Cultural differences with end-of-life care in the critical care unit.

Critical care nurses are providing healthcare for an increasingly multicultural population. This ever-increasing diversity in cultures and subcultures presents a challenge to nurses who want to provide culturally competent care. It is common for patients and families to face difficult decisions about end-of-life care in critical care units, and minority cultures do not always believe in the Westerner's core values of patient autonomy and self-determination. Knowledge of these cultural differences is fundamental if critical care nurses wish to provide appropriate and culturally competent information regarding end-of-life decisions.     

A growing challenge: patient education in a diverse America.

Patient education is a vital part of nursing practice, but the inability to provide consistent culturally sensitive patient care to minority populations has most certainly contributed to disparities in health and healthcare. This article explores minority populations in the United States and their characteristics in relation to health and healthcare, popular cultural competence theories, and nursing school curricula, and discusses teaching strategies for developing more culturally competent nursing professionals.     

Cultural diversity at the end of life: issues and guidelines for family physicians

Ethnic minorities currently compose approximately one third of the population of the United States. The U.S. model of health care, which values autonomy in medical decision making, is not easily applied to members of some racial or ethnic groups. Cultural factors strongly influence patients' reactions to serious illness and decisions about end-of-life care. Research has identified three basic dimensions in end-of-life treatment that vary culturally: communication of "bad news"; locus of decision making; and attitudes toward advance directives and end-of-life care. In contrast to the emphasis on "truth telling" in the United States, it is not uncommon for health care professionals outside the United States to conceal serious diagnoses from patients, because disclosure of serious illness may be viewed as disrespectful, impolite, or even harmful to the patient. Similarly, with regard to decision making, the U.S. emphasis on patient autonomy may contrast with preferences for more family-based, physician-based, or shared physician- and family-based decision making among some cultures. Finally, survey data suggest lower rates of advance directive completion among patients of specific ethnic backgrounds, which may reflect distrust of the U.S. health care system, current health care disparities, cultural perspectives on death and suffering, and family dynamics. By paying attention to the patient's values, spirituality, and relationship dynamics, the family physician can elicit and follow cultural preferences.     

End-of-life care: legal and ethical considerations

OBJECTIVE: To prepare the oncology nurse, under the Patient Self-Determination Act, to analyze and discuss legal and ethical issues that may arise in the clinical area when end-of-life decisions are made. DATA SOURCES: Nursing textbooks, scholarly articles, court cases, and internet publications. CONCLUSIONS: The dying patient has the right to die with dignity, respect, and the right treatment choices. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to understand how to implement the Patient Self-Determination Act regarding living wills, do not resuscitate orders, euthanasia, and whether or not to use feeding tubes.     

Distance Learning Teaching Strategies in Registered Nurse to Baccalaureate Nurse Programs: Advancing Cultural Competence of Registered Nurses in Providing End-of-Life Care

In order to prepare nurses to effectively provide holistic nursing care to an increasingly diverse patient population, nurse educators must incorporate cultural care practices into the nursing curricula. Specifically, teaching culturally competent end-of-life care is essential but can pose challenges for distance education programs. The purpose of this article is to identify multiple learning strategies utilized in an online nursing program to teach students how to provide culturally competent end-of-life care.     

UNDERUTILIZATION OF MENTAL HEALTH SERVICES BY ASIANAMERICANS RESIDING IN THE UNITED STATES

Asian-Americans are the fastest-growing minority in the United States, and they are a culturally diverse group. Knowledge about this growing minority population is important for the purposes of planning appropriate mental health care. Asian-Americans living in the United States rarely use mental health services. The reasons for this, along with suggestions for developing more culturally sensitive mental health services, are presented. A model for cultural competence can provide a framework for psychiatric nurses and other mental health professionals (MHPs) to become more aware of Asian-American values and beliefs and provide more culturally sensitive care. Awareness tools are included to guide MHPs in determining whether culturally competent care is available locally to meet the needs of this underserved population.     

End-of-life care for ethnic minority groups

Death and dying are profound events that bring into focus important ethical and medical questions for all patients, whatever their cultural background. For ethnic minority groups and their families, specific issues or barriers may arise related to culturally appropriate health care practices, cultural or religious differences, diverse health beliefs, and access to services for care and support during end-of-life conditions. National policy and local initiatives in both the United States and the United Kingdom support the development of services that address the care of ethnic minorities. This article examines end-of-life care for ethnic minority groups.     

Patterns of decision making by wives of patients with life-threatening cardiac disease

Implementation of the Patient Self-Determination Act (PSDA) in the United States has transferred decision making from the responsibility of health care professionals to the responsibility of family members. Dilemmas occurring as a result of this responsibility may cause stress and conflict among family members. The purpose of this study is to describe the patterns of decision making by family members of patients with life-threatening cardiac disease. Purposive sampling is used to select 10 wives of patients with life-threatening cardiovascular disease. Data are gathered through unstructured interviews and are analyzed using grounded theory and theory triangulation. Analysis of the data reveal three patterns of decision making: advocacy, acquiescence, and abdication.     

King's theory as foundation for an advance directive decision-making model

This article discusses the utilization of King's conceptual system, transaction process model, and theory of goal attainment as foundations for an advance directive decision-making model. Research has shown nurses may be educationally unprepared, experience conflicts between beliefs and actions, or resist the responsibility to address advance directives and end-of-life issues. Nurses, especially nurse practitioners providing primary care, are in positions to facilitate the process. By understanding and incorporating this model into practice, both the nurse and the client may achieve mutual goal attainment resulting in both increased client autonomy and Patient Self-Determination Act compliance.     

Culturally competent nursing care during the perinatal period

Effective nursing interventions require culturally competent nursing practice. Nurses can develop the skill sets needed to provide culturally competent care. These skills derive from nursing principles and practice that support respect for individual dignity and self-determination. Sweeping changes in health care delivery have shortened the length of client exposure to nursing care, especially in perinatal nursing. Moreover, changes in the United States population challenge the nurse's ability to respond appropriately to the expectations, values, and beliefs of many diverse cultural groups. Nursing theoretical frameworks provide a basis for cultural competence in practice.     

What has the literature taught us about culturally competent care of women and children

This article describes what is currently in the literature about culturally competent care for women and children. With the population of the United States growing increasingly diverse, there is a developing need for cultural competency among nurses and throughout healthcare organizations. Cultural competence includes both culture-specific and culture-generic knowledge, attitudes, and skills. While databased literature on cultural competency still requires further development, we do have evidence of positive outcomes of culturally competent care. The end result of the provision of culturally competent care by culturally competent nurses and healthcare organizations can be significant improvements in the health and well-being of women and children.     

Mental disorders and syndromes found among Asians residing in the United States

The Asian population in the United States is the fastest growing minority; consequently it behooves psychiatric nurses and other mental health professionals to be aware of symptom presentation of emotional problems that may differ from those of other population groups. Specific syndromes, psychiatric disorders, and symptoms that commonly present as physical disorders are discussed. Recommended adaptations of psychiatric interventions, including medications and other therapies, are offered to enable mental health professionals to provide culturally sensitive care. Mental health care that is culturally competent may improve access to care for Asians residing in the United States.     

Advance directives and dementia

Since the 1990 Patient Self-Determination Act, increasing numbers of adults are completing advance directives (ADs), but unfortunately many adults seen in a dementia evaluation program have not completed an AD. This article discusses the issue of individuals with dementia completing ADs. Situational factors that frame this issue are the stage of dementia, degree of certainty of an individual's wishes for end-of-life care, the decision-making act required by care providers, and the degree of contentment or distress experienced by an individual with dementia. Several investigators have demonstrated successful completion of ADs by individuals with mild and moderate dementia. A nurse's knowledge about the stages of dementia is essential to helping an individual through the AD decision-making process. Nurses caring for individuals with dementia should assess decision-making context; recognize the emotions of family, friends, and staff; understand the substance and logic of AD requests; and support individuals and their decisions.     

Health care barriers for Latino children and provision of culturally competent care

The demography of the United States is rapidly changing. The impressive growth rate of Latino populations within the United States has great impact on health care. This article includes discussion of a significant increase from 1988 to 2000 in Latino utilization of emergency department and inpatient services at a pediatric medical center in Salt Lake City, Utah, information on health care barriers for Latinos, and suggestions for providing culturally competent care.     

Health beliefs, practice, and priorities for health care of Arab Muslims in the United States.

The Arab Muslim population is one of the dramatically increasing minorities in the United States. In addition to other factors, religion and cultural background influence individuals' beliefs, behaviors, and attitudes toward health and illness. The author describes health beliefs and practices of the Arab Muslim population in the United States. That population is at an increased risk for several diseases and faces many barriers to accessing the American health care system. Some barriers, such as modesty, gender preference in healthcare providers, and illness causation misconceptions, arise out of their cultural beliefs and practices. Other barriers are related to the complexity of the health care system and the lack of culturally competent services within it. Nurses need to be aware of these religious and cultural factors to provide culturally competent health promotion services for this population. Nurses also need to integrate Islamic teachings into their interventions to provide appropriate care and to motivate healthy behaviors.     

Occupational health nursing with Navajo workers. Providing culturally competent care.

1. Native Americans in the southwestern United States are considered a "vulnerable population." Native Americans have economic difficulties, poor health, and little access to health care. The Navajo nation is the largest Native American reservation in the United States. 2. Occupational health nurses who provide culturally competent care increase the likelihood for Navajo workers to obtain optimal benefits from workplace health services. 3. The nurse uses cultural assessment skills and critical thinking abilities to maximize therapeutic interactions and minimize barriers in communications with workers of other cultural backgrounds. 4. The nurse who is knowledgeable about the Navajo way can help achieve a balance between the traditional ways and Western ways of addressing serious health care issues facing the Navajo worker. This knowledge and cultural awareness also increases the effectiveness of health promotion and health education programs offered to workers, their families, and their communities.     

Incorporating cultural diversity in nursing care: an action plan.

This article examines the context of culture from the perspective of the increase in immigration and concomitant growth of diversity within the United States. It proposes that nurses who deliver culturally competent care are brokers of three cultures: their own; the health care system; and the client. The mechanism for creating approaches to care that utilize this concept is the nursing process. A culture-specific assessment can be achieved using the explanatory model of illness. The inadequacies of some frequently used strategies such as nursing diagnosis are also discussed with suggested changes.     

Care at the end of life in critically ill patients: the European perspective

PURPOSE OF REVIEW: Care surrounding end-of-life has become a major topic in the intensive care medicine literature. Cultural and regional variations are associated with transatlantic debates about decisions to forego life-sustaining therapies and lead to recent international statements. The aim of this review is to provide insight into the decisions to forego life sustaining therapies and end-of-life care in Europe. RECENT FINDINGS: Although decisions to forego life-sustaining therapies are increasingly made in European countries, frequency and characteristics of end-of-life care are still heterogeneous. Moreover, even though many determinants of these variations have been identified, epidemiologic and interventional studies still provide additional information. In agreement with public opinions, recent European laws have emphasized the patient's autonomy. In real life, advance care planning is rarely used. Decisions are often made by caregivers (physicians and nurses) or families, these latter being less involved than in North America. Not only ethic divergences between physicians but also cultural variations account for this disparity. SUMMARY: To optimize end-of-life care in the intensive care unit, there is an urgent need for the development of palliative and multidisciplinary care in Europe. Furthermore, it highlights the need for culturally competent care, adapted to needs and values of every single patient and family. In addition, a lack of communication with families and within the medical team, an uninformed public about end-of-life issues, and insufficient training of intensive care unit staff are crucial barriers to end-of-life care development. Special awareness of professionals and innovative research are needed to promote a high-standard of end-of-life care in the intensive care unit.     

Informed consent and truth-telling: cultural directions for healthcare providers

As the United States becomes more diverse in the healthcare beliefs and practices of its residents, delivery of culturally competent healthcare in an ethical manner becomes increasingly complex. Nurse administrators, who are responsible for interpreting policy and organizational expectations to their employees as well as ensuring that providers maintain the American Nurses Association's code of ethics, are challenged when providing care for diverse populations. Critical to providing culturally sensitive care is an understanding of different approaches to truth-telling. The authors present Korean, Southeast Asian, and First Nations (American Indian) case studies illustrating concepts of truth-telling and informed consent related to issues that arise when group-oriented persons or families respond to their health-care providers' actions.