integration of navajo culture values in primary care setting by rose saltclah, rn/msn/cfnp school...
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Integration of Navajo Culture Values in Primary Care Setting
by
Rose Saltclah, RN/MSN/CFNP School Based Health Clinic Coordinator
Crownpoint HealthCare Facility – IHSCrownpoint, NM
Disclosure Statements
• I have no financial arrangements related to the content of this presentation.
• I have no financial arrangements with the sponsors of this activity.
• I will not discuss off label use of any medications.
Objectives
By the end of this presentation participates will be able to:
• A. Discuss two examples of Navajo ceremonies• B. Discuss at least three unique values of
Navajo culture in relation to primary healthcare• C. Identify at four ways to integrate ceremonial
teachings into primary care setting
Many cultures exist today
Navajo Family – Home
Need for: Counseling Empathy A prayer, a song Educational support Love
Kinaalda and Beauty Way Navajo Ceremonies
Kinaalda Ceremony
• Ceremony performed at puberty; first menstruation
• Signifies transformation from childhood into womanhood
• Four (4) day ceremony• Re-enact changing
women 1st ceremony
* CLAN SYSTEM
* EXERCISE
* GOOD HEALTH
* GOOD PROSPERITY
* MOTHERHOOD
* ADEQUATE NUTRITION * SHARING
* EDUCATION
Kinaalda Teachings
Cont’d: Kinaalda Teachings
• Think positive thoughts• Watch behavior / actions• Negativity must be avoided• Take care of earth• Everyone valued, respect• Everything valued; animals & plants• Earth is mother of all life • Obedience; keep 4 days holy• Future motherhood, family
Process of Kinaalda
• Running / exercise• Mixing of corn mush• Blessing Kanaalda girl• Blessing of corn mush• Blessing others• Sharing
Process of Kinaalda & Teachings
Running Mixing of corn mush
Process of Kinaalda & teachings
Blessing of corn cake Open fire: baking of corn cake
Process of Kinaalda & Teachings
Sharing Blessing others
Navajo Beauty Way: Ho’zhooji’
Definition of Beauty Way
• Beauty way, blessingway or Ho’zhooji’• Beauty Way (Ho’zhooji’) ceremony is
performed to re-established balance, harmony and beauty in one’s life.
• A concept of well-being, worthy, success, pleasant and perfect.
Purpose: Beauty Way Ceremony
• For holistic restoration of beauty• A prophylactic approach to well being
Reasons>Family>Individual self>Employment>Preventive health>Post medical care (surgery)>Veterans
Closure of Beauty Way Prayer
• With beauty may I walk• With beauty before me may I walk• With beauty behind me may I walk• With beauty above me may I walk• With beauty all around me may I walk• It is finished in beauty, it is finished in beauty,
it is finished in beauty, it is finished in beauty
Summary of Kinaalda & Ho’zhooji’
• Physical: Exercise, strength, endurance, good health. Self care, healthy future children (clan system)
• Emotional: positive thoughts, mind, language – speak kind words, strong mind, intellect, education.
• Social: conduct one’s self well; watch actions, help others, share, parenthood, teach children.
• Spiritual: respect blessings from holy people, diety, prayers, songs, and meditation.
Teens
Young, resilient, daring, fun, giggles, playful, uncertain, energetic, free, etc.
More Teens
Navajo Nation (NN) Population 2005 – 06
*Total Navajo population: 298, 215*Navajo Nation residents: 180,462• Female NN residents: 51.8 %• Male NN residents: 48.2%• Navajo non-NN residents distribution: • > PHX: 10,143• > ABQ: 7,889• >Gallup: 6,279• > Farmington: 5,793• > Others: Flagstaff, Tucson, SLC, Utah & LA, Calif.
Education: 2005 – 06
Navajos graduating from high school• 75.5% females annually• 69.3% males annuallyCollege Education • 323 females earned bachelor degree / 4,960
enrolled in college • 102 males earned bachelor degrees / 2, 339
enrolled in college• 49 females earned master’s degrees• 17 males earned master’s degrees
Navajo High School Students Risk BehaviorNavajo Youth Risk Behavior Survey
High School Students 2000 2003 2005 2008
Sometimes or always wore a seat belt 90% 89% 88% 88%
During past month did not ride with a driver who had been drinking alcohol
61% 66% 67% 69%
During past month did not carry a weapon on school property
No Data
No Data
92% 89%
During past YEAR did NOT attempt suicide 84% 80% 80% 82%
During past MONTH did NOT drink alcohol 57% 61% 64% 65%
During past MONTH did NOT use marijuana 61% 32% 66% 67%
Never had sexual intercourse 61% 60% 63% 57%
Ate five or more fruits and vegetables per day 38% 38% 28% 32%
Objective #3: Integration of Cultural teachings & Values in Primary Care
• Physical• Emotional • Social • School Performance
Sports Physical Exam
• 17 year old has an appt to see a medical provider for Sports PE. He wants to play basketball and run track.
• Well appearing with no chief complaint.
PE: Anticipatory Guidance Education
Cont’d : Sports PE - Anticipatory Guidance Education integrated with Ceremonial Teachings
• Safety: car, use of seat belt, no bullying, etc.• Smoking, alcohol, Drugs prevention• Pregnancy Prevention • Nutrition• Sexual education, STIs• Physical Activity• Others
Emotional - case scenario
• Larae, 16 y/o, Navaho girl, comes to teen clinic. Interest in BCM.
• Tells you she is sexuality active, one partner x 6 mos, does not want to become pregnant.
Cont’d: Emotional - Case Scenario• Age at menarche; Kinaalda
done or attended one.?• LMP; regular• Cycle length• Any prior experience with
OCM• PMH: blood clots,
headache, DM, HTN. EYE problem, any pain.
• FMH: blood clots, migraine HA.
• Social hx: use of any drugs; e.g. smoking, ppd, frequency. Family / home setting, adopted? Lives with boyfriend?
• Confidentiality• Medications, allergies
Cont’d: Emotional - Case Scenario
• What to do: urine hcg• Variety of OCM• Methods, what are
they, how to use them, side effects, efficiency, back up method (F & C)
• Kinaalda teachings
Cont’d: Emotional - Case Scenario
• Larue decided to use Depo provera
• Busy life• Start depo today• Re-iterate kinaalda
teaching & prevention of pregnancy / STI.
• Priority - School • Confidentiality
• If method not started today; may not:
> RTC>have additional
unprotected sex> never start a method> potential for unplanned
pregnancy / could have been prevented
• Derek, 17 y/o male comes to teen clinic for immunization
• A depression form completed
• Result positive
Integration of cultural teachings in Primary Care
Social - Case Scenario
Depression Screening Form
Cont’d: Social Case Scenario
• 1. Little interest or pleasure in doing things.
• 2. Feeling down, depressed or hopeless
• PHQ – score: range 0 – 6.
> 0 – 2 is negative > 3 – 6 is positive, further
evaluation
• Depression form : PHQ-2 Version
• Over the past two weeks, how often have you been bothered by the following problems?
Cont’d: Social - Case Scenario HEADSSS
• Head – Home Environment
• E – Education / Employment, Eating / Exercise
• A – Activities & Peer Relationships
• D – Drugs, Cigarettes, Alcohol
• S – Sexuality• S – Suicide,
Depression, mood • S – safety • S – spirituality
Integration of Cultural Teachings & Values in Primary Care -
School Performance / Education
Cont’d: School Performance – cultural values; modern day
teachings
• Good prosperity • Good nutrition • Respect• Language • Behavior / action • Positive thoughts
• Good Health• Work hard • Excel academically • Remember clan
system• Career / life
planning
Educational student opportunities
• High School student summer opportunities>Examples: *AISES College Horizon * Nizhoni
Academy at NAU * U of A Med. Start Program * INMED: Indians into Medicine * NNAYI: National Native American Youth Initiative *Upward Bound available in every States.
• Need good grades, good behavior, letters of recommendation from teacher/counselor.
• Native teachings: good prosperity, good behavior, work hard, respect, life planning.
Scholarship availability
• Web site: www.nmsu.edu/~ird• Published by: New Mexico State University;
Indian Resource Development• Telephone: 575. 646. 1347• Title: 2010 Sources of Financial Aid Available
to American Indian Students
Native Leaders today
• Dr. Beulah Allen, 1st Navajo woman physician
• Dr. Lori Arviso Alvord, 1st Navajo surgeon
• Caudeen Bates-Arthur 1st Navajo Attorney & Chief Justice
• Virginia Ballinger; fashion designer
Our youth; our future
Our role
• Understand others culture
• Help Native youth weave cultural values with its teachings into their life
• Education is the latter to success
Thank you
References• Kinaalda; A Navajo Girl Grows Up. By Monty Roessel, 1993, Lerner
Publications• Kinaalda; A Study of Navajo Girls Puberty Ceremony, 1993. By Charlotte
Johnson Frisbie. University of Utah, SLC, Utah• Navajo Women; SAANI, 2007. By Betty Reid and Kenji Kawano. Native
American Culture Perspectives – Kinaalda: The Navajo Puberty Ritual• http://www.associatedcontent.com/article/106033/native culture
perspectives• Blessingway, 1970. By Leland C. Wyman, U of A Press, Tucson. AZ. • Getting into Adolescents’ Heads, 1998/99, Contemporary Paediatrics, pp
75-90. • A Pocket Guide to Managing Contraception, 2000. • Navajo Nation Facts and Figures, 2005 -06. NN Economic Development ,
NN Scholarship Office and Navajo Election Administration• Navajo Youth Risk Behavior Survey, 2003 – 08. Four Directions, Northern
Navajo Medical Center, Shiprock, NM