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? Spring2011Hospital-MCT_HAguiar2

3. Cultural Assumption Spring2011Hospital-MCT_HAguiar3

4. New Perspective Spring2011Hospital-MCT_HAguiar4

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

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

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

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)

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)

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

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

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

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”?

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

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

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

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

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

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

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.)

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 one’s own cultural values, a risk exist for the nurse to engage in cultural imposition”. (Campinha-Bacote et al 1996)

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?

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?

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

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

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

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

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

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

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?

31. Basic Principles Spring2011Hospital-MCT_HAguiar31 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….”

32. Basic Principles Spring2011Hospital-MCT_HAguiar32 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.

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

34. Questions ? Thank you for your attention!