From History to Healing: A Guide for Nurses Caring for Native Americans

For the past four years, I have worked as a travel nurse in several Native American communities, each with its own customs, language and heritage. Native Americans, living in over 570 federally recognized tribal communities, are an active population with a multifaceted history and many challenges. This situation means adequate healthcare can be offered only if their cultural beliefs are understood and honored. In this blog, I will share my experiences and insights, shedding light on the historical context, health landscape and cultural beliefs of Native Americans, and giving practical advice for my fellow nurses.

Historical Background

To effectively understand the health and cultural issues of Native Americans, we need to consider their historical background. This history (noted briefly here) helps explain the health disparities and cultural values that continue to influence their healthcare.

• 1492: Columbus’s Arrival: European colonization started with Christopher Columbus’s arrival in the New World. This period brought about the spread of diseases such as smallpox, measles and influenza, which killed Native Americans and caused conflict and economic dislocation when their territories were invaded and taken over by Europeans.
• 1776: Declaration of Independence: The Declaration of Independence called Native Americans “merciless Indian savages,” which perpetuated prejudice and enabled unfair and cruel measures for their removal.
• 1830: Indian Removal Act: Signed by President Andrew Jackson, the Indian Removal Act resulted in the Trail of Tears, which was the forced migration of thousands of Native Americans from their homes in the Southeastern United States, leading to the deaths of thousands from exposure, disease and starvation.
• 1851: Indian Appropriations Act: This act created a reserve system that limited the movement of Native Americans to certain regions that were less fertile and arable, causing more economic strain. The system also negatively affected their health and well-being.
• 1864: Long Walk of the Navajo: Many Navajos died of starvation and disease during their forced removal from Arizona to Bosque Redondo Reservation in New Mexico. The Long Walk is one of the most significant events in Navajo history, as it symbolizes suffering and perseverance. Today, the Navajo people continue to experience the negative impact of this event on their health and well-being.
• 1890: Wounded Knee Massacre: One of the darkest moments in Native American history was the U.S. Army’s massacre of over 250 men, women and children of the Lakota tribe at Wounded Knee Creek, which put an end to the “Indian Wars” and was considered the final victory of the U.S. government in its war against Native Americans.
• 1924: Indian Citizenship Act: This act gave citizenship to all Native Americans born in the United States. While it acknowledged their civil liberties as citizens, it also created new legal and social responsibilities for them. Some Native Americans felt that it was another ploy to undermine their sovereignty and culture. Even though the act granted them legal recognition, it further confused their position and rights.
• 1934: Indian Reorganization Act: This act was intended to mitigate some of the effects of earlier policies by encouraging Native American sovereignty and entrepreneurship. It abolished the allotment policy, returned some of the land to the tribes and urged them to adopt constitutions and governments, which changed the focus toward tribal sovereignty and self-governance.
• 1953: Termination Policy: The U.S. government used this policy to force Native Americans to assimilate by abolishing the recognition of several tribes and denying them federal assistance, which led to the loss of land and resources that increased poverty and health problems. Assimilating Native Americans into mainstream America led to a lot of their suffering and displacement.
• 1968: Indian Civil Rights Act: This act added many protections already in the Bill of Rights to individuals on tribal lands, thus enhancing their legal and civil rights. It was designed to redress the wrongs committed against Native Americans and to enhance their position in U.S. law. However, its implementation and the effects differed among the various tribes and regions.
• 1969: Occupation of Alcatraz: Native Americans took over Alcatraz Island to protest federal policies and ask for improvements in their lives, thus creating awareness of the lack of Native American rights. The occupation was significant in the Native American civil rights struggle over questions of sovereignty and cultural self-determination.
• 1973: Occupation of Wounded Knee: The American Indian Movement (AIM) took over Wounded Knee to compel the U.S. government to respect treaty rights and listen to the concerns of indigenous people, thus increasing global awareness of Native American civil rights and health concerns.
• 1976: Indian Health Care Improvement Act (IHCIA): Passed by Congress, the IHCIA aimed to provide adequate healthcare services for Native Americans and Alaska Natives to greatly enhance their health and reduce health disparities between Native Americans and other groups, improving their prospects of receiving appropriate medical treatment.
• 1988: Indian Health Service (IHS) Becomes a Public Law: IHS was recognized as a legal entity, and its funding provided healthcare services for American Indians and Alaska Natives.

The analysis of their grim and sometimes tragic history helps to understand the tenacity of the Native American people and the contemporary issues they encounter. This context is useful for healthcare providers who deliver culturally appropriate and competent care.

Health Landscape of Native American Communities

Native American communities experience higher health inequities than nonindigenous populations as a result of factors such as historical injustices, social determinants of health and limited healthcare access.

Common illnesses and health issues include:

• Diabetes: Diabetes is common in Native Americans due to genetic, environmental and lifestyle factors. This situation has led to a diabetic epidemic, partly because of the replacement of traditional diets with processed foods.
• Cardiovascular Disease: The leading cause of death among Native Americans is cardiovascular disease, which is closely related to diabetes and high blood pressure. This disease is also associated with inadequate healthcare and lack of healthy foods.
• Alcoholism and Substance Abuse: Historical/generational trauma, low socioeconomic status and lack of resources have contributed significantly to alcoholism and substance abuse, which have led to other diseases and stagnation of enhancing the population’s health.
• Mental Health Issues: The effects of population displacement, loss of culture and racism persist in influencing mental health, leading to depression, anxiety, suicide and PTSD.
• Obesity: Culturally, indigenous people have shifted from conventional physical exercise and home-cooked foods to a more passive lifestyle and junk food, resulting in high rates of obesity and the complications associated with it.

Addressing these health disparities and health inequity issues requires a deep understanding of the cultural context and a commitment to culturally sensitive healthcare practices.

Cultural Beliefs and Practices

Knowledge of cultural beliefs and practices is crucial to deliver culturally sensitive and appropriate care for the Native American population. Such beliefs and practices may vary from the biomedical model and emphasize integrated perspectives on health.

• Traditional Healing Practices: For most Native Americans, combining traditional practices with modern medicine is still popular. Some practices include using herbs, rituals and treatments conducted by a medicine man or woman. Respecting and incorporating these traditional practices are important to improve trust and cooperation between providers and patients. Some examples:
  • Smudging: A traditional Native American practice for cleansing, purification and spiritual renewal. It involves burning sacred herbs, such as sage, cedar, sweetgrass or tobacco, and using the smoke to cleanse people, objects or spaces.
  • Sweat Lodge: A traditional Native American purification ritual involving intense heat and steam. The ceremony is held in a small, enclosed structure, often dome-shaped, built with natural materials such as willow branches and covered with animal skins, blankets or tarps.
  • Sun Dance: One of the most significant and sacred ceremonies for various Native American tribes, particularly the Plains cultures, such as the Lakota, Dakota, Cheyenne and Arapaho. It is a complex and powerful ritual focused on community, spiritual renewal and personal sacrifice for the greater good.

  Piercing and Tethering: In some traditions, participants undergo a piercing ritual where small incisions are made in their chest or back, and wooden pegs are inserted. These pegs are then tethered to a sacred pole with ropes, and dancers pull back from the pole as they dance, symbolizing their willingness to sacrifice for the community and their spiritual goals. They are acts of great courage and dedication.

• Holistic Health: According to Native American culture, health is the totality of an individual’s physical, psychological, spiritual and emotional status. This perspective focuses on the unity and integration of the person’s personality and environment. Healthcare providers should consider all aspects of the patient, including the patient’s spiritual and emotional well-being.
  • Medicine Wheel: This wheel is a spiritual and symbolic tool representing balance and interconnectedness in life. Divided into four quadrants — East, South, West and North — it aligns with seasons, life stages and aspects of health (physical, emotional, mental, spiritual). It encourages holistic well-being by reminding individuals to live in harmony with nature, community and self.
• Community and Family: Community and family influence are very important to Native Americans when they’re making health choices. Incorporating family and culture into the treatment process can contribute to better results and make treatment a more collective effort.

By recognizing and respecting these cultural beliefs and practices, healthcare providers can build stronger relationships with Native American patients and deliver more effective, culturally sensitive care.

Access to Healthcare

Native Americans primarily access healthcare through two main avenues: the Indian Health Service (IHS) and tribally operated health programs, commonly known as 638 programs.

• Indian Health Service (IHS): The IHS is a federal health program that aims to deliver health services and support to American Indians and Alaska Natives. It was established as a public law in 1988 and operates in hospitals, health centers and clinics across the U.S., although typically in remote or difficult-to-reach areas. However, the IHS is underfunded and frequently cannot offer adequate healthcare to Native American tribes.
• 638 Programs: The tribes, following the Indian Self-Determination and Education Assistance Act (Public Law 93-638), can administer their health programs through contracts and compacts with the IHS. The 638 programs allow tribes to plan and deliver health services that are sufficiently sensitive to tribal contexts. Tribally operated programs are more culturally appropriate and are in a better position to address the special health needs and health equity of the tribes.

The IHS and 638 programs play a crucial role in ensuring Native Americans’ access to healthcare. Nonetheless, these systems experience difficulties, such as shortages of funds, lack of human resources and geographic constraints, which affect the organization and provision of healthcare services. To overcome these problems, there must be a continual fight to ensure that Native Americans receive appropriate healthcare.

Barriers to Healthcare

In my experience as a nurse working with Native American communities, I’ve noticed several barriers that can potentially influence access to and the delivery of healthcare. Understanding these barriers is crucial for providing effective and compassionate care:

• Erosion of Trust: Historical events, prejudice and racism have led to an erosion of trust and negative attitudes among Native American people toward the healthcare system. This mistrust can result in individuals avoiding medical care, not adhering to prescribed treatment or disengaging from healthcare professionals. Rebuilding trust involves good communication, courtesy, acknowledging past mistakes and being committed to rectifying the mistakes.
• Geographic Barriers: Most Native American populations reside in remote areas where they cannot easily access a healthcare facility. Their geographic locations also make it challenging to guarantee that community members have medical checkups as often as required and at the right times. Transportation challenges, an unfavorable climate and poor amenities further complicate these problems. Accessibility issues can be addressed with mobile health clinics, telehealth services and better transportation to doctors’ offices.
• Economic Barriers: Lack of health insurance and high poverty limit the population’s ability to seek and receive proper medical care. Most Native Americans inhabit impoverished regions where monetary issues can bar them from accessing care, purchasing medications or receiving treatments.

It is possible to reduce these barriers through economic support programs, health insurance and other community financial support.

Handling Barriers

To effectively handle the barriers to healthcare in Native American communities, several strategies can be employed:

• Building Trust: Building trust forms the basis of these strategies. Stability, professionalism and culturally appropriate treatment are crucial. Attention must be paid to the historical oppression of native Americans and a demonstration of good faith, while offering them humane and just treatment. Understanding and respecting patients’ cultures helps healthcare professionals establish a good rapport when attending to their needs and concerns.
• Community Engagement: Community leaders who aren’t involved in healthcare initiatives can create gaps and erode trust. However, community leaders who are aware of the importance and requirements of these communities can speak for them. They can supplement strategies to share appropriate health information and enhance the circulation of information between doctors and community members, as well as play a role in appropriate and culturally sensitive public health interventions.
• Mobile Health Clinics: Mobile health clinics play a vital role in providing health services, especially in rural areas. These clinics may offer services such as annual checkups, immunizations, tests, treatments and health promotion activities. Thus, mobile clinics eliminate the issue of geography and help ensure people receive necessary medical care.

These strategies can help remove hindrances to accessing healthcare for Native American communities, thus enhancing their healthcare.

Advice for Fellow Nurses

For nurses who have the opportunity to care for Native American patients, here are some critical pieces of advice:

• Read Ahead: Gather information on the culture, beliefs, practices and health concerns of the specific Native American population you are caring for. Although Native American communities may share certain cultural similarities, each tribe is distinct and requires specific understanding.
• Learn From the Community: Seek advice from the community regarding what they want and need to gain knowledge and build trust. Walk around the community, listen to them, and seek advice and wisdom from their seniors.
• Be Open-Minded: Approach each patient with the appropriate attitude and perception toward their culture. Be willing to change and integrate new care practices in response to traditional healing practices and cultures. If you’re unsure about a practice or belief, it’s always OK to ask respectfully; it demonstrates your commitment to understanding and providing the best care possible.
• Cultural Humility: Power dynamics should be considered for culturally competent healthcare. Be prepared to learn new information from your patients and possibly change your opinion.
• Experience the Culture: To truly understand and connect with Native American communities, immerse yourself in their rich cultural heritage. Here are some experiences that can deepen your appreciation and understanding:
  • Powwows: Attend a powwow to witness vibrant cultural celebrations featuring traditional music, dance and storytelling. These gatherings are not only festive but also offer insights into the spiritual and communal aspects of Native American life.
  • Engage in Community Events: Participate in cultural or educational events organized by Native American communities, such as storytelling workshops, craft fairs or cultural heritage days. These events provide an opportunity to engage with community members, ask questions and build meaningful connections in an environment that fosters mutual respect and learning.
  • Museums: Visit museums dedicated to Native American history and culture.
  • Art: Explore Native American art, which often reflects the spiritual and cultural narratives of the community. Whether it’s pottery, weaving, beading, painting or sculpture, Native American art forms are rich with meaning and history.
  • Food: Savor the traditional foods of Native American cuisine. Try dishes such as fry bread, bison and corn-based recipes to taste the culinary traditions passed down for generations.

Nursing Resources

For further learning and support in providing culturally sensitive care to Native American communities, consider the following resources:

• Online Organizations: Learn about the National Indian Health Board (NIHB), which provides advocacy, policy and educational services to address Native American health issues, including updates on healthcare policies, initiatives and valuable information to enhance care delivery.
• Mentorship: Seek advice from others who have experience working in similar settings and handling the dynamics and opportunities unique to these communities.
• Continuing Education: Participate in continuing education programs on cultural competence. Most organizations offer topics on cultural competence, diversity and inclusion in their healthcare curriculum and educational sessions.

Native American Healthcare Jobs

• Permanent Positions
  • IHS website, job listings throughout the country and 638 facilities.
• Travel Assignments
  • Staffing companies that work with Native American communities:
    • Tribal Health
    • AB Staffing Solutions
    • TRS Healthcare

Personal Experience

Working with Native American communities has been one of the most rewarding experiences of my nursing career. I’ve had the privilege of meeting incredible individuals whose warmth and resilience have touched me deeply. In many ways, my work has felt like a connection to my own Taino ancestry, creating a profound sense of belonging. Serving some of the underserved communities in the country, which are also among the richest in culture and tradition, has filled my heart in ways that words cannot express. The depth of their history and spirit has enriched my journey, both personally and professionally.

Together, we can make a significant difference. Let’s commit to being positive change agents, advocating for the health and well-being of Native American communities, and supporting our fellow nurses in this important work.