end of life culture and ethnicity 09

presentation : 

presentation CULTURE AND ETHNICITY IN END OF LIFE CARE Maimuna M. Itambo HR department October 2010

OBJECTIVES : 

OBJECTIVES Identify various cultural signs that may increase a clinician’s and support staff’s awareness about concepts and preferences of patients regarding: Dealing with illness; and End-of-life care

Getting to know the culture : 

Getting to know the culture DEFINATION: unwritten rules that govern social interaction and possibly impact the way in which individuals perceive, seek and receive services. Family Respect Personalism Trust Espirit, body and mind

What is culture : 

What is culture The term culture implies the integrated pattern of human behaviour that includes:- Thoughts Actions Communications Beliefs Customs Values Institutions of a racial, ethnic, religious or social group

What is ethnicity : 

What is ethnicity Ethnicity is best defined as the practices and traditions of a group such as language, religion, behaviors, and culture.

Potential solutions : 

Potential solutions Exploring cultural beliefs Building trust Addressing communication barriers Addressing religion and spirituality Involving the family Kagawa-Singer, JAMA, 2001; 286:2993

Getting to know us : 

Getting to know us Family involvement often is critical in the health care of the patient. Traditionally, most of us include many people in the extended families, parents, siblings, grandparents, aunts, uncles cousins and close friends and godparents. This can be a problem when one is admitted into the hospital.

Getting to know us cont.. : 

Getting to know us cont.. hospitals are built for all and based on international standards, and are thus not equipped for more than one or two visitors at a time. Visiting hours are often limited. Visiting is a way of showing love and concern for sick/dying family members and is thus both expected and important. we attempt to maintain cultural norms and routines for their loved ones, seen through visiting patterns and the need to monitor the care given by staff. Especially respect to elders.

Cont… : 

Cont… Traditionally our people emphasize interdependence over independence. (This can be problem with our western philosophy: where ethical health care decision making is based on autonomy, beneficence, and justice). Consideration: Including family members in the consultation is often critical to the care of the patient and may contribute to a patient’s ability to adhere to the recommended treatment.

Cont… : 

Cont… Respect (encompasses loyalty, generosity, having “soul” or character and maintaining a patient’s dignity) Respect dictates appropriate deferential behavior towards others based on age, sex, social position, economic status and authority. Health providers, by virtue of their education and training are afforded a high level of respect as authority figures.

Cont… : 

Cont… Out of sense of respect many patients tend to avoid disagreeing or expressing doubts to their health care provider in relation to the treatment. May even be reluctant to ask questions or admit they are confused about their medical instructions or treatment. generally, patients regard the kind of personal treatment they receive from a health care provider as the crucial test of respect.

What do we want : 

What do we want Personalised care people tend to stress the importance of personal relationships. Expect health providers to be warm, friendly, and personal and take an active interest in the patient’s life. Tends to conflict with the health system’s trend towards managed care, the eight-minute visit, and physician rotations in public clinics.

Cont... : 

Cont... Trust (confidentiality) For the provider it means having the patient’s best interests at heart. Over time, by respecting the patient’s culture and showing personal interest, a health care provider can expect to win a patients’ trust. Once this occurs the patient will value the time they spend talking and believe what they say.

The spirit : 

The spirit Our people view health from a more synergistic point of view that is expressed as the continuum of body, mind, and the spirit. Many may use traditional medicine in combination with other approaches Recognizing values such as family, respect, personalism, trust and spirit can allow the clinician insight into the traditional worldview.

Dealing with illness : 

Dealing with illness May see illness as an imbalance, occurring between the internal and external sources (e.g. hot and cold, natural vs. supernatural, the soul is separated from the body. There are folk-defined diseases such as chira, impoto, kisirani, shetani,

Dealing with illness : 

Dealing with illness Don’t be condescending if patient expresses a supernatural cause, instead attempt to get more information on patient’s opinion of what caused illness. Depression may be considered to occur due to supernatural cause ; treat with respect. Usually the family would prefer to hear about bad medical news before the patient is informed. With patient consent, meet with the identified persons to strategize how to communicate medical news.

What is happening : 

What is happening Fatalism and Religious Beliefs Refers that there is little an individual can do to alter fate - you live, you suffer, you die. “That’s the way life is.” This was God’s design, there’s nothing I can do

Cont… : 

Cont… Clinicians must view patients in the context of ethnic and racial background, with an understanding of how this influences conceptualization of diseases and health behavior, i.e., the disease is separate from the physical body or person; the disease is mystical or supernatural. patients utilize traditional healing practices and only seek medical care when these approaches fail - using a combination of tradition/cultural and Christian beliefs.

Cultural Competence: : 

Cultural Competence: “The knowledge and interpersonal skills that allow providers to understand, appreciate and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences, self-awareness, knowledge of the patient’s culture and adaptation of skills”.

What it entails… : 

What it entails… Listen with sympathy and understanding to the patient’s perception of the problem Explain your perceptions of the problem Acknowledge and discuss the differences and similarities Recommend treatment. Negotiate agreement.

Ethnic healing : 

Ethnic healing Explanation Treatment Healers Negotiate Intervention Collaboration

For whom is the bell tolling? : 

For whom is the bell tolling? Individuals Family and friends Providers/healthcare professionals

End-of-life care : 

End-of-life care Traditionally most groups have understood dying. They have descriptions of what it is in the culture and it is related as such. Friends and relatives should gather around the dying person The notion of Self-Determination and the ethical principle of Autonomy in health care is totally foreign to the traditions

Understanding the challenges of end-of-life care : 

Understanding the challenges of end-of-life care First visit start with a short introduction of who you are and probe the origin of the patient and their family..”what tribe are you from?’ Second visit ask what is hurting the patient, is someone suffering and what can I do to help, i.e., facilitate communications with Doctor(s), need of a translator, etc. Third visit offer your services and then discuss advance care planning.

Cont…. : 

Cont…. Every clinical encounter is cross-cultural, so the physician should try to be flexible, sincere and ethical in his or her interactions. Patient- and family-centered care is the goal. There are no one-size-fits-all templates for end-of-life care. Effective care depends on the heightened sensitivity and awareness of social, cultural, psychological, and spiritual issues at the end of life. Most people with chronic illness are not afraid of dying. Some may even know the time and place of their physical death. End-of-life care affords them the opportunity of a psychosocial moratorium to reflect and contemplate their spiritual transcendence.

Palliative care – expandeddefinition : 

Palliative care – expandeddefinition Affirms life, regards dying as a normal process Neither hastens nor postpones death Provides relief from pain, other symptoms Integrates psychological and spiritual care Interdisciplinary team Support system for the family WHO 1990

Closing comments : 

Closing comments We must all add value to end-of-life care by remembering that our community is a rich tapestry woven of many strands and that this tapestry symbolizes the cultural diversity among people. . We are all patients

Cultural space : 

Cultural space The Hospital is also a cultural space and has a cultural life.. ( Price, 1995 ) There is need for a culturally competent management of hospital space ….( Alexander, 2002) Thank you for your time!!!!