Cultural+Awareness+Surrounding+Death

** Tutor: Abbey **

 * Cultural Awareness Surrounding Death? **


 * Cultural Artefact**

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This video is asking the question to health care professionals, about how culturally clued in are they in our hospital and emergency services. It speaks about cultural competency and how important it is that our health care providers are culturally sensitive and aware of their patient’s background of beliefs and values based on their culture. There are many traditions and customs that are practised by different cultures around the globe and health care professionals in Australia need to understand these cultures as there is now a wide range of ethnic groups living in this country.


 * Public Health Issue**

The public health issue being addressed is the importance of understanding and not misunderstanding the culture of patients in a hospital or emergency setting, specifically talking about death. There are many problems including ethnic, racial, or cultural disparities that exist at all levels of health care. (Kemp, C, 2005). As a result of these disparities there can be a lack of services and under-treatment of patients and populations, which can translate to unnecessary suffering and poorer outcomes for minorities. This is seen especially for those who are foreign-born and of non-English-speaking backgrounds. Not only can it lead to poorer outcomes but also if there is no cultural awareness then patients from different cultures can be easily offended or hurt and the quality at the end of their life is not being fulfilled by our health care services.


 * Literature Review**

Research of this public health issue shows that this is a problem not only here in Australia but all around the world. The main issue that we are dealing with is the understanding of different cultures within our health care services. This has become more of an issue in recent times because of the large percentage of different ethnic and migrant groups that are continuing to move into western societies. In 2008 in Australia for example, migrants accounted for over half of Australia’s net population increase in the year to March, figures released by the ABS show that there were 430,000 overseas arrivals during that period. (ABC Premium News, 2008). This goes to show that there is a rapid increase of many different cultures within our country and if our health care services are not culturally competent or aware then there will be many misunderstandings.

Grieving & death rituals vary across cultures and are often heavily influenced by religion. (Clements, 2003). Fourteen masters nursing students from a variety of religious & cultural backgrounds within USA were interviewed about customs & rituals surrounding death, with which they had had personal experience. Similarities and differences in beliefs and practises of death among these groups were identified. (Lobar and Young and Brooten, 2006). Looking at a few of the results from the interviews it’s interesting to see how the different cultures handled death. For example, Mexican American students had a much greater expression of grief compared to Anglo students. Death rituals for Black Americans varied widely because of variation in education, geographic region, and religious affiliations, for example some cry and wail. Others are silent and stoic. Southern Blacks maintain the custom of having the corpse at home for the evening before the funeral. (Lobar, et al, 2006). When a Hindu dies the body is bathed, oil massaged, dressed in new clothes and cremated before the next sunrise to aid the soul’s transition from this world to the next. Rituals are carried out for 10 days and on the 11th day the soul releases its attachment to this world according to Hindu belief. (Lobar et al, 2006). The Chinese emphasise saving face because they believe the more people who mourn for a dead person the more loved they were. Filial loyalty to one’s relative and blessing, luck, fortune, belief in life after life & spirit are important aspects of grieving for the Chinese. (Lobar, et al, 2006). These are just a few examples of the different beliefs surrounding death in different cultures. This is very significant because there is a great difference in the way many ethnic and migrant groups perceive death, according to (Clements, et al, 2003). All cultures have developed methods to cope with death, grief and mourning and so a lack of sensitivity by health care professionals may interfere with the grieving process.

Religion and faith is a very important aspect when looking after a patient who is about to die. While there are some patients who reject spiritual care, it must be noted that religion and faith are a vital part of the end of life care for many people. Providing spiritual care can be a challenge especially when the patient and family are refugees or immigrants. However it is essential that these needs of spiritual care be met as best as possible. According to (Kemp, C, 2005), while patient charts always reflect a religious preference, it is worthwhile to ask the patient and family what faith they follow or have followed in the past. The question of faith in the past is important because many people cease to practise or believe at some point during their life. The onset of a spiritual crisis will most likely bring one back to his or her spirituality.

Immediate aftercare is another issue that must be understood by health care professionals. For example, different cultures practise different customs in the after care of the body. In western society this role is mostly handed over to professionals who are paid for their services of washing, dressing and preparing the body for burial or cremation. The body in this case is separated quickly from the family home and the family members have little to do with the body, (Kemp, C, 2005), whereas In other cultures there may be more family involvement and culturally defined rituals for preparation of the body for death. In Laos for example the body is kept at home for up to 3 days. The family wash, dress the body in white with some clothes on backwards to ward off evil spirits. A coin and answers to riddles may be placed in the mouth. In India only same-sex family members touch the body, it is washed and a cloth tied around the head to keep the mouth closed, thumbs & toes tied, the body is wrapped in red cloth and the head is placed to the south. (Kemp, C, 2005).

Autopsy & Organ Donation is less accepted by traditional cultures than more technologically oriented cultures. Islam- based cultures have resisted autopsy and organ donation because of a belief that the body must go to the grave intact. Disposal of the body is another issue that health care professionals must consider. (Kemp, C, 2005). Some Hindus, Indians want only cremation, others (e.g. Muslim, Iranians) want only burial. Religious and cultural beliefs influence which way head is placed ( e.g. toward the south in India, towards Mecca in Muslim cultures.) Many immigrants and refugees want the final resting place to be in the country of their birth or the town in which they died. (Kemp, C, 2005).


 * Socio Cultural Analysis **

The groups affected are the patients and their families and carers. The carers group includes a wide range of medical professionals: paramedics, nurses, doctors, palliative care nurses, medical administrative staff and others who come into contact with or who serve the patients, eg. visiting ministers, hospital cooks, interpreters, case workers, social workers etc.

Cultural competence is important in the care of those who are dying for so many reasons. There are many diverse cultures (this includes religions ) represented by the patients within Australia. There are also medical staff from varying cultural & ethnic backgrounds. Cultural awareness in the treatment of the dying is necessary in order to provide and treat these patients & their families with the best quality care possible to fully meet their needs at this crucial time of their life’s journey. To offer the best choices for patient and family as death approaches medical staff must be trained in cultural sensitivity and so be able to treat the individual needs of a particular patient with the best possible care available. Cultural competence however is so much more than just the observation of a set of customs or beliefs of a particular group. According to (Lickiss, 2010), cultural competence involves knowledge of communication issues, decision making (ie. how or when the patient/family involved), concepts of disease, meaning of pain, ways death is understood in relation to the rest of life, customs surrounding death & bereavement, burial/cremation, attitudes to medication & diet, privacy issues, spiritual matters, beliefs & rituals.

These issues arise wherever patients are in hospitals, nursing homes, at home, in doctors’ rooms etc. Cultural competence is necessary in all locations but as Lickiss states it is not found in all locations. For this reason the issue of cultural differences in death & dying needs to be discussed. Through discussion awareness is raised and the need for training in cultural competence be made a priority in the education of all those working with dying patients. Discussion will hopefully result in change and in improvements in training in the area of cultural differences in the institutions which need it.

Public Health experts should focus on carrying out more research into the wide & complex range of cultures within Australian society and their beliefs about death & dying and then incorporate the findings into transcultural training programs for medical personnel.

To fully assist dying patients in a culturally sensitive way mixed management should increasingly be the norm. (Lickiss, 2010). The appropriate skills needed to establish a primary care team or specialist may relate to cultural competence and training in this area needs to be improved. With improved training in cultural competence public health will be able to plan and improve services for the future. The ultimate aim should be that healthcare providers are able to apply their knowledge & skill in interactions with their clients and thereby provide culturally competent care.


 * Cultural Artefact Analysis**

The cultural artefact that I chose to use represents the way our health care professionals communicate and work together with those from different ethnicities, cultures, religions and backgrounds. It relates to my topic of being culturally clued in to our health care and emergency services. It shows that countries around the world are becoming more and more culturally diverse and in order for our health care services to continue to progress there must be an understanding between the many cultures that come into contact with one another. In relation to death, (according to Clements et al, 2003), although death is a certainty for members of all cultures, what people experience, believe, or feel after death varies significantly. The duration frequency and intensity of the grief process varies based on the manner of death and the individual, family and cultural beliefs. This shows that beliefs and perceptions about death vary widely across cultures, so as health professionals it is our job to make sure the needs of every culture are met. Personally I’ve learnt a lot from looking at the topic of death and I believe that health care professionals must be trained in this specific area so that they improve their cultural awareness and thereby raise the quality of care given to patients at this most crucial and sensitive time of their lives.


 * References**

Clements, P. & Vigil, G. & Manno, M. & Henry, G. & Wilks, J. & Kellywood, R. & Foster, W. (2003). Cultural Persepectives of Death. Grief, and Bereavement. //Journal of Psychosocial Nursing & Mental Health Services. 41,// 18-27, http://www.slackjournals.com/article.aspx?rid=5016

Niederriter, J, E. (2009). Student nurses’ perception of death and dying. //Cleveland State University,// 16-23.

Eisenbruch, M. (1984). Cross-cultural aspects of bereavement. II: Ethnic and cultural variations in the development of bereavement practices. //Culture, Medicine and Psychiatry, 8,4,// 315-347, doi: 10.1007/BF00114661

Lobar, S. & Youngblut, J. & Brooten, D. (2006). Cross-Cultural Beliefs, Ceremonies, and Rituals Surrounding Death of a Loved One. //Pediatric Nursing, 32(1),// 44-50. http://www.medscape.com/viewarticle/525639

Lickiss, J. (2003). Approaching Death in multi cultural Australia, //The medical Journal of Australia, http://www.mja.com.au/public/issues/179_06_150903/lic10328_fm.html//

Kemp, C. (2005). Cultural Issues In Palliative Care. //Seminars in Oncology Nursing, 21(1),// 44-52. []

Jovanovic, M. (2008). Cultural Competency in Hospice Care: A Case Study of Hospice Toronto. //University of Waterloo,// http://hdl.handle.net/10012/3990

Migrant’s Boost Australia’s Population. (2008). Retrieved from [|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=00e74468-e907-4419-95a9-a7cf5f1a2b55%40sessionmgr110&vid=4&hid=125&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=anh&AN=P6S172824395408]


 * Wiki Reviews**


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