Moderator: Sherri Lamon, RN, Western Medical Center Santa Ana Presenters:

1. 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

2. 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

3. 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

4. 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

5. What builds TRUST? • Communication • Attitude Hospital-MCT_HAguiar

6. Cross-Cultural Communication Skills • Culture & communication connected • Communication – driven by culture • Connection forgotten = risk for misunderstanding Hospital-MCT_HAguiar

7. Laying Foundations Operational Definitions of Culture, Ethnicity, and Race and the Differences Between These Terms Hospital-MCT_HAguiar

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Cultural & Religious Considerations Application of Cultural and Religious Considerations in End-of-Life Care & the Donation Decision Hospital-MCT_HAguiar

15. Culturally Sensitive End-of-Life Care Culture Assessed by Observation: • Dress • Appearance • Speech • Education Hospital-MCT_HAguiar

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Culturally Sensitive End-of-Life Care Simple triggers - the 4Cs: • Call • Cause • Cope • Concerns Hospital-MCT_HAguiar

23. 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

24. Basic Principles Practical Tips for Working with Various Cultures Hospital-MCT_HAguiar

25. 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

26. 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

27. 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

28. 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

29. Need for Multicultural Skills “Cultural competence is a journey, not a destination.” (Galanti, 2008) Hospital-MCT_HAguiar

30. Questions ? Thank you for your attention!