10/3/2017 CULTURAL AND SPIRITUAL CONSIDERATIONS IN END- OF-LIFE CARE CONSIDERATIONS IN END-OF-LIFE CARE

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1 CULTURAL AND SPIRITUAL CONSIDERATIONS IN END- OF-LIFE CARE CONSIDERATIONS IN END-OF-LIFE CARE Judy Fihn, BSN, CHPN, OCN Think back on your encounters with a patient of a different culture What has surprised you? What is a lesson that you have learned? What is the most burning question you bring to this lecture? Every person is like all others, like some others, and like no others. -Proverb Culture Defined The combination of a body of knowledge, a body of belief, and a body of behavior (U.S. DHHS) Provides security, integrity, belonging System of shared symbols Constantly evolving Helps make meaning of illness Not limited to race or ethnicity Influences response to illness Elements of Culture Gender Age Language Customs Place of residency Education level Employment Differing abilities Values Financial status Thoughts and Beliefs Personal identification Communication Religion Sexual Orientation Cultural components specific to end of life related to health beliefs 1

2 Beliefs relating to: Case Study Discussion Part 1 Delivery of bad news Challenges to Interpreters Truth telling Pain Advanced Directives Decision making Use of life sustaining treatment Traditional therapies Place of Death Care of the body Expressions of grief Now what? Cultural Competence Cultural Assessment Numerous tools available Cultural attributes Variation within groups Individuals hold varying degrees of adherence to traditional customs within the same community & family Know Thyself Self assessment Cultural beliefs of co-workers Work culture Kagawa-Singer et al.,

3 Components of Cultural Assessment Components of Cultural Assessment (cont.) Patient, family, community Birthplace Ethnic identity Community Decision-making Language and communication Religion/spirituality Food preferences, prohibitions Economic situation Health beliefs regarding: Death Grief Pain Traditional therapies Care of the body Organ donation Cultural Disparities in End-of-Life Care Access/utilization to hospice services Access to medications for pain and symptom management Gender issues Impact on families with chronic illness Vulnerable Populations & Cultural Considerations Minorities Veterans Homeless Prisoners Immigrant & refugee populations Older adults Disabled Sexual orientation Components of Cultural Assessment CONFHER Model C= Communication O = Orientation N = Nutrition F = Family relations H = Health and Health beliefs E = Education R = Religion Cultural Considerations of Spirituality and Religion Spirituality Meaning-making Need for purpose, forgiveness, love, hope, relatedness, and religious faith Transcendence Religion Organized Institutional beliefs Taylor,

4 FICA: An Example of A Spiritual Assessment Spiritual Care Interventions F = Faith I = Importance, influence C = Community A = Address Providing presence Deep listening Bearing witness Putting compassion into action Puchalski, 2014 Baird, 2015 Cultural Considerations of Communication Conversation style Personal space Eye contact Touch View of healthcare professionals Learning styles Cultural Considerations of Communication (cont) Use of interpreters Avoid use of family members Use telephone translation services/or institution s professional interpreters Speak to patient/family, not to the interpreter Roles of an Interpreter Language Used at the End of Life Conduit: Clarifier: Culture Broker: Typical Triad Interpreter believes it is necessary to help all participants understand. Cultural differences are leading to a misunderstanding on the part of either the provider or patient. Discontinuation DNR Withdrawing/withholding Advanced directives Palliative Care Hospice 4

5 Role of the Family Who is considered family? Who are the caregivers? Who makes decisions? Who is included in discussions? Is full disclosure acceptable? Cultural Influences on Decision Making Beliefs about autonomy and other values differ Disclosure of diagnosis and prognosis How are decisions made in family, in culture? How Culture Influences Death Case Study Part 2 Culture affects: Views of death Social customs Relationships Decision-making When Cultures Clash Where to learn about cultures? Clashes occur Assess your reactions Never lie Offer information Use cultural guides 5

6 Conclusion Culture is a major influence on end-of-life care Many dimensions of culture Self-assessment of culture Culturally and spiritually sensitive care Interdisciplinary care Ending thoughts: We need to trust that our patients are the experts on their lives, culture, and experiences, and if we ask with respect and genuine desire to learn from them, they will tell us how to care for them. Approach all interactions with patients and families as a cross-cultural experience. Patsy Treece, RN, MN What will you take back to your practice? 33 6