Culture and spirituality

At end of life, spiritual and cultural beliefs may have an increased significance for the person and their loved ones. Giving the appropriate support may enhance the positive experience for all.

Cultural needs

You can address cultural and religious needs by communicating with people about what is important to them.

Each person will have cultural, spiritual and religious beliefs that will shape the care you give. Be mindful that:

  • for some people spirituality may be linked to a belief system and for others it may be about finding meaning in what is happening
  • having a conversation and listening to people will help you understand and meet their needs
  • you don’t need to share a person’s values to respect them
  • a person may have rituals that they may need you to support them with before or after death
  • you won’t know what’s important to people unless you ask them
  • it is not possible to provide all the answers and a person may need further support by referral to a specialist team
The following clip demonstrates the impact of not respecting cultural values.


The following clip demonstrates how staff can respect cultural values.


Tips

Use the CULTURE acronym to help you deliver care.

A persons cultural beliefs may have an impact on their thoughts,wishes views and actions in relation to food and drink, especially as they approach the end of their life. These should be explored in a sensitive manner ensuring that we do not make assumptions in relation to cultural needs. Communication is key to ensuring that people receive appropriate cultural care.

Talk with the individual who is dying and their family, ask what is important to them, what gives meaning to their lives and the lives of the people they love. Ask what their views are in relation to food and fluid, and how it may or may not add to the persons comfort as they approach end of life. Poor communication is consistently reported as a barrier for minority ethnic groups when receiving care, lack of sensitivity around individual’s cultural and spiritual difference can enhance the feeling of stigmatism and isolation.

Know your own beliefs and the impact that your culture will have on how you will discuss people’s beliefs and attitudes, you don’t have to share a belief to respect it.
Language barriers and limited access to translators and advocates may result in an inability to understand what is happening and instill fear and anxiety in the person and their family. This may be equally so when inequalities are caused by reasons outside of culture i.e. intellectual disability.

Listen to what people have to say about their beliefs and their values. Help families learn by discussing the impact of artificial nutrition and hydration when someone is dying. It is important to support families to look at comfort measures i.e. the use of flavoured ice cubes, or how to make smaller appetising meals.

Acknowledge for some that the loss of needing or wanting to eat and drink can be devastating for families, more so within some cultures who may want life sustaining treatment such as artificial nutrition and hydration.

Take the time to explore, be interested; Trust the person to make their own decision in line with their beliefs.
Show understanding, remember you can show understanding and compassion to people without sharing a belief system.
Does the person have an affiliation to any religious group; do they have a religious leader they would like to support them; do they have any rituals they would like you to support them with pre or post death? Remember there will be different views held by individuals within any given group, so do not make assumptions. Review, personal beliefs may change when facing an end of life situation.
Everyone has a culture and a belief system, it is part of what makes us who we are. It is empowering to enable people to share their views and beliefs, and it enriches the Nurse Patient relationship and creates an environment whereby difficult conversations (such as those in relation to nutrition and hydration) as part of advance care planning, may take place. For some cultures advance care planning may be seen as an excuse to limit treatment and as such they may choose not to engage, however this should not mean we don’t keeping trying to keep communication pathways open.
 
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