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prevalence of anxiety disorder among American Indians (Sawchuk et al., 2016). Living in geographically isolated communities with little to no economic opportunities is a stressor and risk factor that predisposes Native Americans to anxiety and alcohol use disorder (Enoch & Albaugh, 2016). Spirituality is central to Native Americans and has been linked with recovery from substance abuse. This was evident when MR verbalized fear of not going to heaven due to alcohol and substance abuse. Research showed that spirituality increased from baseline through treatment completion of alcohol cessation by measuring indices like attendance at church or denominational affiliation (Greenfield et al., 2015). Native American patients like incorporating spirituality into therapy (Greenfield et al., 2015). It is essential that nurse practitioners are culturally sensitive to be able to provide proper care to this population and provide interventions that are sensitive to their cultural beliefs.Sensitive Issues for Patient InteractionCultural respect is crucial to decrease health disparities and improve access to quality carethat responds to the patients’ needs. When interacting with Native Americans, nurse practitioners have to be aware of issues that may affect communication with them. American Indians like longperiods of silence and usually take time to carefully think about what they will say (Harjo, Burhansstipanov, & Lindstrom, 2014). It may be essential to give patient MR the time to answer questions and be attentive to his non-verbal cues during the interview. In some Native American
tribal cultures, touching the hair of native men is disrespectful; hence, unless the patient initiates touch, the provider should avoid touching the patient when comforting them (Harjo et al., 2014). Historical trauma has also resulted in fear of the healthcare system resulting in many of them not accessing health care unless there is an emergency (Harjo et al., 2014). The nurse practitioner can help MR reduce the feeling of anxiety through education and addressing his anxiety by expressing knowledge about his culture and traditional treatment. The provider shouldnever make judgments about their beliefs, but rather ask questions about cultural practices in a professional and encouraging way.Targeted QuestionsFive important targeted questions for patient MR to build a good history and assess for health risk include the following:1.How often do you drink alcohol and smoke pot?