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 ( ). Human skeletons, rock paintings, and prehistoric settlements provide documentation of the early civilizations. Agriculture or the domestication of plants and animals served as the main occupation of the earlier inhabitants. In 500 b . c ., iron civilization emerged with one major center at Nok. Clay figures of animals and people produced by the Nok civilization are among the oldest known examples of African sculpture ( ). In the east, Igbo Ukwu bronzes reveal a society in existence by 900 a . d . Not only do the artifacts show impressive artwork, but they also yield information about trade with neighbors and with communities as far away as the Sahara and Venice ( ). Like agriculture, iron technology brought significant changes in people’s lives. Iron tools and weapons were more effective than stone, bone, or wooden ones. Technology was altered, with great consequences on farming, urbanization, and settlements.

The development of kingdoms can be dated to the kingdom of Karem in about 700 a . d . in the area now known as Chad. Islam was adopted as early as the 1000s as the religion in Karem, and it expanded as a dominant religion. In the early 1800s, a Muslim religious leader turned almost all of the northern region into a Muslim empire ( ; ; ).

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 begun ( ). The first kingdom to receive Christianity was Benin, as European missionaries arrived. Dutch, British, and other European traders competed for the control of the slave trade. By the 1700s, the slave trade was led by the British. However, in 1807 the British government outlawed the slave trade, and ships carrying slaves were captured, with the slaves returned to the mainland. Slave trade was replaced by trade in palm oil and other agricultural products ( ). British missionaries converted many freed slaves to Christianity, which then spread along the coastal areas and in the southwest. Christianity was accepted in Nigeria in 1842. It is interesting to note that prior to the introduction of religions, Nigerians believed and worshipped only God. They believed in deities, which originated from the traditional conception of the universe.

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 ( ). In 1900, the charter granted to the Royal Niger Company was revoked, paving the way for the creation of the Protectorate of Northern Nigeria. By 1906, all of southern Nigeria had become the Colony and Protectorate of Southern Nigeria. Finally, in 1914, the British protectorates in both south and north were merged to create modern Nigeria, named after the River Niger and under the control of a governor based in Lagos ( ).

To govern the local communities and to ensure that various ethnic units were differently managed, the British government introduced a system of indirect rule, or divide and rule. The first high commissioner of northern Nigeria and the first governor-general of Nigeria was the architect of indirect rule ( ). The effort to reject the political and cultural domination of British rule gave birth to nationalism. The western and eastern regions obtained internal self-government in 1957, and the north did so 2 years later. The north feared the domination of federal power by the southern elites; the south feared that the north would use its vast size to advantage; and the minorities in all the regions were afraid of domination by the Hausa, Igbo, and Yoruba. Thus, on one hand, there was joy at the impending end of British rule ( ). On the other hand, there was fear that regionalism and ethnic differences would tear the country apart. The United Kingdom granted Nigeria independence on October 1, 1960.

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. Unfortunately, the new president failed to pay attention to declining oil revenues, poverty, and falling living standards, and in 1983 a successful coup placed the military in power ( ). From 1984 to 1999, Nigeria endured the most turbulent years of its modern history under three successive ineffective military regimes ( ).

Following an April 2014 statistical “rebasing” exercise, Nigeria has emerged as Africa’s largest economy, with 2013 GDP estimated at US$ 502 billion. Oil has been a dominant source of government revenues since the 1970s. Regulatory constraints and security risks have limited new investment in oil and natural gas, and Nigeria’s oil production contracted in 2012 and 2013. Nevertheless, the Nigerian economy has continued to grow at a rapid 6% to 8% per annum (pre-rebasing), driven by growth in agriculture, telecommunications, and services, and the medium-term outlook for Nigeria is good, assuming oil output stabilizes and oil prices remain strong. Fiscal authorities pursued countercyclical policies in 2011–2013, significantly reducing the budget deficit. Monetary policy has also been responsive and effective. Following the 2008–2009 global financial crises, the banking sector was effectively recapitalized and regulation enhanced. Despite its strong fundamentals, oil-rich Nigeria has been hobbled by inadequate power supply, lack of infrastructure, delays in the passage of legislative reforms, an inefficient property registration system, restrictive trade policies, an inconsistent regulatory environment, a slow and ineffective judicial system, unreliable dispute resolution mechanisms, insecurity, and pervasive corruption.

Economic diversification and strong growth have not translated into a significant decline in poverty levels—over 62% of Nigeria’s 170 million people live in extreme poverty. President Muhammadu Buhari has established an economic team that includes experienced and reputable members and has announced plans to increase transparency, continue to diversify production, and further improve fiscal management. The government is working to develop stronger public–private partnerships for roads, agriculture, and power ( ).

Implications for Nursing Care

It is important for the nurse and other health care professionals to assess the comprehension level of the Nigerian-American client and family since an immigrant’s common language may be an ethnic language or Pidgin English rather than English. Even if the client and family speak English, the nurse should be aware that words have different meanings and may be stated with different implications. Nurses, who tend to speak fast, should talk more slowly until the comprehension level is clearly evaluated. If necessary, a translator may be used to ensure clear communication, particularly of medical terms and procedures that require more complex understanding. When new immigrants or relatives visiting from Nigeria, who are less versed in English, enter the health care system, a family member fluent in English will commonly accompany the individual to provide linguistic and other forms of support.

It is frightening for the newly immigrated Nigerian American or the Nigerian visiting America to be sick and in unfamiliar surroundings and not to be able to comprehend the language of the health care professionals. The nurse should always begin the assessment phase by establishing rapport. Part of this initial encounter involves finding out how to address the client because titles are important and preferences may vary. If the phrase “your age mate” is used in response to a first-name approach, this can indicate lack of acceptance of the first-name approach or indication of seniority in age (Amadi, personal communication, 2002). Addressing the client appropriately is a stepping stone toward acceptance and meaningful health care delivery.

In general, the nurse’s approach and way of speaking to the Nigerian client will set the tone for how the client reacts to health care professionals. The nurse should be aware that hurrying behaviors may annoy the Nigerian American. The Nigerian-American client may feel this conveys a lack of concern and lack of time to give adequate care. It may be interpreted as not being good enough for the nurse. A hurried approach can also result in the client not asking for help in order to not disturb the nurse.

Cooperation with treatment and care routines will be fostered through communication with and involvement of the family. It is important to include the spouse or other family where possible in planning and giving care. Culturally competent nurses gain credibility because they do not exclude or ridicule traditional beliefs but rather incorporate them in the total plan of care. Often the nurse may have to negotiate with the client or family to carry out the essential medical treatments as well as include cultural practices. For example, some obstetricians in this country are now prescribing cabbage leaves as an adjunct in lactation suppression. Leaves have been used for decades in medical treatments throughout Nigeria.

The ability to use proverbs, analogies, and stories to support a case is highly valued and will enhance communication with Nigerian Americans. Pictures and models are also useful when explaining medical procedures to an individual whose English may be limited.

The nurse may be surprised to find that a newly immigrated Nigerian is fascinated with the opportunity to see a television and listen to the radio. It is more easily understood when the number of televisions (61 per 1000) and radios (197 per 1000) in Nigeria is known ( ). Even a newspaper may seem surprising to an immigrant Nigerian since the daily newspaper circulation in Nigeria is 24 per 1000. Patient teaching in the form of cartoons and videos may be particularly fascinating to the Nigerian-American adult or child.

Nurses interacting with a Nigerian American should follow these guidelines adapted by for communicating in a culturally competent manner:

• 1.
  

  Establish primary language first and assess need for qualified interpreters.

  
  
• 2.
  

  Be aware of importance of body language—by both the nurses and the clients.

  
  
• 3.
  

  Establish the need for a family member or religious leader to be present.

  
  
• 4.
  

  Be aware of appropriate eye and touch contact.

  
  
• 5.
  

  Allow enough time for storytelling and long histories.

  
  
• 6.
  

  Adapt the physical examination to meet privacy and modesty needs.

  
  
• 7.
  

  Avoid a hurried, impatient, or distracted demeanor.

Implications for Nursing Care of the Childbearing Family

Pregnancy and childbirth are the fundamental part of marriage, and births tend to be celebrated by the family with parties. A married couple is expected to have a child within 9 months of marriage. Failure to do this will often result in gossip. Most of the time, the female will be blamed. If the couple is unable to conceive, the man’s family will often blame the woman. The woman will be the first to seek infertility treatment. Acquaintances will wonder about her past life. The question is often “What did she do in her youth to warrant this predicament?” People will wonder how many abortions she committed in the past to make it impossible to conceive a child. All these agonizing statements are made before a visit to a clinic. Even after a visit is made to the clinic and the woman is cleared of any reproductive problems, there is always doubt concerning the tests performed at the clinic. Most of the men will seek medical care for infertility without the knowledge of the wives. Nurses should respect their need for privacy while at the same time encouraging communication with their spouses. It is important to inform clients about the relationship among stress, pregnancy, and treatment outcome.

The nurse working with the family during the delivery process should be aware of beliefs that Nigerian Americans may have related to childbirth. The exception to wanting the whole family in close proximity is the childbirth situation. In labor and delivery, it will not be unusual for older Nigerians to shy away, especially during active labor. The maternity nurse needs to recognize that staying away from labor and delivery is not a sign of lack of love but of respect. The presence of the husband during childbirth varies for Nigerian Americans, who may be used to traditional birth attendants assisting with the delivery ( ). It will not be unlikely for the husband to stay out of the childbirth unit the majority of the time. Some men comment that they will not do what their fathers did not do, signaling that this behavior is not the Nigerian way of life and that their fathers were not present when their mothers were giving birth.

The nurse should be aware that during childbirth, the Nigerian-American woman may receive a lot of visitors. Most visitors will bring food to the hospital, and many people will volunteer to do things for the woman. Nurses can use family and friends as an important resource. They can assist in care; in fact, the client may expect them to do so.

The nurse should be aware that pain is perceived differently across cultures and for Nigerians, particularly at childbirth ( ). Nigerians newly arriving in the United States may not favor certain pain management regimens used in labor and delivery (for example, epidural anesthesia). Cesarean section is seen as a failure in fulfilling this particular female role. The couple will wait to the very end to agree to a cesarean section, regardless of the pain the woman may be experiencing or the condition of the fetus.

In a study by with 279 infertile women in southeastern Nigeria, 69% were unwilling to adopt, stating it was psychologically unacceptable and that adoption was not a solution to their infertility problem. Only 21% actually knew how to adopt, and only 27% knew the correct meaning of adoption. Thus, while motherhood was highly valued, adoption was not commonly seen as an option for a woman who could not bear children. It is not unusual for the adopted child to be ridiculed and discriminated against by the kinsmen.

Nigerian culture includes many myths, rituals, and the use of herbs in attempts to regulate women’s fertility. A culturally competent practitioner will incorporate some of the traditional beliefs while providing care to Nigerians. It is advisable to discuss personal beliefs and practices with clients and to plan care with the client and husband. In Nigeria, some customs frown at premarital sex, and others advocate spacing children 2.5 to 3 years following childbirth.

Implications for Nursing Care

In the health care setting and in relation to situations of illness, birth, or death, Nigerian Americans tend to be more comfortable when distances are narrowed. This may involve distance between the client and family or between the health care professional and the client and family. Nigerian Americans tend to feel that the narrower the space between individuals, the greater the acceptance level.

In general, Nigerians tend to have a more permissive style where space is concerned. In fact, some Nigerians like crowds—the more the better. Thus, the nurse should not be surprised to find a number of family members crowded into the client’s room in a health care setting. The nurse should be aware that family is very important to persons of Nigerian origin and attempt to accommodate the client’s need for the presence of family whenever possible. When appropriate, the nurse should give the client the option to decide who should be allowed to be present when health care is provided.

Social Organization

Marriage

The Nigerian institution of marriage is unconventional by Western standards. The traditional and Islamic systems of polygamy flourish within every social class. Women expect very little from men in terms of companionship, personal care, and fidelity. Their relationships exist without the emotional elements ( ). Polygamy is a crucial component of many women’s lives. Marriage is the unification of two families, not merely of the couple alone. It unites the couple’s lineages and clans. Family role is reflected in the choice of partners, the religious ceremonies that accompany marriages, the bride’s wealth, and the intervention of members of the lineage to resolve marital problems. When a couple wants to divorce, the two people involved tend to consider the feelings and roles of other lineage members ( ).

Practices such as child marriage are disappearing among Nigerians, although girls are still encouraged to marry early. Arranged marriages are becoming less common. Even when the choice is made by the partners themselves, the families still become involved in information gathering to ensure that the other family has a good reputation and an acceptable medical history. If a certain disease is thought to be hereditary, a family in which such a disease appears is avoided in order to prevent possible contamination. Most parents still prefer that their children marry a member of the same ethnic group as themselves. This may be difficult in the United States, where the number of persons of the same ethnic group may be limited.

Whether traditional or modern, a marriage requires the exchange of bride’s wealth and religious ceremonies, both of which involve many people as participants in an important social institution and contract. The customs are also designed to ensure the survival and stability of the relationship. In Islamic, Christian, and court marriages, other ceremonies will follow to legalize the marriage ( ). In the traditional wedding, the gods and ancestors are invoked to bless the marriage. Ceremonies take different forms from one area to another. Among the Ibibio in the southeast, part of the marriage preparation is for women to go to a fattening house, where they eat large quantities of food to gain weight. Weight gain is seen as a sign of beauty. At the same time they receive training in cooking, childrearing, and managing a home ( ).

Married couples place emphasis on responsibility and respect for one another, attention to the moral upbringing of children, attention to the education of the children, fidelity in monogamous couples, and caring for the needs of the extended families. These values have persisted for most Nigerian immigrants to the United States.

Religion

Christianity and Islam are the two dominant religions in Nigeria. Muslims represent about 50% of the population and are concentrated in the north and southwest (Nigerian ; ). Christians make up 40% of the population and are found predominantly in the south and the middle belt. The remaining 10% practice indigenous beliefs native to Africa. For some Nigerians, elements and practices of Islam, Christianity, and the indigenous religions coexist. Islamic law is practiced in a dozen northern Nigerian states. This has presented problems, especially for females. In 2002, amid an international outcry, death sentences were handed down to two Nigerian Muslim women convicted of adultery under Islamic law. The women were pregnant and unmarried. This law discriminates between men and women since men can be convicted of adultery only on the testimony of four witnesses ( ).

For many Nigerians, ancient indigenous practices such as masquerades, priesthood practices, and secret societies coexist with Muslim and Christian traditions. In the majority of cases, the type of education students are exposed to is directly related to their religion. For example, northern Muslims are likely to attend a Koranic school, while the southern Christians are likely to attend a European-style school. For many Nigerian Americans, beliefs about religion play an important role in personal behavior. For example, their attitude toward death is affected by religious beliefs. It may be important for a Catholic Nigerian American, even one who has not been an active church member, to see a priest when death is imminent ( ; ).

Regardless of the present religious beliefs of the Nigerian American, personal behavior may be affected by the deep-rooted religious beliefs of their ancestors, for example, traditional beliefs about the conception of the universe. In Nigeria, in the Igboland, ancestors conceived the universe as being made of this visible world, namely, the firmaments ( Igwe ) and earth ( Ala ) ( ). Human beings, animals, and plants live on the earth. The earth gives food to sustain life. It is in the earth that persons are buried when they die. Consequently, the earth is very much revered, culminating in a ritual known as Ime Ala, meaning to celebrate the earth. Early Nigerians believed that within the universe there exist certain inexplicable forces that intrude in the lives of the people. These metaphysical forces—for example, the earth and the firmaments—control the days and nights from which the Nigerian market days, Eke, Orie, Afo, and Nkwo, derive their names. The same forces control the seasons and the lunar year. The metaphysical forces are neither human beings nor dead ancestors, even though they have the attribute of human beings. Dead ancestors, sometimes referred to as mmuo or ndimmuo, are consistently remembered because they, too, are believed to form part of the universe. These beliefs are the basis for the concept of bad spirits and good spirits held by many Nigerian Americans. Bad spirits are those who lived bad lives and were referred to as the devil’s angels. The good spirits, or God’s angels, lived good lives while on earth. Heaven and hell are where the good or the bad go after death. Some Nigerian Americans believe there are men and women who have the power to interpret and to arrest the evil machinations of the devil’s angels that intrude into their lives. These men and women are consulted when the need arises. Sacrifices are offered to the good spirits by these men and women to invoke their aid in preserving and perpetuating the lineage and in stopping the forces of the evil spirits that intrude into an individual’s life ( ).

In the traditional belief, the Supreme Being known as God stands above metaphysical forces and is recognized by all as the creator of everything in the universe, including all the metaphysical forces already mentioned. The term god with the small letter g was coined by the early colonial masters with their Christian missionary agents to discredit traditional religious practices, which they described as worshiping false gods ( ).

Implications for Nursing Care

When caring for the Nigerian American, the nurse should appreciate that ethnic background influences health practices and responses to illness. Ethnicity is a stimulus in a person’s response to pain and disease. The nurse should be knowledgeable about the impact of family, religion, and ethnicity on the Nigerian-American client to provide culturally competent care and to gain a working relationship with the client in order to meet health care needs.

In 1996, a Nigerian grandmother was arrested in Brooklyn, New York. She had allowed her 6-year-old grandson to be slashed on the face with African tribal marks ( ). 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. Even though this incident was assessed as abuse in New York City, the grandparents and mother were not being abusive according to generations-old Yoruba beliefs and customs. Another ethnic practice that has existed for years in some parts of Nigeria is female genital mutilation (FGM).

The national prevalence rate of FGM is 41% among adult women. Evidence abounds that the prevalence of FGM is declining. The ongoing drive to eradicate FGM is tackled by the World Health Organization (WHO), the United Nations International Children’s Emergency Fund, the Federation of International Obstetrics and Gynecology, the African Union, the economic commission for Africa, and many women’s organizations. However, there is no federal law banning FGM in Nigeria. There is need to eradicate FGM in Nigeria. Education of the general public at all levels with emphasis on the dangers and undesirability of FGM is paramount ( ).

In the summer of 2002, the Nigerian legislature considered passing a law banning FGM and imposing a 2-year jail term for offenders ( ). The legislation is controversial and has yet to be passed. Thus, a nurse may encounter adult Nigerian-American females who were born in Nigeria and may be victims of this traditional practice.

found that research on the structure of illness perceptions consistently suggests the five following dimensions: (1) identity, the label placed on the illness and its symptoms; (2) causes, ideas about how one gets the illness; (3) consequences, the expected outcome; (4) timeline, ideas about the duration of the illness; and (5) controllability/cure, belief about the extent to which the illness can be cured or controlled.

Asuni (cited in ) compared African traditional healing methods with the European model and suggested that the “why” questioning and interpreting of conflict and illness are given more emphasis than the “how” model used by Western health care professionals. Western methods divide illness into different categories of somatic, psychological, and psychosomatic, but the majority of Nigerians do not. They do not split themselves into good and bad parts but express their distress as “when part of me is ill, the whole of me is ill, irrespective of what the illness is” ( , p. 4).