Nurse Care for a Dying Person

Problems pertaining to ‘End-of –life’ care are on the rise especially when concepts of euthanasia and physician assisted deaths are trying to find legitimate positions in the society. The state of Oregon in U.S.A already has a legal backing and the bill introduced by Lord Joffe in U.K. parliament recently has stirred a chain of debates on the ethical aspects of assisted death of the terminally ill. The concepts of Palliative care and Hospice have primarily evolved only to meet the needs of these terminally ill patients (Potter, 2005). The Palliative care is the comprehensive care for patients, whose disease is not responsive to cure and hence, are terminally ill. Hospice is a coordinated programme of inter disciplinary care provided primarily in the home of the terminally ill patients. In the past two decades there has been a study of enormous magnitude in the care for dying and the studies have identified various aspects underlying the principles of care of the dying. These include, respecting patient’s goals, preferences and choices, attending to the medical, emotional, social and spiritual needs of the dying person, using strengths of interdisciplinary resources, acknowledging and addressing concerns and building mechanisms and systems of support (Potter, 2005). Many terminally ill patients suffer only when they do not receive adequate care for the symptoms accompanying their serious illness. Thus, the care for the dying should not be confined to the physical aliment but also the psychological and spiritual needs.

Transcultural Treatments towards a Dying Person

Transcultural nursing is a humanistic and scientific area of formal study and practice in nursing which is focused upon differences and similarities among cultures with respect to human care, health, and illness based upon the people's cultural values, beliefs, and practices (Leninger, 1991). The main goal of transcultural nursing is to provide culturally specific care. Culture refers to norms and practices of a particular group that are learned and shared and guide thinking, decisions, and actions (Leninger, 1991). A methodological approach of ethnographic study is important for the nurse to develop a heightened awareness of culturally diverse needs of individuals (Tripp-Reimer & Dougherty, 1985). The ultimate goal of transcultural nursing is to maximize nurse care penetrating through the barriers of culture and race. Hispanic dying elders have a prestigious status in the family are far more emotionally expressive and they love to be cared. They are not accustomed to the profession of nurses or social workers and rely on their religion, families, other relatives and close friends for support and help (Galanti, 1991). The Middle East population on the other hand place a high value in modern Western medicine and have confidence in the medical profession. But, nurses are perceived as helpers, not health care professionals, and their suggestions and advice are not taken seriously in this group. They consider death to be a destiny decided by God (Meleis, 1981). The Asian patient goes into a silent withdrawal until death and does not express emotions at all. To a Black-American death is the passing from one realm of life to another, as a passage from the evils of this world to another state. The Black patients perceive the use of their first name as a lack of respect and a form of racism and expect the Nurses should refer to all adult patients as Mr., Miss, Ms., or Mrs., unless otherwise instructed(Galanti, 1991). But a nurse should be careful about a common misconception associated with transcultural nursing theories and models that people can be categorized, rather than individualized, by virtue of race, culture, and ethnicity (Galanti, 1991).

A study on Japanese nurses perceptions about disclosure of information at the patient’s end of life (Konishi, 1999) has brought to light the traditional ethical conflicts regarding the issue. A survey involving 147 nurses using a questionnaire brought to focus that information disclosure at the end of life is also one of the most debated ethical issues in Japan. The nurses perceive that non-disclosure of impending death information to patients is the tradition in Japan. The conflict of non-disclosure of death information to the terminally ill has of course created tensions causing a drift between those who believed in strict traditional values and those who adapted to Western values, according to the study. The patients when not informed often grow suspicious, isolated, and angry or die unprepared for their end. The nurses are found trapped in between the patient and the physicians as nurses are perceived as keepers of family secrets in Japan. These nurses want a charge of attitude of the health professionals from curing to caring.

A study on the indicators of quality Medical care for the terminally ill in nursing homes (Keay et. al, 1994) has showed communication, attention to pain and relief to dyspnea as indicators for which 100% performance is expected. Studies pertaining to specific verbal communication interactions in such elderly patients have been carried out (Jones et. al 2002). The studies have been carried out under the categories ‘words spoken’, ‘commands given’, ‘statements made’, ‘Questions asked and answered’ with there ethnic groups namely immigrant, Canadian born and Anglo-born. The studies have highlighted the need for nurses be aware of the implications of differences with there groups.

The ethnic old patients in Canada have been shown to have remained an isolated group as aliens in their own land. These ethnic populations have been shown to be unable to communicate with their care givers (Saldov et al, 1994). Studies have shown that a majority of institutions have interpreter services. Problems developed in such patients without interpreter services have been termed serious. A recent report on palliative care on Manitoulin Island has raised two main areas of care that should be improved. 1. Pain control and 2. Communication, indicating the universal need for addressing these issues in terminally ill patients (Canadian family physician, 2000).

Studies have also revealed the experience of minority ethnic groups in UK in a palliative set up. The main problem of ethic minority is that of communication. The study has highlighted the need for informing South Asian populations on the availability of palliative care services and the need for improving communication between the patients and service providers. The study has also brought to focus the problems in communication of the service provides to these populations in UK (Radhawa et.al, 2003).

Meeting the palliative needs of transcultural communities is a big challenge in nursing with every one having his or her own beliefs about death and illness. A nurse, by profession, has to adapt to different cultural beliefs and practices to develop cultural competence. Assumptions have been seen as an important problem factor which forms the basis of palliative or hospice nursing without taking the views of the patients at all. Listening to the patient, to find out and learn about the patient's beliefs of health and illness is part of this care process. Valuing diversity, having the capacity for cultural self-assessment, being conscious of the dynamics of cultural interaction, institutionalizing cultural knowledge and developing adaptations of service delivery reflecting an understanding of cultural diversity are essential for the
development of this cultural competency(Cross et.al,1989).

Conclusions

The nurses who deal with such multicultural population are under stress because of poor communication process due to a lack of knowledge about cultural differences. The challenges in this process include the challenge of recognizing clinical differences among people of different ethnic and racial groups, communication, ethics and trust (Meyer, 1996).Patient’s perception of illness, disease and death varies by culture and these individual preferences decide the mode of health care. Nurses should develop the ability to understand health behaviors influenced by culture. Only a nurse who understands these needs can effectively provide comfort and care (Harris, 1998). Thus, a nurse needs insight, sensitivity, effective communication skills and strategies to give what a dying patient needs and uphold the values of nursing care.

References

• Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989) Toward a Culturally Competent System of Care. Volume 1. Washington, D.C.: Georgetown University.
• Fernandez V.M. (1995-1999): Personal interviews and experiences with patients in Venezuela, Colombia, Mexico and Cuba.
• Galanti G.A (1991).Caring for Patients from Different Cultures. University of Pennsylvania Press, Philadelphia.
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• Palliative Care and Manitoulin Island (2000). Canadian Family Physician 46.
• Patricia A Potter and Anne Griffin Perry (2005). Fundamentals of Nursing. 6th edition. Mosby.
• Randhawa G et al (2003).Communication in the development of culturally competent Palliative care services in the UK: a case study. Int. J. Palliative Nurs. 9 (1); 24-31.
• Saldov M et al (1994) The ethnic elderly in Metro Toronto Hospitals, nursing homes and homes for the aged; communication and health care. Int J Aging Hum Dev.38 (2), 117.
• Spector R.E (1979).Cultural Diversity in Health and Illness. Appleton-Century-Crofts, New York.
• Spector R.E. (1979).Cultural Diversity in Health and Illness. Appleton-Century-Crofts, New York.
• Tripp-Reimer, T & Dougherty, M.C. (1985). Cross cultural nursing research. Annual Review of Nursing Research 3, 77-104.

 

 

 

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