Cultural Competence in Hospice and Palliative care

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

Cultural Competence
*Refers to a dynamic, continuous process of awareness, knowledge, skill, interaction and sensitivity. *Seeking to become more culturally competent requires learning in : - Attitudes - Values - Beliefs - Cognitive or intellectual - Feelings - Critical thinking - Psychomotor or behavioural domains

 Cultural competence is an on going process, not an end point

identify 4 components necessary in pursuing

Cultural Awareness
* Is their understanding of the differences between themselves and people from other countries or other backgrounds, especially differences in attitudes and values *Begins with an examination of ones own heritage, familys practices, experience and religious or spiritual beliefs.

*Each member of the hospice and palliative care team brings his/her cultural and philosophical 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 life provides and important cultural awareness

Cultural Knowledge
*Since Culture is the prevailing norms, practices, belief, values etc., knowledge about these can be described as Cultural knowledge. *Serve as a guide to assist the hospice/palliative care team members in gaining a better understanding of an individual and family

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

*Multiple tools are available to assess cultural behaviour. These tools focus on: -Religion -Health related Beliefs and practices -Nutrition -Socioeconomic -Considerations - education - communication -values orientation -cultural aspects on disease

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.

 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 a

human 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.

Hospice and Palliative care issues influenced by Culture

-Nutrition
-Decision Making -Pain management -Death and dying rituals

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 and cultural relationships with families, friends, and others. It serves to assess social relationships or interpersonal closeness. For centuries, food has been used to assess, treat and prevent illness.

 Dietary patterns of cultural groups need to be assessed and integrated into the plan of care. When working with the patients and families to identify foods that affect the symptoms, 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 making food and fluid decisions.

Decision making
Patient 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 patient has 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.

 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

 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 on

interdependence among family and community members

is more valued than individual autonomy.

 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.

 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.

 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.

 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.

Pain management
Pain is a highly personal and subjective experienced

influenced 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.

 Assessment of pain can be identified using terms that describe pain intensity across most cultural groups. Pain, hurt, ache are words commonly used by persons of different ethnic and educational backgrounds to describe pain. It is important to standardize the assessment and not rely on culturally laden pain indicators such as facial expression, body movement, and vocalize to assess pain.

 Comprehensive pain management

involves pharmacologic and non pharmacologic interventions may improve

the ability to alleviate pain. Healing

practices to cultures should be offered to patient and family

DEATH RITUALS IN MUORNING PRACTICES

The meaning of death, and how it is recognized, acknowledged, and celebrated, varies among cultures .

 It is the responsibility of the Hospice/Palliative

care team to learn about these rituals and

weave 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

 In helping family members deal with death, the hospice/palliative care team must shoe respect for the familys cultural heritage and encourage the family to identify how they will commemorate the death of their loved one

 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?

 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?

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

 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.