Wednesday, July 6, 2016

The Art and Spirituality of Dying – Culture Makes a Difference

The following item is taken from Baylor Scott and White's North Texas' intranet site and describes a recent symposium in a series of offerings of which, as an employee and member of the Mission and Ministry Community, I am very proud.  It details the 2016 Symposium on improving end of life care through greater cross cultural awareness.  Enjoy! 
July 5, 2016:  A Nigerian mom, who was one of our patients, was dealing with the death of her baby. The Labor and Delivery staff was following the established approach of trying to allow the mom to hold her baby, but the mother kept resisting. One of the nurses took the time to pause and wonder if that had anything to do with the mother's culture. They explored further and found that there were significant cultural differences; it wasn't reluctance to process her grief or anything pathological. By being curious and caring, the staff was able to understand how to meet her needs in the most sensitive way possible.

Improving end-of-life care

On June 14 on the Baylor University Medical Center (BUMC) campus, Robert Hunt, PhD, director of Global Theological Education and director of the Center for Evangelism and Missional Church Studies at Perkins School of Theology at Southern Methodist University (SMU), presented "The Art and Spirituality of Dying." He stressed both modern and non-modern worldviews, and the significant differences between individuals of each worldview when situating themselves in the face of their own mortality. "I think it's very important in a hospital setting for everybody to constantly have a consciousness of cultural diversity, so that they can respond favorably and positively to it," Dr. Hunt explained. "This will provide the best care for the patients and will allow us to obtain the best outcomes for patient health."

With the help of a facilitator, Tia Jamir, PhD, BCC, and a panel had a chance to respond to Dr. Hunt's presentation and educate health care providers about their own faith and beliefs, and how to act around dying patients and families of similar backgrounds. This panel included Dr. Marygrace Hernandez Leveille, PhD, RN, ACNP-BP, Dina Malki, MA, and Pravrajika Brahmaprana.

Being sensitive

Dr. Leveille is a nurse scientist for BUMC and is responsible for nursing research. She started off by speaking about the importance of having a nurse next to a patient who is dying. "The nurse will hold your hand and will be there with your body and your spirit," she added. She went on to talk about her personal experience of being diagnosed with a brain tumor, and how the only thing she could remember after her surgery was praying. "I was sitting in a dark room with no recollection of who my parents were or where I was. I remember the nurse walking in to make sure everything was fine," said Dr. Leveille. She told the nurse that she thought she was praying. "The nurse told me that I was praying the Our Father and the Hail Mary, and began to pray with me. I then realized how strong and powerful that really was."

She continued to talk about the importance of being sensitive and inclusive, and addressing family needs. Dr. Leveille added that staff members and nurses must avoid being culturally insensitive. She shared a story about when she was a traveling nurse at a Jewish hospital, working in the emergency room. They brought in a Hasidic Jew who was covered in blood. Dr. Leveille decided to shave his beard and payot (ear locks). "All I knew was that as an ICU nurse I wanted that face to be cleaned so that an ET tube could stick well and I could do oral care. I didn't know I was being culturally insensitive," said Dr. Leveille. "As nurses, we have to make sure that the patient remains spiritually intact and that we are there for them and their family members." Addressing spiritual care plays a significant role in a nurse's life.

Muslim traditions

Dina is a Muslim American who has lived in Texas for 25 years. Dina discussed how to avoid hurting the dignity of dying Muslims, such as not forcing a patient to take medicine against their will or without the family's permission (depending on the situation), and to allow a dying patient to perform his or her ablution—the act of washing oneself—and to pray with or without the help of the family.
"I came here with the intention of educating the audience about the sensitivities of the Muslim culture and to talk about the spirituality of death," said Dina.

Hindu practices

Pravrajika is a sannyasini (ordained nun) and is currently the resident minister of the Ramakrishna Vedanta Society of North Texas in Dallas. She spoke to the audience about Vedanta, which is one of the six orthodox schools of Hindu philosophy. She went on to educate the group about Mantra initiation, which includes the "practice of constant remembrance to raise one thought in the mind—a chosen ideal—to the exclusion of all others, which grows into a strong current and becomes a mighty river of spiritual power," Pravrajika explained.

"In the early 1980s, when I was in Santa Barbara, Calif., a man named Tim used to frequent our bookstore. A period of time went by where we did not see Tim, and then one day I met him outside of our temple. He told me he had been diagnosed with AIDS, at a time when it was a social death far before a physical one. He began to come to our temple, and we watched Tim over a painful three-year transition. Every day became precious for him. He had received Mantra initiation, and told me that his disease had become his teacher. He lost all his friends and was abused in the hospital when being treated. At the end of his life, he began to visit the temple once a week, twice, thrice, and then once a day.

On the last day of his life, I went to visit him in the hospital, where he was abused again. The stench in his room was overwhelming and there were syringes and bloodstained pads everywhere. The nurses had neglected him. Tim was in a semiconscious state, he was in pain as though his soul was yearning for God. It is a Hindu custom to bring Ganges water from the sacred river. My senior sister told him that the Lord had come to take him, as he opened his mouth to receive the Ganges water. We began to chant the name of God, Tim's chosen ideal, aloud. Minutes passed and suddenly we saw Tim's mouth moving—he was silently chanting with us. Suddenly, from a semiconscious state, he lifted himself up and turned to face us with eyes that could not see, but his face was wreathed in a blissful smile. He was at peace."

Cultural heroes
The director of Pastoral Care at BUMC, Mike Mullender, PhD, BCC, presented the Cultural Hero Award recipients. This special highlight recognized staff members who were nominated after meeting specific criteria, such as helping to advance cross-cultural understanding in their own service line, helping their floor or unit to be more welcoming to people of various cultures and faiths, advocating for an individual patient to make a significant difference in that life, and showing an appreciation and a lifelong commitment to learning about cross-cultural issues. The award recipients included:
  • Deborah Gordon, MSN, MHA, RN
  • Courtney Golden, BSN, RN, CCRN
  • Stacy A. Tackett, MS, RN, ANP-BC
  • Juanita C. Tarango, LMSW
  • W. Mark Armstrong, MD, MACP
  • Jay A. Allport, DO

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