Eliciting the Patient and Family’s Perspectives

Interpersonal Protocol

It is vital for healthcare workers to understand and communicate respect for protocols, values, and ways of life. Alaska Native people respect and follow the protocols of their hosts. For example, when an Alaska Native person goes to a healthcare facility, they typically follow the protocols of the institution, yet when a healthcare provider visits an Alaska Native person in their home or community they may unknowingly violate a cultural communication practice. An elder who does not feel respected will give superficial information or not respond at all. Begin by asking for advice about the appropriate Native protocols in the situation. If the elder is not comfortable explaining the protocols, he or she might refer you to someone who can teach the protocols. Allow yourself to be corrected and ask the elders to teach you proper ways of respect. If the worker feels comfortable visiting an Alaska Native person in their home or rural community to offer a small gift, such as a jar of salmon or jam, this will communicate respect to the older adults.

Communication Process

When working with Alaska Native older adults it is important to slow down your pace of speech to match the pace of the patient. Health care workers need to understand Alaska Native communication patterns. Some Alaska Native older adults may have a specific cadence in their speech, which may require the worker to slow down. You can recognize this speech pattern by noting the delay in elder responses or the general pace of their conversation. Rushing the older adult who speaks slowly may lead them to withdraw instead of opening up. Health care professionals also need to be sensitive to nonverbal communication patterns and to silence.

It is important to listen more than talk and speak in soft tones unless the Alaska Native older adults have hearing loss. Speaking loudly indicates rudeness or anger. Because health care providers are held in high regard, it is customary not to look directly at them while listening intently and giving them total attention. It is vital to allow the older adults ample time to express themselves without interruptions. When Native people are silent, they may be showing respect rather than incomprehension. And finally, keep in mind that the older adults often speak indirectly, in metaphors and stories.

Body Language

When some Alaska Native older adults nod their heads they are indicating that they hear what is being said, and when they raise their eyebrows, they are indicating that they agree. They may furrow their brow to indicate they disagree with what is being said, and when they sigh they are communicating that they are bored. When they hold their arms tight to their body they are communicating that they want to maintain a distance, and when they avoid eye contact they are indicating respect for the person.

Cultural Context of Patient Behavior

When abuse or neglect is suspected, it is essential to understand local reluctance to implicate relatives. Be aware that Alaska Native older adults do not always trust the Euro-Americans. They may be reluctant to implicate others, particularly family members; reporting neglect or abuse may result in jail time or fines for the perpetrator and may threaten individual or community activities such as subsistence hunting, fishing, or gathering.