Moderator:• Sherri Lamon, RN, Western Medical Center Santa AnaPresenters:• 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

Cultural & Religious Considerations in End-of-Life Care & the Donation Decision

Katy Hyman MDiv, BCCSenior Chaplain

Long Beach Memorial Medical Center

Hedi Aguiar RN, CCRN, MSNHospital 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?

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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

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What builds

TRUST?• Communication

• Attitude

Cross-Cultural Communication Skills

• Culture & communication

connected

• Communication –

driven by culture

• Connection forgotten =

risk for misunderstanding

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Laying Foundations

Operational Definitions of

Culture, Ethnicity, and Race and

the Differences Between These Terms

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Laying Foundations – Defining Culture

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“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)

Laying Foundations – Defining Ethnicity

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“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)

Laying Foundations – Defining Race

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“…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

Laying Foundations

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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

Laying Foundations

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Important Clarifications:

─ There are no distinct,

pure races today

─ Religion is very much

entwined with ethnicity,

shaper of health values,

beliefs, and practices

Culturally Sensitive End-of-Life Care

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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)

Cultural & Religious Considerations

Application of

Cultural and Religious Considerations

in End-of-Life Care & the Donation Decision

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Culturally Sensitive End-of-Life Care

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Culture Assessed by Observation:

• Dress

• Appearance

• Speech

• Education

Culturally Sensitive End-of-Life Care

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“Unspoken assumptions regarding

meaning of health, illness, and

death may affect communication

regarding donation.”

Dr. Hawryluck & Knickle (n.d.)

• Effective communication is your responsibility

• Anxiety

• Stereotypes and prejudice

• Language problems

• 6 barriers to communication:

• Nonverbals

• Ethnocentrism

• Assuming similarities vs.

differences

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Cross-Cultural Communication Skills

Culturally Sensitive End-of-Life Care

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• Generalization vs. Stereotyping

• Arthur Kleinman’s Explanatory model

• Unbiased approach to an individual

• Application of Kleinman’s model

Culturally Sensitive End-of-Life Care

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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?

Culturally Sensitive End-of-Life Care

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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?

Culturally Sensitive End-of-Life Care

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Kleinman’s 3 recommendations:

1. Get rid of the term ‘compliance’

2. Model of mediation, not coercion → NEGOTIATE

3. Know your own culture

Culturally Sensitive End-of-Life Care

Simple triggers - the 4 Cs:

1. Call

2. Cause

3. Cope

4. Concerns

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Cross-Cultural Communication Skills

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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

Basic Principles

Practical Tips for Working with

Various Cultures

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Basic Principles

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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?

Basic Principles

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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….”

Basic Principles

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• 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.

Question to Run on:

How comfortable are you with your knowledge of

cultures and religions and how does that impact

your care?

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Need for Multicultural Skills

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“Cultural competence is

a journey,

not a destination.”(Galanti, 2008)

Questions ?

Thank you for your attention!