Case Presentation: An 80 year old non-English-speaking Navajo woman, with a past medical history of diabetes type 2, hypertension, and osteopenia presented from an outside hospital with an acute fracture of the right femoral neck after a mechanical fall. The patient was evaluated by the Orthopedic team who recommended surgical repair. Her calculated pre-operative risk was low (0.4%) and she was cleared by the medicine team to proceed with surgery. In order to obtain informed consent for the procedure, a Navajo interpreter was utilized at the bedside. The patient initially declined surgical intervention. She was shown a picture of her xray, and the risks of the surgery were explained using passive third person phrasing so as not to speak the risks into reality from the patient’s perspective. She communicated understanding of her acute condition and consented to surgical repair. The surgery was performed without complications and physical therapy recommended disposition to skilled nursing for rehabilitation. The patient was discharged to a skilled nursing facility on the Navajo reservation where her traditions, including ceremonies and food, would be practiced. This was an important aspect of the patient’s discharge plan in regards to supporting her participation in a successful recovery.
Discussion: The Navajo culture is rich with unique traditions that are an integral part of people’s lives. A common belief in Navajo culture holds that words change reality and tradition contributes to the individual’s health. It has been reported that discussing negative information may conflict with the Navajo concept of hózhó and may be considered harmful. Clinicians should respect the power of language in Navajo culture by framing discussions in a positive manner. This culturally unique perspective makes providing the Navajo patient with full autonomy, while respecting her beliefs, challenging when obtaining informed consent for surgery.
Conclusions: This case demonstrates the importance of incorporating culturally competent care in obtaining informed consent and providing safe disposition for Navajo patients. Using visual demonstration and avoiding “negative thinking” to obtain informed consent provide Navajo patients with autonomy while respecting their culture. Disposition that involves a Navajo skilled nursing facility where the patient’s traditions are respected and practiced is essential to ensure ultimate healing and health of the patient.