Culturally Sensitive Palliative Care Part II: Team Approach

Amy Wilson, RN, BSN, CHPN

Marquette General Home Health and Hospice

Escanaba, MI

• Geriatric Education Center of Michigan

activities are supported by a grant from the

U.S. Department of Health and Human

Services, Health Resources and Services

Administration, Public Health Service Act,

Title VII, Section 753(a).

Learning Objectives

• Identify cultural sensitivities that may exist in selected cultures (American Indian, African American, Hispanic, Asian, Middle Eastern)

• Develop effective communication techniques to utilize in the discussion of palliative care with older adults and their caregivers.

• Describe effective strategies used by interdisciplinary teams to develop mutually agreed-upon, culturally sensitive care plans.

Culturally Sensitive Palliative Care is…

The care of a person who is living with a

progressive, far-advanced disease for whom

the focus of care is comfort and sustained

quality of life …

Palliative Care

Person-oriented – not disease oriented

Not primarily concerned with life prolongation (nor with life shortening)

Not primarily concerned with producing long-term disease remission

Holistic in approach and aims to address all the client’s problems, both physical and psychosocial

Palliative Care

Multidisciplinary/interprofessional in its approach to cover all aspects of care

Dedicated to the quality of whatever life remains for a person

Not limited to just people living with cancer

Culturally Sensitive Palliative Care includes an awareness of a person’s culture …

The customary beliefs, social forms, and material traits of a racial, religious or social group

The characteristics of everyday existence (a way of life) shared by people in a place or time

Culturally Sensitive Palliative Care realizes that culture is …

Influenced by technology & resources

Generally unexpressed and rarely discussed at a conscious level

Influenced by the role changes of women

Handed down from one generation to another within their value/beliefs systems

Culturally Sensitive Palliative Care realizes that culture is …

Learned from birth through language and socialization

Dynamic and always in a state of change

Adopts in an ongoing way to the environment, social and historical context

• Culture, spirituality and health are inextricably intertwined

• Culture, spirituality and health are not separate components

Culturally Sensitive Palliative Care is also mindful that, for a person’s well-being, …

***Special Note: All people of particular culture do not agree to a

common cultural pattern of responses.

Cultures do change over time.

Culturally Sensitive Palliative Care is also mindful that, for a person’s well-being, (cont.) …

Patient Rights and Responsibilities

Relational Care

Patient rights encompass legal and ethical issues in the

provider-patient relationship, including the patient's right to

privacy, the right to quality medical care without prejudice,

the right to make informed decisions about care and

treatment options, and the right to refuse treatment.

Effective Communication Strategies …

Communicate and watch for:

A person’s personal preference: cultural, spiritual, religious

Body language and other non-verbal communication

Assumptions about those you serve – ask ‘them’ about their culture/traditions

Effective Communication Strategies …

Be Attentive:

Avoid cultural ignorance and hurtful actions

Provide culturally appropriate health promotion materials

Understand the ‘kinship’ web, including family members and extended members in the circle of care

Cultural Sensitivity ~American Indian~

Be attentive to concepts of personal insight, individual awareness, and self-actualization

Family and community is of great importance in healing and illness prevention

Understand the communal effect of traumatic experiences

Cultural Sensitivity ~American Indian~

Understand and respect tribal practices and health belief systems

[prayer, chanting, music, smudging, herbalism, laying on of hands, counseling, and rituals, ceremonies]

Be sensitive to the use of direct eye contact

Touch may be prohibited unless there is an established trust

Cultural Sensitivity ~American Indian~

Speak in a quiet tone of voice

Collaborate with traditional healing practices in the Plan of Care

Listen and respond appropriately to the community members

Cultural Sensitivity ~American Indian~

Move at ‘their’ pace

Seek empowerment of the patient so that he/she is self-reliant

Pay close attention to body language and other nonverbal communication

Avoid assumptions about patients and ask about his/her beliefs

Provide culturally appropriate health promotional materials

Coordinate care with ‘traditional’ healers within the kinship of relationships

Cultural Sensitivity ~American Indian~

Cultural Sensitivity ~Hispanic~

Hispanics initially seek traditional healers

Physician skill is viewed as God’s power

Culture views health and disease from a holistic perspective

Religion has a major influence on the health beliefs and practices

Curanderos (older community women) serve as health practitioners as well as health information-providers

Cultural Sensitivity ~Asian~

Culture is patrilineal and the community is valued over the individual

Family includes both living and dead relatives

Belief in ancestral communication through natural/ animal medians

Views life from a holistic approach

Group harmony, support and well-being is highly valued in community [interdependence and in perfect order]

Young seek mentor/elder who protects and guides them away from misfortune or erroneous ways

Respect those in authority [i.e., Healthcare Providers]

Cultural Sensitivity ~Asian~

Privacy is valued and disclosure of personal information is resisted

Nonverbal cues are more common that overt verbal exchange

Predestination is core in their belief system, such as events are already pre-recorded

Family is patriarchal, hierarchical and traditional

Cultural Sensitivity ~Middle Eastern~

Appraise Individual/Personal Knowledge

As Health Care Professionals:

Be aware of and accepting of cultural differences

Have self-awareness of own culture/traditions

Seek to learn and to understand another’s culture

Provide holisitic care to the whole UNIT OF CARE [physical, emotional, mental, spiritual, social]

My knowledge and attitude will impact my approach to culturally sensitive care …

References & Resources

• Alzheimer’s Association (2007). Alzheimer’s Association Campaign for Quality Residential Care: Dementia care practice recommendations for assisted living residence and nursing homes. Phase 3 end-of-life care. Retrieved from https://insite.alz.org/downloads/programs/professional-training/dementia/care/practice/recommendations-phase-3.pdf

• Barnato, A.E., Anthony, D.L. Skinner, J. & Fisher, E.S. (2009) Racial and ethnic

differences in preferences for end-of-life treatment, Journal of General Internal Medicine, 24, 695-701.

• Betancourt, J.R. (2006). Cultural competence and medical education: Many

names, many perspectives, one goal. Academic Medicine, 81, 499-501. • Bullock, K. (2011). The influence of culture on end-of-life decision making. Journal

of Social Work in End-Of-Life & Palliative Care., 7:1, 83-98.

• Ming-Chen, M.L. (2010) Cultural brokerage: Creating linkages between voices of life, world and medicine in cross-cultural clinical settings. Health, 14, 484-504.

• Mjelde-Mossey, L.A. & Chan, C. (2007). Survey on death and dying in Hong

Kong. Social Work in Health Care, 45:1, 49-65.

• Perloff, R.M. Bonder, B., Ray, E.B. & Siminoff, L.A., (2006), Doctor-patient communication, cultural competence, and minority health: Theoretical and empirical perspectives. American Behavioral Scientist, 49, 855-852.

• Thomas, R., Wilson, D.M., Justice C. Birch & S., Sheps, S. (2008). A

literature review of preferences for end-of-life care in developed countries by individuals with different cultural affiliations and ethnicities. Journey of Hospice and Palliative Nursing, 10, 142-161.

References & Resources

World Health Organization. (2011). Palliative care for older people. Better practices. Retrieved from http://www.euro.who.int/_data/assets/pdf_file/0017/143153/e95052.pdf

Mancuso, L. (2009) Providing culturally sensitive palliative care. Nursing, 39(5),

50-53. International Association for Hospice & Palliative Care (IAHPC). (n.d.). Manual of

palliative care (2nd ed.). Retrieved from http://www.hospicecare.com/manual/principles-main.html.

National Hospice & Palliative Care Organization. (2010). Private conversations and

public discourse: The importance in consumer engagement in end-of-life care. Caring Connections. Retrieved from http://www.caringinfo.org/files/public/Private Conversations_and_PublicDiscourse.pdf

References & Resources

National Hospice & Palliative Care Organization http:www.nhpco.org/templates/1/homepage.cfm

Michigan Hospice & Palliative Care Organization. http://www.mihospice.org

Stanford University. (2001). Curriculum in ethnogeriatrics. Retrieved from http://www.stanford.edu/group/ethnoger/

References & Resources