Culture has become an integral part of palliative care. As a result, medical professionals handling patients who are terminally ill or are nearing death must be careful on how they treat patients and families from different cultural background. Research studies indicate that culture plays a significant role in modifying families’ behaviors when a patient is at his or her deathbed. As a result, the medical professionals caring for the patients who are terminally ill must be vigilant and cooperates with the family members in a manner that allow them to put into practices their cultural beliefs. Such a situation brings a lot of complex issues in palliative care. The nurses and other medical professionals at the palliative care department must be flexible to adopt the changes in family and patient’s behaviors that are brought about by cultural differences. In this article, the basis of discussion is on the cultural beliefs and practices among the Hispanics during the terminal illness, dying and death. The discussion will further reveals the differences that exist between Hispanic culture and the white culture with regards to cultural practices during terminal illness, death and dying. The discussion will conclude by analyzing the roles of nurses during these times, and the extents to which nursing future is likely to feel the impact of awareness of cultural differences at the palliative care.
Hispanic Cultural Beliefs at Terminal Illness, Dying, and Death in General
Death is unpleasant occurrence in human life. Death results to loneliness, poverty, and crises for those people who are left behind. As a result, people try to care for those who are terminally ill and those who are approaching death to ensure they share essential issues with such a person when he or she is still breathing. It is normally challenging for the family members to know at a glance that a person they love is counting days or hours before he or she becomes a past. As a result, different people react differently to such situations. These include sobbing, mourning and staying away or near the person until he or she dies. It is the same issue with Hispanic people. Hispanic individuals have different beliefs and practices while caring for a terminally ill patient, a dying patient, and death in general. Though many of these beliefs and practices resemble other ethnic groups, a good percentage of them are unique to the Hispanic individuals.
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The Hispanic cultural beliefs promote the act of togetherness at the time of terminal illness. Emotional support is critical in giving the family members a hope of the patient’s survival. At this time, family members come together and conduct prayers for the patient. The burden of caring for the patient who is terminal ill rests on the shoulders of a female family member. During this time, a family member who cares for the patients is unlikely to call for outside person to help in caring for the patient. In Hispanic culture, the terminally ill patient is unlikely to seek medical attention at a nursing home or the hospital. These individuals prefer staying with a terminally ill member at home ( Pruitt et al., 2016). While at home, they conduct prayers and care for them until death do them apart. Also, this is the time the family members sit around the thermally ill member, and discusses different things that affect their lives, and also solve minor disputes between the family members and the patient.
As the patient’s condition worsen off and the patient reaches the dying stages, sorrow and grief is the culture that reigns among the Hispanic individuals. Togetherness becomes paramount among the family members. At this time, there is no hospitalization, and the Hispanics do not prefer taking their patients to hospices or nursing home when they are at their dying stages. The culture allows the anticipatory grief among the family members following the news that the family member is seriously ill, and is nearing death ( Irish, Lundquist & Nelsen, 2014). Further, the family members also feel the pain of a loss before the death occurs, and women have a chance at this time to grief without breaking down in front of the dying member. Also, prayer is critical at this point. A local priest from the Catholic Church may lead the prayer continually for the period the patient will remain to breath. In a case where the patient is taken to the hospital or hospice, the situation is different. First, the doctor should not deliver the news directly to the patient. The Hispanic culture views this act as way of subjecting the patient into more pain that may lead to death within a short time. Also, the doctor needs to refrain from shouting the result or discussing them when the patient is hearing him or her ( Pruitt et al., 2016). The culture is shameful among the Hispanic. The doctor needs to understand that Hispanic members prefer an indirect communication of medication, test result, and the patient’s progress. Instead of discussing with the patient, the doctor needs to explain anything with the family members. It is upon the family members to device a mechanism of passing the message to the patient in a friendlier manner. Lastly, breaking the news of death to the patient who is nearing death is not a culture among Hispanic. For instance, the daughter of a hope patient explains the situation when she was given pamphlet narrating the condition of the mother: “They gave me a pamphlet of what to expect. It explained all the steps my mother would go through until the day she would die. I did not want to read it. It was a plan or a guide I did not want to know or want to do. They told me I had to read it to be prepared. Even though it was practical advice about how to handle “the end,” I felt it was very drastic”( Pruitt et al., 2016).
Death is a painful moment among the Hispanic people. After death, the body undergoes preparation for burial. The family members and friends held a wake-up event. A wake-up event is a social event where people come up and sit around the family of the deceased and chat together making stories which focus on the positive things the dead did during his or her days on earth. During the wake-up events, drinks and food grace the occasion. The body does not take long before burial. Burial follows the traditional beliefs of the Catholic Church. The priest must be present to conduct the mass for the dead. Further, an open grieving and mourning is a norm among the Hispanic mostly during burial. After the funeral, the family gathers and eat together. It is also the time for comforting those who are grieving.
Hispanic Vs. the Caucasians
Caucasians (white) also have their culture and practices during the time a family member is terminally ill, dying or dead. A review of the culture and norms among the Caucasians during these times show a sharp difference in culture that is critical for nurses working at the palliative care department. Also, it is notable that though the two ethnic groups have different approaches to handling the situations during terminal sickness, the dying stage, and death in general, some practices are similar.
Unlike the Hispanics who prefer to have their terminally ill patient under their care at home, the Caucasians prefer hospitalizing the terminally ill patients. It is unethical and extreme insanity to have a patient who is at a critical condition at home. The family must organize and take the patient to a clinic, nursing home or a hospice. It is a belief among Caucasians that the hospital is the only place the patient can get help. At this stage though, there is a similarity between the two ethnic groups with regards to care for the terminally ill patient. In both case, the family members always stay around the patient consoling him or her until she or he dies ( Pruitt et al., 2016). Unlike the Hispanics who majorly grant the task of caring for the terminally ill patients to the women, the job is spread among all members despite the gender among the Caucasians. The situation is also different with regards to communication between the patient, family members and the doctors among the two ethnic groups. Among the Hispanics, there is indirect communication. The doctor has to talk to the family who will then find a friendly means of addressing the patient. However, the issue is different among the Caucasians. In their case, there is direct communication between the doctor and the patient. At the stage of terminal illness, the patients among the Caucasians normally seek to know every single information as a way of preparing themselves for the worse or the best. At this point, they have the power of autonomy, and they can still make any decision that affects their lives. It is at this point that they can decide to request a peaceful death such as physician-assisted suicide.
A similar situation is seen in the case of a dying patient. While in both ethnic group, prayers are something crucial when a person is at his or her deathbed; the Caucasians do not pre-mourn. Sorrow engulfs the family, but they do not show it until the person dies. At the dying stage, the Caucasians stay close to their patient like Hispanics. They share a lot of issues including confession and a will that grants the family properties in case of the patient pass away. The patient can make a special request for families at this point. Communication about his or her health progress is still critical at this point. They need health staffs to tell them their progress so that they can prepare for their final departure. Upon death, the post-mortem has been a tradition among Caucasians ( Irish, Lundquist & Nelsen, 2014). Like their Hispanic counterparts, the dead body takes few days before the burial. Grieving is a tradition among the Caucasians after burial or crimination in a situation the patient wrote a will for this procure.
The Role of a Nurse during Palliative Care
A nurse has different roles during palliative care. First, they act as teachers. The patient relies on the nurses at this stage for demonstrations on how to use drugs and take care of themselves in a manner that subject them to less pain. The family members also rely on the nurses to teach them the best ways of taking care of the patients. The nurses also act as caregivers. They are experts who take care of the patient at this time. They ensure that their patients get well ( Harrison, Crowther & Adnan, 2018). Their roles, in this case, include assessing pain, giving the right medication, and also assessing the patient progress. Other than these, nurses act as advocates for the patents who are dying or are at critical conditions. Advocacy is a vital and challenging role a nurse must carry out to ensure that the patient under his or her care makes the right decision. These include intervening in case ethical issues such as euthanasia are in question. They also make interventions in situations where the family is requesting a physician-assisted suicide and much more ( Harrison, Crowther & Adnan, 2018). During this time, the nurse also acts as the messenger. The nurse act as a messenger between the doctor and the patient. They also serve as messengers between the patient and family members.
Application
As a nurse, it will be critical to consider culture while interacting with the patients and family members. When interacting with a patient or a family member from a Hispanic background as a caregiver, the priority will mostly be on the family members. Communication will be between the nurse and the family members to act in accordance with their culture. However, direct contact will be possible for a Caucasian family or patient. Also, multicultural education will be critical for the staffs to help them acclimatize with different cultures to avoid frustrating the patients. Lastly, allowing the family members to associate and be close to their terminally ill patient will be a priority. It will include allowing them to perform different rituals for their patient as long as they satisfy their tradition and cultural practices.
In summary, culture is a critical factor during end-of-life care. On Hispanic perspective, the patient demands a total peace and any communication should be between the doctor and the family members. Togetherness is critical among the family members during the process of illness until death. On the other hand, Caucasians value freedom until they die and as a result, they need constant communication from the doctors. The nurses have a role as teachers, caregivers, messengers and advocates during the end-of-life care. The knowledge of the importance of culture at the end-of-life care is critical in making nursing practices culture oriented.
References
Harrison Dening, K., Crowther, J., & Adnan, S. (2018). An Admiral Nursing and hospice partnership in end-of-life care: Innovative practice. Dementia , 1471301218806427.
Irish, D. P., Lundquist, K. F., & Nelsen, V. J. (2014). Ethnic variations in dying, death and grief: Diversity in universality . Taylor & Francis.
Pruitt, S. L., Tiro, J. A., Xuan, L., & Lee, S. J. C. (2016). Hispanic and immigrant paradoxes in US breast cancer mortality: impact of neighborhood poverty and Hispanic density. International journal of environmental research and public health , 13 (12), 1238.
