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To learn more about cultural diversity and about the cultures in its own community, Presbyterian Hospice and Palliative Care in Albuquerque, NM, hosted a conference that brought in experts from various ethnic and religious groups to share their views on death and dying.
While no culture should be viewed through a narrow set of general characteristics, the conference offered some insight regarding how different cultures approach the dying process.
Jane Bergquist, RN, BSN, hospice program manager for Presbyterian Hospice and Palliative Care, noted the following important characteristics from cultures common among her hospice's patients:
— Not all Hispanics are from the same cultural background. Hispanics may be Mexican, Guatemalan, Puerto Rican, or Spanish, just to name a few Hispanic cultures. In New Mexico, for example, many Hispanics are descendants of Spanish immigrants dating back 200 years.
— Rituals, herbs, and traditional home remedies may be part of the treatment focus. Medical staff should be aware of these treatments so that interactions can be monitored, but should refrain from offering judgments.
— Hispanics tend to be very communally oriented. Expect the need to have the extended family involved in decision-making or present at time of death.
— They tend to be strongly Catholic.
— Cremations are considered acceptable.
• Navajo Indians.
— It is inappropriate to talk about death, because it can cause emotional harm. It is appropriate to discuss do-not-resuscitate orders using vague terms such as: "If you knew someone with a disease like you have, when do you think they should use a ventilator or stop using a ventilator?"
— Know that a decision is not made in isolation. Decisions are communal. Families will wait until all the appropriate family members are present to make decisions. "While this may slow down the process, it is crucial to their way of making decisions," Bergquist says.
— When a sick person chooses to participate in Navajo ceremonies, such as sweat lodges, or to go to the medicine man, it is not for a "cure." Rather, it is to help the person complete their spiritual work. Navajos believe they are on the earth to do a specific work and it needs to be done before death. These ceremonies are part of their search for their life's purpose.
— Burial occurs within 24 hours of death, if possible. Cremations are not considered appropriate, nor are organ donations. They believe the body should be returned to the earth as whole as it was when it came into this world.
• Pueblo Indians.
— Family plays a key role, and decision making is communal.
— It is not appropriate to discuss DNR or organ donations.
— Burial should occur within 24 hours, and cremation is usually not an option.
— Grief is explained by the elders and is handled through prescribed rituals. There is a "letting go" ceremony one year after the death of the loved one.
— A key component is for the family not to have tension after the loved one has died. No wills are necessary, because ownership of material goods is passed on verbally based on cultural norms. For example, property is passed through the mother to the daughters.
— The African-American community often misunderstands hospice, believing that medical professionals recommend hospice because they don't want to treat African-Americans. This community often has a generalized distrust of the medical profession as the result of a long history of racism and discrimination.
• Chinese people.
— They are strongly communal. Family members are crucial in passing on information to their loved one as well as in making decisions.
— Do not talk about death directly. Chinese people believe the best way to die is in one's sleep, not knowing you were going to die.