Native Hawaiian Culture

Family Processes: Ohana

The belief in the importance of ohana, or family, is perhaps the most integral component

of Native Hawaiian life. For Hawaiians ohana includes an individual’s nuclear and extended

family by blood, marriage, and adoption- as well as close friends (Palakiko, 2005). Hawaiians

hold this family dynamic sacred, and ohana is valued over the individual (Miura, 2000). Thus,

Native Hawaiians encourage large families and do not have a preference for either girl or boy

children (Palakiko, 2005). Respect is central within the family, and men and women (regardless

of actual family connection) the age of a person’s mother are often referred to as “Auntie” and

“Uncle” (Sobralske, 2006).

The well-defined ohana roles integrate many generations of family, with the kupunas

(elders/grandparents) serving as “the accepted sources of wisdom, the arbitrators of family

disputes, the troubleshooters of family problems, and the custodians of family history” (Mokuau

& Browne, 1994, p. 44). Kapunas are greatly revered in Hawaiian families, and they often live

with their children sharing in childrearing responsibilities; as keiki (children) are also treasured

members within the ohana (Sobralske, 2006). An elder (kapuna) serves as the family

spokesperson, and is preferred to be the eldest male or female, respectively (Palakiko, 2005).

Kapunas are usually responsible for spiritual matters within the family such as prayers during

significant ohana events (Browne & Mokuau, 2008).

Relationships within the Hawaiian ohana influence and dictate every aspect of life; and

as a result deeply influence choices related to health care (Sobralske, 2006). For example, both

individual and family medical decisions are often influenced by the ohana or by an elder kapuna

(Sobralske, 2006). Caring for an ill family member or pregnant woman is the responsibility of

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the entire ohana; everyone within the family is expected to be present for the birth of a new

member and responsible for the mother’s and newborn’s postpartum care (Palakiko, 2005). In

addition, the ohana is consulted for spiritual and health guidance before external resources are

sought out (Mokuau, Braun, Wong, Higuchi, & Gotay, 2008).

Communication Patterns: Native Hawaiian ho’oponopono and “Talk story”

The basics of Native Hawaiian practices regarding nonverbal and verbal communication

patterns all are derived from the culture’s emphasis on ohana and respect. For example, kapunas

speak first during a conversation and can express differing opinions; while young children do not

speak unless spoken to and those younger than the kapuna must refrain from negative comments

(Palakiko, 2005). Respect is also shown within a group setting via direct eye contact and

individual acknowledgements of all persons present (Palakiko, 2005). It is important to note that

(a short) silence within a conversation is meant to demonstrate agreement with requests or

orders, whether or not full comprehension of the situation is achieved (Palakiko, 2005).

Due to the fact that respect, harmony, and ohana are so valued within Native Hawaiian

culture, when interpersonal conflicts arise the method of ho’oponopono or “setting to right” is

utilized within the ohana to regain balance and establish peace and understanding (Miura, 2000).

Ho’oponopono helps preserve the ohana, and is usually facilitated by the kapuna. The kapuna

serves as a mediator (haku) who manages the intervention by preventing outbursts, maintaining

focus, and offering cues to promote mutual understanding of the issue and all feelings that have

arisen (Miura, 2000).

The ho’oponopono is divided into four phases: opening, discussion, resolution, and

closing (Miura, 2000). The opening haku begins with a pule (prayer) to bless the process, and

then the second phase begins when the haku states the problem or hala. The hala is phrased as a

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metaphorical “cord” that ties all present together, and thus all are responsible for unraveling

(solving) this cord that is entangling the ohana. This entanglement is termed hihia; and because

it entraps each family member’s emotions, the entire ohana is responsible for the untangling or

resolution of the problem (Miura, 2000).

Therefore, each aspect of the hihia is laid out, and each family member speaks to his/her

emotional conflict- one at a time (Miura, 2000). Clearly, this discussion process can be very time

consuming. When this process is finished, the resolution phase begins and the kapuna initiates

the mihi: “the sincere confession of wrongdoing and seeking of forgiveness” (Miura, 2000, p.

22). Once the apology is given, both parties with the original conflict must forgive each other or

offer kala to untie the cord of conflict and release all involved (Miura, 2000).

The closing or pani summarizes the mediation and also reaffirms the family’s bond. The

pani states that the problem has ended and will not be brought up again; thus it is not performed

if the issue is not resolved at the end of the discussion. Finally, after the pani the family gives

thanks in the form of a prayer and then shares a meal which they have collectively prepared-

symbolizing the conflict’s resolution and restored harmony of the ohana (Miura, 2000).

In contrast to the linear progression of the ho’oponopono, everyday Native Hawaiian

conversations usually take the form of “Talk Story”, an English term for a dialogue with no

distinct beginning, middle, or end (Palakiko, 2005). “Talk Story” encourages positive feedback

from those involved in the conversation, and thus long silences within the dialogue are

considered rude (Affonso, Mayberry, Inaba, Matsuno, & Robinson, 1996). In fact, “Talk Story”

no matter what the context of the conversation, is viewed as a reciprocal dialogue between active

participants with a goal to achieve rhythm and grace in communication (Affonso, et al.,1996).

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 When trust and compassion are seen as present (via eye contact, nodding of head,

positive comments and encouragement to continue), the speaker will keep the dialogue going and

will divulge information bit by bit in a “forward and backward movement and pacing” (Affonso,

et al.,1996, p. 739). Within this framework it is important to note that nodding does not indicate

agreement or comprehension of what is said, but rather acknowledgement of the speaker

(Palakiko, 2005).

When “Talk Story” is not deemed equally rewarding for those involved, one may hear

“persistent affirmative responses, heavy sighing accompanied by silence, and expressions of fear

related to divulging too much information” (Affonso, et al.,1996, p. 739) However, normally

“Talk Story” ends with positive ending comments such as “I feel good talking with you” and

“Can we meet again, I have more to tell you” (Affonso, et al.,1996, p. 739).

Nursing interventions specific to Native Hawaiians and their families

Native Hawaiian Culture Family Processes: Ohana

Areas in which conflict may occur: Although traditional American culture does place

importance on respect and family ties, it is largely an individualistic culture placing emphasis on

personal needs and goals. In contrast, the Native Hawaiian culture values the collective over the

individual; thus this collectivistic culture’s values may conflict with those established in

traditional American health care settings. A Native Hawaiian’s close knit ties with family and

communal health decisions may be seen as intrusive and conflict with HIPAA policies.

Furthermore, health care staff may view the presence of many family members as an obstacle to

expedient patient care.

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 Interventions:

Preservation: In order to preserve the close ties of ohana for the Native Hawaiian client it is

imperative to involve family members in health care as much as possible. This would include

inviting varying family members to prenatal classes/parenting education classes and encouraging

the client to involve their family in their care.

Accommodation: Accommodation for the Native Hawaiian client would include such

interventions as allowing family members to “rotate into” the L&D room if they all wish to be

present during the birth process. Accommodation could also include the nurse visiting the

extended family in the waiting room with frequent updates regarding the patient (allowing for

HIPAA policy).

Repatterning: If rotation into the L&D room is not an option, the nurse may suggest that family

members place “representative stones” (see interviewee section below) beside the laboring

mother.

Communication Patterns: Native Hawaiian ho’oponopono and “Talk story”

Areas in which conflict may occur: Traditional American culture follows a linear speech

pattern and dialogue with a clear beginning, middle, and end. Native Hawaiian dialogue is non-

linear and has little defined format. This difference in communication technique could

potentially be frustrating for both the Native Hawaiian client and the health care worker. The

American health care worker may seem rushed and rude to the Native Hawaiian, and the Native

Hawaiian may appear to be uninterested or unmotivated regarding their health care. In addition,

because nodding within conversation for Native Hawaiians does not indicate agreement or

comprehension of what is said (but rather acknowledgement of the speaker), the health care

worker may misread this body language as the client’s consent or understanding.

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 Interventions:

Preservation: Malama Na Wahine Hapai (Caring for pregnant women) was a community health

nursing project in the early 1990s that integrated Native Hawaiian culture with prenatal care via

“Talk Story” sessions with expectant mothers and nurses (Affonso, et al.,1996, p. 739). This

program is a prime example of the positive effects of cultural preservation regarding Native

Hawaiian women and prenatal care.

All nurses can follow this model of preservation by encouraging the Native Hawaiian

client who initiates a nonlinear “story” type dialogue via active listening techniques such as

maintained eye contact, nodding, paraphrasing, and offering positive feedback; ALL aspects of

Native Hawaiian communication that indicate effective communication, respect, and trust. In

essence then, the nurse would indeed be “Talking Story”!

Accommodation: Postpartum nurses can accommodate Native Hawaiian mothers by providing

time and space for the mother’s family to have private “Talk Story” sessions that will following

the birth of a child. This will allow the mother to process her birth experience with her family so

that she can begin to bond with her newborn.

Potential conflict: Native Hawaiian clients’ affinity with peace and harmony and distress with

conflict should be addressed in the health care setting. Native Hawaiians are traditionally taught

not to contradict elders and to only respond with positive feedback. These practices may be

dangerous within the health care setting.

Intervention: The nurse should explain to the client that he/she has the right to and should voice

concerns regarding health care service and point out any overlooked or missed health

information that could impact patient care. In addition, the nurse should encourage the Native

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Hawaiian to voice any pain or discomfort that they are experiencing and that it will not be

perceived as dissatisfaction with their nursing care.

Comparison and Contrast of Literature and Cultural Assessment of Interviewee

My interviewee is “Luana” a 32 year old Native Hawaiian mother of two who lives on

the island of Oahu. A phone interview was conducted on September 1, 2010.

Native Hawaiian Culture Family Processes: Ohana

Comparison:

Luana did confirm all of the aspects of the importance of ohana in her life and the deep

involvement that her kapunas had throughout her pregnancies. Health care decisions were

discussed within her ohana, and her parents and grandparents all view themselves as responsible

for sharing in childcare. Luana’s Pre/Perinatal care was provided by her ohana, and she confirms

that it is believed that the well-being of the mother and baby are the responsibility of the

ENTIRE ohana.

Luana also confirmed her family involvement in health care with the following self-

reported cultural practices:

Kapunas offer prayers in the form of chanting (mele) to ensure an easy labor without

complications. This is also done to ensure a healthy baby. Kapunas are present at birth,

performing a “Mele Oli Hanau” or birth chant to welcome the new child into the ohana and to

ask for a blessing from the gods.

The entire ohana ensures that expectant mothers avoid all closed necklaces and leis. It is

believed that this may cause the baby’s umbilical cord to wrap around the unborn baby's neck

and choke the baby. Ho’okauhua refers to the pregnancy and the cravings of certain foods during

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this time. These cravings are thought to be an expression of the character of the baby and should

be satisfied, therefore, the entire ohana responsible for helping the mother satisfy these cravings.

Luana further confirms that the Entire family should be present for labor and delivery.

If a member of the ohana cannot be present for the delivery someone should place a stone at the

door and say loudly, "Here is _____". After the birth, the stone must be placed somewhere safe

away from pollution and harm.

Luana reports the following postpartum ohana responsibilities:

An “Auntie” immediately binds the lower abdomen after birth to prevent "hanging over"

of the tissues. The eldest Kapuno/a will take the placenta home and bury it with an ulu tree

planted above it. The placenta is believed to be part of the child, and this burial will forever bind

the child to his/her homeland. The ulu tree symbolizes strength and growth. An “Auncle” or

kapuna will bury the umbilical cord (after it dries and falls off of the baby) in a safe place where

a rat cannot gnaw on it. If a rat gets to it, it is believed the baby will have misfortunes and could

become a thief.

Contrast:

When I read the basics of the cultural literature concerning ohana to Luana over the

phone, she reported that it was “one hundred percent of how (her) family works”.

Communication Patterns: Native Hawaiian ho’oponopono and “Talk story”

Comparison:

Luana spoke fondly of her “Talk Story” girlfriends and the close relationship she shares

with her wahine (women) friends. Luana also “Talks Story” with her family about important

personal decisions and work/ethical concerns. She values this “loose” form of communication

and feels that she is able to bring harmony into her life with the help of her ohana and friends.

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 Contrast:

Luana works as a health care professional and reports that “Talk Story” is not encouraged

within her workplace. Furthermore, she reports that ho’oponopono is only practiced on her side

of the family and not within her husband’s family who are also Native Hawaiians.

Comparison and Contrast of personal cultural heritage and native Hawaiian culture

I culturally identify as Mexican-American, more specifically “Chicano”.

Native Hawaiian Culture Family Processes: Ohana

Comparison:

My culture also has a deep respect for family and elders are similarly revered. Mexican

American grandparents also help with childrearing, and are also sought after for health advice-

much like the kapuna.

Contrast:

In Mexican American families, health care decisions are seen as private and are not

typically discussed with non nuclear family members.

Communication Patterns: Native Hawaiian ho’oponopono and “Talk story”

Comparison:

My culture also has a reverential dialogue with elders; the children “speak when spoken

to” rule is also generally applied. Much emphasis is also placed on respect and gratitude when

speaking with others, and positive feedback in conversation is also encouraged. Negative

comments are also generally held back, especially when speaking to elders.

Contrast:

Communication patterns within my culture are linear, and ANY interruptions are seen as

rude and disrespectful (even positive ones).

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 Evaluation of Personal Response:

After some personal reflection regarding this report I realized that I felt a little frustrated

with the possible perception of “passivity” of a Native Hawaiian client regarding health care.

Also, I really came to understand the intricacies involved in family mediation or ho’oponopono,

a truly inspiration method of conflict resolution. Although I lived and worked in Hawaii for three

years, I feel that I learned a lot about the importance of culturally competent care for this highly

underserved and high risk native population.

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