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Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsELNEC- Public HospitalsPalliative Care For Public HospitalsModule 5:Cultural andSpiritualConsiderationsE L N E C Public Hospital CurriculumEnd-of-Life Nursing Education ConsortiumCourse Handouts & Post Test• To download presentation handouts,click on the attachment icon• Presenter discloses no financial relationships with acommercial entity producing healthcare-related productsand/or services. Conflict of interest disclosure andresolution statement is on file with HEN.• This presentation is for educational and informationalpurposes only. It is not intended to provide legal, technicalor other professional services or advice.E L N E C Public Hospital CurriculumObjectives• Identify dimensions of culture and the Influence ofculture and spirituality on palliative care for patientsacross the life span.• Conduct a cultural and spiritual assessment ofpatients facing the end of life.• Discuss beliefs regarding death and dying held byvarious cultures.• State the value of interdisciplinary care in respectingcultural diversityE L N E C Public Hospital CurriculumCopyright Hospice Education Network 20121

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual Considerations• System of shared symbolsCulture Defined• Provides security, integrity,belonging• Constantly evolving• Making meaning of illness• Not limited to race orethnicityE L N E C Public Hospital CurriculumSocial Characteristics of US (CA)• Bachelors degree or higher =27.5% (29.7%)• Foreign born = 12.4%(26.8%)• Speaks a language other thanEnglish at home = 19.6%(42.2%)US Census Bureau, 2005-2009E L N E C Public Hospital CurriculumEconomic and HousingCharacteristics: US (CA)• Median household income (in 2009inflation-adjusted dollars) = $50,221($58,925)• Individuals below poverty line = 14.3%(14.2%)• Owner-occupied housing units = 66.9%(57.9%)• Median value of housing = $185,400($479,200)US Census Bureau, 2010E L N E C Public Hospital CurriculumCopyright Hospice Education Network 20122

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsLanguages Spoken at Home in CA• English = 60.5%• Spanish = 25.8%• Chinese = 2.6%• Tagalog = 2.0%• Vietnamese = 1.3%• Over 200 languages arespoken/read in CAUS Census Bureau, 2000E L N E C Public Hospital CurriculumUS (CA): Race/Ethnicity• Non-Hispanic Whites = 74.5%(57.6%)• Hispanic, Latino = 15.1%(37.6%)• Asian = 4.4% (13.0%)• African American = 12.4%(6.2%)• 2 or more races = 2.2% (3.5%)US Census Bureau (2005-2009)E L N E C Public Hospital CurriculumCA: Religions• Protestants = 36%• Roman Catholics = 31%• Latter Day Saints = 2%• Jewish = 2%• Muslims = 1%• Other = 4%• Non-Religious = 21%Pew Forum on Religion & Public Life, 2008; Wikipedia, 2011E L N E C Public Hospital CurriculumCopyright Hospice Education Network 20123

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsAmericans & Health InsuranceThose With Insurance• 78% have insurance• College degrees• White collar jobs• Receptive to health relatedproducts/concerns• Exercise (bike, golf, usetreadmills)• Buy vitamins• Eat high fiber, low fat• Regular check-ups withMDThose Without Insurance• Live in small towns, ruralcommunities• Modest education• Blue collar jobs• Earn below $25,000/year• Live in low-rise apartments• Roller skate, play bingo, andlove gospel music• 25% are African Americansor HispanicsThe Nielsen Company, 2011E L N E C Public Hospital CurriculumUS Cities With/Without HealthInsuranceTop US Cities WithInsurance• #1: Juneau, AK• #2: Honolulu, HI• #3: San Francisco, CA• #4: Washington, DC• #5: Fairbanks, AK• #12: Santa Barbara, CA• #17: San Diego, CA• #20: Sacramento, CATop US Cities W/outInsurance• #1: Greenwood-Greenville, MS• #2: Harlingen, TX• #3: Meridian, MS• #4: Columbus, MS• #5: Hattiesburg-Laurel, MS• (No CA cities listed in top 20)The Nielsen Company, 2011E L N E C Public Hospital CurriculumHomelessness in America• On average, US cities arereporting a 12% increase inhomelessness since 2009• ~643,000 people experiencehomelessness (1/20Americans)• 58% live in shelters and42% are unshelteredUS Department of HUD, 2009E L N E C Public Hospital CurriculumCopyright Hospice Education Network 20124

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsState of Children: DemographicsUS (CA)– 20% (20%) live in poverty(household annual income$22,350 or less)– 23% (48%) live with immigrantfamilies– 31% (34%) live with familieswhere no parent has full-time,year-round employment– 1.5% (1.1%) born with “verylow-birth weight”– 13% (28%) crowded housingAnnie E. Casey Foundation, 2011E L N E C Public Hospital CurriculumState of Children Demographics (cont):US (CA)• 97% (94%) are UScitizens• 10% (11%) areuninsured• Total Medicaidspending 20.5%(18.6%)Kaiser Family Foundation, 2008E L N E C Public Hospital CurriculumMortality Rates & Causes forInfants/Children/Teens: US (CA)• Infant mortality: 6.8(5.2)/1000 live birth• Child deaths: 19(16)/100,000 deaths• Teen deaths: 62(52)/100,000 deathsAnnie E. Casey Foundation, 2011• Top 5 causes of death– #1: Unintentional injury(motor vehicles,drowning, fire/burns)– #2: Malignant neoplasms– #3: Congenital anomalies– #4: Homicide– #5: Heart diseaseCDC, 2011E L N E C Public Hospital CurriculumCopyright Hospice Education Network 20126

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsUS: Status of the Elderly• 39.6 million Americans are 65or older (1/8 of population)• Median income = $25,877(men)-$15,282 (women)• Nearly 3.4 million elderly(8.9%) live below the povertylevelUS Department of Health & Human Services, 2010E L N E C Public Hospital CurriculumUS Status of the Elderly (cont)E L N E C Public Hospital Curriculum• Those 85 and older arefastest growing segment• Co-morbidities(i.e. arthritis, hypertension,heart disease, hearingimpairment)• 23% over 85 live in aninstitution• 43% of those over 65 diedin a hospitalDerby et al., 2010Cultural CompetenceCulturalAwarenessCulturalDesireComponentsof CulturalCompetenceCulturalKnowledgeCulturalEncountersCulturalSkillCampinha-Bacote, 2003E L N E C Public Hospital CurriculumCopyright Hospice Education Network 20127

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsComponents Within Culture• Ethnicity• Race• Gender• Age• Religion and spirituality• Sexual orientationE L N E C Public Hospital CurriculumComponents Within Culture(cont.)• Differing abilities• Financial status• Place of residency• Employment• Education level• Cause of deathE L N E C Public Hospital CurriculumComponents of Cultural Assessment• Patient, family, community–Birthplace–Ethnic identity–Community–Decision making–Language andcommunicationE L N E C Public Hospital CurriculumCopyright Hospice Education Network 20128

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsComponents of CulturalAssessment (cont.)• Food preferences, prohibitions• Economic situation• Health beliefs regarding–Death–Grief–Pain–Traditional therapies–Care of the body–Organ donationE L N E C Public Hospital CurriculumCultural Considerations ofSpirituality and ReligionE L N E C Public Hospital Curriculum• Spirituality– Meaning-making– Need for purpose ,forgiveness, love, hope,relatedness and religiousfaith– Transcendence• Religion– “Organized”– Institutional beliefsJohnston, 2010FICA: An Example of A SpiritualAssessment• F = Faith• I = Importance,influence• C = Community• A = AddressPuchalski & Romer, 2000E L N E C Public Hospital CurriculumCopyright Hospice Education Network 20129

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsNurse’s Self Assessment of Culture• Self assessment• Cultural beliefs ofco-workersE L N E C Public Hospital CurriculumCultural Considerations ofCommunication• Conversation styles• Personal space• Eye contact• Touch• View of healthcareprofessionals• Learning styles• Language/gesturesE L N E C Public Hospital Curriculum• Who makes thedecisions?Role of the Family• Who is included indiscussions?• Is full disclosureacceptable?E L N E C Public Hospital CurriculumCopyright Hospice Education Network 201210

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual ConsiderationsCultural Influences on DecisionMaking• Beliefs about autonomy and othervalues differ• Disclosure of diagnosis andprognosis• Ascertain desire for disclosureE L N E C Public Hospital CurriculumLanguage Used at the End of Life• “Discontinuation”• “DNR”• “Withdrawing/withholding”E L N E C Public Hospital CurriculumWhen Cultures Clash• Clashes occur• Assess your reactions• Never lie• Offer information• Use cultural guidesE L N E C Public Hospital CurriculumCopyright Hospice Education Network 201211

Hospice Education Network - ELNEC Palliative Care for Public Hospitals - Module 5: Cultural and Spiritual Considerations• Culture is a majorinfluence on end-of-lifecare• Self assessment ofculture• Many dimensions ofculture• Culturally sensitivecare• Interdisciplinary careE L N E C Public Hospital CurriculumConclusionCourse Handouts & Post TestThank you for viewingthis course on theHospice Education NetworkThe Course evaluation and post test areavailable from your course catalog pageTo achieve credit for this course,close the video portion whencompleted and click on Start TestE L N E C Public Hospital CurriculumCopyright Hospice Education Network 201212