This paper conducts a critical literature review on end of life issues relating to Native Americans and Alaska Natives. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to guide this literature review. In particular, a PRISMA flow diagram which outlines the various steps of the critical literature review is given. The review identified 18 papers. Although all of these papers fit the inclusion criteria, there was very little uniformity among them. Six common themes emerged; namely, communications, program development, spirituality, rituals, advance planning, and guidelines. A detailed discussion of these six themes along with nursing implications is presented. While work is being done to develop cultural competence, it is apparent nurses must continue to develop their skills related to these six areas of concentration in order to improve end of life car in Native American and Alaska Native populations.