Cultural Competency – Indian Reservation

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In our first cultural competency blog, we discussed Hawaiian culture and expectations for caregivers when working in Hawaii.  This time we will discuss Native American culture.  You will notice there are many similarities between Hawaiian and Native American societies, but there are unique characteristics in the Native American culture that are beneficial for any traveler to be aware of before providing care to this patient population.

While statistics show that only two percent of the population is Native American, many are concentrated in and around reservations, and therefore, receive healthcare from Indian Health Service (IHS) facilities. Indian Health Services is run by the Department of Health and Human Services Agency. The principal goal of IHS facilities is to provide medical care to members of federally recognized Native American and Alaska Natives.

General IHS

Indian Health Services is set up similarly to the Veterans Affairs office. It is a delivery system for healthcare, not insurance coverage. As such, the coverage is only available at specific locations. Medical Staffing Solutions, LLC is contracted with IHS to provide caregivers throughout the United States. Working at an IHS facility provides an exceptional cultural experience and the opportunity to diversify your skills while giving back to a community in need. Because IHS facilities are government run, they typically offer high pay and look excellent on a resume!

Many of the IHS facilities require a minimum of three years total experience and one year of specialty experience. The hospitals and technology are often older than caregivers are accustomed to, but high importance is placed on excellent patient care and reasonable patient ratios.

Caregivers should always be prepared to care for a broad range of ailments, but frequently seen in IHS facilities are diabetes, alcoholism/domestic violence, and altitude sickness. Being prepared to handle the physical and emotional needs of these patients is vital.

Those traveling to work in IHS facilities should have fundamental knowledge regarding the Native American culture and healthcare.  It is important for caregivers to be cognizant that every tribe has different characteristics, rituals, and beliefs. The following information is an introduction to Native American beliefs to help caregivers familiarize themselves with the Native American culture.

Ceremonial Practices

Healing and religion are closely related in Native American culture.  Regardless of the tribe, the main feature of Native American spirituality is the relationship between man and the land.  A healer, also known as a “medicine man/women” often knows a great deal about remedying ailments with local plant life. A healer can provide traditional diagnostic care using specialties such as: hand trembling and crystal, water, charcoal, and feather gazing.  Because there is such a strong tie between the physical being and religious practices, healers are often religious leaders in their community.

Chantways include ritualized chants and singing that can take place over several days.  They are often used in births, puberty rites, and marriages; it is believed they can have a large impact on the concerned person and are frequently used to bring an afflicted person into harmony with their surroundings.

Sand paintings are used most often by the Navajo, and are created using colored sand and other dry materials. It is believed that sand paintings provide healing by bringing the afflicted person into alignment with nature. The family of the patient and the healer decide on the subject matter of the paintings which may include plants, animals, or other mythical figures. There is also an accompanying ceremony in which the patient sits in the middle of the painting and sand is then applied to the patient.  During the application of sand, it is thought that the painted figures come to life and help heal the patient.

Death is viewed as an important spiritual transition and is linked to the newness of life; the lifespan of a person is circular as they transition from birth to death.  Post death rituals are a way to help ease the deceased into the next stage of the afterlife.  Caregivers should always provide privacy and time for such rituals to take place and delay post mortem care until the family is agreeable and has had an opportunity to complete important rituals. Because many tribes do not think death exists – only a change of worlds, they believe if certain rituals are not completed the soul of the deceased may be stuck and unable to pass on to the afterlife.

The Kinaalda is a Navajo puberty right for girls and takes place soon after a girl begins her first menstrual cycle.  There are several days of ceremonial activities that include chantways.  During the time the girl is going through rites, she is believed to have special healing powers.  People may request a visit from her or seek her out to request healing.

Sweat Lodge Ceremonies cleanse and purify the body while providing spiritual rejuvenation through ceremonial practices.  The ceremony requires an enclosed structure to be built and filled with heated stones.  The leader of the ceremony, often known as the firekeeper, will offer prayers while pouring water over the hot rocks to create steam.  Members of the ceremony will spend hours or days in the sweat lodge, depending on the needs being addressed.


Not all Native American patients are going to have an interest in integrating their cultural beliefs with their medical care.  Each patient is unique and will likely fall on a continuum of how in depth they wish to incorporate their ceremonial practices, but the best caregivers are knowledgeable and supportive of the individual needs of the patients they care for.  Just as when traveling to Hawaii there are some general Etiquette do’s and don’ts when working in an IHS facility.




·      Do encourage patients to educate you about specific cultural protocols in their community. ·      Don’t use medical jargon.  Patients/family may nod their heads to be polite but might not understand what you’re saying.
·      Adapt your tone of voice, volume, and speed of speech to the patterns of the local community. ·      Don’t use intrusive questions early in a conversation.
·      Do listen more than you speak.  Be comfortable with silence or long pauses in conversation.  Adapt your tone of voice, volume, and speed of speech to the patterns of the local community. ·      Don’t interrupt others during conversations or interject during long pauses of silences.
·      Do accept food or beverages if offered, it is considered an important sign of respect. ·      Don’t point your finger, this may be interpreted as rude behavior in many tribes.
·      Do avoid direct eye contact unless it is initiated by a Native. ·      Don’t hug or use personal touch unless initiated from the Native.
·      Do explain what you are writing when making clinical notes in a patients/family’s presence. ·      Don’t touch sacred objects such as medicine bags, ceremonial pieces, hair, jewelry, or other personal or cultural items.
·      Do offer general invitations to speak during assessments/care, then remain quiet and listen. ·      Don’t stand too close to others.
·      Do be careful to avoid imposing your personal values, morals, or beliefs. ·      Don’t rush or look at your watch frequently.
·      Do learn how the community refers to the tribal name in area.
·      Do show great respect to the Native American elders, they are highly honored in the culture.  Where we may use Sir or Ma’am in conversation, the respectful term for elderly Natives is Grandma or Grandpa, or Masima (Grandma) or Chei (Grandpa) in Navajo.







Traveling to work in an Indian Health Services facility will offer you the experience to learn about a new culture, obtain government work experience, and see the most beautiful lands the United States has to offer, all with excellent compensation and great patient ratios.  If you are interested in this amazing opportunity, Medical Staffing Solutions, LLC has a job waiting for you!  As the Natives say… until we meet again friends!


Written by: Ashley Briody, MSS, LLC Clinical Nurse Supervisor

Brodd, J., Little, L., Nystrom, B., Platzner, R., Shek, R., & Stiles, E. (2013) Indigenous religions of North America. In Invitation to world religions (pp.29-51). New York, NY: Oxford University Press.