Breakout Session C:
Cultural & Religious Considerations in
End-of-Life Care and the Donation Decision
Moderator:
• Sherri Lamon, RN, Western Medical Center Santa Ana
Presenters:
• Hedi Aguiar, RN, OneLegacy
• Katy Hyman, BCC, Long Beach Memorial Medical Center
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
Question to Run on:
How comfortable are you with your knowledge of
cultures and religions and
how does that impact your care?
Spring2011
Hospital-MCT_HAguiar
3
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
Spring2011
Hospital-MCT_HAguiar
4
Spring2011
Hospital-MCT_HAguiar
5
Cross-Cultural Communication Skills
• Culture & communication
connected
• Communication –
driven by culture
• Connection forgotten =
risk for misunderstanding
Spring2011
Hospital-MCT_HAguiar
6
Laying Foundations
Operational Definitions of
Culture, Ethnicity, and Race and
the Differences Between These Terms
Spring2011
Hospital-MCT_HAguiar
7
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)
Spring2011
Hospital-MCT_HAguiar
8
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)
Spring2011
Hospital-MCT_HAguiar
9
Laying Foundations – Defining Race
“…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
Spring2011
Hospital-MCT_HAguiar
10
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
Spring2011
Hospital-MCT_HAguiar
11
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
Spring2011
Hospital-MCT_HAguiar
12
Culturally Sensitive End-of-Life Care
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)
Spring2011
Hospital-MCT_HAguiar
13
Cultural & Religious Considerations
Application of
Cultural and Religious Considerations
in End-of-Life Care & the Donation Decision
Spring2011
Hospital-MCT_HAguiar
14
Culturally Sensitive End-of-Life Care
Culture Assessed by Observation:
• Dress
• Appearance
• Speech
• Education
Spring2011
Hospital-MCT_HAguiar
15
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.)
Spring2011
Hospital-MCT_HAguiar
16
Cross-Cultural Communication Skills
• Effective communication is your responsibility
• 6 barriers to communication:
• Anxiety
• Nonverbals
• Stereotypes and prejudice
• Ethnocentrism
• Language problems
• Assuming similarities vs.
differences
Spring2011
Hospital-MCT_HAguiar
17
Culturally Sensitive End-of-Life Care
• Generalization vs. Stereotyping
• Arthur Kleinman’s Explanatory model
• Unbiased approach to an individual
• Application of Kleinman’s model
Spring2011
Hospital-MCT_HAguiar
18
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?
Spring2011
Hospital-MCT_HAguiar
19
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?
Spring2011
Hospital-MCT_HAguiar
20
Culturally Sensitive End-of-Life Care
Kleinman’s 3 recommendations:
1. Get rid of the term ‘compliance’
2. Model of mediation, not coercion → NEGOTIATE
3. Know your own culture
Spring2011
Hospital-MCT_HAguiar
21
Culturally Sensitive End-of-Life Care
Simple triggers - the 4 Cs:
Spring2011
1.
Call
2.
Cause
3.
Cope
4.
Concerns
Hospital-MCT_HAguiar
22
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
Spring2011
Hospital-MCT_HAguiar
23
Basic Principles
Practical Tips for Working with
Various Cultures
Spring2011
Hospital-MCT_HAguiar
24
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?
Spring2011
Hospital-MCT_HAguiar
25
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….”
Spring2011
Hospital-MCT_HAguiar
26
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.
Spring2011
Hospital-MCT_HAguiar
27
Question to Run on:
How comfortable are you with your knowledge of
cultures and religions and how does that impact
your care?
Spring2011
Hospital-MCT_HAguiar
28
Need for Multicultural Skills
“Cultural competence is
a journey,
not a destination.”
(Galanti, 2008)
Spring2011
Hospital-MCT_HAguiar
29
Thank you for your
attention!
Questions ?