Phyllis R. Coolen and Saul Ebema

Cultural competency can be viewed as an ongoing journey of commitment and active engagement through the process of cultural awareness, cultural knowledge, cultural skills, cultural collaboration, and cultural encounter (Kachingwe & Huff, 2007; Leininger, 2002a). 

Cultural competency allows for the delivery of spiritual care within the cultural context of the patient and the avoidance of stereotyping (Kagawa-Singer & Backhall, 2001).  Trust is the underlying purpose behind cultural competency in the development of the hospice chaplain and patient relationship.  Without trust there cannot be an effective therapeutic relationship.

Key Elements of Cultural Competency

The following are the key process elements that require a hospice chaplain to commit to lifelong learning in order to enhance their cultural competency in delivery of spiritual care at the end of life.

Cultural Desire is the process of wanting to become culturally competent.  It is the motivation that is behind the hospice chaplain’s desire to actively engage and commit to becoming culturally competent.  Humility is the key factor in this process.   Humble hospice chaplains have a genuine desire to discover what the patient is thinking and feeling.  Also of critical importance is seeing each individual as a unique and worthy person to be treated with dignity, fairness, and deserving of quality of care.

Cultural awareness is the process of becoming more sensitive, respectful, and attentive to the patient’s cultural beliefs and practices.  Through this process the hospice chaplain becomes cognizant and reflective of his or her own cultural identity, attitudes, biases, and prejudices and how they shape his or her behavior, specifically in the provision of spiritual care at the end of life.

Cultural knowledge is the process of developing an understanding of the differences and similarities between and within cultural groups.  This includes learning about various cultural groups’ values, beliefs, lifestyle practices, and perspectives on life.  Culture is a powerful determinant of behavior towards illness.

Cultural skill is the process of cultural assessment, which obtains relevant information about the patient’s beliefs, values, and practices.  A critical component of cultural skill is the development of interpersonal communication skills that convey respect, appreciation, and sensitivity to other cultures.

Cultural collaboration is the process that requires a partnership approach between the hospice chaplain, the patient, and the family.  An important part of the collaboration is the development of mutually agreeable goals between the hospice chaplain, patient, and family.

Cultural encounter is the process of obtaining cultural experience through active engagement and, if possible, immersion in another culture.  Meaningful encounters require being open to learning, understanding, and appreciating the other person’s viewpoint.

The Relevance of Cultural Competency in End-of-Life Care

Working within the cultural context of the patient and family is an essential underpinning of end-of-life care.  Cultural influences can significantly impact the patient’s reaction to the dying process and the decisions the patient and family make (Giger, et al., 2006; Kagawa-Singer & Backhall, 2001).

Fostering trust is vital to the care of the patient and family during this difficult time.  End-of-life care means more than treating physical symptoms, but extends to the psychosocial, existential, and spiritual aspects of the patient’s needs.

Numerous studies devoted to understanding culture’s relevance to death and dying found that communication was the greatest barrier between the hospice team and the patient and family during end-of-life care (Eues, 2007; Jovanovic, 2011; Klessig, 1992).  

The Hospice team needs to consider the following (Lopez, 2007):

• the patient and family’s perspective on death and dying
• the patient and family’s perspective on health and suffering
• the patient and family’s perspective on hospice care services
• the patient and family’s acceptance of Western health care practices and their use of alternative traditional practices
• the role of spiritual and religious beliefs and practice
• the role of the family, including who is considered part of the family
• how the patient and family communicate (such as the need for interpreter services or that only certain words are acceptable when discussing illness and dying)
• the patient’s own role in problem-solving and in the process of decision-making

References

Agency for Healthcare Research and Quality. (2011). 2010 National Healthcare Disparities Report. (11-0005). Rockville, MD: AHRQ   

Campinha-Bacote, J. (2009). A culturally competent model of care for African Americans. Urologic Nursing, 29(1), 49-54.                

Campinha-Bacote, J. (2011). Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. Journal of Issues in Nursing (Online), 16(2). doi: 10.3923/OJIN.Vol16No02Man05

Carteret, M. (2011). Cultural aspects of pain management, from http://www.dimensionsofculture.com/2010/11/cultural-aspects-of-pain-management/

Carteret, M. (2012 Accessed). Cultural Group Guides. Dimensions of Culture Cross-Cultural Communications for Healthcare Professionals, from http://www.dimensionsofculture.com        

Chrisman, N. (Access 2011). Cultural competence in community health nursing. University of Washington School of Nursing,  (Unpublished manuscript). Seattle, Washington.

Countries and Their Cultures. (2012), 2012, from http://www.everyculture.com