Death and Dying 3-1

8/3/2019 Death and Dying 3-1

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Cultural Considerations

END OF LIFE

y Refers to issues related to death and dying

Follow with respect the bioethical and cultural beliefs andpractices of the client/family/carer

Cultural influences and Advance Directives

African American Clients

European American Clients

Asian American Clients

Hispanic American Clients

Religion and End-of-Life Care

CHRISTIANITY

Catholic and Orthodox Religions

y Priest anoints the sick

y Other sacraments before death include reconciliation and holy communion

Protestant

y No last rites are given (anointing of the sick is accepted in some groups)y Prayers are given to offer comfort and support

Church of Jesus of Latter-Day Saints (Mormons)

y Cleric may administer a sacrament if the client requests Discourage, oppose, or prohibit cremation

Jehovah Witness

y Members do not believe in sacramentsy Members will be excommunicated if they receive a blood transfusion Prohibit organ donation

ISLAM

y Second degree male relatives such as cousin or uncles should be the contact person anddetermine whether the client and/or family should be given information about the

client.

y Client may choose to face Meccay The head should be elevated above the bodyy Discussions about death usually are not welcomedy Stopping medical treatment is against Allahs (Arabic word for God) willy Grief may be expressed through slapping or hitting the body


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y If possible, only a same-sex Muslim should handle the body after death; if not possible,non-Muslim should wear gloves so as not to touch the body

y Discourage, oppose, or prohibit cremationy Prohibit organ donation

JUDAISM

y Prolongation of life is important ( a client on life support must remain so until death)y A dying person should not be left alone (a rabbis presence is desired)y Autopsy and cremation are forbidden

HINDUISM

y Rituals include tying a thread around the neck or wrist of the dying person, sprinklingthe person with special water, or placing a leaf of basil on the persons tongue.

y After death, the sacred threads are not removed and the body is not washed. Prefer cremation and cast the ashes in a holy river

BUDDHISM

y A shrine to Buddha maybe placed in the clients roomy Time for meditation at the shrine is important and should be respectedy Clients may refuse medications that may later their awarenessy After death, a monk may recite prayers for 1 hour (need not be done in the presence of

the body)

y Buddhist in America encourage organ donation and consider it as an act of mercy

Cultural and religious issues

African American

Organ and blood donation usually are not allowed Members prefer to die at home Members discuss issues with the spouse of older family members

Hispanics and Latino Groups

y Predominant religion is Roman Catholicy Prayer and folk remedies are common, as is the use of religious objectsy Members may avoid eye contact as a sign of respecty Members tend not to complain of painy The family generally makes decision and may request to withhold the diagnosis or

prognosis from the client

y Extended family members often are involved in the end-of-life care (pregnant womenmay be prohibited from caring for the dying or attending funerals)

y Several family members may be at the dying clients bedsidey Vocal expression of grief and mourning is acceptable and expectedy Members refuse procedures that alter the body, such as organ donation or autopsy


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y Members prefer to die at home

African American Clients

y Members discuss issues with the spouse or older family members (elders are held inhigh respect)

y Family is highly valued and is central to the care of the terminally illy Pain is reported openlyy Open displays of emotion are common and acceptedy Organ and blood donation usually are not allowedy They are more likely to select aggressive interventionsy Are less likely than European American of Hispanic American clients to have

documented their end-of-life health care wishesy Members prefer to die at home

Chinese Americans

y Family members may make decisions about care and often do not tell the client aboutthe diagnosis or prognosis

y Members often avoid eye contact because it represents disrespect to persons inauthority

y Personal distances should be maintainedy Affection between family members rarely is exhibited in publicy Members may not report painy Dying at home may be considered bad luck

Native Americans

y Eye contact is avoidedy Personal distances needs to be maintainedy Family meeting may be held to make decisions about end-of-life and the type of

treatments that should be pursued

y Members may not report painy Some tribes avoid contact with the dying (prefer to die in the hospital)

Issues on Advancedirective:

E

uropean American Clients

y Are more much likely to have written advance directives than members of othercultures

y Select no code more than do Hispanic American or African American clients but lessthan do Asian American clients

Asian American Clients

y Select no code more than do all other groupsy Are less likely to have advance directives


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Hispanic American Clients

y Are least likely of all groups to select no code

Legal and Ethical Issues

y Outcomes related to care during illness and the dying experience should be based onthe clients wishes

y Issues for consideration may include organ and tissue donations, advance directives orother legal documents, withholding or withdrawing treatment, and cardiopulmonary

resuscitation.

Palliativecare

y Focuses on caring interventions and symptom management rather than cure for diseasethat no longer respond to treatment

y A pain-controlled and symptom controlled environment is established ( the dying clientshould be as pain-free and as comfortable as possible)

y Hospice care provides support and care for clients in the last phases of incurablediseases so that they might live as fully and as comfortable as possible; client and family

needs are the focus of any intervention.

Nursing Care

1. Assessment of the client

a. Assessment should be limited to obtaining essential datab. Frequency of assessment depends on the clients stability (at least every 8

hours); as changes occur, assessment needs to be done more frequently.

c. Avoid repeated, unnecessary assessments on the dying client2. Physical care for the dying client

a. Paini. Administer pain medicationii. Do not delay or deny pain medication

b. Dyspneai. Elevate the head of the bed or position on the sideii. Administer supplemental oxygen

iii. Suction fluids from airway as neededc. Skin

i. Assess color and temperatureii. Assess for breakdown

iii. Implement measures to prevent breakdownd. Dehydration

i. Maintain regular oral careii. Encourage taking of ice chips and sips of fluids

iii. Do not force the client to eat or drinkiv. Use moist cloths to provide moisture to the mouthv. Apply lubricant to the lips and oral mucus membranes

e. Anorexia, nausea, and vomitingi. Provide antiemetics before meals


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ii. Have family members provide the clients favorite foodiii. Provide frequent small portions of favorite foods

f. Eliminationi. Monitor urinary and bowel eliminationii.

Place absorbent pads under the client and check frequently

g. Weakness and fatiguei. Provide rest periodsii. Assess tolerance for activities

iii. Provide assistance and support as needed for maintaining bed or chairpositions

h. Restlessnessi. Maintain a calm soothing environmentii. Do not restrain

iii. Limit the number of visitors at the clients bedsideiv. Allow a family member to stay with the client

i.3. Psychosocial care

a. Monitor for anxiety and depressionb. Monitor for fear

Fear associated with Dying

y Fear of

Pain

o Fear of pain may occur based on anxieties related to dyingo Do not delay or deny pain relief measures to a terminally ill client

y Fear ofLoneliness and Abandonmento Allow family members to stay with the cliento

y Fear ofMeaninglesso Client may feel hopeless and powerlesso Encourage life reviews and focus on the clients positive aspect of

their lifec. Encourage the client and family to express feelingsd. Provide support and advocacy for the client and familye. Provide privacy for the client and familyf. Provide a private room for the clientg. Maintain respect and dignity for the client

4. Postmortem care

a. Maintain respect and dignity for the clientb.

Determine whether the client is an organ donor, if so, follow appropriateprocedures related to the donation

c. Consider cultural rituals, state laws, and agency procedures when performingpostmortem care

d. Prepare the body for immediate viewing by the familye. Provide privacy and time for the family to be with the deceased person

General Postmortem Procedures

y Close the clients eyesy R

eplace denturesy Wash the body


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y Place pads under the perineumy Remove tubes and dressingsy Straighten the body and place a pillow under the head in preparation for

family viewing

Documents

Death and Dying 3-1