End of life care varies across the globe. Different cultures have various traditions, beliefs, and most importantly particular actions that are unacceptable. Working in the health field means that all health care professionals must be educated, empathetic, and aware of what is expected of them to insure every patient receives the care that is respectful to them. Though this level of care should be equal to any human being, the need for cultural and spiritual sensitivity in patient care is still a heavily debated topic. A lack of time, varied beliefs, and attitudes limit the discussion and actions taken by health care providers. This paper will examine three different cultures and their specific end of life palliative care beliefs, focusing on how this affects health care professionals participating in their care.
In broad terms culture deals with the arts, behaviors, beliefs, religion, food, and day to day interactions. Culture is rooted in traditions, though many are constantly changing to present day standards. Though culture does adapt, there are pillars that are fundamental to their foundation. Ideology stems from a culture and can categorize their set of ideas, values, and beliefs accepted by that culture. Values differ from culture to culture but are the principles and ideals upon which a culture exists. Ethnocentrism is an evaluation of a culture that is not the origin of oneself.
This evaluation stems from preconceptions coming from the base values and customs of that individuals culture. These aspects of culture create a group of people that share a foundation of beliefs. These principles have differences in many different places around the world but need to be understood by health care professionals to provide adequate and appropriate health care. Many cultures have values and ideologies when it comes to end of life and palliative care, thus being respectful to these is necessary living in a country that has many different cultures residing in it.
Influence on End of Life and Palliative Care
The concepts of culture, values, ethnocentrism, and beliefs follow people throughout life including their health and their expectations of care delivered to them. Many different groups around the world have a variety of values specific to them. How health care providers perceive and understand this can improve care outcomes for everyone involved. There are disparities in care planning that exist between minority groups in the United States and health care providers; understanding this is essential moving forward. Many cultures have different ideas as to what the end of life means. Religions worldwide play an important role in shaping cultural understanding of life and death (Murray, 2013). In Muslim cultures, death is believed to be the decline of physical forms, but the spirit is continuing forth and that death is the pathway towards the next life (Quran 3:185, Oxford World’s Classics edition).
Within the Chinese culture the use of Buddhism, Confucianism, and Chinese medicine provides a different approach to death. Chinese culture advocates that death is a natural part of life, but the possibility of a good death is influenced by their religion and beliefs. Western cultures fall on religion, but even so in this large body of people, different ethnicities value different levels of intimacy and care. African American individuals value their close family and tend to rely on religion heavily. Following health care advice strictly is more common in western cultures as it is influenced by western medicine and care. Although this culture may have more attentive health care providers, religious preferences such as a chaplain coming to the hospital or asking for prayer is still very important to many in this area of the world.
These different concepts in cultural beliefs influence the way health care professionals should plan end of life palliative care. Differentiating between these diverse cultural beliefs, while time consuming, allows for health care workers to provide adequate care to their patients in end of life palliative care. Language barriers, communication, incorporating spiritual and religious beliefs, values, practices, family roles, and expectations for care are all ways that health care providers must participate in care for groups differing from their own. By utilizing these concepts of end of life palliative care, every individual is given the opportunity to feel confident in sharing the cultural beliefs that shape end of life wishes.
Culture-specific Impact on EOLPC
Providing end of life palliative care for individuals of European descent in the United States generally meets adherence with western medicine. End of life care is accessed by this group as it is believed that health care professionals can provide comfort when nearing the end of life. The use of sedatives to ease pain and suffering is accepted. Access to a chaplain, request for prayers, and baptisms are easy to access as well. Families participate in comfort measures, but individuals choose what will happen when they relinquish decisions to their family if desired. A health care provider of European culture must provide care for a patient with any cultural background. Muslim culture varies differently in expectations for end of life palliative care. Muslims may prefer lowering their intake of sedative drugs to have the ability to recite prayers (Davidson, Boyer, Casey, Matzel, & Walden, 2013).
Sedatives are not a necessity from health care providers and if a patient does not want the warranted amount the health care provider would not have to give them it. Muslim cultures emphasize the importance in gender roles in their culture, and women in the past have not held positions in health care. Though this is changing, a male patient may not be comfortable with a female health professional. This may make that patient uneasy and should be respected. Cultural and spiritually diverse resources used at the end of life such as sacred text, prayer rugs, and rabbis are scarce.
As a nurse providing end of life care for an individual, being able to provide these resources should be prepared and equipped to provide wholistic care to this patient. Providing end of life palliative care for a patient influenced by African American culture revolves around family and religion. African American culture utilizes sedatives for comfort measures, but pain thresholds vary from that of other cultures and many individuals rate pain at a lower scale. Respecting the patient and providing the amount of sedative desired for comfort should be a priority for the health care provider. African American cultures hold religion closely and often reject advance directives limiting life-sustaining treatments since they are going against God’s will, reflect a lack of faith, and reject the possibility of a divine miracle (Loike et al., 2013).
As a health care provider, being respectful of any patients wishes will provide more comfort at the end of life. The availability of prayers and chaplains make for a smooth transition between European decent and African American cultures. Ease of suffering for family members is important in end of life care for this culture and providing access for families to speak to the individual and provide support on the death bed is valuable to this culture. Providing comfort and ease of access to what certain cultures need is an important for health care provides partaking in end of life palliative care.
As a nurse it is very important to be able to connect with any individual of the same or different culture. Knowing the proper religious or spiritual needs of a patient is something that I believe is very important when it comes to end of life palliative care. As many cultures have their own beliefs of what happens to them after death, being able to comfort them both psychologically and physically is a priority. Taking the time to learn a variety of cultural health beliefs for the end of life would greatly increase my cultural competence when delivering end of life palliative care.
Culture, ideals, and beliefs affect end of life palliative care in different ways. Evaluation of different cultures around the world displays the vastness of beliefs and practices. Health care providers are expected to provide end of life palliative care not only by the way they were taught, but in respect to the patient that is in front of them. Language barriers, communication, spiritual and religious beliefs, values, and expectations for care are all ways that health care providers must participate in care for groups differing from their own. The ability for health care workers to do this provides passage and comfort for the terminal patient. Moving forward from the preconceptions and thoughts of some heath care workers will allow for greater patient care. A holistic approach will provide guaranteed care for every individual regardless of culture, thus improving nurse-patient relationships.