NIGERIAN

AMERICAN
01
GROUP 5
 Overview
Nigeria has an area of 656,425 square
miles (923,768 square kilometers),
comparatively more than twice the size
of the state of California, and ranking as
one of the largest countries in the world
Early History
People have lived in what is now Nigeria
for thousands of years. In fact,
archeologists have dated tools they found
to 40,000 years ago
The Coming of the Europeans
The Portuguese were the first Europeans
to reach Nigeria. In the late 1400s, a trade
center near Benin was established, and a
trade in slaves with the African leaders
was established.
British Rule
During the late 1800s, the British
established protectorates in parts of
southern Nigeria. Throughout Nigeria,
there were unsuccessful battles against
the establishment of British rule
 The Republic of Nigeria and
Military Rule In 1963 Nigeria
became the Federal
Republic of Nigeria, with a federal
constitution and a parliamentary system
based on that of the United Kingdom.
However, the next 16 years were marked
by repeated coups and failed
governments. In 1979 the British form of
government was discarded, the U.S. style
of government was adopted, and a
president was installed
IMMIGRATION TO THE
UNITED STATES
The African diaspora, the forced
migration of West Africans between the
sixteenth and nineteenth centuries, was
the starting point for the arrival of
Nigerians in the United States. European
slave traders purchased or captured an
estimated 10 million people on the west
coast of Africa and transported them to
the Caribbean and the Americas.
 1. COMMUNICATIONS
The official language of Nigeria is English, which is
taught in schools throughout the country.
English is not the country’s most commonly used
language, since each of the more than 250 ethnic
groups has its own distinct language.
The most widely used languages are those of the
three largest ethnic groups: the Igbo of the

02 southeast speak Igbo, the Yoruba of the southwest

speak Yoruba, and the northerners speak Hausa.
 1. COMMUNICATIONS
Pidgin English- is the predominant language of
communication, with only educated individuals
using British English.
- Because of diversity in ethnicity, Pidgin became
a way for these mixed groups to comprehend each
other. Pidgin English is regarded by many as “broken
English.”
They may use their ethnic language on most

03 occasions and speak English or another language

at other times.
1. COMMUNICATIONS
Mannerisms vary during communication, which may be
construed as disrespectful by outsiders. It is not a sign
of dishonesty, but of respect, for a younger person not to
make eye contact with an elder or a person in authority
when the elder or authority figure is talking. People of

04
rank or age dominate discussion.
Nigerian Americans are less likely to engage in intimate
behavior, such as touching, kissing, or hugging in public.
 1. COMMUNICATIONS

1. A traditional Nigerian couple in love may not go to the movies,

hold hands, or kiss one another in public places.
2. Even married Nigerians are less likely to show intimate behavior
in public or even in health care settings.
3. For example, if the Nigerian-American husband is present during
labor, the nurse should not expect intimate touching behavior.
 1. COMMUNICATIONS
In addressing an older person, a younger person uses
socially accepted words before his or her name
1. Respect can also be shown by the manner of
greeting
2. Greetings in the morning are considered mandatory
for proper etiquette by some Nigerian Americans,
and it is proper to first inquire about thestate of
health.
3. The younger person is expected to greet the elder
first out of respect for age.
4. The freedom to use first names is allowed only to
seniors and superiors.
 1. COMMUNICATIONS
Nigerians are very proud of traditional titles, and it is not
uncommon to address people with their occupation before
their names
1. Those who have done the pilgrimage to Mecca are
addressed as Alhaji (for men) and Alhaja (for women).
2. One of the most sought-after titles in Nigeria is Chief,
which is considered more important than a doctoral
degree.
3. Those who hold traditional titles, such as Chief, Emir,
Oba, or Eze, enjoy higher status in the community.
 NURSING
IMPLICATIONS
Nurses should assess the comprehension level of the Nigerian American
client and family since their common language may be an ethnic language or
Pidgin English rather than English
Nurses should be aware that words have different implications even if clients
and family members speak English.
If necessary, a translator may be used to ensure clear communication,
particularly of medical terms and procedures that require more complex
understanding.
Nurses should always begin the assessment phase by establishing rapport
Nurses should find out how to address the
client during the initial encounter because e
titles are important and preferences may
vary.
The nurse should be aware that hurrying
behaviors may annoy the Nigerian American
and may feel that this conveys a lack of
concern and lack of time to give adequate
care
Cooperation with treatment and care routines
will be fostered through communication with
and involvement of the family.
Culturally competent nurses should not
exclude or ridicule traditional beliefs but rather
incorporate them into the total plan of care.
Allow enough time for storytelling and long
histories.
Pictures and models are useful when explaining
medical procedures to an individual whose
English may be limited
 2. TIME
The concept of time indicates the focus of the culture
as well as provides a method of marking past, present,
and future events.
Parents inculcate in the children that they stand in the
circle of history, where their ancestors represent the
past, their parents represent the present, and they
represent the future.
Nigerian-American children are socialized to accept the
values and practices in relation to time
The use of time varies from exact dates and events
to so-called African time, known in the United States
as “colored people time”.
Example:
Nigerian women are most likely to state that their
last menstrual period occurred 2 days before or
after Christmas.
Ms. Ezenwa (Igbo) may state her date of birth as
the year in which “two nights occurred in one
day,” meaning the solar eclipse
African time refers to a lack of punctuality. An 8 a.m.
appointment may mean 12 noon.
 NURSING
IMPLICATIONS
The nurse should ask for events happening during the client’s birth time in order to
come up with an estimated date of birth
The nurse must stress the importance of taking the medication on time
In planning care with the client, the implication(s) of taking medication on time or late
must be stressed
The nurse should emphasize for those Nigerian Americans who maintain African time
that this time orientation is not helpful for medications on a required routine
The nurse should be aware that some Nigerian Americans are unlikely to take
prescribed medications whether a set time is required or not.
The nurse should take time in giving instructions with the teaching and act in a caring
manner for the client to be more compliant.

 3. SPACE
Space is an important concept for Nigerian Americans.
Within a home setting, Nigerian Americans may have multiple
families residing together.
polygamy may have been practiced, multiple wives may live in
one home and share a small space with other wives and their
children.
For Nigerian Americans, the nature of any conversation
determines the distance and sound intensity between the
participants in the conversation.
Confidential information tends to be shared in low voices and
in very close proximity.
Other information may be shared with loud voices without
consideration for proximity
 NURSING IMPLICATIONS OF THE
CHILDBEARING FAMILY

Pregnancy and childbirth are the fundamental part of

marriage
A married couple is expected to have a child within 9
months of marriage.
Most of the time, the female will be blamed
4. SOCIAL ORGANIZATION
FAMILY
The family is a biological and social unit for Nigerian
Americans. Most Nigerian-American families are
patriarchal, and rights of inheritance are traced through the
male members of the family.
Polygamy (the practice of having multiple wives) is still
practiced in many parts of Nigeria and contributes to
increased numbers of dependents.
In a study by Tomkiewicz and Adeyemi-Bello (1996), data
suggested that American and Nigerian female management
aspirants are likely to experience barriers to advancement
in Nigeria because of attitudes by both Nigerians and
Americans toward women as managers.
Extended families, in which parents, children, their
spouses, grandchildren, and other relatives live under one
roof, are common in rural areas.
The common dress of many family members living in
cities in Nigeria is Western-style clothing. However,
other city dwellers and most people in rural areas wear
traditional clothing.
For men and women in Nigeria, traditional garments
include long, loose robes made of white or brightly
colored fabrics. Men may wear short, full jackets with
shorts or trousers. Small round caps are popular head
coverings for men, while Nigerian women may wear
scarves tied like turbans.
Migration, new occupations, Western education, and
foreign religions have had significant consequences on
gender roles, marriage, customs, and family life for
Nigerian Americans.
 MARRIAGE
Nigerian institution of marriage is
unconventional by Western standards
Polygamy is a crucial component of many
women’s lives
It unites the couple’s lineages and clans
Arranged marriages are becoming less
common.
In Islamic, Christian, and court marriages,
other ceremonies will follow to legalize the
marriage (Falola, 2001).
In the traditional wedding, the gods and
ancestors are invoked to bless the
marriage
 RELIGION
Christianity and Islam are the two dominant
religions in Nigeria.
Muslims represent about 50% of the
population
Christians make up 40% of the population
The remaining 10% practice indigenous
beliefs native to Africa
For many Nigerian Americans, beliefs about
religion play an important role in personal
behavior
personal behavior may be affected by the
deep-rooted religious beliefs of their
ancestors
ancient indigenous practices such as
masquerades, priesthood practices, and
secret societies coexist with Muslim and
Christian traditions.
 Implications
Nurses should appreciate that ethnic background influences
health practices and responses to illness
Nurses should be knowledgeable about the impact of family,
religion, and ethnicity on the Nigerian-American client.
Nurses may encounter adult Nigerian American females who
were born in Nigeria and may be victims of this traditional
practice.
It is important for the nurse to appreciate that ethnic practices
and values may continue regardless of the location of the
person of Nigerian ethnic origin.
5. ENVIRONMENTAL
CONTROL
Most Nigerian believe that illness is
a natural occurrence resulting from
disharmony and conflict in some
area of a person's life.
HEALTH CARE
PRACTICES
Healthcare practices in Nigeria range
from home remedies to spiritual
healers to, as a last resort, clinics or
hospitals.
Nigerian Americans may tend to see
clinics or hospitals as the final
treatment of choice rather than the
first.
Home remedies and spiritual healers
may be considered cultural practices.
 Efficacious cultural health practices

Practices that are viewed as beneficial to the client’s health status, although
they can differ vastly from modern scientific practices
for example :
Many Nigerian-American couples use rituals, herbal approaches, and similar
practices to regulate fertility for cultural, economic, or personal reasons.
A number of research studies support the healthcare practices used in Nigeria.
For example, Oyelami, Agbakwuru, Adeyemi, and Adedeji (2005) reported the
positive effect of grapefruit seeds in treating urinary tract infections
Okeniyi, Olubanjo, Oguniest, and Oyelami (2005) reported the benefits of honey
in healing incisions of abscessed wounds.
 NEUTRAL CULTURAL
HEALTH PRACTICES
Practices have no effect on the health
status of an individual. Although some
practices are considered irrelevant
for example:
-drinking tea made from various harmless roots
and weeds
-jumping up and down or sneezing after
intercourse to dislodge the sperm
DYSFUNCTIONAL
CULTURAL HEALTH
PRACTICES
Practices may be dangerous or counter
productive and should be discouraged.
For example
-The Nigerian belief that sex during menstruation
will turn people into albinos is not harmful. In
actuality, intercourse during menstruation will
have less likelihood of resulting in pregnancy, so
in this respect it could be said to be efficacious in
terms of the risk of pregnancy.
In some African countries, some women
douche with hot water, salt, vinegar, lemon,
or even potassium after sex to abate
pregnancy. Nurses must stress the
consequences of these dysfunctional
practices.
 FOLK MEDICINE

Folk medicine existed in Nigeria before the

introduction of Western medicine.
It is believed that herbal medicine goes
back to ancient civilizations that Nigerians
studied and made observations of the
various plants growing around them.
Most ethnic groups in Nigeria still practice
folk medicine, and many brought these
practices with them as they immigrated to
the United States (Falola, 2001).
DIFFERENT KINDS OF
FOLK MEDICINE
Cure of sicknesses caused by natural
or unnatural events- believed to be
caused by forces in nature as a result of
the wear and tear of life or by exposure to
some natural contaminants.
Unnatural sicknesses are caused by
fellow human beings who are jealous of
the person or as a result of evil doings by
the person, referred to as karma.
DIFFERENT KINDS OF
MEDICINE MEN OR
HERBALISTS
The good ones provide concoctions to
promote adaptation and wellness.
The bad ones provide concoctions that are
detrimental to health and are believed to
cause death.
The latter kinds are responsible for magic,
voodoo, and witchcraft. They are very cheap.
The good native doctors are very expensive;
they scare their clients and utheir family
members enough to cough out any amount of
money in order to be safe. They often provide
their clients with charms to wear or oils to rub
as prophylaxis (Amadi, 2002).
Persons who can afford Western medicine,
primarily city dwellers, will seek the services
of a trained medical doctor first. However, for
persons without financial resources, the more
reasonable cost of folk medicine may cause
this to be the treatment of choice.
 FACTORS CONTRIBUTING TO
THE POPULARITY OF FOLK
MEDICINES

Long-standing cultural belief that the

treatment will work and the lack of
availability of medical doctors, even if
resources to pay were available.
Nigerians often seek medicine men and
women who use plant-based medicine in
most of their treatments of aches, pains,
and infertility.
Traditional Nigerian healers and
practitioners of folk medicine can also be
found in America through use of Nigeria
Infonet, a premier search engine for Nigeria
and Nigerian Americans
 FOLK MEDICINE
TREATMENT RANGE
Drinking the water from selected leaves after boiling to cure malaria and
certain fevers.
Wearing of beads or ornaments to ward off evil spirits.
Certain roots are soaked in homemade hot drinks and are dispensed as
specified by the traditional healers, who are also known as native doctors.
Traditional healers treat measles by drawing lines all over the body with liquid
from a certain seed.
Placing a traditional necklace with charms around a child's neck can prevent
convulsions.
Most illnesses, especially those that result in complications, are believed to be
caused by one's enemies or those who do not want one to progress.
CUSTOMS AND RITUALS RELATED TO DEATH
AND DYING
Death is revered by Nigerians.
Traditional Nigerians believe that family members owe the deceased rites
and burial customs, which will assist on the journey to join the ancestors.
If rites are violated, the deceased will torment any member of the family
by inflicting some ailment that defies medical explanation.
The spirit is left wandering between the living and dead and cannot be
fully integrated with the ancestors
the family must do everything possible, even if it necessitates borrowing
funds for burial money.
An individual’s mode of living, religious affiliations, profession, and class
dictate the type of burial rite to be performed.
For example, the burial rite for a title holder is different from that for a non–
title holder. Likewise, the burial rite for women is different from that for men.
Lastly, the burial rite for a married man is different from that for a single man.
In the Akpulu community of Eastern Nigeria, a family that has more than
one death must complete burial rites for the first family member before
proceeding to rites for the next.
 The burial ceremony of an Ozo titled man in
Igboland is mainly performed in three stages:

1. The first stage is the interment. When an Ozo title holder dies, the
relations must be quickly informed. Each title holder has to perform some
ritual of killing a cock to disengage himself from any further cultural ties
with the deceased.
2. The second stage is the showcase stage, which is referred to as Igba
Okwukwu in some parts of Igboland. Because of the expense involved,
family members do not hurry into this stage, which is also called wealth
demonstration. The ceremony starts in the evening of Orie Market day
and is know as Ura Ozu
3. The final stage is the celebration in the market square and is known as
iku ozu This takes place on the fourth or eighth day of the ceremony
depends to the status of the deceased. During this stage, a gun is fired to
appease the dead, which marks the end of the ceremony and indicates
that the daughters of the deceased may return to their marital homes.
 NURSING IMPLICATIONS

Nurses need not hold the same views as their Nigerian American
clients but must respect their cultural, spiritual and religious
beliefs.
Nurses demonstrate cultural competence when they allow their
client’s beliefs to mold and direct the care they provide, within
accepted standards of practice.
Advised health care professionals to take advantage of non
harmful rituals
 1. BIOLOGICAL VARIATIONS
Birth weight
Nigerians loves the ideal of their neonate/newborn whose
weight is average to above average since for them it is a sign
of wealth or being able to take care of one’s wife financially.
Northern Nigerian men are usually taller than the Southern
Nigerian men while Southern Nigerian women are average
heavier than Northern Nigerian women (These differences is
due to their diet and lifestyle)
Southern Nigeria consumes a lot of carbohydrates while
northern Nigerians, based from their nomadic lifestyle,
consumes a lot of meat and milk products from their animals
.
 1. BIOLOGICAL VARIATIONS
Skin Color
Nigerians’ skin color varies from very light tan to
very black.
The skin color is attributed to the geographic
location in Nigeria, as well as from mixed
ancestries: New Guinea highlanders and sub-
Saharan Africans are about as different from
each other genetically yet they have physical
similarities because of where they live, including
dark skin.

.

BIOLOGICAL VARIATIONS
Susceptibility to Disease
Hypertension - Scientists have known that the
rate of hypertension in rural West Africa is very
low, except for some parts of the Amazon basin
and the South Pacific. But the Nigerians who
descent in the United states have the among the
highest rates of hypertension.
Malaria - common health problems in Nigeria
which is an infectious parasitic disease that can
be acute or chronic and frequently recurrent that
makes a Nigerian with unknown history of fever
must undergo a test for malaria.
Cancer - Nigerian men are 10 times less likely to
develop prostate cancer and 3.5 times likely to die
from the disease than African - American men.
Lactose intolerance - exists among Nigerian americans
and its a role of the nurses to avoid providing health
teaching about drinking milk. (Encourage foods rich in
calcium such as cooking homemade soup bones and also
lactose free dairy products
Alzheimer’s disease - increased levels of cholesterol and
LDL cholesterol were associated to increased risk of AD in
individuals without the APOE4 allele. There was a
significant interaction between cholesterol, APOE4, and
the risk of AD in the Yoruba, a population with lower
cholesterol levels and lower incidence rates of AD than
African-Americans.
AIDS(HIV) - In Nigeria, the transmission pattern is
heterosexual. Since polygamy is allowed in Nigeria, some
men have as many as seven wives (Alban & Guinness,
2000). If one wife has an extramarital affair, the potential of
HIV/AIDS can emerge and affect a significant number of
individuals
Nigerians isolate patients with the disease. Funerals of
victims are often attended by a handful of people out of
fear that the disease will be caught
Epilepsy - Clients used alternative treatments before
seeking hospital treatment especially spiritual healing
which research stated that it cannot be considered as
irrelevant in the management of epilepsy in Africa.
 BIOLOGICAL VARIATIONS
Psychological Characteristics
Nigerian-American families have close ties to one
another.
Stressful events are discussed among family
members and close friends.
For most Nigerian Americans, when universal
stressors are present, the family attempts to be
supportive, and the recipient of the stressors is not
left alone. Nigerians take turns staying with the
afflicted person or family.
It is a taboo to admit that one’s family member is a
psychiatric patient. Mental illness is a shameful
stigma in the Nigerian culture.
.
Psychiatric illness is often known only to the
husband if the wife has the problem or vice versa
The patient’s children may find it difficult to get a
Nigerian spouse because Nigerians believe that
such illnesses are hereditary. They fear that their
children might inherit it.
psychological illness such as depression may not
share their symptoms with a healthcare professional
because of the negative connotation that goes with
depress
Sometimes psychological stress felt by Nigerian
Americans is related to their vision to succeed in the
United States. Nigerians have typically come to the
United States with a vision, often to acquire an
education and return home to move mountains.
Sometimes the road to realizing this dream is
twisted or curved in many directions that place the
individual in a dilemma. There is the feeling of
failure with its accompanying stress
 NURSING IMPLICATIONS

Assessment of skin color is an important aspect of the nurse’s health assessment as

Nigerians have dark skin.
The nurse should be knowledgeable of differences in skin assessment for persons with dark
skin as opposed to light skin:
1. Pallor in brown-skinned people appears yellow-brown, and a black-skinned person appears
ashen gray.
2. Erythema and inflammation are assessed by palpating for increased warmth of skin, edema,
tightness, or induration of skin.
3. Evaluate the color of the lips, tongue, conjunctiva, palms, and soles of feet to either confirm
or rule out a pale or ashen gray color in assessing cyanosis.
4. Petechiae in black-skinned clients, oral mucosa or conjunctiva will show purplish-red spots.
5. The nurse should observe the sclerae of their eyes, oral mucous membrane, palms of the
hands, and soles of the feet for yellow discoloration in assessing jaundice.
 NURSING IMPLICATIONS

Birthmarks of Nigerians are believed to be God’s special mark of

identification.
Nurses need to be aware that Nigerian Americans may attempt to
hide certain illnesses from other family members.