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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.
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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? Hospital-MCT_HAguiar
Objectives By the end of this presentation the learner will: Understand the definitions of culture, race, and ethnicity 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 Be equipped with practical tips to become culturally skilled Hospital-MCT_HAguiar
What builds TRUST? • Communication • Attitude Hospital-MCT_HAguiar
Cross-Cultural Communication Skills • Culture & communication connected • Communication – driven by culture • Connection forgotten = risk for misunderstanding Hospital-MCT_HAguiar
Laying Foundations Operational Definitions of Culture, Ethnicity, and Race and the Differences Between These Terms Hospital-MCT_HAguiar
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) Hospital-MCT_HAguiar
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) Hospital-MCT_HAguiar
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 Hospital-MCT_HAguiar
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 Hospital-MCT_HAguiar
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 Hospital-MCT_HAguiar
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) Hospital-MCT_HAguiar
Cultural & Religious Considerations Application of Cultural and Religious Considerations in End-of-Life Care & the Donation Decision Hospital-MCT_HAguiar
Culturally Sensitive End-of-Life Care Culture Assessed by Observation: • Dress • Appearance • Speech • Education Hospital-MCT_HAguiar
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.) Hospital-MCT_HAguiar
Cross-Cultural Communication Skills Effective communication is your responsibility 6 barriers to communication: Nonverbals Ethnocentrism Assuming similarities vs. differences • Anxiety • Stereotypes and prejudice • Language problems Hospital-MCT_HAguiar
Culturally Sensitive End-of-Life Care • Generalization vs. Stereotyping • Arthur Kleinman’s Explanatory model • Unbiased approach to an individual • Application of Kleinman’s model Hospital-MCT_HAguiar
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? Hospital-MCT_HAguiar
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? Hospital-MCT_HAguiar
Culturally Sensitive End-of-Life Care Kleinman’s 3 recommendations: • Get rid of the term ‘compliance’ • Model of mediation, not coercion → NEGOTIATE • Know your own culture Hospital-MCT_HAguiar
Culturally Sensitive End-of-Life Care Simple triggers - the 4Cs: • Call • Cause • Cope • Concerns Hospital-MCT_HAguiar
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 Hospital-MCT_HAguiar
Basic Principles Practical Tips for Working with Various Cultures Hospital-MCT_HAguiar
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? Hospital-MCT_HAguiar
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….” Hospital-MCT_HAguiar
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. Hospital-MCT_HAguiar
Question to Run on: How comfortable are you with your knowledge of cultures and religions and how does that impact your care? Hospital-MCT_HAguiar
Need for Multicultural Skills “Cultural competence is a journey, not a destination.” (Galanti, 2008) Hospital-MCT_HAguiar
Questions ? Thank you for your attention!