1. Moderator: Sherri Lamon, RN, Western Medical Center Santa Ana Presenters: Hedi Aguiar, RN, OneLegacy Katy Hyman, BCC, Long Beach Memorial Medical Center Breakout Session C: Cultural & Religious Considerations in End-of-Life Care and the Donation Decision

2. Cultural & Religious Considerations in End-of-Life Care & the Donation Decision Katy Hyman MDiv, BCC Senior Chaplain Long Beach Memorial Medical Center Hedi Aguiar RN, CCRN, MSN Hospital Communications Specialist OneLegacy

3. Question to Run on: How comfortable are you with your knowledge of cultures and religions and how does that impact your care? Spring2011Hospital-MCT_HAguiar3

4. Objectives By the end of this presentation the learner will: 1.Understand the definitions of culture, race, and ethnicity 2.Understand the cultural and religious considerations to be made when caring for a patient and their family at end-of-life and during the donation decision 3.Be equipped with practical tips to become culturally skilled Spring2011Hospital-MCT_HAguiar4

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6. Cross-Cultural Communication Skills Culture & communication connected Communication – driven by culture Connection forgotten = risk for misunderstanding Spring2011Hospital-MCT_HAguiar6

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 “…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. Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar13 Risk of Cultural Imposition “The (HCP) 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 exists for the (HCP) to engage in cultural imposition”. (Campinha-Bacote et al 1996)

14. Cultural & Religious Considerations Application of Cultural and Religious Considerations in End-of-Life Care & the Donation Decision Spring2011Hospital-MCT_HAguiar14

15. Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar15 Culture Assessed by Observation: Dress Appearance Speech Education

16. Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar16 “Unspoken assumptions regarding meaning of health, illness, and death may affect communication regarding donation.” Dr. Hawryluck & Knickle (n.d.)

17. Effective communication is your responsibility Anxiety Stereotypes and prejudice Language problems 6 barriers to communication: Nonverbals Ethnocentrism Assuming similarities vs. differences Spring2011Hospital-MCT_HAguiar17 Cross-Cultural Communication Skills

18. Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar18 Generalization vs. Stereotyping Arthur Kleinman’s Explanatory model Unbiased approach to an individual Application of Kleinman’s model

19. Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar19 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?

20. Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar20 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?

21. Culturally Sensitive End-of-Life Care Spring2011Hospital-MCT_HAguiar21 Kleinman’s 3 recommendations: 1.Get rid of the term ‘compliance’ 2.Model of mediation, not coercion → NEGOTIATE 3.Know your own culture

22. Culturally Sensitive End-of-Life Care Simple triggers - the 4 Cs: 1. C all 2. C ause 3. C ope 4. C oncerns Spring2011Hospital-MCT_HAguiar22

23. Cross-Cultural Communication Skills Spring2011Hospital-MCT_HAguiar23 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

24. Basic Principles Practical Tips for Working with Various Cultures Spring2011Hospital-MCT_HAguiar24

25. Basic Principles Spring2011Hospital-MCT_HAguiar25 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?

26. Basic Principles Spring2011Hospital-MCT_HAguiar26 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….”

27. Basic Principles Spring2011Hospital-MCT_HAguiar27 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.

28. 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 28

29. Need for Multicultural Skills Spring2011Hospital-MCT_HAguiar29 “Cultural competence is a journey, not a destination.” (Galanti, 2008)

30. Questions ? Thank you for your attention!