cultural & religious considerations in end-of-life care & the donation decision

Cultural & Religious Considerations in End-of-Life Care & the Donation Decision

FirstName LastNameTitle

Organization

Hospital-MCT_HAguiar 2

Question to Run on:

How comfortable are you with your knowledge of

cultures and religions and

how does that impact your care?

Spring2011


Cultural Assumption

Spring2011


New Perspective

Spring2011


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

Spring2011


Overview

Spring2011

• Laying Foundations

• Need for Multicultural Skills

• Culturally Sensitive End-of-Life Care

• Basic Principles


Laying Foundations

Operational Definitions of

Culture, Ethnicity, and Race and

the Differences Between These Terms

Spring2011


Laying Foundations – Defining Culture

Spring2011

“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)


Laying Foundations – Defining Ethnicity

Spring2011

“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)

Laying Foundations – Defining Race

Spring2011

“…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


Laying Foundations

Spring2011

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


Laying Foundations

Spring2011

Important Clarifications:

─ There are no distinct,

pure races today

─ Religion is very much

entwined with ethnicity,

shaper of health values,

beliefs, and practices


Thought Question

Spring2011

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”?


Need for Multicultural Skills

Nursing Theory

&

Regulatory Standards

Requiring Multicultural Skills

Spring2011



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)

Spring2011



Spring2011

“Cultural competence is

a journey,

not a destination.”(Galanti, 2008)


Culturally Sensitive End-of-Life Care

Cultural Assumptions & Imposition,

Cultural Beliefs about EOL & Donation &

Cross-Cultural Communication

Spring2011



Spring2011

Culture Assessed by Observation:

• Dress

• Appearance

• Speech

• Education



Spring2011

Practices in EOL & attitudes about donation• Preconceived ideas about cultures– African American– Filipino– Hispanic– Asian

• Religious background– Jewish– Jehovah Witness– Hindu

• Bias vs.. reality



Spring2011

“Unspoken assumptions regarding

meaning of health, illness, and

death may affect communication

regarding donation.”

Dr. Hawryluck & Knickle (n.d.)



Spring2011

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)



Spring2011

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?



Spring2011

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?

Cross-Cultural Communication Skills

• Culture & communication

connected

• Communication –

driven by culture

• Connection forgotten =

risk for misunderstanding

Spring2011 Hospital-MCT_HAguiar 24



Spring2011

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



• Understand your motives

– Concerns for the family

– Concerns for the recipient

– Turning a negative situation

around to be positive



• 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



Spring2011

Professional Empowerment• Developed their your interpersonal skills• Utilize your strengths• Focus on the family– Time – Taking care of their needs– Pick-up on cues from the family– Sensibility, sensitivity and adaptation

Basic Principles

Practical Tips for Working with

Various Cultures



Basic Principles

Spring2011

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?


Basic Principles

Spring2011

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….”


Basic Principles

Spring2011

• 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.

33

Question to Run on:

How comfortable are you with your knowledge of

cultures and religions and how does that impact

your care?

Spring2011 Hospital-MCT_HAguiar

Questions ?

Thank you for your attention!

cultural & religious considerations in end-of-life care & the donation decision

Documents

terms spring2011hospitalmct

haguiar8 culture

multicultural skillsleininger

multicultural skillssp

shared values

key facet of culture

cultural competencerecognize

haguiar7laying foundations