- Sean N. Bennett, RN, MSN - Assistant Professor - Utah Valley University - Orem, Utah
- Cody Fitzwater, RN, BSN - Utah
The Navajo Nation is the largest federally-recognized tribe within the United States. The Navajo Nation population is relatively young – the median age being 22.5 years (2000 Census Count). The Navajo Nation extends into Arizona, New Mexico and Utah and covers over 27,000 square miles, including all or parts of 13 counties in those states. If the Navajo Nation were a recognized state, it would be larger than 10 of the 50 states in the U.S.
Navajo's have higher rates of death due to the following conditions than the rest of the U.S. Population: Diabetes, Cervical Cancer, Alcohol, Suicide, Homocide, Tuberculosis, Influenza, and Pneumonia. They also suffer from a higher number of teen births, infant deaths, postneonatal deaths, and lower incidences of prenatal care in the first trimester.  .
Values and Norms
Religion (Traditions, Beliefs, Attitudes)
For the Navajo people daily life is their religion. Their life, land, and overall well being can be considered their religion. They see all living things as being related, including Earth itself. Each being is given its own spirit which gives it purpose and connects it to the universe. These connections are recognized by the Navajo through daily prayers and ceremonies. It is thus important for the Navajo to maintain balance between himself and his environment and to live in harmony with nature. Navajo people believe that in order to achieve this balance they must practice their religious beliefs on the land that was given them by the Creator. The Navajo people will defend their land and their right/need to retain it because the believe the Creator has instructed them to never leave their homeland. 
Religious beliefs should be understood so that therapies of education can be appropriately tailored to each individual. Counseling emphasis for a prenatal patient is best given once religion is determined as the approach would be different for a Navajo who believes traditionally, for Navajo American Church members (who use peyote) and for Navajos who have converted to Christianity.
History taking is perceived particularly by Navajo elderly as unnecessary. Traditional healers "know" what the problem is, without oral history taking sessions. Combining the history while a physical examination is underway can yield better results.
Therapies may be delayed by the patient so that a traditional healer can be consulted and on occasion a ceremony performed in their hogán (home).
Patients may arrive for healthcare with their skin blackened with charcoal which means they have recently had a ceremony performed for them by a traditional healer. After ceremonies, patients have to observe certain practices outlined by the healer (only eat certain foods, avoid anything dead, etc.).
Navajo concepts of being, health, disease, and the environment are deeply intertwined with Navajo religion.
Sense of Self and Space
When a Navajo baby is born it is born to the clan of the mother and takes on her name. Marrying within one's own clan is forbidden and would be considered incest to the Navajo. For Navajo's it is customary when introducing oneself to state the maternal and paternal clan names so that another Navajo will know where you came from. Two Navajo's from the same clan who meet for the first time will call each other brother and sister. Cousins are seen as brothers and sisters, the father's and mother's cousins are seen as aunts and uncles and the grandparents brothers and sisters are seen as grandmas and grandpas. If a Navajo is in an area that is new to him his relatives or clan will most often take responsibility for his home, food and overall well being. 
Communication Style and Language
- Navajo Indians may be comfortable with long periods of silence, and may not share inner thoughts and feelings with anyone outside their clan.
- Interest in what an individual says is shown through attentive listening skills.
- To establish a positive social relationship, the rule of silence is considered a serious matter that calls for caution, careful judgment, and plenty of time.
- A person may be considered immature if answers are given quickly, or if he/she interrupts another who is forming a response.
- It is important to allow time for elderly Navajo to respond to questions. Not allowing adequate time for information processing may result in an inaccurate response, or no response.
- Navajo Indian family members may show support to family members during doctor appointments not through talking, but by simply being present. For Navajo Indians, silence is being supportive.
- The Navajo language is unwritten and extremely complex.
- Its syntax and tonal qualities make it extremely difficult to understand and it has no alphabet or symbols.
- The Navajo language was the only code considered unbreakable in World War II.
- The Navajo use a great deal of humor in their day to day conversations.
- A Navajo child's first laugh is considered something to celebrate.
Food and Feeding Habits
"Traditionally the Dinè farmed beans, squash and corn and hunted deer, prairie dogs and other animals. Corn was the most important food. Indian corn comes in many colors and could be eaten fresh or dried and ground. Today many raise sheep for meat and wool. Mutton (meat from sheep) and fry bread is a favorite food." There are four basic Navajo food groups which include:
- The Navajo corn and wheat category, which includes many breads and cereals.
- The wild food category which would be fruits and vegetables including things like wild celery and onions, yucca banana, navajo squash, current berries, etc.
- The protein group which is primarily mutton and all parts of the sheep are eaten.
- The milk and cheese group which include goat milk and goat cheese.
Western culture views time as linear, which means an event has a start and a finish and once it has passed it can't be revisited. Navajo culture views time as cyclical, which means that less concern is placed on punctuality. In cyclical time events will reoccur and can be revisited. Because of this thought process the Navajo people place greater importance on relationships and staying until something is completed.
For health care purposes the perception of time is different in that problems may have begun "awhile ago" and menses may be marked in their relationship to lunar cycles. The history of present illness or an acute illness may result in a story which relates the cause to events in the patient's personal life as far back as 50 or more years. 
Relationships and Social Organization
The Navajo people are a matrilineal society in which everything (property and such) are inherited by the women. They are also a matrilocal society which means that the husband typically moves in with the wife and her family. Although they are matilineal and matrilocal they are not a matriarchal society but instead an egalitarian society. Neither gender is considered more or less important. They believe that it is important to find a balance between men and women in order for society to function properly.
Navajo people belong to clans and when a child is born, the child is born into the mothers clan and for the fathers clan. Traditionally it was prohibited to marry someone within your own clan but that principle seems to be deteriorating over time. Navajos value strong family ties even when family members have moved off the reservation. Many times family members working off the reservation will send money home to help those who are still on the reservation.
Education and Learning
School enrollment on the Navajo Nation beginning in 2000 was 55,648 from 1st to 12th grade. There were 7,951 enrolled in nursery school, preschool and kindergarten (US Census 2000). Since then, based on our data collection from New Mexico Public Education department, Arizona Department of Education, the Utah State Education Department and the Bureau of Indian Education, school enrollment on the Navajo Nation has been in a decline from 42,492 in 2006, 40,974 in 2007, 39,203 in 2008, and 38,990 in 2009. These enrollment numbers are for all public schools, Bureau of Indian Education (BIE) schools, and grant schools.
Educational Attainment on the Navajo Nation shows that 55.93% (49,593) of the population has a High School graduate or higher and that 7.29% (6,464) of the population has a Bachelor’s degree or Higher based on the 2000 Census. 
Navajo's may prefer not to make direct eye to eye contact and prefer touching of hands over a firm handshake.
Doing a review of systems can cause tension as any concerns about findings that are expressed to the patient may not be received well. If the patient had a problem with anything he would have informed the clinician ahead of time.
Family decisions in regard to health matters are very common. Make sure to allow the patient and the family enough to time to converse and make their decision.
Before displaying x-rays to the patient always ask if it is alright as some Navajo's have strong feelings in regards to pictures about themselves.
Allow for extra time when translation is required. There are several English terms that do not have a single word translation into Navajo and a simple question may take much longer to translate in the Navajo language.
The use of pinion tree sap and herbs for wounds is not uncommon. If you encounter this scenario with a patient do not criticize or you may risk damaging the nurse-patient relationship.
Many Navajo believe that if you bring up things that may occur in the future (potential complications such as death) that it will cause these events to occur. This can create problems when trying to do health related education with patients. 
- ^Joe, George "Healthcare in the Navajo Nation Fact Sheet 2004" http://www.tribalconnections.org/health_news/secondary_features/GeorgeFactSheet.pdflast accessed 25 March 2013.
- 2,4,6. ^ "Navajo" http://www.angelfire.com/sc3/smmindex3/navajo.html
- 3,8,10. ^"Cross Culture Medicine" http://www.ihs.gov/navajo/index.cfm?module=nao_cross_culture_medicinelast accessed 25 March 2013.
- ^"Silence" http://www.foreverbecoming.com/2009/03/nonverbal-communication-among-navajo.htmllast accessed 1 April 2013.
- ^"Navajo Food" http://navajo-arts.com/food-navajo.html
- ^"Navajo Nation Department of Dine' Education" http://navajonationdode.org/Office_of_Educational_Research_and_Statistics_1.aspxlast accessed 28 March 2013.