Cultural religious considerations in end of life care the donation decision
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Cultural religious considerations in end of life care the donation decision

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

FirstName LastName

Title

Organization


Question to run on

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

Cultural Assumption

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New perspective

New Perspective

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Objectives

Objectives

By the end of this presentation the learner will:

Understand the definitions of culture, race, and ethnicity

Recognize nursing theory supporting cultural competence

Recognize the risk of cultural assumption and imposition

Be empowered to draw upon their professional strengths

Be equipped with practical tips to become culturally skilled

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Overview

Overview

Laying Foundations

Need for Multicultural Skills

Culturally Sensitive End-of-Life Care

Basic Principles

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Laying foundations

Laying Foundations

Operational Definitions of

Culture, Ethnicity, and Race and

the Differences Between These Terms

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Laying foundations1

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

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

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

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 foundations2

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 foundations3

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

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

Need for Multicultural Skills

Nursing Theory

&

Regulatory Standards

Requiring Multicultural Skills

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Need for multicultural skills1

Need for Multicultural Skills

  • Nurse Theorist

  • PhD in Anthropology

  • Transcultural Nursing

  • Transcultural Nursing Society

  • Journal of Transcultural Nursing

  • Talks about culturally congruent care

Madeleine Leininger

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Need for multicultural skills2

Need for Multicultural Skills

Leininger says that nurses are realizing the critical need to become more culturally competent and knowledgeablein working with individuals

of diverse cultures.

(Leininger, 1994)

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Need for multicultural skills3

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 skills4

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 skills5

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 skills6

Need for Multicultural Skills

The Joint Commission definition of cultural competence (cont.):

  • Cultural competence requires organizations and their personnel to:

    • 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 skills7

Need for Multicultural Skills

“Cultural competence is a journey,

not a destination.”

(Galanti, 2008)

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Culturally sensitive end of life care

Culturally Sensitive End-of-Life Care

Cultural Assumptions & Imposition,

Cultural Beliefs about EOL & Donation &

Cross-Cultural Communication

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Play video

Play Video

YouTube - Seinfeld. Is he black?

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Culturally sensitive end of life care1

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 care2

Culturally Sensitive End-of-Life Care

Culture Assessed by Observation:

  • Dress

  • Appearance

  • Speech

  • Education

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Culturally sensitive end of life care3

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 care4

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

  • 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

Cambodia

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Culturally sensitive end of life care5

Culturally Sensitive End-of-Life Care

Native Americans

  • Values in Death & Dying

    • 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

  • 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

    • Depends on tribe – generally not supported but this is changing

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Culturally sensitive end of life care6

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

  • 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

Hmong

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Culturally sensitive end of life care7

Culturally Sensitive End-of-Life Care

  • Belief in Sickness

    • 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

Korean

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Culturally sensitive end of life care8

Culturally Sensitive End-of-Life Care

  • Belief in Sickness

    • 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 good-bye prior to the body being taken

  • Belief in Donation

    • The body is given high respect, cremation is not common practice, may not allow donation

Filipino

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Culturally sensitive end of life care9

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 care10

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 care11

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 care12

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 care13

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 care14

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 care15

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 care16

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 care17

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 care18

Culturally Sensitive End-of-Life Care

Simple triggers - the 4Cs:

  • Call

  • Cause

  • Cope

  • Concerns

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Cross cultural communication skills

Cross-Cultural Communication Skills

  • Culture & communication connected

  • Communication – driven by culture

  • Connection forgotten = risk for misunderstanding

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Cross cultural communication skills1

Cross-Cultural Communication Skills

Effective communication is your responsibility

6 barriers to communication:

Nonverbals

Ethnocentrism

Assuming similarities vs. differences

  • Anxiety

  • Stereotypes and prejudice

  • Language problems

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Cross cultural communication skills2

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 skills3

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 skills4

Understand your motives

Concerns for the family

Concerns for the recipient

Turning a negative situation around to be positive

Cross-Cultural Communication Skills

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Cross cultural communication skills5

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 skills6

Cross-Cultural Communication Skills

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

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Basic principles

Basic Principles

Practical Tips for Working with

Various Cultures

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Basic principles1

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 principles2

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 principles3

Basic Principles

Beware of hand gestures, some examples:

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Basic principles4

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 on1

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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Questions

Questions ?

Thank you for your attention!


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