Culture refers to the way in which people determine what to value in life, how they behave, and how they give meaning to their lives (Schim & Doorenbos, 2010). Health care in all settings, stages of life, and in all types of patients is greatly determined by their way of life. Caring for patients at their terminal stages of death requires an understanding of their culture, and interaction through that culture, in order, to achieve desirable results.

High value is attached to culture by a person who is at the terminal stages of death. This attachment is associated with cultural symbols, and the view that culture provides a sense of security, belonging and integrity. Differences in attitudes are recognizable among palliative patients, and they have a background in culture (Phillip & Charles, 2003, treatment and perception of pain in different cultures and negative stereotypes towards minorities. The components of culture that bring these differences include age, gender, race, ethnicity, religion and spirituality, sexual orientation, and beliefs about causes of death and after-life. For example, research shows that African-Americans are less likely to discuss the end of life care with clinicians, while whites will do (Phillip & Charles, 2003). Also, immigrants from, Mexico, China and Korea believe that discussing death brings it closer.

Decision-making is a very important component of culture in end of life care. Research shows that the Americans give the patient the autonomy of making a decision in their terminal stages (Kwak & Haley, 2005). Europeans and Asians have been seen to be more considerate on beneficence. The Asians, for example, allow the physician to make a decision, while the French considers the family to be the best to make a decision.

(Koenig & Williams, 1995). For example, in the western world, it is believed that the client should be consulted on everything that is being done to them. In such an environment, the nurse may not just go ahead and plan care in advance, without first consulting the clinician. The nurse thus should build and maintain trust with the patient and the family. Community and religious leaders may be involved, and the nurse communicates to the patient in a caring manner (Hern et al., 1998). The role of an interpreter may be sought, but the interpreter should not replace the care-giver. In addition, the nurse considers addressing communication barriers, religion and spirituality, as well as, involving the family in care.

In conclusion, end of life care is affected by cultural beliefs to a great extent. This depends on the clash between the culture of the care-giver, and the client’s culture. There are many aspects of culture that affect end of life care, for example religion. Familiarization of the cultural values of the client is important for care. When culture is considered in end of life care, the outcomes are desirable.

References

Hern, E. H., Koenig, A. B., Moore, L. J., & Marshal, A. P. (1998). The difference that culture can make in end-of-life-decision making. Cambridge Quarterly of Health-Care Ethics, 7(1), 27-40.

Koenig, B. A., & Williams, J. G. (1995). Understanding cultural differences in caring for dying patients. Western Journal of Medicine, 163(3), 244-249

Kwak, J., & Haley, E.W. (2005). Current research findings on end-of –life decision making among racially and ethnically diverse groups.The Gerontologist, 45(5), 634-641.

Phillip, L. D., & Charles, L. S. (2003). Cultural differences at the end of life. Critical Care Medicine, 31(5), 354-357.

Schim, M.S. & Doorenbos, A.Z. (2010). A three dimensional model of cultural congruence: Framework for intervention. Journal of Social Work End Life Palliative Care, 6(3-4), 256-270.