End of Life Issues

Cultural Viewpoint of the End of Life

NURS 412 - Palliative Care
Purpose of Assignment
The purpose of the End of Life Issues paper was to discuss an experience from clinical
that presents an end of life issue and the ethical dilemma associated with it. It allowed the student
to be aware of ethical strategies used in making decisions. The ANA Code of Ethics and the
professional standards of the association of Hospice and Palliative Care Nurses were required to
be referenced.
The purpose of the Cultural Viewpoint of the End of Life Paper was to increase student
awareness of cultural difference with the End of Life by investigating a cultural/religious group
other than their own views aging, grieving, death, and dying.

Student Approach to Assignment

For this assignment, I used two palliative care papers: The End of Life Issues paper and
the Cultural Viewpoint at the End of Life Paper. In this assignment, I reflected on different
aspects related to palliative care and treatment; particularly pain management and end of life
choices. This assignment allowed me to learn how autonomous decision making and dignity in
death provides comfort and peace to the patient and family. It also allowed me to understand
another cultures' (East Asian) perspective on the end of life and how nursing cultural awareness
is important in providing patients with the care they desire at that time.

Reason for Inclusion of the Assignment in the Portfolio

This assignment was included to display my understanding of end of life issues, such as
palliative care and treatment. In the assignment the following objectives are highlighted:

 Professionalism
 Demonstrates accountability for ones own professional practice
 Example: In the End of Life Issues paper, I discussed a patient with a DNR order that
was not followed, and she was resuscitated at the order of her daughter. She was
forced to stay alive which resulted in continued suffering from her many ailments as
well as incurring additional medical bills. The patient was very upset with the
situation and requested that she not be given any food or any further nursing care as
she wanted to take matters into her own hands and let nature take its course. I
empathized with the patient and her autonomous decision-making but was also faced
with a moral dilemma as it was my job to provide nursing care to her.
 Understands the effect of legal and regulatory processes on nursing practice and health
care delivery, as well as limits to one's own scope of practice.
 Example: In the End of Life Issues paper, I discussed end of life legal rights for
patients with terminal diseases and nursing scope of practice. Within the nursing
scope of practice, nurses are required to possess knowledge and skills to manage pain
for patients with terminal illness. Also, it is within the nursing scope of practice to
support the patient's autonomy in end of life decision-making. Nurses can provide
patients with autonomy by providing palliative care as aid-in-dying is only legal in
Oregon.
 Culture
 Demonstrates sensitivity to personal and cultural definitions of health, and how those
beliefs influence an individual's reactions to the illness experience and end of life.
 Example: In my Cultural Viewpoint Paper, I stated that understanding a patient's
culture by having open communication at the end of life is important. I discussed the
dilemma in the East Asian culture where talking about death or dying is taboo and is
viewed as causing bad luck to the family. Therefore, East Asian patients that are
terminally ill do not discuss end-of-life due to it being seen as disrespectful. Pain
management is also a problem in this situation because families are unwilling to
allow the healthcare provider to discuss these end-of-life issues with the terminally ill
family member and this sometimes gets misinterpreted as a refusal of pain
management treatment. However, in the Chinese culture, it is important for patients
that are dying to have a "good death" which involves being pain-free.