Domestic violence is a troubling issue experienced both at national and worldwide levels. The female population happens to be the most vulnerable group to experience domestic violence compared to men. Globally, one in three women experience domestic violence at least once in their lifetime and it may include physical abuse, psychological abuse, financial abuse or even being coerced into sexual acts. Sadly, most often, the abuser can also be a close member of the family. According to reports, domestic violence leads in inquiry cases compared to muggings, car accidents, and rape combined. Today, in the US, studies indicate that around three women lose their lives to murders often perpetrated by their partners. This paper specifically discusses the group of American-Indian women which is one of the most violated groups of women in US. The paper also gives statistics related to the population and the impact of domestic violence on their health and analyzes the psychosocial needs of the group. Lastly, the paper discusses the issues impacting the culturally competent care of American-Indian group of women and describes associated cultural and ethical care methods of nursing practitioners will employ in caring for the population.
American-Indian female group
The American-Indian women population experience high domestic violence rates that are often accompanied by sexual and physical assault and even murder in some cases. However, most of the women do not report the violence due to a variety of reasons ( Chong & Lopez, 2005. Some victims tend to fear retaliation either from friends or families of the perpetrators and some fail to speak of the predicament due to their mistrust in the available systems of help.
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Domestic violence among the American-Indian population is largely aggravated by high poverty rates, especially on reservations. Another cause leading to the perpetration of domestic violence includes cases of drug and alcohol abuse by the ethnic group (Cai, 2016) . Moreover, the fact that no education regarding domestic violence is taught in schools present in the reservation areas also makes the victims ignorant on which actions to take once such violence is done to them ( Anastasia, Marina & Olga, 2018) . In addition to that, the government can help them by increasing victim safety and developing prevention strategies.
Psychological and physical violence is among the major forms of violence that occurs to the American-Indian women population. The reason for selecting the American-Indian women population is mainly because my sister was once a victim ( Chong & Lopez, 2005) . She was emotionally, physically and verbally abused by her husband after 10 years of marriage. The US government should, therefore, try to step in such cases and help in reducing the incidences ( Chong & Lopez, 2005) . The government can accomplish this by providing listening sessions, programs, training sessions, and resources relating to understanding the needs and grievances of the group.
Group statistics of domestic violence on the American-Indian female group and its impact on their health
The American-Indian women population experience higher rates of domestic violence compared to women from any other ethnic group in the US. They are three times more likely to encounter domestic violence compared to other ethnic groups with over half of them reporting cases of sexual at least once in a lifetime (Cai, 2016) . Among couples, 55.5% experienced physical violence while 66.6% encounter psychological abuse. For the case of reserved areas, murder cases are reported to be around 10 times higher than the rest of the country (Duran et al., 2009). What is sad about the violence is the fact that around 70% of the perpetrators are often people from other races.
Due to domestic violence among the American-Indian population, the population seems to have higher levels of alcohol dependence and abuse, mental distress, and suicide rates compared to the general population (Kravchenko, 2014) . There has been an increasing discovery among professions in the healthcare system identifying domestic violence as a highly prevailing public health problem with catastrophic effects on families, communities, and individuals (Cai, 2016) . Moreover, the widespread post-traumatic stress disorder (PTSD) is significantly higher among the American-Indian compared to the rest of the population. This is higher vulnerability to PTSD is mainly due to higher rates of subjection to traumatic events coordinated with their rapid historical, intergenerational, and cultural traumas.
Psycho-social needs of the American-Indian female population
Both mental well-being and emotional needs of the American-Indian population are often violated and overlooked in society. Psychosocial needs of the group include security needs, love and belonging, self-esteem, cultural, ethnic identity, sexuality, and mental health ( Chong & Lopez, 2005). Psycho-social needs are often hard to meet compared to physical needs since they are more of action-oriented. Psycho-social needs can be met through by spending time with the population, listening to their opinions and grievances, and showing concern not only to them but also to their lives ( Chong & Lopez, 2005). The American-Indian population also needs to interact and socialize with other people so that they may not feel isolated and lonely ( Anastasia, Marina & Olga, 2018) . General acknowledgment and interest of the group especially by the government are also expected in order for them to feel valued and respected.
Love and belongingness are also needed by the group since they are sometimes victimized by individuals who happen to be close members of their family. The sexuality of the population should also be respected and rape cases should be avoided at all costs (Kravchenko, 2014) . The cultural and ethnical identities should also be respected and perpetrators should not take advantage of the population due to religious and social differences. In addition to that, the nursing practitioners should also consider social and religious differences when caring for the victims especially those who do not speak or understand English ( Anastasia, Marina & Olga, 2018) . Moreover, the group also expects the nurses to consider the victim’s religion and dietary restrictions and preferences when caring for them.
Issues impacting culturally competent care delivery for American-Indian female group The American-Indian female population who experience domestic violence mostly visit health care facilities for medication and checkups. However, the increased diversity of the U.S. population brings both opportunities and challenges for healthcare systems to deliver services which are culturally competent (Cai, 2016). Issues impacting such service delivery include ethnic, religion, gender identity, and racial imbalance.
Most of the American-Indian women population lack proper documentation in regard to several legal statuses due to their different biographies. This largely affects them and may act as a barrier while seeking help after a domestic violence (Kravchenko, 2014). Another issue is inadequate support, training, and resources from the providers. Moreover, the available resources are usually directed towards the other populations who tend to mostly benefit compared to the rest of the population.
Another factor may be due to lack of sufficient resources and support that are relevant in strengthening and supporting cultural competencies among domestic violence service providers. Usually, it involves maintaining and developing knowledge, skills, values, and attitude that are necessary in order to effectively work and engage the diverse ethnicity, race, and religion ( Chong & Lopez, 2005) . Cultural competency involves constant listening and asking the individual women about their needs and how best they can be supported and served (Kravchenko, 2014) . Such finances may not be readily available in most healthcare facilities and therefore make the enacting of such services difficult.
Domestic violence survivors tend to be hesitant in reporting such cases while others do not even know if such services exist. Failure to report such incidences may be due to embarrassment or shame of the victims while others may not be able to speak or understand English. Other domestic violence victims do not trust in the existing systems of service hence making care delivery to them seem quite difficult (Anastasia et al., 2018). While others are hesitant to report such cases, some do not have the idea of the existence of domestic violence services in healthcare systems ( Chong & Lopez, 2005) . A report suggest that the white and U.S. born population are more likely to look for help and are more knowledgeable about such services than the rest of the population.
Cultural and ethical competent care methods used by Nursing Practitioners in caring for the American-Indian population
Nursing practitioners can employ several methods in order to tackle ethical and cultural issues in the American-Indian female group. To begin with, the nursing practitioners should perform a self-assessment test in relation to cultural competence in order to determine their weaknesses and strengths in regard to working people from diverse cultures (Kravchenko, 2014). Nursing practitioners should also obtain a certificate in cultural competence in an effort to increase their cultural awareness, skills, and knowledge. This can be done through seminars and workshops where the nurses can be trained ( Chong & Lopez, 2005) . Nursing practitioners should also improve communication and reduce language barriers in order to effectively engage with diverse cultural groups such as the American-Indian population.
The practitioners can also use gestures, pictures, or written summaries in order to improve their communication with victims. Nurses should also engage directly in cross-cultural interactions with the patients. This will make them able to explore the patient’s beliefs, needs, and values in an effort build successful relationships with the victims (Kravchenko, 2014). Lastly, the nurses can also use the social media and online networking in order to improve their cultural awareness and maintaining up-to-date information on issues relating to cultural competency.
Conclusion
Generally speaking, domestic violence is rampant among the American-Indian group of women who get violated by people from other races as well as close members of their families. Such violence may be in the form of physical abuse or verbal abuse and may result in several effects such as physical injuries or even mental injuries to the victims. Care delivery to the victims may be challenging at times due to cultural competencies of the victims. However, nursing practitioners can employ methods such as improving their communications and engaging directly in cross-cultural interactions with the victims.
References
Anastasia S. B., Marina A., & Olga A. T. (2018). Intimate Partner Violence: An Overview of the Existing Theories, Conceptual Frameworks, and Definitions. Psychology in Russia: State of Art, Vol. 11, Iss 3, Pp. 128-144 (2018) , (3), 128. https://doi.org/10.11621/pir.2018.0309
Cai, D.Y. (2016). Original Article: A concept analysis of cultural competence. International Journal of Nursing Sciences , 3 , 268– 273. https://doi.org/10.1016/j.ijnss.2016.08.002
Chong, J., & Lopez, D. (2005). Social Networks, Support, and Psychosocial Functioning among American Indian Women in Treatment. American Indian & Alaska Native Mental Health Research: The Journal of the National Center , 12 (1), 62–85. https://doi.org/10.5820/aian.1201.2005.62
Duran, B., Oetzel, J., Parker, T., Malcoe, L. H., Lucero, J., & Yizhou Jiang. (2009). Intimate Partner Violence and Alcohol, Drug, and Mental Disorders among American Indian Women from Southwest Tribes in Primary Care. American Indian & Alaska Native Mental Health Research: The Journal of the National Center , 16 (2), 11–27.
Kravchenko, I. V. (2014). The Influence of Married Couples’ Needs on the Stability of Rural and Urban Young Families. Russian Education & Society , 56 (2), 80–90. https://doi.org/10.2753/RES1060-9393560204
