Transcript Module 24 Cultural Dimensions Powerpoint

Module 24
Cultural
Dimensions in
End-of-Life
Care
Geriatric Aide Curriculum
NC Division of Health Service Regulation
Adapted from: The 2004 PERT Program
Pain & Palliative Care Research Department
Swedish Medical Center, Seattle, Washington
Objective:
1. To obtain an understanding about culture
and its influence on:
A. Caregivers
B. Residents and families
C. Relationships among team members,
residents, and families
D. Clinical care at the end of life
E. Decision making at the end of life
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• Increasingly, health care providers
and clients are from different
cultural backgrounds.
• If trends continue, by 2050, one in
two Americans will claim
membership in an ethnic minority.
U.S. Census Bureau, 2004, "U.S. Interim Projections by
Age, Sex, Race, and Hispanic Origin,"
<http://www.census.gov/ipc/www/usinterimproj/>
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Definitions
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Culture
Socially transmitted values, customs, arts,
behaviors, and beliefs that guide a person’s
world view and decision making.
(Purnell & Paulanka, Transcultural Health Care, 2000)
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Culture . . .
• Is universal
• Dominant & nondominant
cultures
• Includes religious cultures
& subcultures
(Purnell & Paulanka, Transcultural Health Care, 2000)
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World View Includes:
• The purpose of human
life
• The nature of the
universe and humans’
relationship to it
• Relationship to nature
• Social relationships
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World View Includes:
(continued)
• Moral and ethical
thinking
• Beliefs about
magic/religion
• Aesthetics (nature of
beauty and art)
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Race
• Inherited physical
traits that characterize
distinct groups of
humans
• Racism: belief that
race is the key factor
in determining human
qualities and abilities,
and that one race is
superior to another
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Ethnicity
Belonging to a group that is characterized
by:
• Literature, art,
music
• Language
• Social customs
• Dietary practices
• Religion
• Sense of belonging
• Employment
patterns
• Physical community
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Assimilation
The process of assuming the values and
behaviors of the dominant culture
Acculturation
The process of
learning the values
of the dominant
culture without
adopting them
Stereotype
vs
generalization
• A stereotype is an ending point where no
attempt is made to find out if what we think
about a person is true.
• A generalization is a beginning point where
more information is sought to find out if
what we think about a person is true.
Galanti, Caring for Patients from Different Cultures, 1997
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Ethnocentrism
Universal tendency of humans to think that
their ways of thinking, acting, and believing
are the only right, proper, or natural ways
(Purnell & Paulanka, Transcultural Health Care, 2003)
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Culture
and
Care
at the
End-of-Life
How has culture influenced your
care of residents who are dying?
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How Culture Influences Death
• Affects how people view
death, and their distress or
peace with death
• Affects social customs, for
example, care of the body
and mourning rituals
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How Culture Influences Death
(continued)
• Affects how people talk about
death
• Can strain or enhance
relationships between care
providers and
residents/families
• Affects decision making
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End-of-Life Decisions
• Palliative vs. Curative
Therapies
• Use of Pain Medications
• Advance Directives
• Initiation/Withdrawal of
Life-sustaining Therapies
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Cultural Values of the
American Health Care
System
• Truth-telling
• Patient Autonomy
• Personal Control
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Examples of Cultural
Differences
• Interdependence,
especially among family
members, rather than a
focus on individual
autonomy
• Respectful communication
• Trust, rather than control
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Cultural Assessment
at the End of Life
(Adapted from Koenig & Gates-Williams, 1995)
•
•
•
•
•
•
Use of Language
Decision Making
Religious Beliefs
Death Rituals
Hope
Fate or Control
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Cultural Assessment
at the End of Life
(continued)
•
•
•
•
Gender
Age
Power
Historical or
Political Factors
• Community
Resources
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Mourning
• Cultures experience grief as a response
before a pending death or after a death.
• Mourning is the process through which the
grief is expressed.
• Mourning represents culturally accepted
expression of the personal feelings that
follow the death of a loved one.
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Mourning
• Culturally acceptable expressions during
mourning shaving the head, wearing black
or white clothing, and grieving for a set
amount of time.
• Another culture may express grief through
drinking and dancing with the surviving
spouse expected to marry a person with a
certain kinship position.
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Mourning
• A culture may expect the spouse or close
family members of the deceased to mourn
for the rest of their lives by performing
certain rituals, wearing specific kinds of
clothing, being addressed a certain way by
others, and the changing of one’s rights
and obligations to the community.
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Mourning
• Bereaved Balinese may
laugh off a death
because visual
expressions of sorrow
are forbidden among the
Bali.
• Being possessed by the
spirit of the dead may be
considered normal in
other cultures.
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Mourning
• Other cultures may wail, light candles,
cover all mirrors, want to cleanse the
body, or call a priest, monk, rabbi, or
spiritual advisor.
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Culturally Sensitive Care:
Eye contact Examples
• Asian and Hispanic cultures
may avoid eye contact to show
respect.
• Middle Eastern cultures may
avoid eye contact between men
and women.
• Some Native American cultures
may avoid eye contact to avoid
having souls stolen.
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Culturally Sensitive Care:
Touch examples
• Middle Eastern cultures and orthodox
Jewish religions avoid touch between
members of the opposite sex.
• Asians may not like being touched and
physical contact is relatively infrequent in
most Asian countries.
• Most Hispanics, however, will probably
feel quite comfortable with hands-on care.
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Culturally Sensitive Care:
General Approaches
• Knowledge
• Careful assessment without
stereotyping
• Respect for diverse beliefs
and practices
• Understanding and honoring
one’s own values
• Negotiation
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Case Studies
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Summary
• Culture is universal
• Culture affects end of life
decision making
• Cultural patterns can
increase or decrease
vulnerability
• Culture can be a barrier
but also an opportunity
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“You got to go
where he lives”
(Kagawa-Singer &
Blackhall, JAMA, 2001
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THE END
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