Module 5 - Culture Adapted from: The 2004 PERT Program Pain & Palliative Care Research Department Swedish Medical Center, Seattle, Washington Revised

Objective: To obtain an understanding about culture and its influence on: Caregivers Patients and families Relationships among home care aides, patients, and families Clinical care Decision making at the end of life Revised

Increasingly, health care providers and patients are from different cultural backgrounds. If trends continue, by 2050, one in two Americans will claim membership in an ethnic minority. U.S. Census Bureau, 2004, "U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin," http://www.census.gov/ipc/www/usinterimproj/ Revised

Definitions Revised

Culture Socially transmitted values, customs, arts, behaviors, and beliefs that guide a person’s world view and decision making. (Purnell & Paulanka, Transcultural Health Care, 2000) Revised

Culture . . . Is universal Dominant & nondominant cultures Includes religious cultures & subcultures (Purnell & Paulanka, Transcultural Health Care, 2000) Revised

World View Includes: The purpose of human life The nature of the universe and humans’ relationship to it Relationship to nature Social relationships Revised

World View Includes: (continued) Moral and ethical thinking Beliefs about magic/religion Aesthetics (nature of beauty and art) Revised

Race Inherited physical traits that characterize distinct groups of humans Racism: belief that race is the key factor in determining human qualities and abilities, and that one race is superior to another Revised

Ethnicity Belonging to a group that is characterized by: Literature, art, music Language Social customs Dietary practices Religion Sense of belonging Employment patterns Physical community Revised

Assimilation The process of assuming the values and behaviors of the dominant culture Revised

Acculturation The process of learning the values of the dominant culture without adopting them Revised

Stereotype versus Generalization A stereotype is an ending point where no attempt is made to find out if what we think about a person is true. A generalization is a beginning point where more information is sought to find out if what we think about a person is true. Galanti, Caring for Patients from Different Cultures, 1997 Revised

Ethnocentrism (Purnell & Paulanka, Transcultural Health Care, 2003) Universal tendency of humans to think that their ways of thinking, acting, and believing are the only right, proper, or natural ways (Purnell & Paulanka, Transcultural Health Care, 2003) Revised

Optional Group Cultural Research Assignment Handout #1 Health Care Beliefs, Pain, and Food Practices Optional Group Cultural Research Assignment Revised

So what does all of this have to do with home care or end of life care? Revised

What are some examples of issues that have come up for you concerning culture and care giving, especially at the end of life? Revised

How Culture Influences Death Affects how people view death, and their distress or peace with death Affects social customs, for example, care of the body and mourning rituals Revised

How Culture Influences Death (continued) Affects how people talk about death Can strain or enhance relationships between home care aides and patients/families Affects decision making Revised

End-of-Life Decisions Palliative vs. Curative Therapies Use of Pain Medications Advance Directives Initiation/Withdrawal of Life-sustaining Therapies Revised

Cultural Values of the American Health Care System Truth-telling Patient Autonomy Personal Control Revised

Examples of Cultural Differences Interdependence, especially among family members, rather than a focus on individual autonomy Respectful communication Trust, rather than control Revised

key questions that home care aides will want to consider when observing culture Use of Language Decision Making Religious Beliefs Death Rituals Hope Fate or Control Revised

Key Questions (continued) Gender Age Power Historical or Political Factors Community Resources Revised

Mourning Cultures experience grief as a response before a pending death or after a death. Mourning is the process through which the grief is expressed. Mourning represents culturally accepted expression of the personal feelings that follow the death of a loved one. Revised

Mourning Culturally acceptable expressions during mourning shaving the head, wearing black or white clothing, and grieving for a set amount of time. Another culture may express grief through drinking and dancing with the surviving spouse expected to marry a person with a certain kinship position. Revised

Eye Contact Different cultures have different rules for eye contact Revised

Touch There are cultural patterns for touch Revised

General Approaches Knowledge Careful assessment without stereotyping Respect for diverse beliefs and practices Understanding and honoring one’s own values Negotiation Revised

Case Studies Revised

Summary Culture is universal Culture affects end of life decision making Cultural patterns can increase or decrease vulnerability Culture can be a barrier but also an opportunity Revised

(Kagawa-Singer & Blackhall, JAMA, 2001) Addressing and respecting cultural differences will increase trust leading to better and more satisfactory care for patients and their families. We are better prepared to serve them when we prepare ourselves to respect their hearts and their minds and truly “go where he lives.” (Kagawa-Singer & Blackhall, JAMA, 2001) Revised