Cultural Hospice and Palliative Report

7/28/2019 Cultural Hospice and Palliative Report

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Cultural Competence in

Hospice and Palliative care

GROUP 2B**Albano Nicole **Lucas Allan**De Rosas Jency Ann **Rabano Darlen Joy**Javier Jean **Yoma Paolo


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Cultural Competence

*Refers to a dynamic, continuousprocess of awareness, knowledge, skill,interaction and sensitivity.

*Seeking to become more culturallycompetent requires learning in :

- Attitudes - Beliefs- Values - Cognitive or

intellectual- Feelings - Critical thinking- Psychomotor or behavioural domains


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Cultural competence is an on going

process, not an end point


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identify 4 components necessary inpursuing


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Cultural Awareness

* Is their understanding of the differences betweenthemselves and people

from other countries or other backgrounds,

especially differences in attitudes and values

*Begins with an examination of ones ownheritage, familys practices, experience andreligious or spiritual beliefs.


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*Each member of the hospice and palliative

care team brings his/her cultural andphilosophical views, education, religion,spirituality, and life experience to the care

of the patient and family.

*Assessing ones own attitudes, beliefs and

practices surrounding the end of lifeprovides and important cultural awareness


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Cultural Knowledge

*Since Culture is the prevailing norms, practices, belief,values etc., knowledge about these can be described asCultural knowledge.

*Serve as a guide to assist the hospice/palliative care teammembers in gaining a better understanding of anindividual and family


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Cultural Skill* Cultural skill in hospice and Palliative care is required for

competency

*Skills that can be acquired:-Cultural assessment

-Cross cultural communication

-Cultural interpretation

-Appropriate Intervention


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*Multiple tools are available to assesscultural behaviour. These tools focus on:

-Religion-Health related Beliefs and practices-Nutrition

-Socioeconomic-Considerations- education

- communication-values orientation-cultural aspects on disease


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Cultural Encounter

Individuals meet each other with their own conditions,

prejudices and level of education. Just as we do with

people from our own country, we should try to see, listen

to and understand our fellows even if they come from a

foreign place.

Such an encounter is a process in which understanding

is created whilst the parties make an effort to establish

contact, a common foundation and a common language.

We encounter cultures through the people we meet.


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It is one between individuals and must therefore

always be characterised by respect and

openness to the Others worldview. It is

extremely important to regard the Other as ahuman being, a person, an individual with his or

her own feelings, values and goals to which I

should react as politely, wisely and warmly as

possible.


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Hospice and Palliative care issuesinfluenced by Culture

-Nutrition

-Decision Making

-Pain management

-Death and dying rituals


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Nutrition

Across cultures, food is used in building or maintaining human relationships

Food is used in rituals, celebrations, and rites of passage to establish and maintain social andcultural relationships with families, friends, andothers.It serves to assess social relationships or interpersonal closeness.

For centuries, food has been used to assess,

treat and prevent illness.


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Dietary patterns of cultural groups need tobe assessed and integrated into the planof care. When working with the patientsand families to identify foods that affect thesymptoms, it is important to consider food

practices that are culturally significant.

Its important to ask the patient or family if

involving a leader in their cultural or religious group may be helpful in makingfood and fluid decisions.


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Decision makingPatient Self-Determination Act (PSDA) of 1991, health care decision

making shifted from the physician to the patient.

Act was the result of social change and the consumer rights

movement in the early 1970s in the United States.

Based on the belief that patienthas an inherent right to

information relevant to health

care decision making. The

assumption is that patient wants

control over the dying process.

Advance Directives were

initiated as a result of PSDA.


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4 values that provide foundations for the

PSDA and end-of-life decision making in

America include:

Patient autonomy

Informed decision making

Truth telling

Control over the dying process


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This is the Euro-American vision of healthcare. It

assumes that the individual rather than the family or

other social group, is the appropriate decision maker.

But many non-Euro-American cultures do not embrace

this vision or these values.

In many non-Euro-American cultures the concept oninterdependence among family and community members

is more valued than individual autonomy.


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Many cultures are family-centered rather than

individualistic, and would prefer that the family, rather

than the patient, receive and process information.

Autonomy may not be seen as empowering, but rather

may seem burdensome to patients already too sick to

make meaningful choices.


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Some non-European cultures do not approve of

full disclosure. This Western practice of blunt,

truthful communication is seen as rude and

disrespectful in some cultural groups. These

families prefer to receive threatening information

and filter it before telling their loved ones. This

practice is to believed to encourage patients to

maintain hope.


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Hospice / palliative care team members must consider

the harm that may occur when the medical community

violates cultural practices. It may be helpful to explain

the Euro-American perspective to enhance

understanding and present needless suffering.


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It is essential for hospice / palliative care

team members to be aware that ethical

norms in the United States are guided by a

Euro-American perspective and may not

be appropriate in other cultures.


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Pain management

Pain is a highly personal and subjective experiencedinfluenced by cultural learning. Pain is whatever the

person says it is, and existing whenever the person says

it does. Patterned attitude of pain behaviors exist in

every culture as demonstrated by Zoborowskis classic

work. Pain tolerance varies from person to person

depending on numerous factors such as past

experiences with pain, coping skills, motivation to endure

pain and energy level.


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Assessment of pain can be identified using terms thatdescribe pain intensity across most cultural groups.

Pain, hurt, ache are words commonly used bypersons of different ethnic and educational backgroundsto describe pain. It is important to standardize theassessment and not rely on culturally laden painindicators such as facial expression, body movement,and vocalize to assess pain.


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Comprehensive pain management

involves pharmacologic and non

pharmacologic interventions may improvethe ability to alleviate pain. Healing

practices to cultures should be offered to

patient and family


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DEATH RITUALS IN MUORNING

PRACTICES

The meaning of death, and how it is recognized, acknowledged, and

celebrated, varies among cultures

.


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It is the responsibility of the Hospice/Palliative

care team to learn about these rituals andweave them into a culturally meaningful context

for the pt and family

Most cultures have specific rituals that begin

before death and may last for months or even

years after death


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In helping family members deal with death,the hospice/palliative care team must shoerespect for the familys cultural heritageand encourage the family to identify howthey will commemorate the death of their loved one


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Family Questions Regarding Cultural

Traditions In Dealing With Death

What are the prescribed rituals for

handling dying, the dead body, the

disposal of the body, and rituals to

commemorate loss?

What are the groups beliefs about

what happens after death?


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What do they believe about

appropriate emotional expression and

integration of a loss experience?

What are the gender rules for handling

the death?

Are certain deaths particularly

stigmatized or traumatic for the group?


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It is important to recognize that cultures differ in public expression of grief.


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During the dying experience and after

death, the major tasks of the grief

process are universal regardless of the

cultural differences.

Accept the reality of the loss.

Feel and experience the pain of grief associated with loss.

Begin to adjust to an environment without the deceased and begin

the transformation to new society and family roles.

Withdraw emotional energy from the dead and focus energy on the

living.


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Documents

Cultural Hospice and Palliative Report