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Cultural Sensitivity &
Culturally Diverse Families
Involved in the
Deceased Donation Process
Wendy Sherry, RN MN
Nurse Clinician for Organ & Tissue Donation
Presentation for Interprofessional Trauma Conference ,
September 29, 2015
Potential Conflicts of Interest Disclosure
• I do not have and I have not in the past
two years, an affiliation with / or financial
interest of any nature in a business
corporation
• I did not receive remuneration, royalties or
research grants from a business
corporation
Objectives • Relevance
• Literature Review
• Defining Culture
• Reasonable Accommodation vs.
Personalization of Care
• Expert Panel on Global Nursing and
Health
– Leininger’s theory of Culture Care Diversity and
Universality
• Integrating Cultural Congruent Care
Relevance
• 20.6% of the Canadian population
immigrated from other countries
• Asia and the Middle-East are the largest
sources of immigration
• 19.1% of the population identify
themselves as a visible minority
• Majority of immigrants reside in
– Toronto, Ontario
– Vancouver, British Columbia
– Montreal, Quebec
Relevance con’t
• Canada has over 4100 people actively
waiting for an organ transplant
• Quebec has 850 people on the organ
transplant wait list
• In Montreal, the mother tongue of 11.7% of
the population is Arabic, Spanish, Italian,
Creole, Chinese, Greek, Portuguese,
Romanian, Vietnamese, and Russian
Relevance con’t
• 33% of Montreal’s inhabitants are members of an
ethnocultural community
• Over 200 ethnicities live within Greater Montreal
• Almost 40% of MUHC referrals involve patients who
are members of an ethnocultural community
• At the MUHC ethnocultural family decision-making
is influenced by personal values, cultural and
spiritual beliefs, lack of knowledge and pre-mortem
discussion on OTD, body integrity concerns,
interference with end of life rituals, and
misconceptions
Defining Culture
“The learned, shared, and transmitted
knowledge of values, beliefs, norms, and
lifeways of a particular group of people that
guides an individual or group in their thinking,
decisions, and actions in patterned ways”
Leininger, 1995, p. 60
Literature Review
Nurses’ perception of organ & tissue
donation (OTD)
– Complexity of looking after a donor and family
members increases level of stress
– Lack of transcultural nursing knowledge
impacts willingness to modify nursing care to
meet patient and family needs
Literature Review con’t
• Demonstrates need for good
communication skills and a knowledge of
different ethnocultural end of life rituals,
values, and beliefs
• Nurses who are aware of their own cultural
biases and beliefs are more likely to
develop a care plan that reflects
ethnocultural family needs
Literature Review con’t
Family needs and OTD
– The dying process creates intense emotions
– Difficulty accepting a diagnosis of neurological
death and making a decision about OTD
– Appreciate an individualized approach to care;
conveys nursing care is not just about procuring
body parts
– Need support coping with a difficult situation,
and want to make the right decision
Describing Families
Negative Language
• Demanding
• Controlling
• Angry
• Passive, indifferent, non-participatory
• Non-compliant
Positive Language
• Strong advocate
• Actively involved, aware
of own needs
• Concerned, worried
• May need more time
• Has different priorities
Social Context
• The feeling there is an increase in special
requests in healthcare from members of
ethnocultural communities
• Frequent questions regarding the care
provider – patient / family relationship and
their rights
• Intercultural questions are judged as
« difficult patient / family »
• Bouchard-Taylor Commission
Reasonable Accommodation
• Judicial term used in Canadian
multiculturalism politics
• Notion of equality and prohibition of
discrimination
• Obligation to come to an agreement to end
racial discrimination
Personalization of Care
• Recognition of a person and family’s
uniqueness
• Foster autonomy, dignity, confidence, and
satisfaction with care
• Permits care to be adapted for
ethnocultural community members who
could be members of our vulnerable and
at risk populations
Personalization of Care con’t
DOES NOT MEAN to give in to all of the
family’s demands
BUT RATHER
To open a dialogue to reflect and to
exchange thoughts to find satisfactory
solutions for the people involved
Integration of Personalized Care
• Recognize others might have a different
understanding of health, illness, and death
• Facilitate a discussion on the family’s values,
beliefs, and rituals
• Explore how cultural and religious practices
could be integrated or adapted to the constraints
of the unit / institution
• Incorporate the information / decisions in to the
care plan
• Involve family members in the search for
solutions
Established Boundaries
• Deontology – Standards of practice
• Security, hygiene, infection control
• Undue costs (financial and human resources)
• Requests cannot infringe on the right and
liberties of other people
Promotion of Transcultural Nursing
A 2010 Task Force that developed a set of
standards for cultural competence.
One of the standards focuses on the
importance of cultural knowledge and the
need to create resources for nurses
containing specific information on commonly
cared for ethnocultural communities
Leininger’s Theory of
Culture Care Diversity and Universality
• Based in anthropology and nursing
• Prepares nurses to provide culturally
congruent care by safeguarding cultural
values, accommodating beliefs, and
restructuring cultural viewpoints so that
care becomes relevant within a family’s
frame of reference
• Fosters a therapeutic nurse-family
relationship
A Family Cultural Assessment
• Want to facilitate the creation of meaning and
context for patients and families throughout the
OTD experience
• Information gathered from the cultural
assessment is used to identify a family’s unique
needs that may impact the OTD process and to
develop tailored interventions that reflect
culturally congruent care
• Assessment is on-going
• Based on Leininger's Sunrise Enabler Model
Sunrise Enabler Model
Composed of seven factors:
• Kinship & Social
– Family composition
– Description of cultural background
– Decision-making structure
– Spoken languages
– Family end of life rituals
• Religious & Philosophical
– Family views and / or cultural influences on spiritual
beliefs, religious affiliations, and death
Sunrise Enabler Model (con’t)
• Technological
– The machines and equipment used in the care of the
potential donor
– Family computer literacy (find information,
communicate with family and friends)
• Cultural Values, Beliefs, & Lifeways
– Knowledge of OTD
– Perception of medical professionals
– Health and illness practices
Sunrise Enabler Model (con’t)
• Political & Legal
– Political and social affiliations / beliefs
– Perception of legal documents
– Immigration status
• Economic (socioeconomic status)
– Financial resources
– Family support
– Community support
– Work place support
• Educational
– Level of completed education
Case Study
Maria is a 24 year old Brazilian-Canadian
who was celebrating her university
graduation with friends and Canadian
boyfriend of three years.
She was hit by a car while crossing the road
and suffered a non-survivable TBI.
Her GCS is 5T.
Case Study
• The family immigrated to Quebec when
the father accepted a promotion
• Maria and her three siblings were less
than ten years of age at the time of the
move
• Mom does not work outside the home
• Maria is the eldest and lives at home with
her family
• Practicing Catholic
Case Study
• Maria’s condition continues to deteriorate.
Thirty-six hours post-accident she meets
the criteria for neurological death.
• You notice the back of her Medicare card
is signed, providing consent for organ and
tissue donation
• The parents agree to meet with the nurse
clinician for OTD to explore this end of life
option
Interventions
• Based on gathered patient and family
information
• The information is categorized per type of
culture care
• The results create an individualized plan of
care to promote culturally congruent
nursing care
Type of Culture Care
• Integration: Actions and decisions to retain,
preserve or maintain beneficial care beliefs and
values
• Accommodation / Negotiation: Creative actions
and decisions that help families adapt to or
negotiate with others for culturally congruent,
safe and effective care
• Restructuring Cultural Viewpoints: Collaborative
actions and decisions to help families and / or
institutions change, modify or restructure their
habits for beneficial health care practices
Take Home Messages • Learn how to facilitate a dialogue with a diversified
clientele to gather information on the values, beliefs,
and lived experiences
• The majority of cultures and religions support
donation. This option MUST be offered to the family
of eligible potential donors.
• Breaking down barriers means families are offered
the opportunity to make a decision that best reflects
the deceased’s values and beliefs, as well as their
own
• Many families feel donation brings meaning to the
death of a loved one
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