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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 – IHS Crownpoint , NM . Disclosure Statements. I have no financial arrangements related to the content of this presentation.

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  1. Integration of Navajo Culture Values in Primary Care SettingbyRose Saltclah, RN/MSN/CFNP School Based Health Clinic CoordinatorCrownpoint HealthCare Facility – IHSCrownpoint, 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 1st ceremony

  8. Kinaalda Teachings * Clan System * Exercise * Good Health* Good prosperity* Motherhood* Adequate Nutrition* Sharing * Education

  9. 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

  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 Running Mixing of corn mush

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

  13. Process of Kinaalda & Teachings Blessing others Sharing

  14. Navajo Beauty Way: Ho’zhooji’

  15. 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.

  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 & 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.

  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 master’s degrees • 17 males earned master’s degrees

  23. Navajo High School Students Risk BehaviorNavajo Youth Risk Behavior Survey

  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. 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

  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. 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

  30. 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

  31. Cont’d: Emotional - Case Scenario • Larue decided to use Depoprovera • 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. Integration of cultural teachings in Primary CareSocial - Case Scenario • Derek, 17 y/o male comes to teen clinic for immunization • A depression form completed • Result positive

  33. Depression Screening Form

  34. 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?

  35. 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

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

  37. 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

  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: 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

  40. 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

  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, 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

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