What things do you need to consider when caring for a dying person from a multicultural background

Table of Contents Show

Culture and the meaning of death
Cultural rituals regarding death
Personal differences in grief and mourning
Grief and cultural sensitivity
Related Resources
Different Cultures Have Different Practices
Three Practices To Help Patient Interactions
Moving Ahead
Where Are The Best Nursing Jobs?

Many people experience grief and a sense of loss after the death of a loved one. But the ways in which they experience and express these feelings may differ across cultures. Culture is the mix of beliefs, values, behaviors, traditions, and rituals that members of a cultural group share. Each culture has its own rituals that influence the expression of grief. Carrying out these practices offers a sense of stability and security. Rituals can also help people who are dying and bring comfort to the loved ones who are preparing for their loss.

Culture and the meaning of death

Every culture has its own set of beliefs that describe how the world works and people’s roles in the world. In societies in which most people share the same religion, religious beliefs significantly shape the culture. Each culture has its own beliefs about the meaning and purpose of life and what happens after death. This informs how people in those cultures approach death. For example, people may find death more bearable if they believe in a life after death. In some cultures, people believe that the spirit of someone who has died directly influences the living family members. The family members are comforted by the belief that their loved one is watching over them. In general, beliefs about the meaning of death help people make sense of it and cope with its mystery.

Cultural rituals regarding death

In each culture, death is associated with rituals and customs to help people with the grieving process. Rituals offer people ways to process and express their grief. They also provide ways for the community to support the bereaved. A person who is bereaved is in a period of grief and mourning after a loss. Death can create a sense of chaos and confusion. Rituals and customs provide a sense of routine and normalcy. They provide a set of directions that help structure the time surrounding death. Also, they direct people’s roles during this time. Rituals and customs can help address:

How people care for people as they approach death. This includes who is present and what ceremonies are performed at the moments before and after death.
How a person's body is handled after death. This includes how the person's body is cleansed and dressed, who handles the body, and whether the body is buried or cremated.
Whether grief is expressed quietly and privately or loudly and publicly. This includes whether public crying or wailing is appropriate.
Whether people of different genders or ages grieve differently.
What rituals people perform after death and who is included in these rituals.
How long family members are expected to grieve. And how they dress and behave during the mourning period.
How the deceased are honored over the lifetime of the family. This includes ongoing rituals to celebrate or talk with the deceased.
What new roles family members are expected to take on. This includes whether a widow remarries or an oldest son becomes the family leader.

Personal differences in grief and mourning

People often adapt the beliefs and values of their culture to meet their unique needs and circumstances. As a result, grief responses within a culture vary from person to person. This is especially true in societies made up of people from many cultural backgrounds. A family with members from 2 or more cultural backgrounds may develop its own set of rituals and customs.

In some instances, a person’s experience of grief may be at odds with cultural norms. For example, someone who is quiet and reserved may not feel comfortable crying in public as expected. Others may have a level of despair that feels out of step with cultural beliefs about life after death. Despite cultural norms, people need to grieve in ways that feel right to them.

Grief and cultural sensitivity

There is no correct way to grieve. Mourning rituals that are normal to one culture may seem strange to another. It may be difficult to know how to be sensitive to a grieving person from a different cultural background. Consider the following questions as you seek to support a person with a different cultural background:

What emotions and behaviors are normal grief responses within the person’s own culture?
What are the bereaved family's beliefs surrounding death?
Who should attend mourning ceremonies, and how are attendees expected to dress and act?
Are gifts, flowers, or other offerings expected?
What special days or dates will be significant for the bereaved family?
What types of verbal or written condolence are expressed?

Consider talking with someone who shares that cultural background or searching for information on the Internet to learn more about the customs and mourning practices of a person from another culture.

Coping With Grief

Coping With Change After a Loss

Navigating the unique cultural and religious needs of your patients can be unnerving. You could accidentally offend your patient or their family by not knowing about a crucial cultural practice or you could witness something that goes against your personal beliefs or convictions.

Everyday routines that the predominant culture takes for granted such as time orientation, eye contact, touch, decision-making, compliments, health-beliefs, health-care practices, personal space, modesty, and non-verbal communication can vary dramatically between cultures, sub-cultures, and religions.

Different Cultures Have Different Practices

Practices that might be considered unethical to an autonomous American (e.g. allowing a family member to speak for and dictate all medical care and decisions for an aging parent), or disrespectful/suspicious to a Caucasian (e.g. avoiding direct eye contact), or curious to a nutritionist (e.g. not allowing a child to eat heated foods when they have certain illnesses), could be the acceptable practice of your patient’s culture.

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Three Practices To Help Patient Interactions

The trend of today’s healthcare leans toward being more inclusive of personal and cultural preferences. This demands a knowledgeable and open response from caregivers. What can we, as nurses, do to facilitate this trend toward honoring individual choices and beliefs, even when we are not fully aware of them? By incorporating three practices, we can make these interactions both easier and more successful.

Awareness

One of the most important elements emphasized in pursuit of competent cultural care is identifying your own beliefs and culture before caring for others. According to Culture Advantage, an organization formed to help individuals develop cross-cultural awareness and communication skills, “Caregivers are expected to be aware of their own cultural identifications in order to control their personal biases that interfere with the therapeutic relationship. Self-awareness involves not only examining one’s culture but also examining perceptions and assumptions about the client’s culture.” Developing this self-awareness can bring into view the caregivers biases or culturally-imposed beliefs. It can also shed light on oppression, racism, discrimination, and stereotyping and how these affect nurses personally and their work.

As an example, a nurse might learn that a patient participates in folk medicine, which incorporates certain unfamiliar healing rituals, or promotes the ingestion of an array of plant-based concoctions as mixed and prescribed by a healer. Without examining his/her own beliefs, the nurse might judge those practices as primitive or scientifically bogus without having a clue about the cultural or symbolic meaning. Meanwhile, the following Sunday that nurse may head to a church service donning a crucifix around her neck—a violent death symbol to the casual observer—where she recites strange, nonsensical liturgy back to a man dressed in a robe and consumes a little cracker and grape juice or wine and calls it “the body and blood of her savior.”

To the outside observer, this could seem primitive, superstitious, or even bogus, but to the participant, these rituals are rich with meaning and even healing.

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Acceptance

A successful physician with more than forty years of experience in family medicine recently told me, “I frequently tell my patients that the key to healing is loving and accepting yourself.” What an insightful statement. Acceptance becomes a powerful tool, but one that demands solidarity between nurse and patient.

How can patients love and accept themselves in ways that promote healing if we, as nurses, are not willing to offer them acceptance in their myriad of problems and complexities? Through the simple act of acceptance, nurses can become an agent of healing, whether or not they are aware of it.

This is the premise of Margaret Newman’s nursing theory, “Health as Expanding Consciousness,” whereby through the nurse’s presence and acceptance, the patient becomes empowered during times of personal duress or chaos to make lasting changes that promote hope, well being, and an increasingly satisfying state of “health”—one that is not dependent upon the absence or presence of disease.

In other words, healing has meaningful implications that reach beyond the current medical model’s definition as “the absence of disease.” As the patient is able to articulate meaningful events of life and to be heard without judgment, he or she becomes more conscious or “awakened” to patterns that have blocked health progress, and therefore able to choose transformational behaviors, with the continuing support of the nurse.

Asking

There is no way nurses can be expected to be aware of and practice cultural sensitivity at all times because most religions and cultures have been developed over centuries and are replete with practices that carry symbolic meaning. When in doubt, the best way to provide sensitive care to patients of diverse cultures is to ask.

When you initiate care during your initial assessment, ask if there are any cultural or religious practices or beliefs that you need to know about in order to respect and support their needs. Many of them are used to living out their own subculture within the greater American culture and they will probably know by experience how to educate you on their care. If they are unsure or unaware of their unique needs in the healthcare setting, reassure them that you are willing to adjust your care based on their values if they do become aware of any issues. Encourage them to communicate those needs to you as they happen to arise.

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Moving Ahead

The trend in health care is to allow for more liberty in patient choices and involvement, as well as the ability to carry out their normal practices as much as possible.

Sensitive cultural care is not just a phenomenon that takes place when occasionally encountering foreigners in the hospital or providing care to someone of a different religion. It is the result of the awareness that everyone belongs to a unique subculture based on beliefs and practices and the mindful consideration and space given to each and every patient. The conscientious nurse can affirm, respect, and nurture all patients through deliberate awareness, acceptance, and asking.

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Julie Ferwerda, BSN, works as a resource nurse at Kootenai Health in Coeur d’Alene, Idaho, a magnet hospital affiliated with Mayo Clinic. She has been writing articles and books for many years on a variety of topics including health, fitness, relationships, and spirituality. When she is not working she is exploring the beautiful Northwest.