Culturally Sensitive Palliative Care Part II: Team Approach Amy Wilson, RN, BSN, CHPN Marquette General Home Health and Hospice Escanaba, MI
Geriatric Education Center of Michigan activities are supported by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Public Health Service Act, Title VII, Section 753(a).
Learning Objectives Identify cultural sensitivities that may exist in selected cultures (American Indian, African American, Hispanic, Asian, Middle Eastern) Develop effective communication techniques to utilize in the discussion of palliative care with older adults and their caregivers. Describe effective strategies used by interdisciplinary teams to develop mutually agreedupon, culturally sensitive care plans.
Culturally Sensitive Palliative Care is The care of a person who is living with a progressive, far-advanced disease for whom the focus of care is comfort and sustained quality of life
Palliative Care Person-oriented not disease oriented Not primarily concerned with life prolongation (nor with life shortening) Not primarily concerned with producing long-term disease remission Holistic in approach and aims to address all the client s problems, both physical and psychosocial
Palliative Care Multidisciplinary/interprofessional in its approach to cover all aspects of care Dedicated to the quality of whatever life remains for a person Not limited to just people living with cancer
Culturally Sensitive Palliative Care includes an awareness of a person s culture The customary beliefs, social forms, and material traits of a racial, religious or social group The characteristics of everyday existence (a way of life) shared by people in a place or time
Culturally Sensitive Palliative Care realizes that culture is Influenced by technology & resources Generally unexpressed and rarely discussed at a conscious level Influenced by the role changes of women Handed down from one generation to another within their value/beliefs systems
Culturally Sensitive Palliative Care realizes that culture is Learned from birth through language and socialization Dynamic and always in a state of change Adopts in an ongoing way to the environment, social and historical context
Culturally Sensitive Palliative Care is also mindful that, for a person s well-being, Culture, spirituality and health are inextricably intertwined Culture, spirituality and health are not separate components
Culturally Sensitive Palliative Care is also mindful that, for a person s well-being, (cont.) ***Special Note: All people of particular culture do not agree to a common cultural pattern of responses. Cultures do change over time.
Patient Rights and Responsibilities Relational Care Patient rights encompass legal and ethical issues in the provider-patient relationship, including the patient's right to privacy, the right to quality medical care without prejudice, the right to make informed decisions about care and treatment options, and the right to refuse treatment.
Effective Communication Strategies Communicate and watch for: A person s personal preference: cultural, spiritual, religious Body language and other non-verbal communication Assumptions about those you serve ask them about their culture/traditions
Effective Communication Strategies Be Attentive: Avoid cultural ignorance and hurtful actions Provide culturally appropriate health promotion materials Understand the kinship web, including family members and extended members in the circle of care
Cultural Sensitivity ~American Indian~ Be attentive to concepts of personal insight, individual awareness, and self-actualization Family and community is of great importance in healing and illness prevention Understand the communal effect of traumatic experiences
Cultural Sensitivity ~American Indian~ Understand and respect tribal practices and health belief systems [prayer, chanting, music, smudging, herbalism, laying on of hands, counseling, and rituals, ceremonies] Be sensitive to the use of direct eye contact Touch may be prohibited unless there is an established trust
Cultural Sensitivity ~American Indian~ Speak in a quiet tone of voice Collaborate with traditional healing practices in the Plan of Care Listen and respond appropriately to the community members
Move at their pace Cultural Sensitivity ~American Indian~ Seek empowerment of the patient so that he/she is self-reliant
Cultural Sensitivity ~American Indian~ Pay close attention to body language and other nonverbal communication Avoid assumptions about patients and ask about his/her beliefs Provide culturally appropriate health promotional materials Coordinate care with traditional healers within the kinship of relationships
Cultural Sensitivity ~Hispanic~ Hispanics initially seek traditional healers Physician skill is viewed as God s power Culture views health and disease from a holistic perspective Religion has a major influence on the health beliefs and practices Curanderos (older community women) serve as health practitioners as well as health informationproviders
Cultural Sensitivity ~Asian~ Culture is patrilineal and the community is valued over the individual Family includes both living and dead relatives Belief in ancestral communication through natural/ animal medians Views life from a holistic approach
Cultural Sensitivity ~Asian~ Group harmony, support and well-being is highly valued in community [interdependence and in perfect order] Young seek mentor/elder who protects and guides them away from misfortune or erroneous ways Respect those in authority [i.e., Healthcare Providers]
Cultural Sensitivity ~Middle Eastern~ Privacy is valued and disclosure of personal information is resisted Nonverbal cues are more common that overt verbal exchange Predestination is core in their belief system, such as events are already pre-recorded Family is patriarchal, hierarchical and traditional
Appraise Individual/Personal Knowledge As Health Care Professionals: Be aware of and accepting of cultural differences Have self-awareness of own culture/traditions Seek to learn and to understand another s culture Provide holisitic care to the whole UNIT OF CARE [physical, emotional, mental, spiritual, social]
My knowledge and attitude will impact my approach to culturally sensitive care
References & Resources Alzheimer s Association (2007). Alzheimer s Association Campaign for Quality Residential Care: Dementia care practice recommendations for assisted living residence and nursing homes. Phase 3 end-of-life care. Retrieved from https://insite.alz.org/downloads/programs/professionaltraining/dementia/care/practice/recommendations-phase-3.pdf Barnato, A.E., Anthony, D.L. Skinner, J. & Fisher, E.S. (2009) Racial and ethnic differences in preferences for end-of-life treatment, Journal of General Internal Medicine, 24, 695-701. Betancourt, J.R. (2006). Cultural competence and medical education: Many names, many perspectives, one goal. Academic Medicine, 81, 499-501. Bullock, K. (2011). The influence of culture on end-of-life decision making. Journal of Social Work in End-Of-Life & Palliative Care., 7:1, 83-98.
References & Resources Ming-Chen, M.L. (2010) Cultural brokerage: Creating linkages between voices of life, world and medicine in cross-cultural clinical settings. Health, 14, 484-504. Mjelde-Mossey, L.A. & Chan, C. (2007). Survey on death and dying in Hong Kong. Social Work in Health Care, 45:1, 49-65. Perloff, R.M. Bonder, B., Ray, E.B. & Siminoff, L.A., (2006), Doctor-patient communication, cultural competence, and minority health: Theoretical and empirical perspectives. American Behavioral Scientist, 49, 855-852. Thomas, R., Wilson, D.M., Justice C. Birch & S., Sheps, S. (2008). A literature review of preferences for end-of-life care in developed countries by individuals with different cultural affiliations and ethnicities. Journey of Hospice and Palliative Nursing, 10, 142-161.
References & Resources World Health Organization. (2011). Palliative care for older people. Better practices. Retrieved from http://www.euro.who.int/_data/assets/pdf_file/0017/143153/e95052.pdf Mancuso, L. (2009) Providing culturally sensitive palliative care. Nursing, 39(5), 50-53. International Association for Hospice & Palliative Care (IAHPC). (n.d.). Manual of palliative care (2 nd ed.). Retrieved from http://www.hospicecare.com/manual/principles-main.html. National Hospice & Palliative Care Organization. (2010). Private conversations and public discourse: The importance in consumer engagement in end-of-life care. Caring Connections. Retrieved from http://www.caringinfo.org/files/public/private Conversations_and_PublicDiscourse.pdf
References & Resources National Hospice & Palliative Care Organization http:www.nhpco.org/templates/1/homepage.cfm Michigan Hospice & Palliative Care Organization. http://www.mihospice.org Stanford University. (2001). Curriculum in ethnogeriatrics. Retrieved from http://www.stanford.edu/group/ethnoger/