CULTURAL COMPETENSE, SPIRITUALITY AND OF END-OF LIFE CARE

Dr. Elas Ortega Drew University

AGENDA
OVERVIEW OF THEME LEARNING OBJECTIVES INTERACTIVE ACTIVITY RELIGION, SPIRITUALITY, AND END-OFLIFE ETHICS PRESENTATION Q&A

CULTURE, RELIGION, SPIRITUALITY, AND END-OF-LIFE ETHICS PRESENTATION: PRELIMINARY COMMENTS

I SEE MYSELF AS A FACILITATOR: YOU ARE AN EXPERT AND SEASONED CARE PROVIDER. YOUR WISDOM, EXPERIENCE, AND CREATIVITY WILL ENRICH WHAT WE DO. WHY SPEAK ABOUT RELIGION, SPIRITUALITY, AND ETHICS AND THE END-OF-LIFE.
RELIGION AS A MEANING MAKING PRACTICE. RELIGIOUS PRACTICES AND TRADITIONS ARE HISTORICAL, DYNAMIC, IN CONSTANT CHANGE. THE SENSE OF AN ENDING CULTURAL DIFFERENCE SHAPE OUR UNDERSTANDING THE PROCESS OF DYING DIFFERENT

LEARNING OBJECTIVES

ENGAGE A CONVERSATION OF CULTURAL/ETHNIC EXPRESSIONS OF RELIGIOUS IDENTITY

HIGHLIGHT STRATEGIES FOR PROMOTING CULTURAL COMPETENCE AND ITS POTENTIAL IMPACT IN HEALTH CARE PRACTICES. STIMULATE SELF-REFLECTION ON HEALTH CARE.

INTERACTIVE ACVITITY
EACH ONE OF YOU RECEIVED THREE INDEX -CARDS. FOR EACH CARD WRITE ONE OF THE FOLLOWING:
1. ONE TALENT YOU HAVE 2. A RELATIONSHIP/PERSON THAT IS DEAR TO YOU 3. A HOPE OR A DREAM YOU ARE STRIVING TO FULFILL REFLECT ON HOW YOUR SELF-UNDERSTANDING OF YOUR CULTURE SHAPE YOUR MEANING OF THESE THINGS.

RELIGION, SPIRITUALITY, AND END-OF-LIFE ETHICS

IN A MULTICULTURAL AND MULTIRELIGIOUS SOCIETY AS THE UNITED STATES, IT IS TO THE ADVANTAGE OF HEALTHCARE PRACTITIONERS TO DEVELOP CULTURAL COMPETENCE. MORE OFTEN THAN NOT, RELIGIOUS PRACTICES MAY BE SEEN AS A LIABILITY TO TREATMENT INSTEAD OF AN ASSET.

WORKING DEFINITIONS

Religion

Spirituality
Multiculturalism/Ethnic Diversity

RELIGION

THERE IS NOT ONE GOOD DEFINITION OF RELIGION. A SET OF PRACTICES, BELIEFS, RITES, TRADITIONS THAT CONNET PEOPLE/COMMUNTIES TO THE SACRED. THEY ARE ALSO RELATED TO CULTURAL UNDERSTANDING.

PUBLIC PRACTICES

SPIRITUALITY
IT ATTEMPTS TO CAPTURE INTERNAL/PERSONAL DEVOTIONAL PRACTICES THAT GROUNDS THE SELF TO SACRED. PRIVATE PRACTICES. OFTEN TIME OUTSIDE OF THE BOUNDS OF RELIGIOUS ORTHODOXY. Although religion and spirituality are complementary they are not the same thing: RELIGION : Public Manifestations of devotional practices and communal life. SPIRITUALITY: Internal states, piety, experiences of transcendence .

DIVERSITY
DIVERSITY IS THE BUZZ WORD WHEN IT COMES TO MULTICULTURALISM/ETHINIC IDENTITIES. WE NEED TO BE CAREFUL WITH OVERGENERALIZATION PERTANING CULTURAL/ETHNIC IDENTITY:
THERE IS NO SET BASELINE OF THIS IS HOW LATINOS/HISPANICS ARE. GENERAL CHARACTERISTICS VS INDIVIDUAL PREFERENCES

WHEN IT COMES TO END -OF-LIFE CARE BEING AWARE OF CULTURAL PREFERENCES GAINS SALIENCE:

MULTICULTURALISM AND ETHNIC DIVERSITY

WE LIVE IN A GLOBAL VILLAGE: DIFFERENT TRADITIONS, PRACTICES, RELIGIONS COME TOGETHER IN GEOGRAPHICAL SPACE.

MYCOMMUNITY, THEIR COMMUNITY,OUR COMMUNITY: WE ARE ON THIS TOGETHER.

SNAPSHOT 1: RELIGIOUS DIVERSITY IN N.J.

INTERESTING FACT: THERE ARE OVER 230 RELIGIOUS TRADITIONS BEING PRACTICED IN THE U.S.A. RELIGIOUS TRADITIONS PRESENT IN NJ:
CATHOLIC 42% (24% NATIONAL). EVANGELICAL/ MAINLAND PROTESTANT 12-3% (18-26% NATIONAL) UNAFFINILATED 12% (16% NATIONAL) JEWISH 6% (2% NATIONAL) HINDU 2% (-.5% NATIONAL) BUDDHIST, MUSLIMS,OTHERS 1% (1-2% NATIONAL)
(Data from Pew Religious Forum , http://religions.pewforum.org/maps )

SNAPSHOT 2: RACIAL/ETHNIC DIVERSITY IN N.J.

From the 2010 Census:
White persons-74% (Persons reporting 1 race) White-non-Hispanic 58% Black Persons-14.6% Hispanic/Latino-18% (Hispanic may be of any race) Asian 8.7% Persons of two or more races: 1.9%

Foreign Born 20% New Jerseians claim a language other than English as first language.

TOP 5 LANGUAGES SPOKEN IN NJ OTHER THAN ENGLISH

SPANISH (11%) HINDI MANDARIN-CHINISE HATIAN CREOLE PORTUGUESE

(Data from Office of Minority and Multicu ltu r al Health, State of New Jersey Departmen t of Health, http ://www.n j.gov /h ealth / o mh /lan gu ag e.sh tm l )

IMMIGRANTS COMMUNITIES: PERCEPTIONS OF CARE

INEQUALITY IN TREATMENT
LANGUAGE BARRIER STEREOTYPES NO CLEAR UNDERESTANDING OF TREATMENT

IF RELIGIOUS
CARE PROVIDERS DO NOT GET MY FAITH COMMITMENT WESTERN MEDICAL PRACTICES AND VIEWS ON PRIVACY AT ODDS WITH HOW WE MAKE DECISIONS. GOD WILL HEAL ME! PLEASE WOULD YOU PRAY FOR ME?

BARRIES TO CARE

STRUCTURAL: ACCESS TO CARE, LIMITED RESOURCES

CULTURAL: TRAINED TRANSLATORS, VARIOUS CULTURES INTERACTING LEADING TO MISCOMMUNICATIONS. INDIVIDUAL: WILLINGNESS TO ENGAGE STRESSORS: LATENT CULTURAL BARRIERS AND/OR LATENT RACISM (INDIVIDUAL/INSTITUTIONAL) ALL THESE ARE HIGHTHENED AT THE END -OF-LIFE

EFFECTIVE CARE IN A MULTICULTURAL SETTING

CULTURE REFERS TO A CONSTELLATION OF SHARE MEANINGS, VALUES, WAYS OF INTEREACTING THAT SHAPE HOW PEOPLE MAKE SENSE OF THE WORLD AND HOW THEY COPE WITH FEAR OF THE UNKNOWN. MULTICULTURAL SETTINGS REQUIRES CULTURAL COMPETENCY OF CARE PROVIDERS:
FIRST STEPS IN BECOMING A CULUTURAL COMPETENT CARE PROVIDER:
RECOGNITION THAT WE INHABIT CULTURAL SPACES COMMUNICATION (LANGUAGE) AND EMPATHY ASK QUESTIONS: GOOD QUESTIONS PREVENTS FUNCTIONING OUT OF STEREOTYPES COMPASSION

CULTERAL COMPETENCE GOES BEYOND TOLERATION -IT STRIVES TOWARDS CELEBRATION:

IT HAS TO DO WITH LEARNING TO WORK EFFECTIVELY IN A DIFFERENT CULTURE: TO VALUE, TO RESPECT.

END-OF-LIFE CARE AND CULTURAL COMPETENCE

DISPARITY ON READINESS WHEN IT COMES TO END-OF-LIFE DECISION MAKING AMONG COMMUNITIES OF COLOR. THE MAIN OBSTACLE: THE NOTION OF AUTONOMY:
US HEALTH MODEL IS BASED ON A MEDICAL DECISION -MAKING MODEL THAT VALUES THE AUTONOMY AND PRIVACY OF THE INDIVIDUAL BUT OTHER CULTURES THAT VALUE COMMUNICAL DECISION MAKING PROCESS. AUTONOMY VS COMMUNAL. AT FACE VALUE, OUR MEDICAL SYSTEM NOT BE FLEXIBLE TO ACCOMMODATE THIS DISTINCTION.

END OF LIFE DECISION: WHO DECIDES? HOW? WHY?

MEDICAL CONTEXT
THERE ARE A SETS OF MEDICAL TREAMENT PROCEDURES AND LEGAL PARAMETERS THAT ESTABLISH DECISION MAKING PROCESS.

COMMUNAL
DIFFERENT ETHNIC AND RELIGIOUS COMMUNITIES HAVE DEVELOP WAYS TO DEAL WITH END-OF-LIFE DECISIONS. INFORMED/UNINFORMED OF THE MEDICAL/LEGAL PROCESS VULNERABILITY

CULTURAL DIFFERENCES
AUTONOMY
BASED ON PRINCIPLES DNR, POWER OF ATTORNEY ARE WAYS TO PROLONGUE AUTONOMY PHYSICIAN ARE EXPECTED TO PROVIDE SCIENTIFIC EXPLANATIONS/NOT SUPPORT AUTONOMY IS ALSO A CULTURAL CONSTRUCTION

CULTURAL-BASED
VARYING EMPHASIS ON AUTONOMY OR REDEFINING THE LOCUS OF DECISION MAKING AS COMMUNAL BENEFICENCE/NONMALEFI CENCE: PROTECTING THE PATIENT FROM SUFFEREING PHYSICIAN/CARE PROVIDER: EXPECTED TO PROVIDE A WORD OF HOPE

BEING PROACTIVE
BEING PROACTIVE IN OUR PART AS CARE GIVERS CAN FACILITATE THIS PROCESS. SOME EFFECTIVE PRACTICES:
ASK QUESTIONS:
WHAT IS THE DEFINITION OF THE FAMILY (EXTENDED, NUCLEAR, BLOODKIN)? ADHERENCE TO RELIGIOUS PRACTICES VIEWS ON GENDER ROLES, CARE OF CHILDREN AND OF ELDERS WHAT ARE THE COMMUNICATION PATTERS: DIRECT, INDIRECT, EMPHASIS ON VERBAL/NON-VERBAL PERSPECTIVES OF SUFFERING, AFTERLIFE. WHAT/WHO WOULD MAKE YOU FEEL MORE CONFORTABLE?

CONSIDERATIONS WHEN DEALING WITH ASIAN/ASIAN-AMERICAN COMMUNITIES

DIRECT INFORMATION OF A TERMINAL ILLNESS MAY BE INTERPRETED AS CRUEL AND UNCARING. THIS NEWS IS THE FAMILYS BURDEN NOT THE PATIENCE. BAD NEWS MAY BE SEEN AS DETRIMENTAL TO HEALTH. AN EXPECTATION OF CARE PROVIDERS TO HAVE A WORD OF HOPE. DIRECT KNOWLEDGE OF MORTALITY MAY BE SEEN AS SELF-FULFILLING: YOU SPEAK SOMETHING INTO EXISTENCE REVERENCE TO AGING FAMILY MEMBERS/THEY SHOULD NOT BE BURDENED UNNECESSARILY ILLNESSES CONSIDERED AS A FAMILY MATTER AND NOT INDIVIDUAL

AT THE END OF LIFE

FOR MANY ASIAN/ASIAN-AMERICAN END OF LIFE DECISIONS ARE SEEN AS A SHARE DECISION MAKING PROCESS THAT INVOLVES THE PHYSICIAN: THIS IS A SHARE PROCESS. FOR ASIAN/ASIAN-AMERICAN, INDIANS, AFRICANS, AND MANY HISPANICS THE RESPONSIBILITY FOR THE AILING AND/OR ELDERLY IS PART OF THE FAMILY UNIT-THIS IS AS ODDS WITH THE WESTERN PREFERENCE OF AUTONOMY. THIS COLLECTIVE PATTERN ALSO NEGATIVELY IMPACT THE ACCEPTANCE OF ADVANCE DIRECTIVES.

LATINO/A-HISPANICS
LIKE MANY ASIAN/ASIAN -AMERICAN, LATINOS/ASHISPANICS VALUE COMMUNITY BASED DECISION MAKING. RELIGIOUS LANGUAGE AND PRACTICES (TRADITIONAL/NON/TRADITIONAL) GAIN PREVALANCE AS A WAY TO COPE, ENCOURAGE HOPE, AND GET THINGS IN ORDER. FEAR: LEGAL STATUS, LANGUAGE BARRIER, RELATIONS WITH FAMILIES. LACK OF KNOWLEDGE GENERATIONAL DIFFERENCES.

WHAT TO DO
PAY ATTENTION TO COMMUNICATION PATTERS:
ASK ABOUT WHAT CULTURAL ISSUES MAY AFFECT COMMUNICATION. TRAINED TRANSLATORS

HOW THEY WOULD LIKE TO BE INFORMED ABOUT HEALTH ISSUES: DIRECTLY? INDIRECTLY? INCLUDE FAMILY MEMBERS? WHO IS ABLE TO MAKE DECISION
IF INFORMATION/DECISION MAKING POWER IS TO BE SHARED/PASSED TO A FAMILY MEMBER: TO WHOM?

ELLICIT INFORMATION AND RESPECT/FOLLOW CULTURAL PREFERENCES REGARDING DISCLOSURE, AND CARE DIRECTIVES. IF ASKED TO PARTICIPATE IN A RELIGIOUS CEREMONY: ASK FOR GUIDANCE. YOU ARE BEING ASKED BECAUSE YOU ARE VALUED.

CULTURAL WORK IS HARD WORK

HAVE PACIENCIA: WITH OTHERS AND WITH YOURSELF ASK QUESTIONS CLARIFY SHARE INFORMATION CELEBRATE LIFE

HEALTH-CARE PRACTITIONERS: FRONT-LINE AT THE BEDSIDE

HEALTH-CARE PROFESSIONALS OFTEN HAVE TO MANAGE THE LEGAL ASPECTS OF END -OF-LIFE ISSUE WHILE SUPPORTING GRIEVING FAMILIES. THE GRIEVING PROCESS IS UNIQUE AND COMPLEX:
ANGER FRUSTRATION SADNESS UNRESOLVED ISSUES

BURN-OUT:
SIGNS:
DEPRESSION, ANGER, TIREDNESS, DISAFECTED.

HEALTH-CARE PRACTITIONERS AND BURNOUT

THE NEED TO ENGAGE IN PRACTICES OF SELF -CARE:
AN INVITATION TO BRAINSTORM WITH ME

THE ROLE OF EMPATHY: WHATS NECESSARY?

HONESTY AT TIMES SAYING AND DOING. PERFORMANCE MIGHT BE NECESSARY.

SELF-CARE: INTEGRAL TO SUCCESSFUL TREATMENT

A CARE PROVIDER THAT IS PHYSICALLY, EMOTIONALLY, AND SPIRITUALLY HEALTHY IS AN ASSET TO THE INDIVIDUALS AND FAMILIES FACING A TERMINAL ILLNESS.

Q&A