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The ABCD cultural assessment is outlined below. Click to view PDF of this table.
What is their general attitude towards discussion of death and dying? Do they have positive or negative attitudes about particular aspects of care? Determine if the patient or family has positive or negative attitudes about a particular aspect of care being addressed, such as advance directives.
What is important for me to know about your faith or spiritual needs? What is the general decision-making style of the cultural group and specifically of the patient and family? Is the emphasis on the individual decision-making process or the family decision-making process?
What resources and support are available to the patient and family? Identify community resources that may be of assistance to the health care provider and the patient and family, such as translators, health care workers from the same community as the patient, community associations, religious leaders, and healers.
Advance Directives The Patient Self-Determination Act PSDA of Electronic Code of Federal Regulations, requires health care facilities to ask patients if they have an advance directive and if not, requires them to provide patients with information about advance directives.
The intent of the advance directive is to improve end-of-life care. There are two types of advance directives: Although the advance directive is legally valid throughout the United States, each state may have different laws governing advance directives.
In Washington State, the advance directive is used only when life-sustaining treatment would artificially prolong the process of dying in a terminal condition or if the individual is in an irreversible coma and there is no reasonable expectation of recovery. The advance directive becomes a legal document once the individual signs it and it is signed in front of the two required witnesses.
The completed advance directive form does not need to be notarized, but it is advisable. The advance directive form does not need to be filled out by a lawyer. The advance directive does not have an expiration date.
The individual can change or use his or her own words on an advance directive form or even create their own form; however, individual and witness signatures are still required. It is translated into 26 languages.
There is a cost associated with obtaining the document in an online or booklet format. The health care provider could utilize the online version of the Five Wishes as a discussion tool with the patient and family, and take the opportunity for the patient and family to fill out the form and have it printed and signed during the office visit.
The POLST are specific orders by the physician that indicate what type of life-sustaining treatment the individual wants, or does not want at the end of life. Key Points to Know About a Durable Power of Attorney for Health Care A durable power of attorney for health care is a legal document in which an individual designates a person to make medical decisions when the individual is incapacitated.
The designee can be a family member and more than one person can be designated, including a back-up person if the designee is not able to fulfill the role.
In Washington State, the document does not need to be notarized or witnessed. However, it is advisable to have a lawyer prepare the document and notarize it. The Washington State Medical Association provides information on advance planning, including forms available for download for advance directive, POLST, and for durable power of attorney for health care: The key in discussing advance directives is in the planning process.
The following are specific areas of concern: Lack of knowledge and understanding about advance directives.
Distrust of the health care system. Trust issues between the patient and provider can cause discord, leading to non-compliance with treatment suggestions and unwillingness to complete an advance directive.
Acculturation refers to the process of adopting the cultural norms of the dominant culture, which in this case is how acculturated the individual is regarding American core values and beliefs relevant to end-of-life issues. A study of English-speaking Japanese Americans found that despite acculturation, many of the subjects retained some of their Japanese cultural values and beliefs influencing end-of-life care and decision-making process, such as a strong preference for the group surrogate decision-making model Matsumura et al.
Some Filipino Americans, although they may have lived in the U. When the family is the decision-maker on health care issues, this may include the discussion and decision around an advance directive. Having advance directive planning discussions with the patient, before a serious illness, can eliminate this stress at end of life.
Preference for physician to make health care decisions. Some cultures may feel that initiating discussions about advance directive planning may be a sign of disrespect. Talking about death and dying is taboo in many cultures.King's College London's Faculty of Life Sciences & Medicine.
Latest news, features and press releases from the Faculty of Life Sciences & Medicine. boston, ma | march 14–17, the annualassembly hospice & palliative care presented by the place to learn the latest in hospice and palliative care.
This volume is directed towards professionals who work in the fields concerning death and dying. These professionals must perceive the needs of people with cultural patterns which are different from the "standard and dominant" patterns in the United States and Canada.
Our Vision is A world where life limiting illness, death and grief are managed with respect and compassion. Our Mission is To lead, promote and develop excellence in palliative care. 1.
PreambleWhilst diagnosis of a malignant disease such as cancer can result in a relatively short period of decline that may begin and end in acute care, for those living with life limiting illnesses such as dementia, disease progression is gradual and irreversible.
A. Demonstrates knowledge about Hospice and Palliative Care. Able to articulate the philosophy and services including the practice and roles of social work and the interdisciplinary team.