Transcript Main Title - OneLegacy

Cultural & Religious Considerations in
End-of-Life Care & the Donation Decision
FirstName LastName
Title
Organization
Question to Run on:
How comfortable are you with your knowledge of
cultures and religions and
how does that impact your care?
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Cultural Assumption
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New Perspective
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Objectives
By the end of this presentation the learner will:
1. Understand the definitions of culture, race, and ethnicity
2. Recognize nursing theory supporting cultural competence
3. Recognize the risk of cultural assumption and imposition
4. Be empowered to draw upon their professional strengths
5. Be equipped with practical tips to become culturally skilled
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Overview
• Laying Foundations
• Need for Multicultural Skills
• Culturally Sensitive End-of-Life Care
• Basic Principles
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Laying Foundations
Operational Definitions of
Culture, Ethnicity, and Race and
the Differences Between These Terms
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Laying Foundations
• Culture is requires a broad definition and should
include:
─ Ethnographic variables
─ Demographic variables
─ Status variables
─ Affiliation variables
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Laying Foundations – Defining Culture
“Culture is defined as a
specific set of social, shared,
educational, religious, and
professional behaviors,
practices and values that
individuals learn and ascribe
to while participating in or
outside of groups with whom
they typically interact.”
(Bomar, 2004)
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Laying Foundations – Defining Ethnicity
“Ethnicity is a key facet of culture and refers to a
common ancestry, a sense of ‘peoplehood’ and group
identity. From a common ancestry and a shared social
and cultural history and national origin have evolved
shared values and customs.”
(Friedman et al., 2003)
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Laying Foundations – Defining Race
“…an ancient, nonscientific, political
classification of human beings and is
based on physiological
characteristics, such as skin color, eye
shape, and texture of hair.” (Bomar, 2004)
• It is a narrower term then ethnicity and denotes a
human biological definition
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Laying Foundations
Important Clarifications:
• Race and ethnicity should NOT be confused
• People of one race can vary in terms of their
ethnicity and culture
• Race is NOT considered a correct or useful means of
classifying people
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Laying Foundations
Important Clarifications:
─ There are no distinct,
pure races today
─ Religion is very much
entwined with ethnicity,
shaper of health values,
beliefs, and practices
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Thought Question
Knowing that people of one race can vary in terms
of their ethnicity and culture, can we truly make
assumptions about someone based on their
biological looks or even based on the little we may
know of their “culture” or “ethnicity”?
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Need for Multicultural Skills
Nursing Theory
&
Regulatory Standards
Requiring Multicultural Skills
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Need for Multicultural Skills
•
•
•
•
Nurse Theorist
PhD in Anthropology
Transcultural Nursing
Transcultural Nursing
Society
• Journal of Transcultural
Nursing
• Talks about culturally
congruent care
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Need for Multicultural Skills
Leininger says that nurses
are realizing the critical
need to become more
culturally competent and
knowledgeable in working
with individuals
of diverse cultures.
(Leininger, 1994)
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Need for Multicultural Skills
• Health Care Professionals’ Multicultural Needs
– The Joint Commission requirement
• Data reported to The Joint Commission demonstrates
most root cause of sentinel events is due to
communication:
• Many standards relate to importance of
understanding, acknowledging and respecting the
patient’s culture
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Need for Multicultural Skills
• U.S. Department of Health & Human Services – The
Office of Minority Health standards
– 14 CLAS standards set for health care organizations
with the following themes:
• Culturally Competent Care (Standards 1-3),
• Language Access Services (Standards 4-7), and
• Organizational Supports for Cultural Competence
(Standards 8-14)
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Need for Multicultural Skills
The Joint Commission definition of
cultural competence:
• the ability of health care providers and
organizations to understand and respond
effectively to the cultural and language
needs brought by the patient to the
health care encounter
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Need for Multicultural Skills
The Joint Commission definition of cultural competence
(cont.):
• Cultural competence requires organizations and their
personnel to:
1.
2.
3.
4.
5.
value diversity;
assess themselves;
manage the dynamics of difference;
acquire and institutionalize cultural knowledge; and
adapt to diversity and the cultural contexts of individuals
and communities served
• culturally and linguistically appropriate
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Need for Multicultural Skills
“Cultural competence is
a journey,
not a destination.”
(Galanti, 2008)
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Culturally Sensitive End-of-Life Care
Cultural Assumptions & Imposition,
Cultural Beliefs about EOL & Donation &
Cross-Cultural Communication
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Play Video
YouTube - Seinfeld. Is he black?
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Culturally Sensitive End-of-Life Care
• What assumptions were being made in this clip?
• What were the characters basing their
assumptions on?
• Have you ever made an assumptions about
someone’s culture / religion / race purely based on
their looks?
• Did you ever discover that your assumption was
completely wrong?
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Culturally Sensitive End-of-Life Care
Culture Assessed by Observation:
• Dress
• Appearance
• Speech
• Education
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Culturally Sensitive End-of-Life Care
Practices in EOL & attitudes about donation
• Preconceived ideas about cultures
–
–
–
–
African American
Filipino
Hispanic
Asian
• Religious background
– Jewish
– Jehovah Witness
– Hindu
• Bias vs.. reality
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Culturally Sensitive End-of-Life Care
• Belief in Sickness
– Imbalances causes sickness
– Focus on symptoms vs. illness
– Comfortable with Western
medicine, but more likely to try
traditional first
Cambodia
• Values in Death and Dying
– Monks need to recite prayers,
family members should be
present, family faces death
quietly, incense may be burned
• Belief in Donation
– Unlikely to allow donation, body
cremated, due to belief in
reincarnation, desire for body to
be intact
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Culturally Sensitive End-of-Life Care
Native Americans
• Values in Death & Dying
• Belief in Sickness
– Interconnectedness leads to
relationship between man, God,
fellow man, and nature
– Sickness is an imbalance
– Healing is not separated from
rest
– Healing cannot happen without
spiritual intervention
• Belief in Donation
– May avoid contact with the
dying
– Family present 24 hrs/day
– Atmosphere may be jovial
with eating, joking, playing
games, and singing
– Once death occurs –
wailing, shrieking may
occur
– Children included
– May prefer open window
– Depends on tribe – generally not supported but this is changing
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Culturally Sensitive End-of-Life Care
• Belief in Sickness
– Illness can have natural or
supernatural etiologies, possible
belief of illness might be soul loss
or ancestral spirit seeking attention
Hmong
• Values in Death and Dying
– Amulets need to remain in place,
Shaman rituals may be performed,
after death specific rituals
performed to help send person’s
spirit to heaven
• Belief in Donation
– Traditionally will not donate because they believe one of three spirits
will remains with body, therefore the body needs to remain whole.
Christian Hmong believe body and soul are separate and may consent
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Culturally Sensitive End-of-Life Care
• Belief in Sickness
Korean
– Illness and death part of life,
many believe, illness is bad luck
or misfortune or karma
• Values in Death and Dying
– Mourning and crying may appear
over-dramatized to outsider,
chanting, incense burning,
praying, etc. may be involved.
Family will want to spend time
with patient after death and may
request to cleanse body
– Cremation not common
• Belief in Donation
– Donation usually considered
negatively. Associated with
tampering of body/soul/spirit
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Culturally Sensitive End-of-Life Care
• Belief in Sickness
Filipino
– Result of imbalance, associated
with bad behavior punishment,
may not respond to illness until
it is advanced
• Values in Death and Dying
– Death is a spiritual event, family
may want to wash the body, will
want all the family to say goodbye prior to the body being taken
• Belief in Donation
– The body is given high respect,
cremation is not common
practice, may not allow
donation
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Culturally Sensitive End-of-Life Care
Hispanics
• Belief in Sickness
– Columbians – severe illness attributed to God’s design or punishment
for bad behavior
– Central Americans – imbalance, concern with hot/cold & strong/weak,
caused by strong emotions and/or evil eye or curse
• Values in Death and Dying
– Columbians – may be surrounded by all family members except small
children, catholic prayer common, may ask for priest, may cry
uncontrollably and loudly, women may be hysterical
– Central Americans – Assure privacy and quiet for sacrament of sick,
candles may be used, family members prepare body for burial, death
considered a spiritual event
• Belief in Donation
– Columbians – may consent to donation
– Central Americans – donation acceptable if body treated with
respect
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Culturally Sensitive End-of-Life Care
Iranians
• Belief in Sickness
– Illness discussed and challenged,
remedies and advice solicited,
body viewed in relation to
environment, e.g. God, society,
nutrition, etc.
• Values in Death and Dying
– Notify head of family first, DNR
not difficult, death seen as
beginning of spiritual existence
• Belief in Donation
– Organ donation acceptable,
speak to head of family
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Culturally Sensitive End-of-Life Care
African American
• Belief in Sickness
– Illness due to natural causes, poor life-style, exposure to cold
air/winds, unnatural or supernatural causes, God’s punishment,
work of the devil or spell
• Values in Death and Dying
– Family wants professionals to cleanse and prepare body,
deceased highly respected, cremation avoided
• Belief in Donation
– Taboo to donate organs and blood, exception if there is a need
in the family
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Culturally Sensitive End-of-Life Care
“Unspoken assumptions regarding
meaning of health, illness, and
death may affect communication
regarding donation.”
Dr. Hawryluck & Knickle (n.d.)
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Culturally Sensitive End-of-Life Care
Risk of Cultural Imposition
“The nurse must examine his/her biases and prejudices
toward other cultures as well as explore his/her own
cultural background….Without becoming aware of the
influence of one’s own cultural values, a risk exist for the
nurse to engage in cultural imposition”.
(Campinha-Bacote et al 1996)
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Culturally Sensitive End-of-Life Care
• Generalization vs. Stereotyping
• Arthur Kleinman’s Explanatory model
• Unbiased approach to an individual
• Gain the emic perspective versus our etic perspective
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Culturally Sensitive End-of-Life Care
Anthropological terminology:
• Emic perspective –
insider’s perspective
• Etic perspective –
outsider’s perspective
• Both perspectives –
most effective vantage point
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Culturally Sensitive End-of-Life Care
Explanatory Model – 8 Questions by Arthur Kleinman:
• What do you call your illness? What name does it have?
• What do you think has caused the illness?
• Why and when did it start?
• What do you think the illness does? How does it work?
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Culturally Sensitive End-of-Life Care
Explanatory Model – 8 Questions (cont.)
• How severe is it? How long do you think you will have it?
• What kind of treatment do you think the patient should
receive? What are the most important results you hope
he/she receives from this treatment?
• What are the chief problems the illness has caused?
• What do you fear most about the illness?
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Culturally Sensitive End-of-Life Care
Simple triggers - the 4 Cs:
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Call
2.
Cause
3.
Cope
4.
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Cross-Cultural Communication Skills
• Culture & communication
connected
• Communication –
driven by culture
• Connection forgotten =
risk for misunderstanding
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Cross-Cultural Communication Skills
• Effective communication is your responsibility
• 6 barriers to communication:
• Anxiety
• Nonverbals
• Stereotypes and prejudice
• Ethnocentrism
• Language problems
• Assuming similarities vs.
differences
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Cross-Cultural Communication Skills
• Good intercultural communicators:
– Personality strength
– Communication skills
– Psychological adjustment
– Cultural awareness
• Eight different skills:
– Self-awareness, self-respect, interaction, empathy,
adaptability, certainty, initiative, and acceptance
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Cross-Cultural Communication Skills
Cultural considerations
• Identify the Decision Maker
• Give the family what they need and want
• Do not project your own personal feelings
• Assess their readiness – let the family guide the
conversation
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Cross-Cultural Communication Skills
• Understand your motives
– Concerns for the family
– Concerns for the recipient
– Turning a negative situation
around to be positive
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Cross-Cultural Communication Skills
• Communication varies:
– overt & direct vs. covert & indirect
• Overt & direct challenged by covert & indirect
• Covert & indirect find overt & direct aggressive
• Use indirect communication to identify and
uncover perceptions of disease causation and
best treatment
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Cross-Cultural Communication Skills
Professional Empowerment
• Developed their your interpersonal skills
• Utilize your strengths
• Focus on the family
–
–
–
–
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Time
Taking care of their needs
Pick-up on cues from the family
Sensibility, sensitivity and adaptation
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Basic Principles
Practical Tips for Working with
Various Cultures
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Basic Principles
Reflections – know & understand yourself:
• What is your culture? Your beliefs?
• Have your culture and beliefs been influenced by
your family? Has it evolved?
• If you have changed your perspectives, what led you
to change your perspectives?
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Basic Principles
Cultural-Communication Tips
• Learn and use a few phrases of
greeting and introduction in the
patient’s native language – conveys:
– Respect
– Demonstrates your willingness to learn about their culture
• Avoid saying “you must….”, use, e.g., “some people in this
situation would….”
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Basic Principles
Beware of hand gestures, some examples:
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Basic Principles
• Do not assume you know the culture
• Seek to understand –
Don’t be afraid to ASK!
• Become a student of the person / the family
• Identify what provides value in death to that
individual
Remember - your culture is not superior.
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Question to Run on:
How comfortable are you with your knowledge of
cultures and religions and how does that impact
your care?
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Thank you for your
attention!
Questions ?