Forging a Stronger Bond between Nurses and Native American Cancer Patients

A divide of misunderstanding too often separates Native American cancer patients from the nurses who care for them. UA College of Nursing assistant professor Natalie Pool, PhD, BSN, RN, hopes to heal those differences with cultural safety training developed during her most recent research.

Pool became aware of the challenging dynamic early in her career. Her work as a medical-surgical nurse serving the White Mountain Apache and Northern Ute reservations occasionally involved cancer patients dealing with the side effects of cancer treatment or end-of-life issues. She cared for similar populations working surgical-oncology in the Tucson area.  During those experiences, she noticed a disproportionate number of Native American patients experiencing significant cancer complications. “There were many end-stage patients with cancers that we consider highly preventable and treatable in the general population,” she said. “Such as cervical, colon or prostate cancer.”

One reason, Pool discovered, was the long history of wariness Native American populations had for healthcare providers and the healthcare system. Lack of access to wellness resources and adverse experiences within the system caused some communities to view health services and providers with skepticism. Many patients resisted seeking care until there was no other choice.

“Nurses want to be culturally respectful and have a meaningful connection with their patients regardless of who they are." ~ Natalie Pool, PhD, BSN, RN

Ironically the situation actually served to widen the cultural divide. Pool’s interviews with cancer nurses who cared for Native American people revealed feelings of frustration with what they interpreted as noncompliant behavior. Additionally, patients tended to have a very different perception of cancer than their caregivers, which led to conflicting expectations that often felt confusing and alienating to nurses. That dissatisfaction often led to disillusionment and high turnover rates of nursing staff.

Realizing that optimism is essential for cancer nurses, Pool theorized that the key to improving the situation for patients and nurses alike was education to raise culture-specific knowledge. “Nurses need comprehensive cultural training to better integrate into their care and understanding of the health-related issues Native American communities face,” she said, citing such challenges as food security issues, transportation dilemmas, and communication and language barriers.

“What they require are the right tools, because ultimately most nurses want to provide unbiased, inclusive care for all of their patients,” said Pool. “They want to be culturally respectful, and have a meaningful connection with their patients regardless of who they are. They want to partner with other providers serving Native American people, social workers and traditional healers in the interest of better long-term cancer care for these patients.”

Fueled by the results of the study, Pool advocates comprehensive and targeted cultural safety training designed to better equip nurses to provide culturally congruent care. “Improving the work satisfaction for the nurse will improve the patient’s experience as well,” she said. 

She hopes her findings will spur changes in how nurses learn to provide care with Native American populations, not only for those already working in the field but for those studying to become registered nurses.  That’s especially important in the Southwest, which is home to more than 20 percent of U.S. Native Americans.