aimed at understanding how women with end stage renal disease undergoing hemodialysis want nurses to address their spirituality. Interviews were conducted with 16 women from outpatient hemodialysis centers in a large Midwestern city. Eighty-three significant statements yielded meanings representing four theme clusters, highlighting how these women prefer nurses to incorporate spirituality into their care: (a) displaying genuine caring, (b) building relationships and connectedness, (c) initiating spiritual dialogue, and (d) mobilizing spiritual resources. Participants expressed that nephrology nurses are uniquely positioned to understand their individualized spiritual needs and implement spiritual care.]

Walton, J. [Helena and Hospice Chaplain, St. Peter's Hospital, Helena, MT]. "Finding a balance: a grounded theory study of spirituality in hemodialysis patients." Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association 29, no. 5 (October 2002): 447-456, with discussion on p. 457. [(Abstract:) The purpose of this study was to discover what spirituality means to hemodialysis patients and how it influences their lives. Grounded theory qualitative research method was used to discover meaning, provide understanding, and create a beginning substantive theory of spirituality. Four men and 7 women, 36 to 78 years of age, receiving outpatient hemodialysis in the northwestern United States, volunteered to participate in this study. Demographic data were collected and indepth interviews were completed. The Glaserian method of grounded theory was used for data collection and analysis. The central core category of this study was finding a balance, which occurred in the following four phases: (a) confronting mortality, (b) reframing, (c) adjusting to dialysis, and (d) facing the challenge. Categories of spirituality were faith, presence, and receiving and giving back. Participants described spirituality as a life-giving force from within, full of awe, wonder, and solitude, that inspires one to strive for balance in life. Participants validated the description of spirituality, categories, and phases to assure that it captured their person experiences. A focus group of hemodialysis staff validated the results for clarity, understanding, and application to clinical practice. The results of this study provide a theoretical framework to guide nursing practice as well as an understanding of what spirituality means to hemodialysis patients and how it influences their lives.]

II. There is remarkably little material in the health care literature that considers Native American spirituality, but the following recent articles touch on the subject in varying degrees:

Beals, J., Novins, D. K., Spicer, P., Whitesell, N. R., Mitchell, C. M. and Manson, S. M. for the American Indian Service Utilization, Psychiatric Epidemiology, Risk, and Protective Factors Project Team [American Indian Program, University of Colorado at Denver and Health Sciences Center, Aurora, CO;]. "Help seeking for substance use problems in two American Indian reservation populations.." Psychiatric Services 57, no. 4 (April 2006): 512-520. [(Abstract:) OBJECTIVES: This study examined the extent and types of help seeking (biomedical, traditional, and 12-step groups) for substance use problems in two American Indian reservation populations by using data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk, and Protective Factors Project (AI-SUPERPFP). This study also sought to understand the correlates of such help seeking, including measures of need, demographic characteristics, spirituality, and ethnic identity. METHODS: AI-SUPERPFP, completed between 1997 and 2000, was a cross-sectional probability sample survey. Altogether 2,825 tribal members, aged 18 to 54 years, representing two tribal groups living on or near their home reservations, were randomly sampled from the tribal rolls. Response rates averaged 75.3 percent. The primary outcome measure was help seeking in the past year for substance use problems, which was further divided into help seeking from biomedical services, traditional healing sources, and 12-step programs. RESULTS: Help-seeking rates were high, with 13 percent of the population and 38 percent of those with diagnoses of substance use disorders in the past year having sought services for alcohol or drug problems in the preceding 12 months. Correlates of help seeking included variables related to need for services (substance use disorders, tobacco use, and mental and physical health problems), marital status, and spirituality. Slightly more than half of service users sought help from formal biomedical providers; use of traditional healing and 12-step programs was also common. Need and spirituality variables best differentiated among the users of the three modalities. CONCLUSIONS: Help seeking for alcohol and drug problems was common in these communities, with traditional healing and 12-step resources as essential components of the local service ecologies.]

Call, K. T., McAlpine, D. D., Johnson, P. J., Beebe, T. J., McRae, J. A. and Song Y. [School of Public Health, University of Minnesota, MN, and Mayo Clinic, Rochester, MN;]. "Barriers to care among American Indians in public health care programs." Medical Care 44, no. 6 (June 2006): 595-600. [Among the findings of this survey of 1281 American Indian (AI) and White adults and the parents of 572 child enrollees (from the abstract:) "…Among adults, AIs are more likely (than Whites) to report racial discrimination, cultural misunderstandings, family/work responsibilities, and transportation difficulties. …In addition to racial discrimination and cultural misunderstandings, parents of AI children are more likely than parents of White enrollees to report limited clinic hours, lack of respect for religious beliefs, and mistrust of their child's provider as barriers."]

Hill, D. L. [School of Medicine, University of Minnesota, Duluth, MN;]. "Sense of belonging as connectedness, American Indian worldview, and mental health." Archives of Psychiatric Nursing 20, no. 5 (October 2006): 210-216. [(Abstract:) The concept of sense of belonging as connectedness is an abstract dimension of relatedness. Gaining an understanding of this concept within a cultural worldview has the potential to positively impact the mental health of ethnic minority populations. Sense of belonging as connectedness portrays the dynamic nature of human existence. The role of sense of belonging to interpersonal relationships and the well-being of individuals, family, and community is emphasized through the worldview of the American Indian population. It is a dynamic phenomenon of social significance. ]

Nauman, E. "Native American medicine and cardiovascular disease." Cardiology in Review 15, no. 1 (January-February 2007): 35-41. [(Abstract:) Native American medicine provides an approach to the treatment of cardiovascular disease that is unique and that can complement modern medicine treatments. Although specific practices among the various Native American tribes (Nations) can vary, there is a strong emphasis on the power of shamanism that can be supplemented by the use of herbal remedies, sweat lodges, and special ceremonies. Most of the practices are passed down by oral tradition, and there is specific training regarding the Native American healer. Native American medicine has strong testimonial experiences to suggest benefit in cardiac patients; however, critical scientific scrutiny is necessary to confirm the validity of the benefits shown to date.]

Pelusi, J. and Krebs, L. U. [Native American Cancer Research, Pine, CO 80470-7830]. "Understanding cancer-understanding the stories of life and living." Journal of Cancer Education 20, no. 1, Supplement (2005): 12-16. [(Abstract:) BACKGROUND: Storytelling is an effective and efficient educational methodology for American Indians/Alaska Natives (AIs/ANs). It has been used for hundreds of years, is well respected, and has significant implications in the oncology setting. Storytelling not only values the individual sharing the story but also offers educational information and emotional support to those who hear it. METHODS: Content analysis of transcripts from an educational session in which AIs/ANs were encouraged to share stories of living with/surviving cancer identified 12 themes that revealed the essence of their cancer experiences. RESULTS: The themes identified were: cancer journey, responsibility to self and community, getting beyond the diagnosis, cancer lessons-cancer gifts, the strength of our stories, being connected, prospering through cancer, pain is more than a word, survival is an attitude, spirituality and cancer, specific cancer issues and understanding our ways. CONCLUSIONS: These themes are a reminder for health care professionals to spend time looking at, listening to and trying to understand how cancer and its treatments affect the everyday lives of people and families we treat and how this should guide our overall management plan. They teach us the importance of taking time to listen to the stories, responding to the cultural needs of every patient and family member and honoring teach the cancer journeys of all people.]

Spicer, P., Bezdek, M., Manson, S. M. and Beals, J. [American Indian and Alaska Native Programs, University of Colorado at Denver and Health Sciences Center, Aurora, CO;]. "A program of research on spirituality and American Indian alcohol use." Southern Medical Journal 100, no. 4 (April 2007): 430-432. [(Abstract:) In this brief report we summarize a pattern of findings that has emerged from our research on American Indian (AI) alcohol use and spirituality. With funds from the National Institute of Alcohol Abuse and Alcoholism and the Fetzer Institute (AA 13 053; P. Spicer, PI) we have used both epidemiologic and ethnographic methods to develop a more complete understanding of the role that spirituality and religion play in changes in drinking behavior among AIs. We begin by first situating the importance of research on spirituality in the more general literature on the AI experience with alcohol before highlighting our published findings in this area. We then close with some speculation about possible next steps in this research program to address what remains one of the most compelling sources of health disparities in the first nations of the United States.]

Stone, R. A., Whitbeck, L. B., Chen, X., Johnson, K. and Olson, D. M. [Department of Sociology, University of Nebraska-Lincoln;]. "Traditional practices, traditional spirituality, and alcohol cessation among American Indians." Journal of Studies on Alcohol 67, no. 2 (March 2006): 236-244. [(Abstract:) OBJECTIVE: The detrimental effects of alcohol misuse and dependence are well documented as an important public-health issue among American Indian adults. This preponderance of problem-centered research, however, has eclipsed some important resilience factors associated with life course patterns of American Indian alcohol use. In this study, we investigate the influence of enculturation, and each of the three component dimensions (traditional practices, traditional spirituality, and cultural identity) to provide a stringent evaluation of the specific mechanisms through which traditional culture affects alcohol cessation among American Indians. METHOD: These data were collected as part of a 3-year lagged sequential study currently underway on four American Indian reservations in the upper Midwest and five Canadian First Nation reserves. The sample consisted of 980 Native American adults, with 71% women and 29% men who are parents or guardians of youth ages 10-12 years old. Logistic regression was used to assess the unique contribution of the indicators of alcohol cessation. Excluding adults who had no lifetime alcohol use, the total sample size for present analysis is 732 adult respondents. RESULTS: The findings show that older adults, women, and married adults were more likely to have quit using alcohol. When we examined the individual components of enculturation, two of the three components (participation in traditional activities and traditional spirituality) had significantly positive effects on alcohol cessation. CONCLUSIONS: Although our findings provide empirical evidence that traditional practices and traditional spirituality play an important role in alcohol cessation, the data are cross-sectional and therefore do not indicate direction of effects. Longitudinal studies are warranted, in light of the work that concludes that cultural/spiritual issues may be more important in maintaining sobriety once it is established rather than initiating it.]

Weiner, D., Burhansstipanov, L., Krebs, L. U. and Restivo, T. [Native American Cancer Research, Pine, CO 80470-7830]. "From survivorship to thrivership: native peoples weaving a healthy life from cancer." Journal of Cancer Education 20, no. 1, Supplement (2005): 28-32. [(Abstract:) BACKGROUND: In this commentary, we describe culturally specific cancer support and education programs that have been successfully adapted for use with both urban and reservation-based California Indian communities. METHODS: The Native American Cancer Survivor Support Circles were initiated in Los Angeles County in 2000 and were tailored for specific use with reservation-based communities in 2002. Support circles include culturally respectful ground rules, prayers, and culturally specific education topics (spirituality, coping with chemotherapy) and psychosocial support as well. RESULTS AND CONCLUSIONS: Evaluation showed that both Native men and women had greater confidence in their abilities to cope with their healing and recovery from cancer following participation.]

Yoon, D. P. and Lee, E. O. [University of Missouri-Columbia, School of Social Work, Columbia, MO;]. "Religiousness/spirituality and subjective well-being among rural elderly Whites, African Americans, and Native Americans." Journal of Human Behavior in the Social Environment 10, no. 1 (2004): 191-211. [(Abstract:) Little attention has been paid to subjective well-being among non-White elderly in rural areas where medical resources and financial support are deficient. The present study assessed a rural community sample of 215 elderly comprising 85 Caucasians, 75 African Americans, and 55 Native Americans, to examine roles of spirituality/ religiousness on their subjective well-being. This study found ethnic differences in the reliance on religiosity/spirituality and a significant association between dimensions of religiousness/spirituality and subjective well-being among all ethnic rural elderly groups. The results of the study suggest that health providers, social workers, and faith communities need to provide rural elderly with religious and spiritual support in order to enhance their life satisfaction and lessen their emotional distress.]


If you have suggestions about the form and/or content of the site, e-mail Chaplain John Ehman (Network Convener) at .
Copyright © 2007
The ACPE Research Network. All rights reserved.