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Wakanki Ewastepikte: An Advance Directive Education Project With American Indian Elders

Isaacson, Mary J. PhD, RN, CHPN

Journal of Hospice & Palliative Nursing: December 2017 - Volume 19 - Issue 6 - p 580–587
doi: 10.1097/NJH.0000000000000392
Feature Articles

Many American Indian tribes' traditional philosophy of death is one of realism; death is a part of the cycle of life. Yet, health care professionals harbor misperceptions regarding beliefs about death and dying in American Indian tribes, fearing that it is inappropriate to broach the subject. These fears hamper end-of-life discussions, which are crucial for advance care planning and completion of advance directives. This community-based participatory project was conducted on an American Indian reservation in the Northern Plains, where American Indian elders and a nurse researcher developed and implemented a culturally specific advance directive program. At program completion, the 2 elders visited 11 different communities, conducted 270 face-to-face educational sessions, and traveled more than 1000 miles across the reservation. Of those attending the educational sessions, nearly 93% had never heard of a living will, with roughly 7% indicating some knowledge of living wills; 1 person reported having a living will. This community-based, American Indian, elder-led project demonstrates that this population is concerned about its care at end of life and wishes to receive more information. Improving American Indian awareness regarding palliative/end-of life care options and the need for advance directives can help to ensure that their end-of-life wishes will be honored.

Mary J. Isaacson, PhD, RN, CHPN, is assistant professor, College of Nursing, South Dakota State University, Sioux Falls.

Address correspondence to Mary J. Isaacson, PhD, RN, CHPN, College of Nursing, South Dakota State University, 2300 N Career Ave, Suite 260, Sioux Falls, SD 57107 (

This project was supported through an agreement between South Dakota State University and the South Dakota Department of Health, under funds awarded through cooperative agreement number DP003943 from the Centers for Disease Control and Prevention. The contents of this manuscript are solely the responsibility of the author and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the South Dakota Department of Health and Human Services.

The author has no conflicts of interest to disclose.

© 2017 by The Hospice and Palliative Nurses Association.