Cultural Sensitivity &

Culturally Diverse Families

Involved in the

Deceased Donation Process

Wendy Sherry, RN MN

Nurse Clinician for Organ & Tissue Donation

Presentation for Interprofessional Trauma Conference ,

September 29, 2015

Potential Conflicts of Interest Disclosure

• I do not have and I have not in the past

two years, an affiliation with / or financial

interest of any nature in a business

corporation

• I did not receive remuneration, royalties or

research grants from a business

corporation

Assessing Cultural Sensitivity

Objectives • Relevance

• Literature Review

• Defining Culture

• Reasonable Accommodation vs.

Personalization of Care

• Expert Panel on Global Nursing and

Health

– Leininger’s theory of Culture Care Diversity and

Universality

• Integrating Cultural Congruent Care

Relevance

Relevance

• 20.6% of the Canadian population

immigrated from other countries

• Asia and the Middle-East are the largest

sources of immigration

• 19.1% of the population identify

themselves as a visible minority

• Majority of immigrants reside in

– Toronto, Ontario

– Vancouver, British Columbia

– Montreal, Quebec

Relevance con’t

• Canada has over 4100 people actively

waiting for an organ transplant

• Quebec has 850 people on the organ

transplant wait list

• In Montreal, the mother tongue of 11.7% of

the population is Arabic, Spanish, Italian,

Creole, Chinese, Greek, Portuguese,

Romanian, Vietnamese, and Russian

Relevance con’t

• 33% of Montreal’s inhabitants are members of an

ethnocultural community

• Over 200 ethnicities live within Greater Montreal

• Almost 40% of MUHC referrals involve patients who

are members of an ethnocultural community

• At the MUHC ethnocultural family decision-making

is influenced by personal values, cultural and

spiritual beliefs, lack of knowledge and pre-mortem

discussion on OTD, body integrity concerns,

interference with end of life rituals, and

misconceptions

Literature Review

Defining Culture

“The learned, shared, and transmitted

knowledge of values, beliefs, norms, and

lifeways of a particular group of people that

guides an individual or group in their thinking,

decisions, and actions in patterned ways”

Leininger, 1995, p. 60

Literature Review

Nurses’ perception of organ & tissue

donation (OTD)

– Complexity of looking after a donor and family

members increases level of stress

– Lack of transcultural nursing knowledge

impacts willingness to modify nursing care to

meet patient and family needs

Literature Review con’t

• Demonstrates need for good

communication skills and a knowledge of

different ethnocultural end of life rituals,

values, and beliefs

• Nurses who are aware of their own cultural

biases and beliefs are more likely to

develop a care plan that reflects

ethnocultural family needs

Literature Review con’t

Family needs and OTD

– The dying process creates intense emotions

– Difficulty accepting a diagnosis of neurological

death and making a decision about OTD

– Appreciate an individualized approach to care;

conveys nursing care is not just about procuring

body parts

– Need support coping with a difficult situation,

and want to make the right decision

Describing Families

Negative Language

• Demanding

• Controlling

• Angry

• Passive, indifferent, non-participatory

• Non-compliant

Positive Language

• Strong advocate

• Actively involved, aware

of own needs

• Concerned, worried

• May need more time

• Has different priorities

Reasonable Accommodation

vs.

Personalization of Care

Social Context

• The feeling there is an increase in special

requests in healthcare from members of

ethnocultural communities

• Frequent questions regarding the care

provider – patient / family relationship and

their rights

• Intercultural questions are judged as

« difficult patient / family »

• Bouchard-Taylor Commission

Reasonable Accommodation

• Judicial term used in Canadian

multiculturalism politics

• Notion of equality and prohibition of

discrimination

• Obligation to come to an agreement to end

racial discrimination

Personalization of Care

• Recognition of a person and family’s

uniqueness

• Foster autonomy, dignity, confidence, and

satisfaction with care

• Permits care to be adapted for

ethnocultural community members who

could be members of our vulnerable and

at risk populations

Personalization of Care con’t

DOES NOT MEAN to give in to all of the

family’s demands

BUT RATHER

To open a dialogue to reflect and to

exchange thoughts to find satisfactory

solutions for the people involved

Integration of Personalized Care

• Recognize others might have a different

understanding of health, illness, and death

• Facilitate a discussion on the family’s values,

beliefs, and rituals

• Explore how cultural and religious practices

could be integrated or adapted to the constraints

of the unit / institution

• Incorporate the information / decisions in to the

care plan

• Involve family members in the search for

solutions

Established Boundaries

• Deontology – Standards of practice

• Security, hygiene, infection control

• Undue costs (financial and human resources)

• Requests cannot infringe on the right and

liberties of other people

Expert Panel

on Global Nursing & Health

Promotion of Transcultural Nursing

A 2010 Task Force that developed a set of

standards for cultural competence.

One of the standards focuses on the

importance of cultural knowledge and the

need to create resources for nurses

containing specific information on commonly

cared for ethnocultural communities

Leininger’s Theory of

Culture Care Diversity and Universality

• Based in anthropology and nursing

• Prepares nurses to provide culturally

congruent care by safeguarding cultural

values, accommodating beliefs, and

restructuring cultural viewpoints so that

care becomes relevant within a family’s

frame of reference

• Fosters a therapeutic nurse-family

relationship

A Family Cultural Assessment

• Want to facilitate the creation of meaning and

context for patients and families throughout the

OTD experience

• Information gathered from the cultural

assessment is used to identify a family’s unique

needs that may impact the OTD process and to

develop tailored interventions that reflect

culturally congruent care

• Assessment is on-going

• Based on Leininger's Sunrise Enabler Model

Sunrise Enabler Model

Composed of seven factors:

• Kinship & Social

– Family composition

– Description of cultural background

– Decision-making structure

– Spoken languages

– Family end of life rituals

• Religious & Philosophical

– Family views and / or cultural influences on spiritual

beliefs, religious affiliations, and death

Sunrise Enabler Model (con’t)

• Technological

– The machines and equipment used in the care of the

potential donor

– Family computer literacy (find information,

communicate with family and friends)

• Cultural Values, Beliefs, & Lifeways

– Knowledge of OTD

– Perception of medical professionals

– Health and illness practices

Sunrise Enabler Model (con’t)

• Political & Legal

– Political and social affiliations / beliefs

– Perception of legal documents

– Immigration status

• Economic (socioeconomic status)

– Financial resources

– Family support

– Community support

– Work place support

• Educational

– Level of completed education

Case Study

Maria is a 24 year old Brazilian-Canadian

who was celebrating her university

graduation with friends and Canadian

boyfriend of three years.

She was hit by a car while crossing the road

and suffered a non-survivable TBI.

Her GCS is 5T.

Case Study

• The family immigrated to Quebec when

the father accepted a promotion

• Maria and her three siblings were less

than ten years of age at the time of the

move

• Mom does not work outside the home

• Maria is the eldest and lives at home with

her family

• Practicing Catholic

Case Study

• Maria’s condition continues to deteriorate.

Thirty-six hours post-accident she meets

the criteria for neurological death.

• You notice the back of her Medicare card

is signed, providing consent for organ and

tissue donation

• The parents agree to meet with the nurse

clinician for OTD to explore this end of life

option

Interventions

• Based on gathered patient and family

information

• The information is categorized per type of

culture care

• The results create an individualized plan of

care to promote culturally congruent

nursing care

Type of Culture Care

• Integration: Actions and decisions to retain,

preserve or maintain beneficial care beliefs and

values

• Accommodation / Negotiation: Creative actions

and decisions that help families adapt to or

negotiate with others for culturally congruent,

safe and effective care

• Restructuring Cultural Viewpoints: Collaborative

actions and decisions to help families and / or

institutions change, modify or restructure their

habits for beneficial health care practices

Take Home Messages • Learn how to facilitate a dialogue with a diversified

clientele to gather information on the values, beliefs,

and lived experiences

• The majority of cultures and religions support

donation. This option MUST be offered to the family

of eligible potential donors.

• Breaking down barriers means families are offered

the opportunity to make a decision that best reflects

the deceased’s values and beliefs, as well as their

own

• Many families feel donation brings meaning to the

death of a loved one

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