Culture, Spirituality, and Loss Lecture NUR 120 FA24 PDF

Culture, Spirituality, and Loss NUR 120 By Shawn Jeune, DNS, MS, APRN-ACNS, RN, CST, CNOR  Culture &Vulnerable Populations Homelessness Poverty Mentally illness Physically disabled Vulnerable...

Culture, Spirituality, and Loss NUR 120 By Shawn Jeune, DNS, MS, APRN-ACNS, RN, CST, CNOR  Culture &Vulnerable Populations Homelessness Poverty Mentally illness Physically disabled Vulnerable populations can be Some ethnic and considered Young Elderly racial minority subcultures of groups major cultural groups  Conversation Starters What were some birthday traditions in your family growing up? What was important to you as a child about birthdays? Do you keep up those traditions? How and when does your family celebrate the new year? · What tradition do you have around new babies? How do you celebrate the coming of a new baby? What do you do for the arrival? Anything within the first year? Describe a Thanksgiving tradition that you enjoy. (Remember, for people who did not grow up in the US, or who are children of recent immigrants, Thanksgiving is not generally celebrated in other countries.) What was a food served in your family growing up that you really didn’t like? If you wanted to serve a visitor a meal that would help them to understand your cultural heritage, what meal would you serve? What kind of knowledge do you need to become culturally competent?  Theoretical knowledge: Health-related needs, beliefs, behaviors; culture specifics  Self-knowledge: Recognize and be aware of biases; resist judgmental attitudes  Helps to These influence understand health client behavior Why is it Important to Awareness of *Knowing the why clients tendencies for Understand from different cultures have certain problems can Cultural different expectations of health guide you int he assessment of your client* Specifics?  How to Provide Culturally Competent Care  Respect.  Advocate  Identify alternative to harmful practices  Take the time to understand the individuals' beliefs, practices and values  Recognize there are differences among individuals that belong to the same cultural group  Use a medical interpreter to overcome language barriers  Communicating with clients who speak a different language...  Must be a facility approved medical interpreter  Do not use family/friends  Direct questions to the client, not the interpreter  Face-to face interpretation by trained person  Telephone interpreters  **Healthcare interpreters must be used to obtain informed consent and assist with understanding treatments plans**  Bringing Nursing Theory to Practice The Purnell model for cultural competence: teamwork in providing culturally sensitive and competent care = improve outcomes for individuals, families, and communities (Purnell, 2014; Purnell & Paulanka, 2013). Purnell’s model defines cultural competence as “adapting care to be congruent with the patient’s culture” (Purnell, 2014, p. 5). Levels of cultural competence: 1. Unconsciously incompetent—not being aware that you lack knowledge about another culture 2. Consciously incompetent—being aware that you lack knowledge about another culture 3. Consciously competent—learning about the client’s culture, verifying generalizations about the culture (e.g., archetypes), and providing culture specific interventions 4. Unconsciously competent—automatically providing culturally congruent care to clients of diverse cultures (Purnell, 2013). ***Increasing one’s consciousness of cultural diversity improves the possibilities for healthcare practitioners to provide culturally competent care. How Should I Respond to Cultural Health Practices? Theory Guided Practice Negotiation: The client’s perspective may differ from yours about the effects of a particular practice. Negotiation acknowledges that gap. Key Point: You must negotiate when folk or traditional practices might be harmful to the client. Repatterning/Restructuring occurs when you attempt to change your actions or the client’s lifestyle (Leininger, 1991; McFarland & Wehbe-Alamah, 2018). While still respecting his cultural values and beliefs, you would support and encourage the client to significantly modify his behaviors and to adopt new, different, and beneficial health behaviors. Case Study:  A Japanese American client is  Is your client truly experiencing no pain? transferred to your unit s/p and  Is her response reflective of her beliefs? open exploratory medical procedure.  *It is important to NEVER draw  She refuses pain medication; assumptions. however, her nonverbal cues Communicate with your client. indicate that she is in a great deal of pain. Ask her if she is experiencing pain.  She continues to refuse pain Ask her about beliefs surrounding pain medication when offered for medication... the remaining passing hours. Use non-pharmacological techniques  Possible Effects of a Patient’s Cultural Health Practices Efficacious (Helpful) Ex: Bringing ethnic foods that are appropriate for the client’s prescribed diet. Nursing approach: Encourage practices that will likely improve client health and help her preserve cultural values related to health. Neutral (Neither Helpful nor Harmful) Ex: Some people associate good health with eating properly and fasting to cure disease; using specific ingredients Nursing approach: There should be no harm in allowing a patient to continue a neutral health practice. You would not want to interfere with these neutral practices. Uncertain (Unknown by You) Ex: A client drinks a daily smoothie that consists of certain herbs and spices such as ginger, cinnamon, and basil for “good health.” Nursing approach: You can neither encourage nor discourage these practices until you obtain more information about them. Do this as soon as possible. Dysfunctional (Harmful) Ex: A client may refuse to give prescribed medication to her child. Nursing Approach: Discourage folk practices that may cause harm. In such instances, you should support and enable the client to adapt to biomedical therapies (repatterning/restructuring) or negotiate with the client to achieve satisfying outcomes. What nursing interventions are appropriate? o Assess your client, offer alternative pain relief methods o Discuss pain management goals explain that 0-3 is tolerable, now ask her to rate her pain from 0- 10 o Have an open conversation! Ask her beliefs on pain medication o Document what worked, what didn't and the patient's response to the intervention  Culturally Competent Care Improves Patient Outcomes! Establishes a therapeutic provider-client relationship Trusting relationship sets a foundation for mutual goal setting and compliance Patients will provide more information that help providers understand their practices and desired outcomes Puts aside stereotypes and biases to ensure care is provided Better patient utilization of healthcare services Digital Stories: Culture & Ethnicity https://www.fadavis.com/product/nursing-fundamentals-me d-surg-fundamentals-of-nursing-2-volum e-set-wilkinson-treas-4 Spiritual Assessment Do you have spiritual beliefs that help you cope with stress?  Faith: Do you have spiritual beliefs that help you cope with stress?  Implication, Importance or Influence: How do your beliefs affect how you make life decision? How do these beliefs impact your current situation?  Community: Is there a group of people you meet or interact with regularly, who share these beliefs  Address: How would you like these personal beliefs to affect your health care? Will it affect how you make treatment choices?  Spiritually Competent Care: Nursing Interventions  Identify the client's perception of a higher power  Look for cues: environmental, behavioral, verbal  Allow for time/resources for practicing religious rituals  Provide privacy during times of prayer, meditation and/or reading religious texts  Utilize pastoral care as needed i.e.: chaplain  Awareness of dietary/care restrictions  A. Does not follow the tenets of a specific faith B. Is in denial about his religious The nurse notes on the admission form that the beliefs client has indicated “no religious preference.” C. Does not believe in God or a “higher power” What does this indicate to the nurse about the D. Will not want to pray or visit with client? the chaplain  Loss vs. Grief What is Loss? Any loss of a desired object, person, situation Not always associated with death Perception of loss changes throughout a lifetime What is Grief? Grief: Response to loss Mourning: Actions Bereavement: Adjustment Categorizing Loss Actual vs Perceived loss Physical vs Physiological loss External loss Loss of relationship Environmental loss This Photo by Unknown author is licensed under CC BY-NC-N What affects one's ability to grieve?  Significance of loss  Support system  Unresolved Conflict  Previous or multiple losses  Spiritual Beliefs  Timeliness of death This Photo by Unknown author is licensed under CC BY-NC-N  Case Study: Mr. Austin Mr. Austin's wife, Anne, is told that the resuscitation attempts have failed, and her husband has passed away. Anne bursts into tears screaming “You must be talking about someone else’s husband!” “Mine has to be alive!” The provider leaves the room, the nurse places their hand on Anne's shoulder. After 45 minutes of attempting CPR the health care team was unsuccessful resuscitating Mr. Austin. The nurse and provider leave the room to speak with the client's wife. What stage of grieving do you think Anne is experiencing? This Photo by Unknown author is licensed under CC BY-NC. Mr. Austin After a few minutes of silence with the nurse, Anne requests to say goodbye to Mr. Austin. The nurse What should the nurse do to asks another nurse to sit with Anne prepare Mr. Austin? while she prepares Mr. Austin for Anne to say goodbye.  Mr. Austin One year later Anne is still unable to talk about the loss of her husband. She has immersed herself in work and always stays busy. ​ What type of grief reaction may she be experiencing?  Grief Reactions Normal/Uncomplicated Anticipatory Complicated Disenfranchised Masked Chronic Nursing Assessment History of loss Knowledge base Coping pattern/ability Support system Cultural & spiritual needs Determine funeral home preference Assist with calling family members Determine advanced directives ***  Advanced Directives  Health Care Proxy: a person appointed to make health care decisions if you are no longer able to do so  Living will: provides specific instructions to guide their proxy  DNR/DNI  Assisted Suicide  Euthanasia  Autopsy  Organ Donation https://www.compassionandchoices.org/stories/ana-romero  Hospice Care Palliative Care Holistic care for Provided for a long period patients who are of die for slowly actively dying progressive diseases Provider must certify Establishes continuity of that they will likely die care within 6 months Addresses emotional and Focused on dignity in spiritual concerns death Focused on symptom Family respite management 24/7 nursing support Promotes informed Follow up bereavement decision making care for the family  Encourage verbal and nonverbal expression Take your time providing care FA C I L I T A T I N G GRIEF Do not compare their loss to your experience!!! Memory recall through discussion or reviewing photos  Continuity of Care  Hand off/ Shift report  Recognizing your own bias  Contacting CDT  Cultural considerations: Contact the chaplain  Contacting hospice or palliative care  Neuro consult to determine brain death as appropriate  END of life assessment Increased sleep, nutrition 1 to 3 months prior to death changes 1 to 2 weeks prior to death Physical and cardiovascular changes, temperature Days to hours prior to death fluctuations Moments prior to death Energy surge, dysphagia, dehydration Unresponsive, apneic  Education for the Client/Family  Teach the family what to expect: Cheyne stokes breathing, buildup of resp. secretions​  Signs of discomfort & when to notify the nurse: labored breathing, groaning, restlessness​  Incontinence ​  Unresponsiveness​  Continue to communicate with the individual  Therapeutic Communication Listen. Encourage expression of emotions Reassurance of feelings (anger, relief, or other) Nonverbal communication: touch, eye contact, physical presence Self-awareness. Communicate with your client, even if they are unresponsive or comatose  The "Death Rattle": Nursing Interventions  Raise the head of the bed to 30 degrees  Turn the client on their side  Contact MD for anticholinergic medications or administer PRN dose i.e.: scopolamine patch, atropine  Medicate for other symptoms such as labored breathing, nausea, anxiety, agitation  Post-mortem care Maintain privacy Remove all tubes ** Unless organ donation/medical examiner's case Clean and align the body supine some cultures may prefer to have spiritual representative clean the body Apply fresh linens, cleanse the body of any fluids Remove "clinical" items from the environment Honor the decisions of the family for viewing Clarify where personal belongings should go Fill out post-mortem paperwork as required by facility Apply identification tags per facility policy POST-viewing The Uniform Anatomical Gift Act (UACA) General donors must Next of kin can Relatives cannot be 18+ request donation, revoke one's years/emancipated unless known donation minor objection by client The individual making Organs will often not the donation can be procured if there revoke or amend is a strong family decisions at any objection time Organ donation  https://donatelifecalifornia.org/education/faqs/religious-views-on-organ-donation/  https://www.organdonor.gov/learn/who-can-donate/religion Maria Gonzalez  Age: 55 years old  Background: Hispanic, Catholic  Presenting Problem: Maria was admitted to the hospital following complications from a stroke. She has a history of hypertension, diabetes, and obesity. She has limited mobility and is currently on a ventilator in the ICU. Maria Gonzalez  Maria has two adult children who are actively involved in her care. She is deeply religious and has expressed concerns about the spiritual aspects of her health, particularly about the possibility of death. She has requested a visit from a priest for last rites but is also concerned about her family’s ability to handle her passing.  The nursing team must address Maria’s physical, emotional, cultural, and spiritual needs while providing care and support for the family during this critical time. Question 1 How should the nurse address Maria’s cultural and spiritual concerns when planning her care? A. Focus primarily on the physical aspects of care, as Maria's family will handle the spiritual matters. B. Encourage Maria’s family to address her cultural and spiritual needs without involving hospital staff. C. Collaborate with Maria’s family and request a Catholic chaplain to visit, respecting her religious beliefs and preferences. D. Avoid discussing spiritual concerns with Maria, as it may worsen her emotional state. Question 2 Maria has expressed concern about the possibility of death and the impact it would have on her family. Which nursing intervention is most appropriate to help her cope with these fears? A. Reassure Maria that her condition is not as serious as it seems and that she will recover. B. Encourage Maria to suppress her thoughts of death and focus only on recovery. C. Facilitate a conversation about her concerns with her family, and encourage her to express her fears. D. Suggest that Maria avoid discussing death with her family to prevent distress. Question 3 Maria’s family members are concerned about her potential loss and are struggling with how to support her. Which action should the nurse take to assist the family in coping with this potential loss? A. Directly tell the family that Maria may not survive and suggest that they prepare for her death. B. Recommend that the family take a break and leave the hospital to avoid witnessing Maria’s suffering. C. Encourage the family to stay with Maria, provide comfort, and consider their own emotional and spiritual needs during this time. D. Advise the family to focus solely on medical interventions and not to think about loss until absolutely necessary. Question 4 Which of the following is an example of culturally competent care when managing Maria’s end-of-life concerns? A. Insisting that the family accept all medical treatments and avoid spiritual practices. B. Offering Maria’s family a private space for prayer and spiritual rituals, in line with Catholic practices. C. Suggesting that the family avoid speaking about death and focus only on Maria's physical care. D. Promoting the use of pain medications as the sole method of managing Maria's distress. Question 5 As Maria’s condition deteriorates, she becomes less responsive, and her family is concerned about her comfort. Which of the following interventions would best promote Maria’s comfort while also honoring her cultural and spiritual beliefs? A. Administer pain medication to ensure Maria’s comfort, and allow her family to guide decisions regarding her spiritual care. B. Withhold pain medication to avoid hastening death and allow Maria to remain conscious. C. Suggest to the family that they limit their visits to prevent Maria from becoming overwhelmed. D. Administer pain medication but discourage family members from staying at the bedside to focus on medical care.