Slide 1

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

Slide 2

Question to Run on: How comfortable are you with your knowledge of cultures and religions and how does that impact your care? Spring2011Hospital-MCT_HAguiar2

Slide 3

Cultural Assumption Spring2011Hospital-MCT_HAguiar3

Slide 4

New Perspective Spring2011Hospital-MCT_HAguiar4

Slide 5

Objectives By the end of this presentation the learner will: 1.Understand the definitions of culture, race, and ethnicity 2.Recognize nursing theory supporting cultural competence 3.Recognize the risk of cultural assumption and imposition 4.Be empowered to draw upon their professional strengths 5.Be equipped with practical tips to become culturally skilled Spring2011Hospital-MCT_HAguiar5

Slide 6

Overview Spring2011Hospital-MCT_HAguiar6 Laying Foundations Need for Multicultural Skills Culturally Sensitive End-of-Life Care Basic Principles

Slide 7

Laying Foundations Operational Definitions of Culture, Ethnicity, and Race and the Differences Between These Terms Spring2011Hospital-MCT_HAguiar7

Slide 8

Laying Foundations Defining Culture Spring2011Hospital-MCT_HAguiar8 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)

Slide 9

Laying Foundations Defining Ethnicity Spring2011Hospital-MCT_HAguiar9 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)

Slide 10

Laying Foundations Defining Race Spring2011Hospital-MCT_HAguiar10 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

Slide 11

Laying Foundations Spring2011Hospital-MCT_HAguiar11 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

Slide 12

Laying Foundations Spring2011Hospital-MCT_HAguiar12 Important Clarifications: There are no distinct, pure races today Religion is very much entwined with ethnicity, shaper of health values, beliefs, and practices

Slide 13

Thought Question Spring2011Hospital-MCT_HAguiar13 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?

Slide 14

Need for Multicultural Skills Nursing Theory & Regulatory Standards Requiring Multicultural Skills Spring2011Hospital-MCT_HAguiar14

Slide 15

Hospital-MCT_HAguiar15 Need for Multicultural Skills Leininger says that nurses are realizing the critical need to become more culturally competent and knowledgeable in working with individuals of diverse cultures. (Leininger, 1994) Spring2011

Slide 16

Need for Multicultural Skills Spring2011Hospital-MCT_HAguiar16 Cultural competence is a journey, not a destination. (Galanti, 2008)

Slide 17

Culturally Sensitive End-of-Life Care Cultural Assumptions & Imposition, Cultural Beliefs about EOL & Donation & Cross-Cultural Communication Spring2011Hospital-MCT_HAguiar17

Slide 18

Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar18 Culture Assessed by Observation: Dress Appearance Speech Education

Slide 19

Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar19 Practices in EOL & attitudes about donation Preconceived ideas about cultures African American Filipino Hispanic Asian Religious background Jewish Jehovah Witness Hindu Bias vs.. reality

Slide 20

Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar20 Unspoken assumptions regarding meaning of health, illness, and death may affect communication regarding donation. Dr. Hawryluck & Knickle (n.d.)

Slide 21

Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar21 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 ones own cultural values, a risk exist for the nurse to engage in cultural imposition. (Campinha-Bacote et al 1996)

Slide 22

Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar22 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?

Slide 23

Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar23 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?

Slide 24

Cross-Cultural Communication Skills Culture & communication connected Communication driven by culture Connection forgotten = risk for misunderstanding Spring2011Hospital-MCT_HAguiar24

Slide 25

Cross-Cultural Communication Skills Spring2011Hospital-MCT_HAguiar25 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

Slide 26

Cross-Cultural Communication Skills Spring2011Hospital-MCT_HAguiar26 Understand your motives Concerns for the family Concerns for the recipient Turning a negative situation around to be positive

Slide 27

Cross-Cultural Communication Skills Spring2011Hospital-MCT_HAguiar27 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

Slide 28

Cross-Cultural Communication Skills Spring2011Hospital-MCT_HAguiar28 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

Slide 29

Basic Principles Practical Tips for Working with Various Cultures Spring2011Hospital-MCT_HAguiar29

Slide 30

Basic Principles Spring2011Hospital-MCT_HAguiar30 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?

Slide 31

Basic Principles Spring2011Hospital-MCT_HAguiar31 Cultural-Communication Tips Learn and use a few phrases of greeting and introduction in the patients 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.

Slide 32

Basic Principles Spring2011Hospital-MCT_HAguiar32 Do not assume you know the culture Seek to understand Dont 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.

Slide 33

Question to Run on: How comfortable are you with your knowledge of cultures and religions and how does that impact your care? Spring2011Hospital-MCT_HAguiar 33

Slide 34

Questions ? Thank you for your attention!