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

1. Cultural & Religious Considerations in End-of-Life Care & the Donation Decision FirstName LastName Title Organization

2. Question to Run on: How comfortable are you with your knowledge of cultures and religions and how does that impact your care? Hospital-MCT_HAguiar

3. Cultural Assumption Hospital-MCT_HAguiar

4. New Perspective Hospital-MCT_HAguiar

5. 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 Hospital-MCT_HAguiar

6. Overview Laying Foundations Need for Multicultural Skills Culturally Sensitive End-of-Life Care Basic Principles Hospital-MCT_HAguiar

7. Laying Foundations Operational Definitions of Culture, Ethnicity, and Race and the Differences Between These Terms Hospital-MCT_HAguiar

8. 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) Hospital-MCT_HAguiar

9. 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) Hospital-MCT_HAguiar

10. 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 Hospital-MCT_HAguiar

11. 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 Hospital-MCT_HAguiar

12. 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 Hospital-MCT_HAguiar

13. 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”? Hospital-MCT_HAguiar

14. Need for Multicultural Skills Nursing Theory & Regulatory Standards Requiring Multicultural Skills Hospital-MCT_HAguiar

15. 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) Hospital-MCT_HAguiar

16. Need for Multicultural Skills “Cultural competence is a journey, not a destination.” (Galanti, 2008) Hospital-MCT_HAguiar

17. Culturally Sensitive End-of-Life Care Cultural Assumptions & Imposition, Cultural Beliefs about EOL & Donation & Cross-Cultural Communication Hospital-MCT_HAguiar

18. Culturally Sensitive End-of-Life Care Culture Assessed by Observation: • Dress • Appearance • Speech • Education Hospital-MCT_HAguiar

19. 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 Hospital-MCT_HAguiar

20. 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.) Hospital-MCT_HAguiar

21. 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) Hospital-MCT_HAguiar

22. 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? Hospital-MCT_HAguiar

23. 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? Hospital-MCT_HAguiar

24. Cross-Cultural Communication Skills • Culture & communication connected • Communication – driven by culture • Connection forgotten = risk for misunderstanding Hospital-MCT_HAguiar

25. 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 Hospital-MCT_HAguiar

26. Understand your motives Concerns for the family Concerns for the recipient Turning a negative situation around to be positive Cross-Cultural Communication Skills Hospital-MCT_HAguiar

27. 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 Hospital-MCT_HAguiar

28. 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 Hospital-MCT_HAguiar

29. Basic Principles Practical Tips for Working with Various Cultures Hospital-MCT_HAguiar

30. 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? Hospital-MCT_HAguiar

31. 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….” Hospital-MCT_HAguiar

32. 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. Hospital-MCT_HAguiar

33. Question to Run on: How comfortable are you with your knowledge of cultures and religions and how does that impact your care? Hospital-MCT_HAguiar

34. Questions ? Thank you for your attention!