Advanced Effective Communication, Cultural Competence, and ...

A Roadmap for Hospitals
Chapter Four: End-of-Life-Care
decision-makers and family members whose preferred
language is not English or who have sensory or
communication impairments to facilitate involvement
in end-of-life care. *
• Make sure that appropriate communication supports
are in place during care discussions; staff should not
rely on the patient’s family or friends to interpret.
• Notify the surrogate decision-maker and family of
ongoing opportunities to ask questions. Encourage the
surrogate decision-maker and family to write down
questions for discussion with the care team.
❑ Address patient mobility needs during
end-of-life care.
Patients receiving end-of-life care may develop new or
additional mobility needs. The patient also may be at an
increased risk for falls.
• Assess whether the patient needs mobility assistance,
including the type of and circumstances in which
assistance is required.
• Determine whether the patient requires
accommodations (such as adaptive switches or an
intercom call system) to access the nurse call system.
• Make sure appropriate precautions are in place to
prevent falls. Some hospitals post a sign above the
patient’s bed or door or use special colored socks or
bracelets to identify a patient at risk for falls.
• Note the need for mobility assistance in the medical
record and communicate these needs to staff.
❑ Identify patient cultural, religious, or
spiritual beliefs and practices at the
end of life.
Cultural, religious, or spiritual beliefs can affect the
patient’s or his or her family’s perception of illness and
how they approach death and dying. End-of-life situations
often trigger distress and reduce the patient’s ability to
cope, communicate, and participate in care decisions.
• Ask the patient if there are any cultural, religious, or
spiritual beliefs or practices that may ease his or her
care at the end of life.
• Consult a professional chaplain, whenever possible,
when staff identify a patient entering the end-of-life
phase of care. The chaplain can complete a spiritual
assessment and may have screening questions to
Helpful Tip: Cultural, Religious,
and Spiritual Considerations at the
End of Life
Each patient has unique beliefs and preferences, and several
cultural, religious, and spiritual considerations may arise
during end-of-life care. Staff should respect the patient’s
needs and approach the following issues with sensitivity:
• Openly discussing death and dying
• Completing advance directives
• Acknowledging the end of life
• Discussing organ and tissue donation
• Performing rituals prior to and after death
• Positioning or touching the patient as death
approaches
• Identifying the individuals the patient wants to be
present during the dying process and at death,
including family members, friends, religious leaders,
and cultural leaders
• Removing and disposing of tubes and needles
• Using sedation
• Washing of the body
• Moving the body after death
• Allowing individuals to remain with or near the body
after death
identify religious practices, relaxation techniques, and
other coping resources.
• Make sure that staff are aware of any garments,
religious items, or rituals important to the patient
during end-of-life care.
• Provide an area or space to accommodate the patient’s
and family’s need to pray. In addition, ask the patient
and family if there are specific times of day to avoid
scheduling tests or procedures in order to respect
religious or spiritual practices.
• Note any cultural, religious, or spiritual needs at the
end of life in the medical record and communicate
these preferences to staff.
❑ Make sure the patient has access to his
or her chosen support person.
The patient should have an opportunity to identify an
individual to provide emotional support, give comfort,
and alleviate fear at the end of life. A patient that did not
* See Chapter 6: Organization Readiness: Provision of Care, Treatment, and Services (page 40 and 41) for additional information on providing
language services, auxiliary aids, and augmentative and alternative communication resources.
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