Assignment 1 – Developing your research question
Word count: NUMWORDS * MERGEFORMAT 896
Student name: Student ID:
Title
The effects of culture on the provision of end-of-life culture on African American patient.
Research problem
Culture has been identified as a very important aspect to consider when giving end-of-life care (Ball et a., 2010; Steinberg, 2011; Ganz e al., 2006; Schim & Doorenbos, 2010). During their end-of-life days, many patients are affected by their values, societal beliefs, religious beliefs and personal beliefs (Hern et al., 1998). Steinberg (2011) identifies that, for many clinicians, the discussion and consideration of culture in a palliative patient are a difficult area. According Ganz et al. (2010), cultural variation in different regions affects decision-making during end-of life care, and this effects the outcome of care.
Considering that culture has some effect on the outcomes of care (Steinberg, 2011), adhering to the demand of respecting culture is likely to be a challenge in a multicultural setting, as the United States, where people share. Coolen (2012) observes that the problem is worse when the care provider and the patient are of different cultural backgrounds. The care of African Americans in a society dominated by the whites poses a great challenge. According to Coolen (2012), the American values emphasize autonomy in decision-making during end of life care, while African-Americans view the family as the best place institution to make decisions. Because of these disparities and conflicts, the results can be miscommunication with patient or family, inadequate care, inappropriate symptom management and poor diet for the patient. While research has been conducted to show the effects of culture on patients, few have focused on this specific group of African Americans. There is need for research in this area because African Americans live in a culture dominated by the whites, and at the same time they need to preserve their values. This research paper focuses on the need to consider cultural effects while caring for African American patients.
What is already known
Several researches have been conducted, and they agree on one thing: that culture has a significant effect on the end of life care (Coolen, 2012; Raghavan, Smith & Arnold, 2008). The values and attitudes of African Americans towards end of life care differ greatly compared with those of the entire American population (Raghavan, Smith & Arnold, 2008). Searight and Gafford (2005) agree that patient dissatisfaction, ineffective communication and poor patient-goal outcomes have been realized due to cultural differences between African American patients and white care providers. According to Steinberg (2011), a complicated challenge arises further because cultural differences exist even within the African American communities. Coolen (2012) posits that clinicians have always made a mistake by assuming that the values and beliefs of all African Americans are similar. The assumptions eventually lead to undesirable patient outcomes. Steinberg (2010) argues that culture affects not only the patient that are being nursed, but also the relatives and the healthcare workers that are attending the patients. Thus, culture should not be considered on the part of the patient alone. The beliefs of the nurse and the other members of the health care team are very likely to affect the outcome of care, as influenced by their cultural beliefs (Koening & Williams, 1995; Kwak & Harley, 2006). In relation to informal family care-giving, Herbert and Schultz (2006) argue that the family cares for the palliative patient with a lot of reference to their beliefs.
According to Raghavan, Smith & Arnold (2008), African Americans are less likely to be satisfied with end of life care, enroll in hospice, and receive appropriate symptom management. Additionally, they are more likely to stop hospice care, and receive very aggressive treatment at their end of life. According to Valente (n.d), African Americans tend to associate hospice care with giving up, while the whites have a preference for hospice care. They do not take directives from care providers very serious. Rather, they verbalize their situations with family members. According to Steinberg (2011), these behaviors are not rooted in the lack of education, because they have also been observed in African American physicians. It is thus clear that these behaviors are rooted in strong cultural beliefs among his African Americans. The behavior also reflects a strong faith on the part of African Americans, in that they believe strongly that death is controlled by God.
The other area of disparity as identified by Searight and Gafford (2005) is in revealing bad news to the client or the family. American values emphasize truth-telling regardless of the magnitude of the news. This is very much different from the African Americans who consider that plain revealing of bad news as a diagnosis of chronic disease may be a disrespect to the client or the family (Phillip & Charles, 2003). The culture of the African Americans has been that the clinician conceals the news until the family or the client has got some clue on the information. Valente (n.d) laments that, even as many people appreciate the value of communication during end of life care, some African American cultures consider talking about death a taboo. In regard to this, the care provider attending to such a patient must have the knowledge of the culture of the individual in order to incorporate cultural values in the care (Krakauer,Crenner & Fox, 2002). Failure to do this results to inappropriate care to the patient.
Gap in knowledge
The many researches that have been conducted concerning culture and its effects in end of life care, focus on two major groups: the whites, and the minority groups (Steinber, 2011; Valente, n.d; Coolen, 2012). Only a few of the researches have given some preference to specifically study a single minority group (Raghavan, Smith & Arnold, 2008). In addition, the research focus more on the differences between the values of the European Americans versus the minority groups in the US (Werth et al., 2002). A focus on the effects of violations of these beliefs and preferences has not been given priority. Where this has been discussed, assumptions made by care providers about the values of African American have been documented, leading to poor outcomes, and inappropriate care. Since with the existing knowledge, there are still many issues of violations of cultural values and preferences, leading to poor clinical outcomes, it is important to give preference to study deeply the cultural beliefs of African Americans, and their influence on the provision of care. This study thus focuses on the cultural values of African Americans, and how they affect the provision of end of life care.
Research question
The research seeks to provide a solution to the existing gap in knowledge concerning the relationship between the culture of African Americans, and the outcomes of end of life care. The research question would thus be: What are the impacts of culture on the provision of end of life care among African Americans?
What needs to be known
The reviewed literature has revealed that, even though some information is known about the preferences of African Americans, errors are still prevalent in the provision of end of life care. Assumptions have been made that all communities of African Americans share values and beliefs (Coolen, 2012), but they have not borne positive results. There is thus a need to study deeply the underlying strong cultural values of African American communities and know how best to intervene, in order to improve his end of life care. The study adopts a literature-based method. The population of the study will be the existing literature. A mixed-method of research has been adopted. In this study, provision of end of life care will be the dependent variable, because it is affected by attitudes, beliefs and values of patients and care providers. The independent variables will be the effects of culture. The existing literature will be reviewed, and data synthesis employed for analysis of results.
Project aims and expected benefits
The aim of this research is to investigate the impacts of culture on the provision of care among minority African Americans in the dominant white population of the US. The reviewed articles in this area reveal that, although some information is known about the topic, cases of assumptions have been reported, which lead to poor patient outcomes. Poor understanding of African American culture leads to inappropriate management and ineffective communication, thus dissatisfaction of the patient. The results of this research paper will be beneficial in correcting this problem, thus improving the provision of end of life care.
References
Ball, G. C., Navsaria, P., Kirkpatrick, W. C., Velcler, C. Dikson, E., Zink, J., … & Feliciano, V. D. (2010). The impact of country and culture on end of life care from injured patients: Results from an international survey. Journal of Trauma, 69(6), 1323-33.
Coolen, R. P. (2012). Cultural relevance in end of life-care. Retrieved from ethnomed at http://ethnomed.org/clinical/end-of-life/cultural-relevance-in-end-of-life-care
Ganz, D. F., Bembenishty, J., Hersch, M., Fischer, A., Gurman, G., & Sprung, C. L. (2006). The impact of regional culture on intensive care end of life decision making: An Israeli perspective from an ETHICUS study. Journal of Medical Ethics, 32(4), 196-199.
Herbert, S. R., & Schulz, R. (2006). Care-giving at the end of life. Journal of Palliative Medicine, 9(5), 1174-1187.
Hern, E. H., Koenig, A. B., Moore, L. J., & Marshal, A. P. (1998). The difference that culture can make in end-of-life-decision making. Cambridge Quarterly of Health-Care Ethics, 7(1), 27-40.
Koenig, B. A., & Williams, J. G. (1995). Understanding cultural differences in caring for dying patients. Western Journal of Medicine, 163(3), 244-249
Krakauer, E. L., Crenner, C., & Fox, K. (2002). Barriers to optimum end of life care for minority patients. Journal of the American Geriatrics Society, 50(1), 182-190.
Kwak, J., & Haley, E.W. (2005). Current research findings on end-of –life decision making among racially and ethnically diverse groups. The Gerontologist, 45(5), 634-641.
Phillip, L. D., & Charles, L. S. (2003). Cultural differences at the end of life. Critical Care Medicine, 31(5), 354-357.
Raghavan, M., Smith, A., & Arnold, R. African Americans and end of life. Retrieved online from http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_204.htm
Schim, M.S. & Doorenbos, A.Z. (2010). A three dimensional model of cultural congruence: Framework for intervention. Journal of Social Work End Life Palliative Care, 6(3-4), 256-270.
Searight, R. H., & Gafford, J. (2005). Cultural diversity at the end of life: Issues and guidelines for family physicians. American Family Physician, 71(3), 515-522.
Steinberg, M. S. (2011). Cultural and religious aspects of palliative care. International Journal of Critical Illness and Injury, 1(2), 154-156.
Valente, S. (n.d). Culturally diverse communities and end of life care. American Psychological Association. Retrieved from HYPERLINK “http://www.apa.org/pi/aids/programs/eol/end-of-life-diversity.pdf” http://www.apa.org/pi/aids/programs/eol/end-of-life-diversity.pdf
Werth, J. L., Blevins D., Toussant K., & Dhurham M. (2002). The influence of cultural diversity on end of life care. American Behavioral Scientist 46(2), 204-219.
