Diversity can have an impact on the way people approach dying and death – and the health decisions that they make when affected by a life-limiting illness.[1, 2]
Diversity is what makes a person or group unique and is not just associated with ethnic background. Diversity can be reflected in several ways including:[2-4]
- Ethnicity and race
- Sexual orientation
- Age and generation
- Socioeconomic status
- Disability status
- Religion, faith and other beliefs.
Diversity influences health beliefs and practices, including beliefs about dying, death and bereavement. However, you cannot assume a person’s preferences based on their identification with a particular group. Discuss care options and needs to ensure that people receive the right care at the right time.[3, 5]
- The ‘lens’ through which we view the world and interpret or make sense of the experiences of life including illness, dying and death
- A system of interrelated values active enough to influence patterns of thought, behaviours, communication styles and beliefs about life and death
- A dynamic construct. Values and beliefs can change from one generation to the next depending on life experiences.
Cultural groups can vary according to where people live (urban, rural or remote regions), their environment and education.
In the context of dying and death, culture can influence:[5, 7-9]
- Language and communication styles
- Beliefs about illness and ill health
- Family involvement in care
- Expression of pain and other symptoms
- Meaning of life, dying, death, and grief
- Practices associated with care immediately after death
- Beliefs about what happens to the body after death
- Use of complementary and alternative therapies.
Australia is a highly diverse and multicultural society.
Australia’s culturally and linguistically diverse (CALD) population includes people who were born overseas, have a parent born overseas or speak a variety of languages.[7, 10]
• 28% of Australians were born overseas
• 21% of Australians had one or both parents who were born overseas
• 21% of Australians spoke a language other than English at home.
Cultural safety and its application to palliative care
It is important to acknowledge cultural diversity and to provide care and support according to people’s preferences. Your personal attitudes and beliefs can distort how you perceive people from different cultures and diverse groups.
Cultural safety provides an important framework for palliative care. It involves health professionals examining their own beliefs, behaviours and practices, as well as issues such as institutional racism, to ensure that their services are perceived as safe by the person receiving care.[8, 15]
Cultural safety is a framework developed by Māori nurse, Irihapeti Ramsden in the late 1980s. It extends beyond cultural awareness and cultural sensitivity and aims to ensure that the care provided:[6, 7, 16-18]
- Meets cultural needs and promotes feelings of being safe
- Provides positive outcomes to all people – regardless of whether they hold a different cultural outlook
- Is mindful of culture
- Recognises the distinct lifestyle and beliefs of the person and their family/carers.
A culturally safe approach to palliative care requires health professionals to:[6, 7, 16-18]
- Accept that everyone has their own unique culture
- Understand that individual views of the world, health, illness, dying and death are influenced by culture and the power dynamics that this creates in and between cultures
- Engage with all people as individuals in a culturally safe and respectful way
- Foster open, honest and compassionate professional relationships
- Be aware and mindful of their personal attitudes and values towards gender, race, religion and sexuality
- Be self-aware and reflect on their practice – particularly in relation to how their own cultural background influences their decisions and behaviour (and how it can differ from the people that they are supporting)
- Be aware of the different communication styles and norms used by diverse cultures. For example, within some cultures holding another person’s eye contact is disrespectful, while in others it is disrespectful not to
- Understand that all members of a cultural group do not have homogenous health needs, lifestyles or beliefs about care, dying and death
- Act respectfully in order to empower the person
- Promote shared respect, meaning, knowledge and experiences
- Recognise the need for and use professional interpreter services to support provision of care and effective communication.
Unsafe cultural practice occurs when actions diminish, demean or disempower the cultural identity of an individual.[6, 7, 18]
Cultural safety applies to all healthcare professions. Review the following links to find out more about cultural safety for your profession:
- Australian Association of Social Workers (AASW): Culturally responsive and inclusive practice in Australia
- Cultural Responsiveness in Action: An IAHA Framework
- Using the relevant link for your profession, describe the key elements of cultural safety and their implications for the care of people with a life-limiting illness.
- What would you do to avoid stereotypes and ensure that your practice is culturally safe and encompasses diversity in all of its forms for everyone in your care?
- How can health services create a culturally safe care environment for people who are dying?
- Find out how to access professional interpreter services in your clinical practice context when caring for people with a life-limiting illness who require this support.
- Murray, S.A., et al., Palliative care from diagnosis to death. BMJ, 2017. 356.
- Hayes, B., et al., Health and death literacy and cultural diversity: insights from hospital-employed interpreters. BMJ Support Palliat Care, 2017.
- Crawford, T., S. Candlin, and P. Roger, New perspectives on understanding cultural diversity in nurse-patient communication. Collegian, 2017. 24(1): p. 63-9.
- Jhutti-Johal, J., Understanding and coping with diversity in healthcare. Health Care Anal, 2013. 21(3): p. 259-70.
- Halm, M.A., et al., Broadening cultural sensitivity at the end of life: an interprofessional education program incorporating critical reflection. Holistic Nursing Practice, 2012. 26(6): p. 335-349.
- Bozorgzad, P., et al., Cultural Safety: An Evolutionary Concept Analysis. Holist Nurs Pract, 2016. 30(1): p. 33-8.
- Laverty, M., D. R McDermott, and T. Calma, Embedding cultural safety in Australia’s main health care standards. Vol. 207. 2017. 15-16.
- Huntir, A. Cultural safety crucial in Aboriginal and Torres Strait Islander healthcare. 2018 [cited 2018 7/11/2018]; Available from: https://palliativecarensw.org.au/new/cultural-safety-crucial-in-aboriginal-and-torres-strait-islander-healthcare/.
- Wiener, L., et al., Cultural and religious considerations in pediatric palliative care. Palliative & Supportive Care, 2013. 11(1): p. 47-67.
- Australian Bureau of Statistics. Feature article 2: Australia’s cultural and linguistic diversity. 2010 [cited 2016 June 7]; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Previousproducts/1301.0Feature%20Article32009%E2%80%9310?opendocument&tabname=Summary&prodno=1301.0&issue=2009%9610&num=&view=.
- Australian Bureau of Statistics. Cultural Diversity in Australia. 2016 Census Data Summary. 2017 April 2018]; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Cultural%20Diversity%20Data%20Summary~30.
- Australian Bureau of Statistics. Australia’s Leading Causes of Death, 2015. 2016; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2015~Main%20Features~Australia’s%20leading%20causes%20of%20death,%202015~3.
- Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015. 2017 09/06/2015 [cited 2018 27/06/2018]; Available from: https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/data.
- Australian Institute of Health and Welfare. Australia’s health 2018. Australia’s health series no. 16. AUS 221 2018 09/06/2015 [cited 2018 24/06/2019]; Available from: https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/data.
- Nguyen, H.T., Patient centred care. Cultural safety in indigneous health. Australian Family Physician, 2008. 37(12): p. 990-994.
- Taylor, K. and P. Guerin, Health care and indigenous Australians: cultural safety in practice. 2010: Palgrave Macmillan.
- Richardson, S. and T. Williams, Why is cultural safety essential in health care? Med Law, 2007. 26(4): p. 699-707.
- Phiri, J., E. Dietsch, and A. Bonner, Cultural safety and its importance for Australian midwifery practice. Collegian, 2010. 17(3): p. 105-11.