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Wanigi Waci also gave Welch a chilling-yet empowering-explanation of her severe illness. He pointed out that Welch and her mother came from a Mennonite culture that was oppressive to women, and he believed it was no accident that she had five kidney stones-one for each generation of women who had nearly died during childbirth. He believed Welch's illness was an opportunity to heal the generations of emotional and physical sickness in the family.

"It gave me clarity to know that we really are all interconnected, and my decisions and thoughts become my children's whether I like it or not," Welch said. "The choices I make along the way make it harder or less hard for my children. I really do believe that."

Spiritual analysis

This clarity gave Welch the strength to overcome the excruciating pain, and her remaining stones finally began to pass. Welch has been free of pain for more than three years, and she and her mother are working on a project that aims to introduce American Indian holistic health to diabetes treatment. The Health and Human Services project, which is based in South Dakota, tracks the effect of spiritual and familial connection on blood sugar levels.

In the Western medical approach to diabetes, exercise and food intake are the most important factors linked to blood sugar levels, Koerner said. In the new project, American Indians with diabetes are starting to track how glucose levels are affected by other decisions, such as attending ceremonies, festivals or reunions that nurture a connection to family. The participants in the project also are asked to track blood sugar levels after spiritual events, such as naming or grieving ceremonies or prayer ceremonies.

Like Koerner, Lanette Perkins, RN, is a nurse vying for more American Indian practices in the hospital setting. Perkins, whose father was Crow, Chippewa and Cherokee, works as an American Indian patient advocate at Deaconess Billings Clinic in Montana.

She's witnessed the power of smudging, a cleansing ceremony, and she recently completed the hospital's first official smudging policy.

During one of these ceremonies, members of a patient's tribe typically burn cedar, sage or sweet grass in a patient's room and pray to give the patient spiritual cleansing. Now, when a patient requests a smudging ceremony at the hospital, the staff can read the policy to find out who to call to have it approved and how to handle patients on a ventilator.

Perkins' next goal is to create an amputation policy because many American Indian patients suffer from diabetes, a disease that can increase a patient's chances of losing a limb. The hospital's usual policy is to incinerate amputated limbs, but tribes in Perkins' area believe that when a person dies, the entire body should be with the deceased in the world after death.

Perkins would like to develop a policy that will allow patients to take their limbs home.

"To me, it will be an exciting challenge that will hopefully help hospital staff be respectful to certain tribes," Perkins said. "A lot of times when I worked as a nurse before, Native American patients had such a negative experience and thought Caucasians just didn't understand.

"One of the biggest things I enjoy is being able to help the patients and their families feel like they are valued."

Perkins also has worked with hospital staff to help them accept that American Indian patients may have more than the usual number of visitors. She's accustomed to finding space for 60 to 80 people from a tribe who may come to visit a patient.

It's all relative

The importance of family connection also is an American Indian value that John Lowe, Ph.D., RN, has capitalized on in his treatment of teens who suffer from substance abuse. Lowe, a Cherokee and an assistant professor at Florida Atlantic University, has developed an intervention project that uses Cherokee values to help American Indian teens recover from addiction to alcohol and drugs.

Lowe believes the American value of individualism can sometimes conflict with the Cherokee value of an individual's deep connection to others. In his program, he encourages teens to respect their heritage.

"I explain that if you harm yourself, you are harming everyone you are connected to," Lowe said. "When one person or one thing is not able to make their contribution, then the circle is not whole and there is an incompleteness."