Objectives
The objectives of this presentation are linked to the specifics of end-of-life care. Since death and dying and the perception of them are linked with the person’s culture and their life experiences, it is essential for a healthcare professional to comprehend how patients may approach death. Hence, the links between culture and elements of it such as religion and, how to integrate the understanding of these elements into the EOL care, the specifics of Western values, and some issues linked to culture.
Introduction
According to Srivastava (*), EOL care is influenced by two elements: culture and patient’s life experiences. Culture is linked with elements that guide a person’s behavior and perception of events, mainly, their values, beliefs, and practices. In this presentation, the presenter will explore culture as the main elements that impact attitudes towards death and dying and discuss specific factors that healthcare professionals should consider when making a decision regarding palliative care.
Specifics of EOL care in the US
According to Wachterman et al. (2016), historically, EOL care in the United States focused primarily on patients who had cancer, although the majority of people requiring this type of care services die from other conditions. Hence, this fact and the aging population in the state mean that the efforts of care providers should be directed at making palliative care inclusive. The author’s conducted a study and found that the quality of palliative care differs depending on the patient’s diagnosis, for example, organ failure and frality were associated with lower quality (Wachterman et al., 2016). Therefore, within the palliative care system in the United States, there are several areas of quality that should be addressed by policymakers and healthcare professionals.
Culture and Views on Death and Dying
Firstly, every healthcare professional has generic knowledge about different cultures, or a broad understanding of the specifics of a certain cultural group. Specific knowledge, however, is something unknown to the general population that allows a healthcare professional to distinguish people from different cultural groups and provide them care services that are tailored towards their culture.
Some people may argue that understanding culture in the context of EOL care is non-essential, and the focus should be on ensuring that the patient is comfortable and experiences as little discomfort and pain as possible. One’s culture and beliefs play an important role for psychological comfort. Hence, respecting these beliefs, learning about the key differences, and tailoring the practices to suit these beliefs is crucial. Spiritual and emotional well-being of a patients is as essential as their physical comfort.
Death and Dying
Although dealth is a normal part of living, not all individuals can talk about it and discuss different aspects of death. In a study by Ohr et al. (2016), the researchers examine attitudes of elders towards death. Ohr et al. (2016) report that “64% of Eastern Europeans and 53% of Asia/Pacific groups believed that death should be avoided at all costs” (p. *). Moreover, people from the Asia/Pasific group report valuing a consensual approach towards measures that can prolong life, unlike other groups the researchers spoke with. This shows that there are some differences in the way that people from different cultures perceive measures taken to prolong life and the overall perception of death and dying. The authors of this study recommend integrating a procedure of acquiring information from patients about their religious and cultural beliefs in the end-of-life care settings.
Legal Aspects of EOL Care
The decision of prolonging one’s life or choosing to avoid this practice has to be based on a patient’s beliefs. According to Kuldeep et al. (2017), “The treatments Americans would choose near the end of life are often different from the treatments they receive” (p. *). For this reason, the government introduced Advance Care Directive (ACDs). This document allows one to plan their EOL care decisions beforehand to ensure that their wishes and preferences are respected in case they lose the capability to decide for themselves. DNR is another example of how an individual can voice their EOL preferences, by citing their desire to be resuscitated or to forbid the use of this practice on them. However, Kuldeep et al. (2017) report that the number of people who have ACD is low, despite the efforts that governments put towards promoting this practice. The statistics shows that one out of three citizens in the United States has completed at least one form of ACD.
Organ Donation
Organ donation is a distinct aspect of EOL because although this practice can save lives of others, it is a matter of personnel preference and religious beliefs. First and foremost some religions forbid people from allowing to use their organs. Next, under the current laws, the decision maker or the patient themselves have to make a decision and sign a document stating if they allow the medical professionals to use their organs. Another issue, is that organs have to be transported in a matter of hours in order for them to be used in surgeries for other people (S*).
When Life Ends?
From a medical perspective, brain death markes the overall, death of an individual. This stems from the medical procedures that can be used to restore the functions of other organs, for example, resuscitation can be used to restore heart’s function. However, if resuscitation is not performed in a timely manner, the damage to the brain makes it impossible for a person to function. However, non-medical professionals may have a different perspective. These attitudes can affect the perceptions of aggressive treatments and organ donations.
ABC
One way of assessing a patient’s end of life preferences is called ABC. The ABC framework stands for arerness, bearing witness, and comfort (Srivastava, *).
Awareness
This element of the ABC model refers to the knowledge that a healthcare professional has about cultural groups. It is unlikely that a single individual possesses information about all practices that different cultural groups have. However, having awareness about the differences and distinct features is essential. Awareness of the differences in EOL care can be developed. Acknowledging, that a patient’s perception of how their life should be managed may differ from that of a healthcare professional is the first step to developing awareness.
Bearing Witness
The next element of the ABC model of bearing witness. This step refers to being present with the patient and their family. According to *, this is a skill, which means that any healthcare professional can work on becoming a bearing witness.
Comfort
4F’s
- Feelings
- Family
- Faith
- Finality
The four F’s model helps healthcare professionals remember the triggers for identifying problems that need to be addressed.
Feelings
Feelings from the perspective of EOL imply that a patient and their families are going through the time of emotional turbulence, when they find out about the diagnosis and arrange the EOL. S * notes that feelings are strongly impacted by culture. For example, it is commonly assumed that patients with terminal diagnoses experienced fear of death. However, a non-westerner may approach death as an inevitable part of life and experience fear in association with leaving their family or other emotions. Here, an advice for healthcare professionals is to be self-aware, acknowledge the patient’s feelings, and do not assume the causes for certain feelings beforehand.
Family
Families of terminally ill patients also require support and comfort. Most importantly, it is important for a healthcare professional to recognize the different types of families, more specifically those that do not fit into the traditional image of a nuclear family. These individuals plan for the EOL care and designs and mourn their family members. EOL care can be emotionally depleting for family members, which is something that a medical professional should recognize and address through their work. Here, a medical professional should be aware of some practices, such as bringing gifts for healthcare providers or disclosing diagnosis to the family members first, and the policies of their healthcare organizations, to maintain a proper balance between the two.
Faith
Faith can play a central role in the way people perceive and experience death. However, this does not mean that a patient has to be very religious, since spirituality not connected to a particular religion can matter for them as well. *S notes that an apestc of faith to consider is patients looking for answers to questions about the meaning of death and the impact it will have on their families.
Disclosure
As noted by S*, not all religions and cultures emphasize the importance of truth telling connected to EOC, for example, in Iran, it is common for physicians to not tell terminally ill patients about their conditions. The families of these individuals also do everything to protect the patient from this knowledge. In Western societies, in contrast, individualism and informed decision making are more important. Moreover, doctors are required to share information about the diagnosis and prognosis with the patient. Again, a Western perspective is based on planning and allowing the person to make decisions about their life and death. People from non-Western cultures, for instance family members may ask the healthcare professionals to not disclose the diagnosis of the patient.
Conclusion
To conclude, this presentation’s focus is end-of-life care and aspects of a patient’s culture and life experiences that may be important to providing good palliative care services. The EOL is a topic that is linked with the cultural diversity and the differences in the way people live and perceive the world around them. Having an understanding of the basic differences between the Western and non-Western cultures is essential for a healthcare professionals. The two models, ABC and 4F’s explored in this paper also help understand the different aspects of EOL and improve health professionals’ awareness.
Reference
Ohr, S., Jeong, S., & Saul, P. (2017). Cultural and religious beliefs and values, and their impact on preferences for end-of-life care among four ethnic groups of community-dwelling older persons. Journal Of Clinical Nursing, 26(11-12), 1681-1689. Web.
Pottinger, A., Perivolaris, A., & Howes, D. (2006). The end of life. In Srivastava, R. (Ed.), The healthcare professional’s guide to clinical cultural competence (pp. 227-244). Elsevier.
Wachterman, M., Pilver, C., Smith, D., Ersek, M., Lipsitz, S., & Keating, N. (2016). Quality of end-of-life care provided to patients with different serious illnesses. JAMA Internal Medicine, 176(8), 1095. Web.
Yadav, K. N., Gabler, N. B., Cooney, E., Kent, S., Kim, J., Herbst, N., & Courtright, K. R. (2017). Approximately one in three US adults completes any type of Advance Directive for end-of-life care. Health Affairs, 36(7), 1244–1251. Web.