1. Module 5 - Culture Adapted from: The 2004 PERT Program
Pain & Palliative Care Research Department
Swedish Medical Center, Seattle, Washington
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2. 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
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3. 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,"
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4. Definitions
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5. 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)
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6. Culture . . . Is universal Dominant & nondominant cultures
Includes religious cultures & subcultures
(Purnell & Paulanka, Transcultural Health Care, 2000)
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7. World View Includes: The purpose of human life
The nature of the universe
and humans’ relationship to it
Relationship to nature
Social relationships
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8. World View Includes: (continued)
Moral and ethical thinking
Beliefs about magic/religion
Aesthetics (nature of beauty and art)
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9. 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
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10. 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
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11. Assimilation
The process of assuming the values and behaviors of the dominant culture
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12. Acculturation
The process of learning the values of the dominant culture without adopting them
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13. 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
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14. 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)
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15. Optional Group Cultural Research Assignment
Handout #1
Health Care Beliefs, Pain, and Food Practices
Optional Group Cultural Research Assignment
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16. So what does all of this have to do with home care or end of life care?
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17. What are some examples of issues that have come up for you concerning culture and care giving, especially at the end of life?
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18. 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
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19. 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
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20. End-of-Life Decisions
Palliative vs. Curative Therapies
Use of Pain Medications
Advance Directives
Initiation/Withdrawal of Life-sustaining Therapies
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21. Cultural Values of the American Health Care System
Truth-telling
Patient Autonomy
Personal Control
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22. Examples of Cultural Differences
Interdependence, especially among family members, rather than a focus on individual autonomy
Respectful communication
Trust, rather than control
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23. 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
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24. Key Questions (continued)
Gender
Age
Power
Historical or Political Factors
Community Resources
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25. 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.
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26. 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.
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27. Eye Contact Different cultures have different rules for eye contact
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28. Touch
There are cultural patterns for touch
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29. General Approaches Knowledge Careful assessment without stereotyping
Respect for diverse beliefs and practices
Understanding and honoring one’s own values
Negotiation
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30. Case Studies
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31. 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
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32. (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)
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