Papers by Michelle Kahn-John
AMA Journal of Ethics
American Indian (AI) and Indigenous peoples utilize traditional medicine/healing (TM/H) for healt... more American Indian (AI) and Indigenous peoples utilize traditional medicine/healing (TM/H) for health and well-being. Allopathic health care practitioners (HCPs) receive minimal training and education on TM/H and its application and integration into health care settings. Lack of knowledge and practice guidelines on how to navigate these 2 health care perspectives (allopathic and traditional) creates uncertainties in the treatment of AI and Indigenous peoples. Such conflicts can undermine patient autonomy and result in culturally incongruent practice. This article presents a case study showcasing suggestions for how HCPs can direct clinical decision making when working with AI/Indigenous patients who utilize TM/H. The article argues that health professions education institutions and HCPs must dedicate effort to expanding awareness of and education about TM/H to enhance the delivery of evidence-based and integrated clinical treatment for AI/Indigenous patients. Case Ms Q is a 72-year-old Navajo woman seeing Dr S, a new physician at an Indian Health Service (IHS) unit in New Mexico. Ms Q reports 5 months of weight loss, fatigue, epigastric pain, and jaundice. She lives in a remote community on the Navajo Nation, and her granddaughter drove 2 hours to bring her to the IHS clinic, insisting that Ms Q's symptoms should be evaluated by an allopathic physician. Traditional Navajo healing practices and customs are important aspects of Ms Q's life. Although she does not routinely visit the IHS clinic, Ms Q is open to being evaluated by Dr S. In a follow-up visit, Dr S discusses test results with Ms Q. Based on laboratory evidence of obstructive jaundice and a computed tomography scan revealing a solid mass in the head of Ms Q's pancreas, Dr S suspects that Ms Q has pancreatic cancer and recommends endoscopic retrograde cholangiopancreatography (ERCP), a procedure that enables examination of the liver and pancreas ducts, with endoscopic ultrasound (EUS) to confirm the diagnosis. Ms Q feels hesitant to pursue ERCP with EUS and the required travel and requests to see her medicine man to discuss her symptoms and Dr S's recommendations. Unfamiliar with traditional Navajo healing, Dr S wonders how to respond.
Journal of Nursing Education
International Journal of Environmental Research and Public Health
From the start of the COVID-19 pandemic on the Navajo Nation, Diné (Navajo) traditional knowledge... more From the start of the COVID-19 pandemic on the Navajo Nation, Diné (Navajo) traditional knowledge holders (TKHs), such as medicine men and women and traditional practitioners, contributed their services and healing practices. Although TKHs are not always fully acknowledged in the western health care system, they have an established role to protect and promote the health of Diné people. To date, their roles in mitigating the COVID-19 pandemic have not been fully explored. The purpose of this research was to understand the social and cultural contexts of the COVID-19 pandemic and vaccines based on the roles and perspectives of Diné TKHs. A multi-investigator consensus analysis was conducted by six American Indian researchers using interviews with TKHs collected between December 2021–January 2022. The Hózhó Resilience Model was used as a framework to analyze the data using four parent themes: COVID-19, harmony and relationships, spirituality, and respect for self and discipline. These ...
and the AI-SUPERPFP Team, 2003) explored factor structure of six cultural concepts (spirituality,... more and the AI-SUPERPFP Team, 2003) explored factor structure of six cultural concepts (spirituality, respect, reciprocity, relationship, thinking, discipline) in a Southwestern American Indian (AI) Tribe. The relationships of these underlying factors with psychological distress and health related quality of life were then explored. The purpose of this study was to highlight concepts in AI culture and to determine their relationships with two common assessments of health among members of a Southwest AI Tribe. The primary investigator sought to determine agreement by cultural experts who evaluated items, selected from a pre-existing database, that potentially reflected the six concepts under review; discover the factor structure of the resulting items; and to determine if a relationship existed between the concept factors and outcomes of psychological distress and health related quality of life in a Southwestern AI tribe. Literature reviewed on the present state of AI health highlighted the present-day health disparities, historical trauma, models of resilience, AI protective factors and led to development of a model modifying the work of Gunnestad. iv Exploratory factor analysis, confirmatory factor analysis, and path analysis were conducted on the original sample of 1446 subjects. A 3-factor structure provided the best fitting model. The latent variables were Harmony, Spirituality, and Respect. The health related quality of life measure used separated out physical and mental component summaries (PCS and MCS, respectively). Significant relationships were discovered between Respect and the MCS (β=0.382), Respect and the PCS (β=0.310), Respect and psychological distress (β=-0.392), Spirituality and the PCS (β=-0.09). No significant relationships found between Harmony and psychological distress or health related quality of life. Conclusions were that these AI cultural concepts had significant relationships with psychological distress and health related quality of life in a Southwest AI Tribe. Further investigation of cultural concepts is warranted for the development of culturally relevant instruments and health promotion interventions for AI populations. The form and content of this abstract are approved. I recommend its publication. Approved: Joan K. Magilvy v ACKNOWLEDGEMENTS 'Ahéheé (Thank You) to my committee members who graciously and patiently shared their knowledge and expertise while providing incredibly generous and sincere support for this work. 'Ahéheé to the Centers for American Indian and Alaska Native Research and the AI-SUPERPFP team for the data that provided the foundation for this secondary analysis. Ahéhéé to Mat Greiner for his assistance in designing the beautiful graphic artwork for the Native American Protection Shield Model. 'Ahéheé to my loving and supportive family, friends, and colleagues. 'Ahéheé to the Creator, The Holy Ones, the Six Directions (Above, East, South, West, North, Below), the sacred mineral and plant elements of the earth, earth, fire, water, air, the sun, the moon, my healers, my guiding ancestors, my animal helpers, my spirit relatives, and all my relations. 'Ahéheé to my Mom, Elsie Marie Kahn for sharing all her knowledge and instilling in me, the sacredness and importance of the Diné Hózhó philosophy. vi TABLE OF CONTENTS CHAPTER
Integrative Nursing, 2018
Anxiety is a sense of perceived threat to one’s physical safety or emotional wellbeing, and sympt... more Anxiety is a sense of perceived threat to one’s physical safety or emotional wellbeing, and symptoms are experienced in body, mind, and spirit. This chapter focuses on anxiety as a normal reaction to stressors—external, internal, or existential. Everyone experiences anxiety, both trait anxiety and state anxiety at multiple points in their lives; however, prolonged and severe symptoms of anxiety can evolve into a clinical form of anxiety, such as generalized anxiety disorder, panic disorder, or posttraumatic stress disorder. This chapter reviews assessment of anxiety, including evidence-based screening measures and the patient-centered interview. Symptom identification and management incorporating integrative nursing principles are presented, including patient self-management strategies as well as provider-directed treatment options. In clinical decision-making for anxiety symptom management, concordance with the patient in establishing a treatment plan is emphasized. A case study hi...
Frontiers in Public Health, 2022
ObjectiveThe purpose of this study was to culturally enhance a diabetes education program for Din... more ObjectiveThe purpose of this study was to culturally enhance a diabetes education program for Diné (Navajo) community members with Type 2 diabetes. Though the recommendation to culturally adapt health education curricula was meant to improve health education for American Indians and Alaskan Natives (AIANs), it has inadvertently created a “one size fits all” approach. This approach does not properly address the need for tribe-specific cultural health messaging, defined as incorporating cultural elements deemed relevant to the population. Tribe-specific health information and programming, such as integrating Diné worldviews and Indigenous knowledge among Diné people as described here, are essential to creating a culturally relevant and effective and meaningful approach to disease self-management.MethodsA conversation guide, based on the Hózhó Resilience Model—a Diné framework on healthy living, was used to engage key cultural experts in interviews about traditional stories and teachin...
Health Affairs, 2022
Structural racism toward American Indians and Alaska Natives is found in nearly every policy rega... more Structural racism toward American Indians and Alaska Natives is found in nearly every policy regarding and action taken toward that population since non-Natives made first contact with the Indigenous peoples of the United States. Generations of American Indians and Alaska Natives have suffered from policies that called for their genocide as well as policies intended to acculturate and dominate them-such as the sentiment from Richard Henry Pratt to "kill the Indian…, save the man." The intergenerational effect is one that has left American Indians and Alaska Natives at the margins of health and the health care system. The effect is devastating psychologically, eroding a value system that is based on community and the sanctity of all creation. Using stories we collected from American Indian people who have experienced the results of racist policies, we describe historical trauma and its links to the health of American Indians and Alaska Natives. We develop two case studies around these stories, including one from a member of the Navajo Nation's experiences during the COVID-19 pandemic, to illustrate biases in institutionalized structures. Finally, we describe how the American Indian and Alaska Native Cultural Wisdom Declaration can help policy makers eliminate the effect of systemic racism on the health of American Indians and Alaska Natives-for instance, by lifting constraints on federal funding for American Indian and Alaska Native initiatives and allowing payment to traditional healers for their health services.
While autism is still a mysterious developmental disorder, expansion of research efforts over the... more While autism is still a mysterious developmental disorder, expansion of research efforts over the past 10 to 15 years has yielded a number of important clues impli-cating both genetic and environmental factors. We can
This secondary analysis of data from the American Indian Service Utilization, Psychiatric Epidemi... more This secondary analysis of data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) study (Beals, Manson, Mitchell, Spicer, and the AI-SUPERPFP Team, 2003) explored factor structure of six cultural concepts (spirituality, respect, reciprocity, relationship, thinking, discipline) in a Southwestern American Indian (AI) Tribe. The relationships of these underlying factors with psychological distress and health related quality of life were then explored. The purpose of this study was to highlight concepts in AI culture and to determine their relationships with two common assessments of health among members of a Southwest AI Tribe. The primary investigator sought to determine agreement by cultural experts who evaluated items, selected from a pre-existing database, that potentially reflected the six concepts under review; discover the factor structure of the resulting items; and to determine if a relationship existed be...
Integrative Health Nursing Interventions for Vulnerable Populations, 2020
Journal of Transcultural Nursing, 2020
Purpose: Hózhó is the cultural wisdom that guides the Diné lifeway. This study examines understan... more Purpose: Hózhó is the cultural wisdom that guides the Diné lifeway. This study examines understanding of cultural wisdom (CW) across three generations: elders, adults, and adolescents. Method: A focused ethnography was conducted on the Navajo Nation. Twenty-two Diné (Navajo) were recruited through convenience sampling. Data were collected via two semistructured interviews and photovoice methods. Data were analyzed using content analysis, thematic analysis, and participatory visual analysis of photos. Results: The Diné elders embodied the greatest in-depth understanding of CW followed by the adolescents. An unexpected finding was the scarcity of understanding of CW among the adults. Conclusion: The Diné understanding of CW is transferred through discussion with elders, listening to and speaking traditional language, cultural preservation activities, and participation in cultural practices. The Diné believe cultural wisdom is a health sustaining protective factor, therefore strategies...
Applied Nursing Research, 2016
Global Advances in Health and Medicine, 2015
Hózhó is the complex wellness philosophy and belief system of the Diné (Navajo) people, comprised... more Hózhó is the complex wellness philosophy and belief system of the Diné (Navajo) people, comprised of principles that guide one's thoughts, actions, behaviors, and speech. The alignment of integrative nursing principles and the Hózhó Wellness Philosophy illustrates the power that integrative nursing offers as a meta-theoretical perspective that can transform our healthcare system so that it is inclusive and responsive to the needs of our varied populations. Integrative nursing offers the opportunity to re-introduce cultural wellness wisdom, such as Hózhó, as a means to improve whole-person/whole-systems wellbeing and resilience. Integrative nursing, through the acceptance and validation of indigenous health-sustaining wisdom, contributes to the delivery of effective, authentic, culturally tailored, whole-person/whole-system, patient-centered, relationship-based healthcare. Highlighting the Diné Hózhó philosophy re-introduces this philosophy to the Diné, other American Indian/Alas...
... Hays, RN, MS, Doctoral Student; Michelle Kahn-John, MS, APRN, PMHNP-BC, Doctoral Student; Rho... more ... Hays, RN, MS, Doctoral Student; Michelle Kahn-John, MS, APRN, PMHNP-BC, Doctoral Student; Rhonda Knapp-Clevenger, PNP, BC, Doctoral Student; Pamela Lake, MSN, RN, Doctoral Student;Priscilla Nodine, RN ... Appears in collections: WIN - Western Institute of Nursing. ...
Advances in Nursing Science, 2010
Native people of the United States face challenges in attaining physical, mental, spiritual, and ... more Native people of the United States face challenges in attaining physical, mental, spiritual, and environmental health. This article presents a concept analysis of Diné Hózhó, a complex and misunderstood wellness concept the Diné (Navajo) strive to attain. Findings from a literature review are presented to explore anthropological definitions and uses of the concept Hózhó. The method of concept analysis of Walker and Avant is utilized, model cases are presented. Recommendations for application in nursing practice are presented.
Journal of Transcultural Nursing
Introduction: American Indian (AI) people have protective factors embedded in cultural teachings ... more Introduction: American Indian (AI) people have protective factors embedded in cultural teachings that buffer against high-risk behaviors. This study applies a qualitative, grounded theory approach to identify cultural assets for a Diné (Navajo) mother-daughter intervention aimed at preventing substance abuse and teen pregnancy. Method: Focus groups and in-depth interviews were conducted with 28 AI females’ ages 8 years and older from the Navajo Nation. Results: Key themes were (a) preserving the Diné way of life, (b) cultural assets related to being a healthy Diné woman, (c) matrilineal networks as a source of strength/pride, (d) historical trauma as a source of resilience, (e) male influences as protective health factors, (f) Western education as a measure of success, and (g) integrating different belief systems. Discussion: Study findings may be applied as foundational elements for culturally grounded AI substance abuse and teen pregnancy prevention strategies, as well as cultural...
Uploads
Papers by Michelle Kahn-John