Given the inherently humane elements within nursing, it is inevitable that cultural beliefs and backgrounds should significantly influence just how each nurse approaches their calling. In no uncertain terms, culture makes a difference in nursing because culture informs the value systems of the nurse, and how this process serves to create distinct contributions to nursing may be seen in examining the work and lives of two Native American nurses, Viola Garcia and Susie Walking Bear Yellowtail. This represents, of course, a limited reflection of an important cultural impact. Nonetheless, in viewing the paths of only these two remarkable women, the moral and professional imperatives of legacy nursing as a whole are reinforced, just as the relevance of Native American culture to the profession is revealed.
As noted, culture shapes both the individual and the larger arena of living, and it does so by providing ideas and values held to be important, if not inviolable. Anglo-American culture is necessarily an amalgam, comprised of a number of Western and Eastern traditions, predominant European origins, and faith-based ideologies. All of this has merged to create the modern American culture, and no minor factor in this mainstream culture is the marginalization of both women and minorities. It is then all the more interesting how one minority culture, that of the Native American, may be seen as promoting the core values of nursing in a way that both empowers the women and attaches greater significance to the profession as it relates to female practitioners. As the examples of the nurses to be discussed illustrate, a powerful irony is perceived; as women and Native Americans, Garcia and Yellowtail have faced excessive obstacles in order to bring a greater focus of nursing to the larger culture so impeding them.
While there can be no strict similarity in the various belief systems of different Native American populations, certain elements are consistent in all. What primarily sets these belief systems apart from mainstream Anglo society are ideologies reflecting harmony with nature, which in turn reflect the greater sense of a complete interdependence as existing in all life (Plumbo, 1995, p. 156). It may be said, generally speaking, that Native American culture holds to a sense of the totality of living typically absent in the more commercialized, larger arena of American society. The traditions of most Native Americans as being tangibly linked to the worlds of nature and the spirit, then, seems to call nursing itself into prominence. Interestingly, the connection is not one always identified by Native American nurses themselves. In her study of five such women, Margaret Anne Plumbo did not understand one nurse’s resistance to her culture as linked to her calling, until Plumbo comprehended how visceral the presence of the culture is. Meaning is intuited, rather than derived through analysis (Plumbo, 1995, p. 168), and this indicates the degree to which Native American nursing has always been a more holistic force. It may be reasonably asserted that all nurses respond to internal needs to offer care and address those in pain in ways beyond actual medical treatment; the Native American nurse, however, more aligned with natural process of spirit, physicality, and nature itself, is culturally enabled in a way beyond that of the Anglo nurse.
With this enabling, however, come challenges of immense proportions, and this is evident in the pioneering contributions of Susie Walking Bear Yellowtail. If anything may be said to define Yellowtail’s work, in fact, it is how her nursing career evolved to address the abuses and challenges occurring to and within her culture. There is a strong social component to Yellowtail’s work, necessitated by how her nursing exposed unacceptable conditions and prompting her to extend her commitment beyond nursing itself. There is also strong evidence that she pursued her education and career in order to make a difference for her own people. Yellowtail, the first Native American to become an RN, studied in Massachusetts and then practiced at Boston City Hospital. In due course, however, she returned to her Crow tribe, working with the Indian Health Service of Montana and Minnesota (Voda, 2012, p. 3). She combined traditional Native American cures with modern medicine, and it was in this environment that her advocacy flourished. In simple terms, she witnessed multiple deprivations impacting on the communities of her people; not only were living conditions poor, but access to clinics and hospitals was extremely limited. It is important as well to note that Yellowtail’s work occurred largely in the early and mid-20th century, when public awareness of Native American circumstances was either limited or non-existent. Her career is exemplified by pragmatic and consistent efforts to address both the immediate conditions of the Crow and the social structures maintaining them. A great deal of her efforts went to educating the public as to these real and unhealthy conditions, and her battles were often waged against practices there were unconscionable in health care; Yellowtail discovered, for example, that sterilization was being performed on Native American women without their consent (Pharris, Bosher, 2008, p. 13).
It is difficult to properly assess Yellowtail’s contributions to nursing, ironically because of her pioneer role. Native American social services and health care would remain poorly funded, even after she was appointed to the President’s Council on Indian Health, Education, and Welfare in the 1970s (Voda, 2008, p. 3). At the same time, it is frightening to consider how much worse these services would have been without her dedication to changing the status quo. Clearly, Yellowtail’s career was marked by a consistent conflict between her aims to better health care for Native Americans and more widespread indifference, or direct opposition, to such efforts. On one level, the social and political components of Yellowtail’s work may be seen as illustrating the need for any marginalized culture to have advocacy. At the same time, however, there is an undeniable connection between the Native American culture and the efforts that is unique. That Yellowtail made great strides, for example, relied on her real understanding of how her culture reacted to external elements, and what her culture valued as essential to it. This is established by her incorporating traditional healing methods with the modern she acquired in her Eastern education. Ultimately, Susie Yellowtail contributed to nursing chiefly because she retained an intense interest in her own culture, both as a valuable entity in itself and as one demanding attention from a larger nation historically abusive to it.
The remarkable career of Viola Garcia would seem to be less reflective of Native American culture as contributing to nursing in general. Unlike Yellowtail, Garcia did not return from studies to better the lives of her native people, the Catawba. Her early life, in fact, is marked by consistent struggles to achieve only a high school education. A Native American girl in a poor region of Colorado, the only school available to her was shut down due the the Depression (Pollitt, Streeter, & Walsh, 2011). Continued applications to the Bureau of Indian Affairs finally enabled Garcia to attain her high school diploma at the age of 21. This blatantly indomitable spirit carried her into nursing programs, even as she was greatly discouraged as to her chances. Admitted to Arizona’s Sage Memorial, her attendance was only made possible by the financial support of the former headmistress of her school. What each phase of her educational career indicates, however, is an unwavering determination on Garcia’s part to advance in nursing learning as much as possible.
At Sage, Garcia’s studies were combined with actual nursing, and in rough conditions; it was not unusual for patients to arrive slung on horseback. She worked diligently and, interestingly, took the time to learn the Navajo language common to the area. It would be World War II, however, in which Garcia’s commitment would be both tested and prominently noted. Informed the volunteering for military nursing service would allow her to select assignments, Garcia enlisted, requesting no surgical duties. In the war years following, she was in fact employed in surgeries in the most harsh conditions imaginable. In Colorado’s Fort Carson, she assisted in endless amputations on soldiers returning from Europe. Later, she was a part of an actual invasion force sent to Tokyo; the hospital carrier ship, supposedly safe from enemy attack, operated without lights for fear of drawing enemy fire. For over a year afterward, Garcia was stationed in Tokyo, attending to Bataan Death March survivors with little or no medical equipment (Pollitt, Streeter, & Walsh, 2011). These years were, in no uncertain terms, evidence of nursing as representing authentic heroism. More to the point, it appears that Garcia’s ceaseless commitment to easing pain was a legacy of her own cultural experience and background. As noted, the Native American culture is expansive; it seeks to encompass all that is meaningful in life because it holds to a universality of existence beyond culture. As Garcia fought impossible conditions to offer aid in devastated areas across the world, this is culture as tangible practice.
It is dangerous to seek to assess how the cultural backgrounds of nurses reveal aspects of that culture as directly enhancing nursing itself. Nursing is, after all, a calling essentially common to all cultures, in that the nurse is dedicated to improving life and well-being for all. At the same time, there can be no disputing that certain cultures evince unique characteristics, or more strongly emphasize traits common to all cultures. With the Native American, there is always an awareness of the importance of looking beyond earthly matters; more than anything, spirituality is the defining core of all Native American culture (Plumbo, 1995, p. 166). Then, the marginalization of that culture within mainstream society more distinctly defines it as such, creating obstacles for the Native American nurse even as the cultural foundation encourages the commitments. In the disparate careers of Susie Walking Bear Yellowtail and Viola Garcia, just how this cultural process occurs is strikingly evident. Yellowtail fought for care at home, even as she upheld the traditions in medicine itself important to her people and lobbied as an advocate for her people; Garcia consistently defied odds and the most daunting circumstances to practice care at home and overseas, which also reflects a core of intense spiritual concern for human life. These two women, in simply and inevitably representing their Native American culture, reveal how essential that culture may be as a contributing agent in nursing everywhere.
Pharris, M. D., & Bosher, S. D. (2008). Transforming Nursing Education: The Culturally Inclusive Environment. New York: Springer.
Plumbo, M. A. (1995). Living in Two Different Worlds or Living in the World Differently: A Qualitative Study with American Indian Nurses. Journal of Holistic Nursing, 13 (2), 155- 173. Retrieved from DOI: 10.1177/089801019501300206
Pollitt, P., Streeter, C., & Walsh, C. (2011). A Nurse’s Journey. New York University College of Nursing. Retrieved from http://www.minoritynurse.com/sage-memorial-nursing-school- and-story-one-alumni
Voda, S. C. (2012). Remembering Visionaries in Nursing Practice. Nursing, 42 (8), 1-3. Retrieved from doi:10.1097/01.NURSE.0000414875.67606.a1