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Of Monks and Milk: Addressing Cultural and Spiritual End-of-Life Needs for a Cambodian Family in the Pediatric Intensive

Learn about the complex role of culture and spirituality in decision-making, coping, and communication for a Cambodian family caring for their dying child in the Pediatric Intensive Care Unit. Explore interventions, bereavement support, and lessons learned.

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Of Monks and Milk: Addressing Cultural and Spiritual End-of-Life Needs for a Cambodian Family in the Pediatric Intensive

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  1. Of Monks and Milk: Addressing Cultural and Spiritual End-of-Life Needs for a Cambodian Family in the Pediatric Intensive Care Unit Claire Crawford, LMSW & Kirstin Springmeyer, M.Div, BCC Texas Children’s Hospital Professionals Day September 19, 2019

  2. Learning outcome Identify the complex role of culture and spirituality as a family makes decisions, copes, and communicates goals of care for their dying child.

  3. 3 year-old female Dyskeratosiscongenita, small bowel obstruction, ileostomy, protein losing enteropathy with chronic diarrhea, combined immunodeficiency, hypogammaglobulinemia with multiple infections Hospitalized almost continuously in her last year American citizen Parents immigrated from Cambodia; speak English as a second language Parents of Buddhist faith 4 year-old brother Father works at a donut shop; mother does not work Limited family support in the U.S., rely on help from father’s coworkers Case description: “B” Angkor Wat Image from flyingroups.com

  4. The beginning: Culture and spirituality • Healing miracles • Prayers • Long distance Communication AchanBuddhadasa

  5. Verbal cues “I could lose my license.” “My job is to treat the patient, not the parent.” “They gave her WHAT?” “It’s not medicine, and we shouldn’t use that word with the family.” “I know they think I’m silly.”

  6. Nonverbal cues

  7. Nonverbal cues Image from Etsy

  8. Royal Embassy of Cambodia • The foreign and Commonwealth Office • John Allison Monkhouse • Osborn Funeral Services http://diamant-ltd.com/map-of-southeast-asia/seasia-vintage-map-of-southeast-asia/

  9. Family Interventions • Listening, eliciting, and validating • Advocacy • Printing pictures of B to hang on the wall

  10. Care coordination interventions • Sharing family’s feelings/perspectives • Cultural broker: “The act of bridging, linking, or mediating between groups or persons of different cultural backgrounds for the purpose of reducing conflict or producing change. In health care, it involves brokering between patients and representatives of the orthodox health care system”. (Jezewski, 1990, p. 497) • Challenging and confronting bias • Compromise on milk mixture • Regularly scheduled in-person Cambodian interpreter

  11. Bereavement interventions • Discussions with temples and Cambodian embassy • Funeral, cremation, and transportation planning • Follow-up bereavement support Jade Buddhist Temple, Houston, TX Image from visithoustontexas.com

  12. Ask early and often what a family’s beliefs and practices are…and how they might change over time. Schedule regular in-person interpretation when a language is rarely used. Prepare the interpreter for the content of sensitive conversations, particularly at end of life. Gently explore implicit biases with floor staff. Discuss non-verbal gestures that may indicate judgment. Do not wear religious t-shirts for patient care. Always check Culture Vision! Lessons learned

  13. Corr, C. A., Corr, D. M., & Doka, K. J. (2018). Death & dying, life & living. Cengage learning. Feudtner, C., Walter, J. K., Faerber, J. A., Hill, D. L., Carroll, K. W., Mollen, C. J., ... & Hinds, P. S. (2015). Good-parent beliefs of parents of seriously ill children. JAMA pediatrics, 169(1), 39-47. Jezewski, M. A. (1990). Culture brokering in migrant farmworker health care. Western Journal of Nursing Research, 12(4), 497-513. Stroebe, M., Schut, H., & Van den Bout, J. (2013). Prolonged grief disorder: cognitive–behavioral theory and therapy. In Complicated Grief (pp. 239-252). Routledge. References

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