Transcript Hispanics Relationships an Eye to the Soul

Hispanics
Relationships an Eye to the Soul
The Vision of Opportunity
Religious and Cultural Views on
Donation and End of Life Issues
April 17, 2012
Diversity
 Social Aspects
 Cultural Aspects
 Bilingual
 Bicultural
Immigrant Experience
 “pillage/plunder”
 Taken away without one’s permission
 Always looking behind you
 Losing one’s own blood
 Fear of being caught
Being an immigrant not a natural
choice
 For life
 For security
 For education
 Freedom of religion
 Possibilities not offered in homeland
Cultural Competency
 quality issue
 cut costs of unnecessary testing
 raise patient satisfaction scores
 address the values of many of our institutions
Cultural Identity
 Country of origin
 Language
 Education
 Spiritual traditions
 Family traditions
 Diet and nutrition
 Traditional medical practices
 Attitudes about illness and death
 Migration experiences
Cultural Competency
 Is the ability to interact successfully with people from various
ethnic and/or cultural groups.
 As health care providers we must gather information from
the patient and/or family that can be useful in the plan of
care.
 Relevant data pertinent to the patient’s situation and/ or
bio-psycho-social-spiritual/religious health
 Understanding someone’s cultural background helps create a
comprehensive plan of care.
 Becoming culturally competent is an ongoing process
CLAS Standard 13…
 “Health care organizations should ensure that conflict and
grievance resolution processes are culturally and linguistically
sensitive and capable of identifying, preventing, and resolving
cross-cultural conflicts or complaints by
patients/consumers.”
 Some may not feel comfortable putting a complaint in
writing
 People whose voices not heard
CLAS Standard 14…
 “Health care organizations are encouraged to regularly make
available to the public information about their progress and
successful innovations in implementing the CLAS standards
and to provide public notice in their communities about the
availability of this information.”
 Share information through public events, health fairs, faithbased organizational events, and cultural media outlets…
Basic guidelines
 Learn about the values, family norms, traditions
 Involve staff workers who are bilingual and bicultural
 Establish rapport
 Gain acceptance
 Be nonjudgmental,
respectful and credible
 Practice active listening skills
Kaiser Permanente
 What one hears and also what one sees
 How those waiting relate with each other
 Who is in charge and who does the family/group look to for
help
 How they address staff or other family members
 EYE CONTACT
Hispanics misconceptions
 Mutilation
 Whole
 Church
 Need for Education
 Mistrust of healthcare
Needs
 Media
 Education
 Remember Hispanos are “warm blooded people” are
relationship people
 Help them understand through relationship building,
donation takes place after death, signing up as donors not at
risk of organs taken before death, need of all body parts for
afterlife, personal expressions…
As Hispanics, we share a bond rooted
in a proud culture of tradition and
deeply passionate beliefs
 We share the unique ability to help our families, friends and
community members who are waiting for an organ, tissue or
eye donation
 Talk to your family and
your friends.
You will probably discover
that the need for donation
is closer than you think.
“The Mexican is familiar with death ,
Jokes about it, caresses it, sleeps with it,
celebrates it:
It is one of his favorite toys and his most
steadfast love… he looks at it face to face
with impatience, disdain of irony.”
--Tellez-Giron 2007
Role of the Family in End of Life
Decisions
 Both the immediate and extended family
 Decisions are made by consensus rather than individually
 Family and friends are seen as a great comfort (one letter per
family does not work with Hispanics)
 Enduring pain is part of the role of family members, meant
to protect other family members from suffering and
worrying
Role of Religion and Spirituality
 Patients and families turn to God for hope, believing that
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whatever happens will have meaning
Group Prayer
Mass offerings—Anointing of the Sick
Cleansings or limpias
Mandas
 Preservation of life
Barriers to End-of-Life Care
 Fear their beliefs would not be respected and addressed
 Fear related to immigration status and discrimination
 Reasons for the lack of Hospice care include language
barriers, cultural beliefs, distrust in institutions and poor
information about services
 Some believe that the health care system controls treatment
and that communicating one’s wishes to caregivers is
pointless
 Use Promotoras
Recommendations on
End of Life Issues
 Learn about the basic concepts of the culture
 Acknowledge cultural differences and similarities
 Provide education --US health system and disease processes
 Keep an open communication channel
 Explore patient’s beliefs and values
 Collaborate and compromise to reach the most balanced
consensus on decision making to provide the best possible
care
Cross Cultural Interview Questions
Regarding End-of-Life Issues
 “Some people want to know everything about their
medical condition, and others do not. What is your
preference?”
 “Do you prefer to make medical decisions about future
tests or treatments for yourself, or would you prefer that
someone else make them for you?”
To patients who request that the physician discuss their condition with
family members:
 “Would you be more comfortable if I spoke with your
(brother, son, daughter) alone, or would you like to be
present?”
If the patient chooses not to be present:
 “If you change your mind at many point and would like
more information, please let me know. I will answer any
questions you have.”
When discussing medical issues with family members, particularly
through a translator, it is often helpful to confirm their
understanding:
 “I want to be sure that I am explaining your mother’s
treatment options accurately. Could you explain to me
what you understand about your mother’s condition and
the treatment that we are recommending?”
 “Is there anything that would be helpful for me to know
about how your family/community/religious faith views
serious illness and treatment?
 Sometimes people are uncomfortable discussing these issues
with a doctor who is of a different race or cultural
background. Are you comfortable with me treating you?
Will you please let me know if there is anything about your
background that would be helpful for me to know in working
with you or your (mother, father, sister, brother)?”
Bibliography
 “Cultural Competencies” Professional Spiritual and Pastoral
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Care, Edited by Rabbi Stephen B. Roberts, 2011 Skylight
Paths
Latino Catholicism, Timothy Matovina, 2012 Princeton
University Press
Donate Life Texas, Texas Registry 2009
“Attitudes, Beliefs and Behaviors Surrounding Organ
Donation among Hispanic Women”, NIH Public Access, 2009
“End-of-Life Issues for Hispanics”, David Acosta, M>D> and
Maribel Serrano, University of Washington, 2008