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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: & the Donation Decision

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 & the Donation Decision

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New perspective
New Perspective & the Donation Decision

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Objectives
Objectives & the Donation Decision

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 & the Donation Decision

Laying Foundations

Need for Multicultural Skills

Culturally Sensitive End-of-Life Care

Basic Principles

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Laying foundations
Laying Foundations & the Donation Decision

Operational Definitions of

Culture, Ethnicity, and Race and

the Differences Between These Terms

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Laying foundations1
Laying Foundations & the Donation Decision

  • 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 & the Donation Decision

“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 & the Donation Decision

“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)

Hospital-MCT_HAguiar


Laying foundations defining race
Laying Foundations – Defining Race & the Donation Decision

“…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 & the Donation Decision

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 & the Donation Decision

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 & the Donation Decision

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 & the Donation Decision

Nursing Theory

&

Regulatory Standards

Requiring Multicultural Skills

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Need for multicultural skills1
Need for Multicultural Skills & the Donation Decision

  • 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 & the Donation Decision

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 & the Donation Decision

  • 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 & the Donation Decision

  • 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 Donation Decision

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 Donation Decision

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 & the Donation Decision

“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 & the Donation Decision

Cultural Assumptions & Imposition,

Cultural Beliefs about EOL & Donation &

Cross-Cultural Communication

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Play video
Play Video & the Donation Decision

YouTube - Seinfeld. Is he black?

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Culturally sensitive end of life care1
Culturally Sensitive End-of-Life Care & the Donation Decision

  • 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?

Hospital-MCT_HAguiar


Culturally sensitive end of life care2
Culturally Sensitive End-of-Life Care & the Donation Decision

Culture Assessed by Observation:

  • Dress

  • Appearance

  • Speech

  • Education

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Culturally sensitive end of life care3
Culturally Sensitive End-of-Life Care & the Donation Decision

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 & the Donation Decision

  • 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 & the Donation Decision

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 & the Donation Decision

  • 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 & the Donation Decision

  • 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 & the Donation Decision

  • 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 & the Donation Decision

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 & the Donation DecisionCare

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 & the Donation Decision

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 & the Donation Decision

“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 & the Donation Decision

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 & the Donation Decision

  • 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 & the Donation Decision

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 & the Donation Decision

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 & the Donation Decision

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 & the Donation Decision

Simple triggers - the 4Cs:

  • Call

  • Cause

  • Cope

  • Concerns

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Cross cultural communication skills
Cross-Cultural Communication Skills & the Donation Decision

  • Culture & communication connected

  • Communication – driven by culture

  • Connection forgotten = risk for misunderstanding

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Cross cultural communication skills1
Cross-Cultural Communication Skills & the Donation Decision

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 & the Donation Decision

  • 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 & the Donation Decision

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 & the Donation Decision

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 & the Donation Decision

  • 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 & the Donation Decision

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 & the Donation Decision

Practical Tips for Working with

Various Cultures

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Basic principles1
Basic Principles & the Donation Decision

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 & the Donation Decision

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 & the Donation Decision

Beware of hand gestures, some examples:

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Basic principles4
Basic Principles & the Donation Decision

  • 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: & the Donation Decision

How comfortable are you with your knowledge of cultures and religions and how does that impact your care?

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Questions

Questions & the Donation Decision?

Thank you for your attention!


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