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Cultural Competence in End-of-Life Care


Patricia Sherman, Ph.D., LCSW People must learn their own history and culture in order to understand the importance of history and culture to others. – PowerPoint PPT presentation

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Title: Cultural Competence in End-of-Life Care

Cultural Competence in End-of-Life Care     
Patricia Sherman, Ph.D., LCSW
  • People must learn their own history and culture
    in order to understand the importance of history
    and culture to others.

What are your historical and cultural
backgrounds? How might they affect your approach
to end-of-life issues?
Mourning Rituals From Committee for the Study of
Health Consequences of the Stress of
Bereavement. (1984). Bereavement Reactions,
Consequences, and Care. National Academy of
  • Involve changes in self-concept and transition to
    a new stage of identity
  • Provide for sanctioned public articulation
    of private distress
  • Allow for reincorporation of bereaved into the
    social fabric and reaffirmation of
    their solidarity with the group

Impact of Culture
  • Determines how loss is perceived
  • Provides norms
  • Prioritizes ranking of loss
  • Suggests expectations about social support
    and coping styles
  • Gives rules for ways of regarding and responding
    to death

Factors That May Complicate Mourning in the U.S.
  • Decline of kinship and religion
  • Nuclearization and high mobility of the family
  • Diminished sense of community
  • Disengagement of the elderly
  • Laws governing disposal of dead bodies
  • Place of death
  • Employer leave policies

Factors That May Facilitate Mourning in the U.S.
  • Religious and other social rituals
  • Values and beliefs by which people are comforted
  • Shared norms that provide meaning
  • Networks that supply supportive needs
  • Structures to support emotional expression of
    feelings and needs

Questions to Ponder
  • How are cultural traditions and customs regarding
    death transmitted from generation to generation?
  • What moral and ethical issues relate to
    end of-life care and death and how do people of
    diverse cultural backgrounds react to these moral
    and ethical principles?

  • How are life and death conceptualized
    in different cultures?
  • What are the different roles of religion
    and spirituality?
  • How has history affected the mourning process of
    various cultures?

Questions to Ask from National Cancer Institute,
Loss, Grief, and Bereavement http//
thProfessional Lobar, Youngblut, Brooten.
(2006). Cross-cultural beliefs, ceremonies, and
rituals surrounding death of a loved one.
Pediatric Nursing, 32(1)44-50.
  • What are the culturally prescribed rituals
    for managing the dying process, the deceaseds
    body, the disposal of the body, and commemoration
    of the death?
  • What are the familys beliefs about what happens
    after death?

  • What does the family consider an
    appropriate emotional expression and integration
    of the loss?
  • What does the family consider to be the gender
    rules for handling the death?
  • Do certain types of death carry a stigma
    (e.g., suicide) or are certain types of
    death especially traumatic (e.g., death of
    a child)?

  • What does the immediate family do when a family
    member dies?
  • What do friends and other relatives do when a
    family member dies?
  • What expectations do people have for
    the immediate family and other relatives?
  • How long is bereavement expected to last?

  • What is different if it is a child or adult
    who dies?
  • What meaning is attached to the death of
    an infant or child?
  • How does religious affiliation affect what family
    members do and what is expected of them?

  • Body should be placed on the floor facing North
  • Issue death certificate promptly to
    ensure cremation (unless a child)
  • Post mortem only if essential
  • Only persons of same gender should touch body
    after death

  • Stoic acceptance of death crying discouraged
  • Life seen as transient stage towards Nirvana
  • Close eyes, straighten limbs
  • Family will wash and dress body
  • Lay out body at home
  • Children and adults are cremated stillborn and
    infants are buried
  • Organ donation OK
  • Post mortems only if necessary

  • Dress deceased in white cotton shroud along with
    5 Ks (Kara bangle worn on right wrist serves
    as reminder of faith Kesh uncut hair Kanga
    small wooden or plastic comb, denoting ordered
    and disciplined life Kirpan symbolic
    sword worn under clothes symbolizing protection
    of the weak Katchera special underwear
    symbolizing modesty and sexual morality)

  • Spanish Roman Catholic
  • Vocal expressions of grief expected
  • Prefer to die at home (may believe soul will be
    lost if die in hospital)
  • Family attends to body
  • Prolonged wakes
  • Dead are often worshipped Day of the Dead,
    November 1st and 2nd

Chinese American
  • Combination of Buddhist and Christian religions
    (or none, since religious practice outlawed in
  • Dying at home considered bad luck
  • Quiet expressions of grief (to save face)
  • Mourning reactions often somatized

Chinese Buddhism
  • Clean and dress body in new clothing,
    shoes, jewelry and ornaments after it
    is completely cold
  • Close eyes
  • Seal corpse in coffin
  • Altar set up in front of coffin for
    displaying offerings of candles, flowers,
    incense, and fruits

  • If accidental death, family members go to spot of
    accident to call and escort the soul home
  • Delay sending body to funeral home because of
    belief that before the consciousness has left
    completely, refrigeration, use of chemicals, and
    cremation may cause suffering
  • White piece of paper announcing the death
    is posted outside main entrance to home

  • Temporary altar with deceaseds photo and lotus
    seat is established
  • Visitors come for next 49 days, bringing incense,
    flowers and food for the deceased and present
    money or posters honoring the deceased for the
  • Rituals performed every seven days,
    since Buddhism teaches that consciousness in the
    limbo state goes through dying process every
    seven days

  • Close eyes, cover body with clean sheet
  • Wash and shroud body (unless a martyr then bury
    in clothes they died in)
  • Body treated minimally and quickly with funeral
    service held within 24 hours of death
  • Only men accompany body to gravesite
  • No coffin, if possible body lies on right
    side, facing Mecca
  • Excessive grief a sign of lack of faith

  • Body treated minimally and quickly with funeral
    service held within 24 hours of death
  • Tearing of black ribbon or garment
  • Pallbearers carry casket, stopping seven times to
    commemorate seven stages of life
  • Bowl of water placed in cup at entrance of home
    to dispel spirits of uncleanness

  • Light Shiva candle to begin seven days
    of mourning
  • First meal after funeral is prepared by neighbors
    and friends often contains round foods, such as
    hard boiled eggs and lentils, to symbolize
    cyclical nature of life
  • Recite Kaddish (ritual prayer affirming
    life and faith in God) at graveside,
    anniversary of death, and four sacred times
    during the year

First Nations
  • Each tribe has different cultural practices
  • Avoid contact with dying often prefer to die in
  • Fear of openly expressing religious
    beliefs due to past persecution
  • Discomfort with idea of afterlife place
    large rocks over gravesite