End of Life Care – Cultural Considerations
The term culture can be defined as the ideas, customs and social behaviours of a particular group of people. A person’s culture can be influenced by many things, including (but not limited to) where that person lives, their religion, their family background and social circumstances, gender, and personal experiences. Given all of these different influences, it is important to note that despite some people having similarities, each person’s culture is highly individualised.
When it comes to end of life care, a patient’s culture will impact on how this care should be delivered. Their culture will affect their decisions (or their families’ decisions) about factors such as whether or not to accept treatments such as resuscitation, blood transfusion and continued use of respirators, as well as other medical interventions such as pain relief. They may need to participate in certain cultural rituals near the time of death or immediately afterwards, and this may require nurse involvement. In order to fully support patients and their families during end of life care, we need to deliver culturally competent practice. The American Nurses Association describe culturally congruent practice as “the application of evidence based nursing that is in agreement with the preferred cultural values, beliefs, world view and practices of the healthcare consumer” (2015, p31). Culturally competent practice is also an aspect of patient centered care. Communication is key to exploring patient’s cultural needs when they are dying, and this should be something you should be able to feel comfortable doing with patients and their families.
Delivering culturally competent nursing care at the end of life may involve communicating more with certain people in different areas of nursing. For example, nurses working in intensive care wards may be less knowledgeable about their patient’s requirements (for example in trauma cases where loss of life is unexpected) and care delivery may need to be guided more by the family’s needs and wishes. Whereas nurses working in long term care or with patients with chronic health conditions may be able to help that person (and their family) plan for their own death guided by their own values and beliefs.
When delivering culturally competent end of life care it is important to note that your own culture may differ to your patient’s culture. If this is left unexplored it can sometimes make it difficult to understand and accept some of their decisions or practices. To be fully able to deliver culturally competent practice in end of life care for patients and families, it is necessary to adopt a non-judgemental attitude to cultural differences. Understanding your own culture and how it may differ from that of your patients is key to doing this. The US is a very diverse country and you will be caring for patients and families from many different religious and cultural backgrounds, who may have very different views and practices from your own. It is very important that you do not allow your own beliefs to interfere with the quality of care that you deliver during end of life care.
However, if there is a particular area of the patient or family’s cultural beliefs or practices that you are having difficulty accepting, speak to your unit manager or peers, or participate in clinical supervision sessions if they are offered by your organisation. It is important to acknowledge these feelings if you experience them, and talking about them usually leads to better acceptance of how individuals deal with the concept and process of death and dying.
Using continued education to improve your knowledge and skills around end of life care will help you to develop confidence in this area. This can have a positive effect on how you communicate with patients and families, and make the whole experience better for all of those involved. Adopting an overall healthy lifestyle and having good support and coping mechanisms will also enable you to better fulfil your role in nursing end of life patients.
American Nurses Association. (2015). Nursing: Scope and Standards of Practice. 3rd Edition. Silver Spring, MD: ANA.