The Journey to the End of Life Multicultural Considerations

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The Journey to the End of Life Multicultural
Considerations

• Donna Soltura, MSW
• Linda Piotrowski, MTS, Certified Chaplain
• DHMC Palliative Medicine Program
• January 10, 2007

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CULTUREWhat is it?
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CULTUREThe sum total of the way of livingValues
BeliefsStandardsLanguageThinking
patternsBehavioral NormsCommunication
styleGuides decisions and actions of a group.

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End-of-Life ExperienceHow one finds meaning out
of illness, suffering and dying.Explains cause
and effect.Defines role of healers.
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Cultural Makeup of the
United States
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2000 US CensusRespondents self-identified
as65 White13 Black13 Hispanic4.5
Asian/Pacific Islander1.5 American
Indian/Alaskan native2.5 Bi-ethnic
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Increased diversity in population means
increased cultural interactionwith the health
care system
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• Who lives in your community?

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• No two, individuals
• regardless of their locale,
• are the same.

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Multicultural Awareness

• Is
• an attitude
• celebrating differences
• hearing my neighbors voices
• a deeply personal journey
• the right thing to do/way to be

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Multi-Cultural ConsiderationsAgeEthnicityHistor
y of Substance AbuseSpiritual/RitualsEconomicSe
xual orientationNational OriginDiffering
AbilitiesMental IllnessGenderLanguage
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Differences in Health Care ExpectationsInformatio
n sharing (truth telling, sharing bad
news)Decision-makingUse of life-prolonging
technologyHealing SufferingPatient-Physician
relationshipDocumentation of Code status
Advance Directives
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Religion Spirituality
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Spirituality

• is lived faith
• cuts across denominational lines
• sees all of life as a chance to uncover the
  holy
• includes vision, lifestyle experience
• gives ultimate meaning purpose to life
• is the ultimate ground of all of our hopes,
  fears, questions loves
• may or may not be expressed through participation
  in a religion

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Religion

• is the framework people put around their
  spiritual beliefs
• Includes
• organizational participation
• private religious behavior
• doctrines, activities, moral codes, individual
  corporate rituals, practices

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Spiritual Careisdiscoveringreverencingand
tending to the spiritof another person.-Rev.
Joseph Driscoll
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• The journey with another
• begins
• with your self-awareness.
• Everything builds on that.

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WHO ARE YOU?

• Cultural/spiritual profiles personal and
  heart-searching
• What are five categories that help to define you?

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Your Spirituality meets Anothers

• Ask yourself-
• What does my faith have to do with this
  situation?
• How do I invite the other to share?

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• Dietary restrictions
• End of life rituals, beliefs, practices
• If I am to be reincarnated, what does that mean
  if I am missing an organ?

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• What is life and death?
• What was I taught in the church/the
  mosque/temple/meeting about suffering/pain? What
  has life taught me?
• In the midst of suffering and pain we ask these
  questions
• Think

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• What is your personal history with suffering?
  From what place do your draw your energy?
• What kind of space do you draw around yourself?
• Awareness of this will help with
• Existential questions people ask

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• Each individuals concept of the Divine
• is what makes each spiritual journey unique.

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Remember the Divine is already present
before You or (I) show up.
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L-E-A-R-NModel Of Cross-Cultural Guidelines for
Health PractitionersLISTEN with sympathy and
understanding to the patients perception of the
problemEXPLAIN your perception of the
problemACKNOWLEDGE and discuss the differences
and similaritiesRECOMMEND treatmentNEGOTIATE
agreementBerlin Fowkes 1983
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Kleinmans Explanatory ModelWhat do you call
your problem? What name does it have?What do you
think caused your problem?Why do you think it
started when it did?What does your sickness do
to you? How does it work?How severe is it? Will
it have a short or long course?
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Kleinmans Explanatory Model(continued)What do
you fear most about your disorder?What are the
chief problems that your sickness has caused for
you?What kind of treatment do you think you
should receive?What are the most important
results you hope to receive from treatment?
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Communication ConsiderationsWho to talk to,
about whatUse of InterpreterPersonal
spaceTouchStyleEye contactBeliefs/expectations
regarding role of health care providersBeliefs
regarding formalized documentation of Code Status
and Advance DirectiveTime orientation
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• The Invitation
• by
• Oriah Mountain Dreamer
• www.oriahmountaindreamer.com

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For further informatione-mailDonna.L.Soltura_at_hi
tchcock.orgLinda.F.Piotrowski_at_hitchcock.orgor
DHMC Palliative Care Service603-650-5402