grief & culture. our journey today defining grief consideration of culture the barrier is not...

Grief & Culture

Our Journey Today

Defining Grief

Consideration of Culture

The Barrier is Not Culture

Communication & Preparation

Walk Beside the Family

Cultural Assessment Questions

Defining Grief

“Grieving is a necessary passage and a difficult

transition to finally letting go of sorrow - it is

not a permanent rest stop.”

(Dodinsky)

What is Grief?

Comes from the Latin word “gravis” meaning “heavy”

The process of experiencing the psychological, behavioral, social, and physical response to the perception of loss (Rando, 2000)

Grief

Is a natural reaction to loss

Is a healthy emotional response for dealing with loss

Acknowledges, honors & expresses feelings connected to loss

Grief can occur in response to loss of anything one values or is attached to

Grief is also…

Complex and individualized phenomenon

Each individual and family grieve in their own way

Strongly influenced by culture, experiences and role models

Considerationof Culture

Culture is…

Shared values, traditions, norms, customs,

teachings, arts, history, folklore, and institutions of a group of people.

Consider culture because it…

Helps us to understand the values, attitudes and behaviors of others

Helps us to avoid stereotypes and biases that undermine our efforts

Plays critical role in development and delivery of services responsive to needs of recipient

Our Challenge

How do you as professionals work with patients and

families who are from diverse cultures and who may have perspectives different from

your own?

The Barrier Is Not Culture – It Is Us

The Personal

We have our own…Values, attitudes and behaviors

Life experiencesLevel of stressStereotypes and biases

Personal Introspection

Need for understanding culture and how it relates to our approach to service delivery

Need to possess warmth, empathy & genuineness

Need for respect and compassion for those different than one’s self

Beliefs

Develop awareness of our own beliefs

Recognize people from other cultures may not share these same beliefs

Challenge assumptions you may have of a person’s cultural beliefs and customs

Helps families express their thoughts and feelings

Facilitates exploration of alternatives

Provides information to make informed choices

Recognizes factors affecting people’s ability to choose among viable alternatives

The Professional

Plays critical role in development & delivery of services responsive to needs of families

Influences… How we listen What we hear How we process information How we make decisions How we carry them out

The Intersection…

What are some of the values, beliefs,

attitudes, behaviors, life experiences, levels of

stress, stereotypes and biases I feel and bring

to the work with families?

Ask Yourself …

Communication & Preparation

Cultural Dialoguing

Inquire

Integrate multiple perspectives

Uncover & examine assumptions

Unfold shared meaning

Ask Yourself…

When talking with someone who has a different opinion than me, I tend to:

Discuss (debate) Dialogue

Guidelines

Avoid ethnocentrism

Suspend judgments

Make no assumptions

Listen towards understanding

Listen to needs, views & concerns

Inquire out of genuine curiosity

Reflect

Walk Beside the Family

Do Not Assume

Do not assume a person who belongs to a particular cultural group follows the culture’s usual practices and beliefs. Always ask about the individual’s

beliefs,practices, and preferences.

Language

Be aware of need for interpreter

If family speaks English but it is their second language, then ask if they would like an interpreter

Use an interpreter so family member does not need to interpret Could prove embarrassing

or upsetting to translate Culture may impact

translation

ListenListen, listen, listenDo not always need to say

something Allow for silencesListen in nonjudgmental and

accepting mannerDo not offer solutions or try to

“fix” person’s feelingsAsk open-ended questionsAttend to nonverbal

communication

Communicate

If family talk about loss, do not avoid or change subject

Accept you cannot take away the family’s pain; they need to work through it & this takes time

Provide reassurance and affirm the normalcy of their grief reactions

Honor Feelings

Be open to the family’s emotions & thoughts

Do not use phrases such as “I know exactly how you feel” or “I can imagine how you are feeling; instead, “I cannot begin to imagine how you are feeling”

Honor Word Choice

Use of different phrases: pay attention and use

Cross the river

Walk on

Passing to other side

Going to the spirit world

Touch

Ask before touching (i.e., holding a hand or giving a hug) as touch may not be

appropriate in some cultures.

Eye Contact

Pay attention to and honor the type of eye contact that

the family uses.

Cultural Assessment Questions

(Adapted from Lum & Arnold, 2009)

Beginning the Discussion

“In regard to organ donation, are there any special customsor beliefs that I should know

about as we begin talking together?”

Who Should be Involved?

Would you like me to speak with you alone or you and your family?

Decision-Making

Communal or Individualistic? Do you prefer to make

medical decisions or would you prefer that others in your family or community make them for or with you?

Practices and/or Restrictions

Are there aspects of medical care that you wish to forgo or have withheld because of your cultural beliefs?

Is anything discouraged or forbidden?

Practices and/or Restrictions

Are there specific practices or restrictions that are important to honor at the time of death or afterwards?

Unique Cultural Values

What concerns do you have about organ donation?

Are there things that are important to you or your family that I should know about?

Unique Cultural Values

Is there anything that would be helpful for me to know about how you and your family view organ donation?

Are there cultural beliefs, practices, or preferences that I should be aware of?

Dedication

This work is dedicated to the terminally ill elders who sacrificed precious hours of their remaining

days to share their dying experiences and to teach me about dying.

After all...how can we, the living, teach others about dying? We

cannot. The dying are our teachers and we the pupils.

I am deeply grateful to have been their pupil.

Tracy Schroepfer

University of Wisconsin-Madison

tschroepfer@wisc.edu

Contact Information