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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.

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Presentation on theme: "Integration of Navajo Culture Values in Primary Care Setting by Rose Saltclah, RN/MSN/CFNP School Based Health Clinic Coordinator Crownpoint HealthCare."— Presentation transcript:

1 Integration of Navajo Culture Values in Primary Care Setting by Rose Saltclah, RN/MSN/CFNP School Based Health Clinic Coordinator Crownpoint HealthCare Facility – IHS Crownpoint, NM

2 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.

3 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

4 Many cultures exist today

5 Navajo Family – Home Need for: Counseling Empathy A prayer, a song Educational support Love

6 Kinaalda and Beauty Way Navajo Ceremonies

7 Kinaalda Ceremony Ceremony performed at puberty; first menstruation Signifies transformation from childhood into womanhood Four (4) day ceremony Re-enact changing women 1 st ceremony


9 Contd: 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

10 Process of Kinaalda Running / exercise Mixing of corn mush Blessing Kanaalda girl Blessing of corn mush Blessing others Sharing

11 Process of Kinaalda & Teachings RunningMixing of corn mush

12 Process of Kinaalda & teachings Blessing of corn cakeOpen fire: baking of corn cake

13 Process of Kinaalda & Teachings SharingBlessing others

14 Navajo Beauty Way: Hozhooji

15 Definition of Beauty Way Beauty way, blessingway or Hozhooji Beauty Way (Hozhooji) ceremony is performed to re-established balance, harmony and beauty in ones life. A concept of well-being, worthy, success, pleasant and perfect.

16 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

17 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

18 Summary of Kinaalda & Hozhooji 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 ones self well; watch actions, help others, share, parenthood, teach children. Spiritual: respect blessings from holy people, diety, prayers, songs, and meditation.

19 Teens Young, resilient, daring, fun, giggles, playful, uncertain, energetic, free, etc.

20 More Teens

21 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.

22 Education: 2005 – 06 Navajos graduating from high school 75.5% females annually 69.3% males annually College Education 323 females earned bachelor degree / 4,960 enrolled in college 102 males earned bachelor degrees / 2, 339 enrolled in college 49 females earned masters degrees 17 males earned masters degrees

23 Navajo High School Students Risk Behavior Navajo Youth Risk Behavior Survey High School Students Sometimes or always wore a seat belt90%89%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 92%89% During past YEAR did NOT attempt suicide84%80% 82% During past MONTH did NOT drink alcohol57%61%64%65% During past MONTH did NOT use marijuana61%32%66%67% Never had sexual intercourse61%60%63%57% Ate five or more fruits and vegetables per day38% 28%32%

24 Objective #3: Integration of Cultural teachings & Values in Primary Care Physical Emotional Social School Performance

25 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.

26 PE: Anticipatory Guidance Education

27 Contd : 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

28 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.

29 Contd: 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

30 Contd: 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

31 Contd: 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

32 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

33 Depression Screening Form

34 Contd: 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?

35 Contd: 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

36 Integration of Cultural Teachings & Values in Primary Care - School Performance / Education

37 Contd: 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

38 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.

39 Scholarship availability Web site: Published by: New Mexico State University; Indian Resource Development Telephone: Title: 2010 Sources of Financial Aid Available to American Indian Students

40 Native Leaders today Dr. Beulah Allen, 1 st Navajo woman physician Dr. Lori Arviso Alvord, 1 st Navajo surgeon Caudeen Bates-Arthur 1 st Navajo Attorney & Chief Justice Virginia Ballinger; fashion designer

41 Our youth; our future

42 Our role Understand others culture Help Native youth weave cultural values with its teachings into their life Education is the latter to success

43 Thank you

44 References Kinaalda; A Navajo Girl Grows Up. By Monty Roessel, 1993, Lerner Publications Kinaalda; A Study of Navajo Girls Puberty Ceremony, By Charlotte Johnson Frisbie. University of Utah, SLC, Utah Navajo Women; SAANI, By Betty Reid and Kenji Kawano. Native American Culture Perspectives – Kinaalda: The Navajo Puberty Ritual culture perspectives Blessingway, By Leland C. Wyman, U of A Press, Tucson. AZ. Getting into Adolescents Heads, 1998/99, Contemporary Paediatrics, pp A Pocket Guide to Managing Contraception, Navajo Nation Facts and Figures, 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

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