Exploring Culture as it Relates to Death and Dying

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Exploring Culture as it Relates to Death and Dying
BC Farnham, MSW, MBA Debbie Favel, RN, MSN,
CHPN Dr. Denise Green Sheryl Matney, MS Jenny
Gilley Carpenter, LPN. Karina Lemos, RN.
Elizabeth R. Pugh, LBSW.
This program is made possible through a
collaborative community-education partnership
between The Consortium for Advancements in Health
Human Services, Inc. and the presenting agency.
The primary goal of this effort is to increase
public awareness and access to hospice care,
through the provision of community-based
education. Contact Hours are awarded to
professionals who complete this program by The
Consortium for Advancements in Health Human
Services, Inc.
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Important Information

• This education program for healthcare
  professionals was developed by The Consortium for
  Advancements in Health and Human Services, Inc.
  (CAHHS) and is facilitated by the presenting
  agency via a community education partnership
  agreement. CAHHS is a private corporation and is
  solely responsible for the development,
  implementation and evaluation of its educational
  programs. There is no fee associated with
  receiving contact hours for participating in this
  program titled, Exploring Culture as it Relates
  to Death and Dying. However, participants
  wishing to receive contact hours must offer a
  signature on the sign-in sheet, attend the entire
  program and complete a program evaluation form.
• The Consortium for Advancements in Health and
  Human Services, Inc. is an approved provider of
  continuing nursing education by the Alabama State
  Nurses Association, an accredited approver by the
  American Nurses Credentialing Center's Commission
  on Accreditation.The Consortium for
  Advancements in Health Human Services, Inc., is
  approved as a provider of continuing education
  in Social Work by the Alabama Board of Social
  Work Examiners, 0356, Expiration
  Date 10/31/2014.
• The course listed above was completed on / /
  and is approved for 1.0 CEUs. Approval number
  79003632. To claim these CEUs, log into your CE
  Center account at www.ccmcertification.org.
• In most states, boards providing oversight for
  nursing and social work recognize contact hours
  awarded by organizations who are approved by
  another state's board as a provider of continuing
  education.  If you have questions about
  acceptance of contact hours awarded by our
  organization, please contact your specific state
  board to determine its requirements. Provider
  status will be listed on your certificate.
• CAHHS does not offer free replacement
  certificates to participants. In the event that
  CAHHS elects to provide a replacement
  certificate, there will be a 20.00
  administrative fee charged to the individual who
  requests it.

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Learning Objectives

• Participants completing this program will be able
  to
• Discuss how Native American culture impacts
  practice when facing death and dying.
• Identify how Asian culture impacts practice when
  facing death and dying.
• Discuss how African American culture impacts
  practice when facing death and dying.
• Identify how Latino culture impacts practice when
  facing death and dying.

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Native American Culture

• Because they lived so close to nature, all Native
  American peoples from the Stone Age to the modern
  era knew that death from hunger, disease, or
  enemies was never far away. The various death
  customs and beliefs, which first evolved during
  the invasions of Asians from Siberia to Alaska
  across a land bridge during the last Ice Age at
  least 12,000 years ago, gave them the means to
  cope with that experience.

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Native American Culture

• Most Native American tribes believed that the
  souls of the dead passed into a spirit world and
  became part of the spiritual forces that
  influenced every aspect of their lives.

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Native American Culture

• Burial customs varied widely from tribe to tribe.
  Indians disposed of their dead in a variety of
  ways.
• Lets explore the practices of some different
  tribal groups.

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Native American Culture

• Rites among Native Americans tended to focus on
  aiding the deceased in their afterlife. Some
  tribes left food and possessions of the dead
  person in or near the gravesite. Other groups,
  such as the Nez Perce of the Northwest,
  sacrificed wives, slaves, and a favorite horse of
  a dead warrior.

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Native American Culture

• Some Southwestern tribes, especially the Apache
  and Navajo, feared the ghosts of the deceased who
  were believed to resent the living.
• And, others take a rather organic and mystic
  position about death and dying. Consider this
  excerpt from a recent article.

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Native American Culture

• History shapes the future
• Although many of these practices are now
  considered to be only a matter of cultural
  history. Many Native Americans practice modified
  versions of their customs and death practices of
  the past.

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Asian Culture

• Almost every human being has the desire for
  continuance after death and as with many
  religions, the Chinese believe they have a soul.
• Therefore the Chinese people are encouraged to
  live a life that will prepare them for personal
  salvation in the afterlife.

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Asian Culture

• The Taoists believe that human energies live in
  the underworlds, spiritual mountains and heavenly
  places.
• The concept of soul is influenced by Buddhism,
  Confucianism, Taoism and folk religion.
  Confucians believe in hierarchy of souls within
  each person and these souls are linked to the
  energies of the cosmic universe.
• Taoists, Confucians and folk religions believe
  that the energies of the soul return to the
  universe in the form of yin and yang forces and
  that the souls need help to go their separate
  ways.

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Asian Culture

• There is evidence that as early as the Shang
  period (1500 1050 B.C.) that the Chinese cared
  for their departed ancestors as well as feared
  them. The Chinese focused their attention on
  their life's continuance through their ancestors,
  who gave them life and sacrificed many of life's
  pleasures.
• They believe that to sacrifice for one's
  offspring is to instilled in them a sense of
  obligation to their elders and ancestors.
  According to the "Scripture of Filiaty" (Warring
  States Period 453 221 B.C.) these obligations
  consist of taking care of the body, as it is a
  gift from one's parents, to be successful in
  life, to glorify ancestors, respect to ones
  elders, just to name a few.

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Asian Culture

• The Chinese believe that they live beyond the
  grave.
• It is assumed that the dead influence the life of
  the living, therefore proper burial, observance
  mourning and continuous offerings of food and
  gifts to the ancestors will ensure that the
  living will be taken care of. When these rituals
  are not observed it can result in the wrath of
  your ancestors raining upon you, resulting in
  sickness, financial ruin and cause disharmony in
  the family.

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Asian Culture

• The realm of the ancestors is considered to be
  dark and murky.
• The Chinese believe that the world of the
  departed spirits is similar to our world, only
  difference being time.
• Morning in our world is night time in their world
  and that is why the spirits show mainly at night.
  
• They believe that the spirits in the other world
  also need food, clothes, money, processions they
  also believe that they must also deal with
  bureaucrats.
• "Ten Courts of Hell", where spirits where judged
  and suitable punishment is meted out. Here it was
  decided who would go to hell, return to earth or
  remain in heaven.

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There are nine standardized funeral rites
according to Master Zhu (Zhu Xi, 1130 1200C.E)

• 1. family gives public announcement
• 2. family members don mourning clothes of white
  cotton and hemp
• 3. ritual bathing of the corpse
• 4. make food offerings to the dead, burn spirit
  money and other possessions such as houses, car,
  furniture made of paper
• 5. install ancestral tablet at the family alter
• 6. pay money to ritual specialists to safely
  remove the corpse
• 7. play music to settle the spirit
• 8. seal the corpse in airtight coffin
• 9. remove the coffin by procession to the grave
  site.

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Asian Culture

• It is believed that the bones of the corpse
  represents power which lasts beyond death which
  can affect the fate of the living, because of
  this belief the Chinese prefer to bury their dead
  rather then cremate.
• A fung shui expert will be called in to determine
  the time, place and direction the body should be
  buried.
• After the burial the soul must be cared for
  according to mourning customs.

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African American Culture

• Death has always been to many a forbidden topic
  of discussion. However, in the African American
  community death is very much an important aspect
  of culture. It has been stated that death
  traditions, customs, procedures, mourning
  practices, burial rites, and even the structure
  of African American cemeteries differ greatly
  from that of non-African Americans. It has been
  stated amongst the black community that death is
  not a time of sadness but a time to rejoice for
  the deceased no longer has to endure the trials
  and tribulations of this earthly world. The
  deceased are indeed mourned and missed, however,
  death is also a time of celebration. These
  emotions and procedures of death is what is
  focused on.

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African American Culture

• Many African Americans may not be aware that some
  of the present day traditions and customs of
  death can be traced back to African roots of the
  Bakongo and the LaDogaa tribes.

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African American Culture

• Death to African Americans is not an event which
  just occurs, is "handled," and then forgotten
  about.
• Old beliefs and superstitions, are remembered and
  acted upon.

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African American Culture

• There is usually a five to seven day mourning
  period before the actual funeral. Before the
  funeral takes place there is generally a ceremony
  known as a wake.
• At this time, close friends of the family of the
  deceased pay respects to the family and view the
  body.
• Many wakes take place at the funeral parlor, but
  have been known to take place at the church or
  the home of the deceased. This is a time when
  everyone gathers and eats food cooked by the
  family members, and shares memories of the
  deceased.

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African American Culture

• Once reaching the cemetery many traditions (or
  superstitions) are followed concerning the actual
  burial of the dead. It is believed that it is
  important that the dead be buried feet facing
  east to allow rising at Judgment Day. Otherwise
  the person remains in the crossways of the world.
  
• Coins are placed on the eyes of the dead to keep
  them closed. However, coins were also sometimes
  placed in the hands as the deceased person's
  contribution to the community of the ancestors-or
  perhaps, as a token for admittance to the spirit
  world.
• For the same purpose coins are also placed on or
  around the grave site.

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Latino Culture

• In the Latino culture, there is a complex
  relationship between health and illness, as well
  as the physical, mental, and spiritual parts of a
  persons life.
• Family involvement is very important. The
  family-centered model of decision making is
  highly valued and may be more important than
  patient autonomy. In the Latino culture, this is
  called familismo, which is characterized by
  interdependence, affiliation, and cooperation.

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Latino Culture

• Relatives participate in the spiritual and
  physical care of their ill family member. The
  family may be apprehensive about giving technical
  care without receiving education and training.

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Latino Culture

• The family may prefer to hear about medical news
  before the patient is informed so that they can
  shield the patient or deliver the news gradually.

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Latino Culture

• Your patient and family may prefer to be at home
  at the end of life. The patient may believe that
  the hospital setting is impersonal or that the
  routine disrupts the familys ability to take
  care of their loved one.
• Your patient and family may believe that God
  determines the outcome of illness and that death
  is a natural part of the life process.

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Latino Culture

• When talking to your patient and family about
  terminal illness do not use euphemisms. They do
  not translate well, and it makes it difficult for
  the interpreter to communicate. Use of clear and
  specific language will help the patient and
  family better understand the prognosis and make
  decisions about palliative care.
• Your patient and family members may not be
  assertive or aggressive when communicating with
  doctors and clinical staff. They may not want to
  have any direct disagreement. As a result,
  important issues and problems may not be
  discussed, unless you initiate a dialogue

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Latino Culture

• Your patient and the family may display pictures
  of saints. Saints have specialized and general
  meanings for Catholics. For example, St.
  Peregrine is associated with cancer, St. Joseph
  with dying, and Our Lady of Lourdes with body
  ills.
• Some families may want to honor their deceased
  relative by cleansing the body.

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Latino Culture

• Prayer and ritual may be a part of the
  end-of-life process for your patient and the
  family members. Family members may use prayer or
  bring special amulets and rosaries (prayer beads)
  while visiting a dying patient.
• The family members may request that they keep
  candles burning 24 hours a day as a way of
  sustaining worship. Electric candles should be
  made available for patients and families.

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Latino Culture

• There may be a belief that a persons spirit is
  lost if they die in the hospital rather than the
  home setting.
• The last rites (now anointing of the sick) are
  important for people who are Catholic. A priest
  or lay visitor may be asked to perform these
  rituals when a person is close to death.

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Conclusion

• Death and dying is a significant aspect of life
  for anyone regardless of culture.
• It is important professionals continue to
  increase knowledge and skills that support
  culturally competent practice.

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Program Evaluation

• Once you have completed the program evaluation,
  certificates for professionals who desire them
  are available.
• Thank you for your participation and interest in
  our community education programs.

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References

• The following are electronic references used to
  develop this continuing educational program
• http//www.mainehospicecouncil.org/diversity/EndLi
  feCare-Latino9_04.pdf
• http//www.deathreference.com/Me-Nu/Native-America
  n-Religion.html
• http//www.theosophy-nw.org/theosnw/world/america/
  my-moff5.htm
• http//www.helium.com/items/1322399-chinese-belief
  s-about-death
• http//northbysouth.kenyon.edu/1998/death/deathhis
  tory.htm