A Culturally Competent Caregiver at the End of Life

Tacy Silverberg-Urian, RN, BSN, CHPN and author of “The Last Mile of the Way” writes:
 "I begin to develop a trusting relationship with my patients, which makes them comfortable with disclosing even more personal desires for their EOL vision. This process takes time and commitment on the part of the practitioner, with the goal of gathering information and determining how best to honor patients’ cultures, beliefs, and values.

 For example, I would honor and respect the request of a Cuban patient’s family to avoid using the term “hospice” in front of their loved one, my patient; for an Orthodox Jewish family, I would defer to their rabbi for their Halachic pathway; and for a lesbian family that may not be biologically connected, I would invite those close friends they define as family to their family meetings.

The process of becoming a culturally competent provider involves a never-ending commitment to learning, listening, and melding care with patients’ needs and requests. It involves knowing the people you serve so that your patients are not solely responsible for your education. In Culture and Nursing Care: Pocket Guide, Lipson and Steiger (2000) describe the process of working toward cultural competency as follows:

By itself, information about a specific culture/ethnic group does not make for culturally competent care, but neither can good care be provided in its absence. Many nurses believe that one does not need to know about a patient’s culture to provide good nursing care; good clinical skills and interpersonal sensitivity are enough. However, we believe that nurses must know something about their patients’ sociocultural backgrounds. It is too easy to inadvertently insult a patient when nurses act only on what they feel is correct, which is usually based on their own values and education.  

Cultural information by itself can interfere with care if nurses use it in a cookbook manner and attempt to apply cultural facts indiscriminately to a patient of a particular ethnic group. Cultural information can lead to stereotyping patients, particularly by nurses who lack self-awareness, are ethnocentric, or who fail to recognize the variability within any cultural group. Stereotyping differs from generalizing. When stereotyping, one makes an assumption about a person based on group membership without bothering to learn whether or not the individual in question fits that assumption. In contrast generalizing begins with an assumption about a group but leads to seeking further information about whether the assumption fits the individual.  

Thus, it is important to learn whether people consider themselves typical or different from others in their cultural group, because age, education, and individual personality influence how individuals express their culture. Because stereotyping comes from jumping to conclusions based on insufficient data or experience with a cultural group, it is useful to suspend judgement as long as possible. However, the paradox is that the more one learns about a different cultural group, the more one realizes how much more there is to learn.

Working in Diverse Communities as a Hospice Educator and Nurse | Hospice Times: