Native American Patients: 6 Considerations for Culturally Sensitive Care

Growing up with Native American values and cultural experiences as a member of the Lac du Flambeau Band of Lake Superior Chippewa Indians in Wisconsin taught Lisa Martin, PhD, RN, FAAN, to honor and respect individuals’ choices as representing who they are. As a nurse she has applied these cultural values to always approach patient care by first asking about the patient and family perspectives, and then designing the health care experience that best fits their understanding.

Martin says a holistic and individualized approach in nursing can be a valuable lens to look toward culturally sensitive care for Native Americans. In Martin’s current roles as clinical associate professor of nursing at the University of Minnesota – Twin Cities, as a diversity, inclusion, and equity consultant for the Future of Nursing  Campaign for Action, and as past-president of the National Alaska Native American Indian Nurses Association (NANAINA), she works to encourage open and honorable awareness and dialogue for nursing care.

Karen Cochran, PhD, RN, CNOR, echoes a similar approach of honor, respect and awareness in perioperative patient care for Native Americans. Cochran is a perioperative education specialist at AORN who was raised within the Houma United Nation in southern Louisiana. Growing up with a mother who is ¾ Native American and a Caucasian father led her to grow up walking in two worlds. This unique perspective has helped her understand the unique needs of Native American patients, while also seeing the blind spots non-Native American healthcare providers have when caring for this patient population.

“It’s important to be culturally aware, humble and respectful, and to realize that the world your patient comes from may not be the same world you come from,” Cochran stresses. “Listen to your patients and meet them where they are.”

As nurses recognize Native American Heritage Month, Martin and Cochran both say this is an important time to raise awareness about cultural heritage, current health disparities and respectful care approaches for Native Americans across the country.

Here are six care considerations they advise nurses think about:

1. Many Native Americans Distrust Health Care
   The Native American Holocaust experienced in this country over the past 300 years decimated Native American populations from 15 million prior to European immigration to 200,000 Native Americans by the end of the 19th century, Cochran explains. The atrocities Native Americans have experienced as recent as the 1950’s through murder, starvation, displacement and forced assimilation is not forgotten among Native Americans, she adds. “Many Native Americans in their 80s today were forced to attend government boarding schools where children experienced horrendous abuse they often succumbed to. These schools were designed to abolish native traditions and assimilate native children into white society.”
   
   These historic abuses can make it more difficult for many Native Americans to put their trust in health care providers, Cochran adds. “Nurses need to be aware of this distrust and listen to their Native American patients to identify possible trust issues because this could prevent these patients from adhering to their care plan and achieving optimal outcomes.”
2. Native Americans Do Not Always Receive Adequate Access to Health Care
   The current spotlight on healthcare disparities among minorities does not always include a focus on Native American health care disparities and this needs to change, Cochran stresses. Heart disease, cancer, unintentional injuries, and diabetes are the leading causes of American Indian and Alaska Native death. These Native Americans have a life expectancy that is 5.5 years less than non-native US races, which is attributed to “inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences,” according to the federal Indian Health Services.
   
   “These disparities mean Native American patients receiving perioperative care are more likely to have co-morbidities and have higher acuity illnesses that perioperative nurses need to take into consideration through each phase of perioperative care,” Cochran advises.

3. Respect Individual Choice for Native American Patients
   For example, during a Native American patient’s preoperative assessment, you can start by asking if a Native American patient is affiliated with a specific Native American community, Martin explains, noting that this can start an open dialogue that leads to a healthy and honorable care experience. “If your assessment protocol does not include this as a standard question, maybe it’s time to add this question,” Martin suggests.

4. Education Level Could Be Lower for Native American Patients
   Speaking from her own experiences growing up in a predominantly Native American community, Cochran says there was not an emphasis on going to college or even finishing high school because the primary jobs available were in fishing or the oil fields, which did not require an extensive education and similar trends are a reality among other Native American tribes. She suggests this lack of advanced education could put Native Americans at a disadvantage during health care if nurses do not use communication strategies such as “teach back” to ensure directions such as postoperative care instructions are fully understood.
5. Be Aware of Evolving Terminology
   Terminology is an area that is evolving for many diverse groups including Native American people, Martin acknowledges. She notes that terms that were once accepted in nursing and other contexts are now changing to preferred terms as lessons learned during the COVID-19 pandemic and the Black Lives Matter movement are driving new understandings of respectful language and terminology.
   
   “I don’t think we have arrived yet at preferred terminology for Native Americans, so I recommend asking a patient and their family, if present, what they prefer, and what terms would be most respectful,” Martin advises.

6. Promote Inclusion and Diversity Among Colleagues
   Within the perioperative work environment, perioperative nurses can play an important role in promoting inclusion of diversity and health equity in response to patients seen and the professional team itself, Martin stresses. “This kind of work is very important to create an inclusive team dynamic, which creates a higher quality of healthcare.”