The cultural protocols and practices influence the temperamental patterns and behavior of individuals living in any geographical confinement. However, variations across these cultural beliefs and aboriginal practices generate various perspectives in context to end of life attributing to ideological differences developed under the influence of cultural diversification prevalent across the globe. Indeed, patients affected by life threatening conditions require specialized medical assistance in terms of palliative care with the intent of mitigating the disease manifestations rather than providing complete cure to fatal medical morbidities. The cultural approaches and practices in relation to end of life stages influence the psychological state of individuals affected by life threatening conditions. Therefore, thorough understanding of these cultural perspectives highly warranted in efficiently rendering palliative care and support to the patients by the qualified nursing professionals.
Keywords: Medical, palliative, cultural, aboriginal, nursing
Indigenous Practices and their Relationship with Culturally Appropriate Palliative Care
The ancient Catholic beliefs consider the acts of envy and evil spirits as primarily responsible for the death of individuals. The indigenous aboriginal Australian people variably trust on the concept of afterlife and perform funerals in accordance with their social demands and ancient customs (Lemone et al, 2014, p. 94). The concepts about life and death in aboriginal societies follow their understanding of identity, origin, destiny and spirit in terms of survival and adaptation. The academic literature reveals the traditional contention of Chinese, Italian and Greek Australians about death and dying, thereby warranting provision of improved palliative care services for these societies (Lemone et al, 2014a, p. 94). Indeed, these ancient societies consider discussions in context to death and dying as worthless and inappropriate and therefore, create challenges for the nurses engaged in palliative care of patients experiencing advanced stages of life threatening clinical morbidities. The palliative care to the patients during their end of the life stages includes conducting open discussions regarding death experiences to facilitate sense of wellness and psychosocial stability among the dying individuals. The model of palliative care for indigenous societies focuses on developing culturally sensitive services in context to the regional practices and customs about death and dying. Furthermore, the configuration of local assistance and information dissemination bridges warranted to create awareness about various fatal morbidities and their supportive strategies across the aboriginal societies to make them understand the intent and requirement of palliative nursing care during the end stages of human life. Chang & Johnson (2014, p. 240) discuss about the reduced life expectancy among the indigenous communities pertaining to New Zealand and Australia. Indeed, the perspective of cultural safety among the aboriginal societies emphasizes the emotional bonding between the patients and their immediate surroundings including community, family and relatives in context to the indigenous principles prevailing between the traditional groups. These perspectives generate the sense of self esteem and individualization among the aboriginal patients, thereby warranting the requirement of rendering culturally sensitive palliative care to these patients groups by the nursing professionals.
The influence of traditional beliefs and customs on the indigenous patients impact their way of communication with the nursing professionals and make them reluctant in availing treatment from the renowned healthcare centers located outside their geographical territories. Furthermore, the indigenous societies remain unaware in context to the disability service facilities particularly functioning to assist and facilitate the well being of individuals experiencing physical and mental challenges under the influence of various clinical morbidities (Biddle et al, 2014, p. 101). The indigenous people indeed consider hospital palliative care wards as their final destination and therefore, resist in receiving care and therapy outside their home locations due to this traditional outlook (Chang & Johnson, 2014a, p. 241). The Australian indigenous groups remain uncomfortable in sending their relatives (diagnosed with fatal conditions) to palliative care units for receiving clinical and psychological assistance. Furthermore, aboriginal societies consider hospital facilities as evil places and therefore, patients face tremendous challenges while sustaining in the palliative care settings in context to seeking medical assistance. People following the traditional customs prefer dying within their family surroundings rather than hospital setting, as evidenced by the academic literature. The Indian indigenous practices include penalizing the husband of pregnant woman in event of her death due to the presumed inattention by her in-laws. The Bonda Indian communities indeed practice unhygienic methods resulting in manifestations including nasopharyngitis and malnutrition, and utilize their traditional approaches rather than clinical intervention in treating the disease conditions. Consequently, the untreated morbidities intensify with the course of time and lead to severe mortalities among the tribal population. The indigenous societies predefine their country of death with the belief of their spiritual transformation in homeland. Additionally, their emotional anticipation in context to the Western Medicine never allows them to avail palliative care during the end stages of life under the influence of serious clinical morbidities. The clinical literature reveals the circulatory manifestations, traumatic conditions, carcinomatous states and nutritional insufficiencies as the leading causes of morbidities among the Australian indigenous societies (Goodacre et al, 2013, p. 67). Furthermore, the life expectancy among indigenous people is comparatively less as compared to the non indigenous societies. The disease burden among indigenous population is considerably more as compared to other communities in terms of fatalities resulting from the life threatening conditions like cancer and cardiovascular abnormalities. Hubner et al (2015, p. 82) describe the states of interpersonal disturbances and self-disintegration while mourning on the deaths of their relatives and friends corresponding to same ancestral lineage. This certainly relates to the relevance of kinship among indigenous societies affecting the state of such patients inside their community, and its proportionate impact on the palliative care rendered by the nursing professionals. The cultural themes of the indigenous societies therefore, warrant recognition in context to delivering culturally sensitive palliative care to their people affected by traditions, rituals and customs across various regions of the world.
The concept of death and dying varies widely across various regions of the world. Some of the cultures believe death as a natural process rather than a fearful event, while some others describe it as a predetermined phenomenon resulting in the transfer of individual from one phase to another (Leming & Dickinson, 2015, pp. 79-80). The cultural variations in terms of beliefs about death reveal the difference in perspectives of various communities about the end of life. Some of the indigenous societies consider death as painful event; however, few of them celebrate the moments following death with the belief of attaining a better world by the dying individual. The thorough understanding of various customs and beliefs about death practiced by various communities required by the nursing professionals for restoring confidence among patients receiving palliative care and therapy in the clinical setting. Indeed, the nursing professionals bear the responsibility to render care and support to the patients as well as their families during the end stages of life (Coward & Stajduhar, 2012, p. 253). This type of culturally sensitive palliative care is possible only when nurses acquire understanding of aboriginal notions in context to the conditions of death and dying. The clinical literature reveals the lack of relevance in context to significance of palliative care and therapy among the indigenous communities across Australian subcontinent (Croft, 2011, p. 447). Indeed, the aboriginal communities believe the care and therapy of the dying individuals under community domain rather than in the isolated clinical setting. Therefore, the nursing professionals require understanding these culture perspectives with the intent to deliver culturally relevant nursing care and assistance to the indigenous patients experiencing end stages of their life. Some of the aboriginal people consider life after death as a continuous process and death as only a channel of transferring the soul from one medium to another. The prolonged rituals practiced after death of an individual by the indigenous people with the intent to facilitate the peaceful transgression of the soul to another world.
These cultural beliefs and variations across indigenous societies prove to be the major challenge in effectively rendering palliative care and therapy to the dying patients. Therefore, the nursing professionals require gaining cultural competence in terms of awareness regarding cultural prejudices, knowledge of various indigenous beliefs and perspectives, skills in context to rendering palliative care in multicultural domain and experience regarding multicultural encounters in the clinical setting. The acquisition of these interpersonal skills will indeed, facilitate unbiased and non judgmental care to the patients pertaining to indigenous domain while establishing trust and integrity with their society in context to the cultural conventions. The display of respect toward cultural protocols by nurses will assist in developing rapport with the patients while emphasizing the worth of palliative care during the end stages of patients’ life. Indeed, these approaches will assist the nursing fraternity in developing cross cultural models to effectively render palliative care and therapy to the patients representing multiple aboriginal sections. Addressing the cultural requirements of indigenous societies through conducting various interactive sessions, counseling episodes and seminars will generate ample scope to bridge the gaps between nursing professionals and indigenous societies in terms of effectively rendering palliative care and assistance during the terminal conditions.
Biddle, N., Al-Yaman, F., Gourley, M., Gray, M., Bray, J., Brady, B., Pham, L., Williams, E., & Montaigne, M. (2014). Indigenous Australians and the National Disability Insurance Scheme. Australia: ANU Press.
Chang, E & Johnson, A. (2014). Chronic Illness and Disability: Principles for Nursing Practice (2nd edn.). Australia: Elsevier.
Chang, E & Johnson, A. (2014a). Chronic Illness and Disability: Principles for Nursing Practice (2nd edn.). Australia: Elsevier.
Coward, H., & Stajduhar, K. (2012). Religious Understandings of a Good Death in Hospice Palliative Care. NY: State University of New York.
Croft, H. (2011). Caring in the Community. Australia: Pearson.
Goodacre, S., Collins, C., & Slattery, C. (2013). Cambridge VCE Health and Human Development. Australia: Cambridge.
Hubner, L., Leaning, M., & Manning, P. (2015). The Zombie Renaissance in Popular Culture. UK: Palgrave Macmillan.
Leming, M.R., & Dickinson, G.E. (2015). Understanding Dying, Death, and Bereavement (8th edn.). USA: Cengage.
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., Reid-Searl, K., Berry, K., Carville, K., Hales, M., Knox, N., Luxford, Y., & Raymond, D. (2014). Medical-Surgical Nursing (2nd edn.). Australia: Pearson.
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., Reid-Searl, K., Berry, K., Carville, K., Hales, M., Knox, N., Luxford, Y., & Raymond, D. (2014a). Medical-Surgical Nursing (2nd edn.). Australia: Pearson.
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