cultural hospice and palliative report
TRANSCRIPT
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Cultural Competence in
Hospice and Palliative care
GROUP 2B**Albano Nicole **Lucas Allan**De Rosas Jency Ann **Rabano Darlen Joy**Javier Jean **Yoma Paolo
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Cultural Competence
*Refers to a dynamic, continuousprocess of awareness, knowledge, skill,interaction and sensitivity.
*Seeking to become more culturallycompetent requires learning in :
- Attitudes - Beliefs- Values - Cognitive or
intellectual- Feelings - Critical thinking- Psychomotor or behavioural domains
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Cultural competence is an on going
process, not an end point
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identify 4 components necessary inpursuing
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Cultural Awareness
* Is their understanding of the differences betweenthemselves and people
from other countries or other backgrounds,
especially differences in attitudes and values
*Begins with an examination of ones ownheritage, familys practices, experience andreligious or spiritual beliefs.
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*Each member of the hospice and palliative
care team brings his/her cultural andphilosophical views, education, religion,spirituality, and life experience to the care
of the patient and family.
*Assessing ones own attitudes, beliefs and
practices surrounding the end of lifeprovides and important cultural awareness
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Cultural Knowledge
*Since Culture is the prevailing norms, practices, belief,values etc., knowledge about these can be described asCultural knowledge.
*Serve as a guide to assist the hospice/palliative care teammembers in gaining a better understanding of anindividual and family
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Cultural Skill* Cultural skill in hospice and Palliative care is required for
competency
*Skills that can be acquired:-Cultural assessment
-Cross cultural communication
-Cultural interpretation
-Appropriate Intervention
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*Multiple tools are available to assesscultural behaviour. These tools focus on:
-Religion-Health related Beliefs and practices-Nutrition
-Socioeconomic-Considerations- education
- communication-values orientation-cultural aspects on disease
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Cultural Encounter
Individuals meet each other with their own conditions,
prejudices and level of education. Just as we do with
people from our own country, we should try to see, listen
to and understand our fellows even if they come from a
foreign place.
Such an encounter is a process in which understanding
is created whilst the parties make an effort to establish
contact, a common foundation and a common language.
We encounter cultures through the people we meet.
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It is one between individuals and must therefore
always be characterised by respect and
openness to the Others worldview. It is
extremely important to regard the Other as ahuman being, a person, an individual with his or
her own feelings, values and goals to which I
should react as politely, wisely and warmly as
possible.
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Hospice and Palliative care issuesinfluenced by Culture
-Nutrition
-Decision Making
-Pain management
-Death and dying rituals
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Nutrition
Across cultures, food is used in building or maintaining human relationships
Food is used in rituals, celebrations, and rites of passage to establish and maintain social andcultural relationships with families, friends, andothers.It serves to assess social relationships or interpersonal closeness.
For centuries, food has been used to assess,
treat and prevent illness.
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Dietary patterns of cultural groups need tobe assessed and integrated into the planof care. When working with the patientsand families to identify foods that affect thesymptoms, it is important to consider food
practices that are culturally significant.
Its important to ask the patient or family if
involving a leader in their cultural or religious group may be helpful in makingfood and fluid decisions.
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Decision makingPatient Self-Determination Act (PSDA) of 1991, health care decision
making shifted from the physician to the patient.
Act was the result of social change and the consumer rights
movement in the early 1970s in the United States.
Based on the belief that patienthas an inherent right to
information relevant to health
care decision making. The
assumption is that patient wants
control over the dying process.
Advance Directives were
initiated as a result of PSDA.
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4 values that provide foundations for the
PSDA and end-of-life decision making in
America include:
Patient autonomy
Informed decision making
Truth telling
Control over the dying process
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This is the Euro-American vision of healthcare. It
assumes that the individual rather than the family or
other social group, is the appropriate decision maker.
But many non-Euro-American cultures do not embrace
this vision or these values.
In many non-Euro-American cultures the concept oninterdependence among family and community members
is more valued than individual autonomy.
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Many cultures are family-centered rather than
individualistic, and would prefer that the family, rather
than the patient, receive and process information.
Autonomy may not be seen as empowering, but rather
may seem burdensome to patients already too sick to
make meaningful choices.
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Some non-European cultures do not approve of
full disclosure. This Western practice of blunt,
truthful communication is seen as rude and
disrespectful in some cultural groups. These
families prefer to receive threatening information
and filter it before telling their loved ones. This
practice is to believed to encourage patients to
maintain hope.
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Hospice / palliative care team members must consider
the harm that may occur when the medical community
violates cultural practices. It may be helpful to explain
the Euro-American perspective to enhance
understanding and present needless suffering.
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It is essential for hospice / palliative care
team members to be aware that ethical
norms in the United States are guided by a
Euro-American perspective and may not
be appropriate in other cultures.
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Pain management
Pain is a highly personal and subjective experiencedinfluenced by cultural learning. Pain is whatever the
person says it is, and existing whenever the person says
it does. Patterned attitude of pain behaviors exist in
every culture as demonstrated by Zoborowskis classic
work. Pain tolerance varies from person to person
depending on numerous factors such as past
experiences with pain, coping skills, motivation to endure
pain and energy level.
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Assessment of pain can be identified using terms thatdescribe pain intensity across most cultural groups.
Pain, hurt, ache are words commonly used bypersons of different ethnic and educational backgroundsto describe pain. It is important to standardize theassessment and not rely on culturally laden painindicators such as facial expression, body movement,and vocalize to assess pain.
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Comprehensive pain management
involves pharmacologic and non
pharmacologic interventions may improvethe ability to alleviate pain. Healing
practices to cultures should be offered to
patient and family
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DEATH RITUALS IN MUORNING
PRACTICES
The meaning of death, and how it is recognized, acknowledged, and
celebrated, varies among cultures
.
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It is the responsibility of the Hospice/Palliative
care team to learn about these rituals andweave them into a culturally meaningful context
for the pt and family
Most cultures have specific rituals that begin
before death and may last for months or even
years after death
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In helping family members deal with death,the hospice/palliative care team must shoerespect for the familys cultural heritageand encourage the family to identify howthey will commemorate the death of their loved one
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Family Questions Regarding Cultural
Traditions In Dealing With Death
What are the prescribed rituals for
handling dying, the dead body, the
disposal of the body, and rituals to
commemorate loss?
What are the groups beliefs about
what happens after death?
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What do they believe about
appropriate emotional expression and
integration of a loss experience?
What are the gender rules for handling
the death?
Are certain deaths particularly
stigmatized or traumatic for the group?
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It is important to recognize that cultures differ in public expression of grief.
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During the dying experience and after
death, the major tasks of the grief
process are universal regardless of the
cultural differences.
Accept the reality of the loss.
Feel and experience the pain of grief associated with loss.
Begin to adjust to an environment without the deceased and begin
the transformation to new society and family roles.
Withdraw emotional energy from the dead and focus energy on the
living.
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