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According to Colin Murray Parkes et al. in their book Death and Bereavement Across Cultures, a person’s personal view surrounding death and bereavement is heavily influenced on the culture in which said person was raised (Parkes, 2015). Cultural considerations surrounding death and bereavement must always be taken into consideration prior to the application of nursing care. To show respect to a family an open mind free of ethnocentricity as well as personal opinions must be considered in order for an optimal amount of nursing care to be provided (Parkes, 2015).
Christian, Islamic, and Jewish cultures will be explored, with a heavy emphasis on nursing considerations surrounding death and dying rituals as well as cultural practices. This being said one size does not fit all when considering how an individual could react in such a stressful situation, the purpose of this discussion is to provide a nurse with a framework of how an individual could react. It is also important to note that being a nurse encompasses more than providing physical as well as mental health care.
To provide a holistic aspect to being a nurse the mind, body, as well as spirit must be healed.
When reading Dickinson and Leming’s book Understanding, Death, Dying, and Bereavement, there are several passages exploring the topic of Christian Culture. The book describes that Christianity as a whole, encompasses a plethora of sects who practice customs and rituals differently when compared amongst each other (Leming, 2016). The common thread amongst cultural practices is to prepare Christian believers for the inevitability of death.
Most sects of the Christian faith believe in the existence of heaven and hell as places where believers have been judged and sent to serve judgment (Parkes, 2015). Following Christian ideals places one in heaven whilst abandoning beliefs and moral codes sentences a Christian to hell. Christian scripture helps dictate funeral rights and practices, but again the common thread amongst sects of Christianity is that depending on which sect the patient believes in will effect funeral practices (Leming, 2016). For example patients of the Christian faith can perform a wake, in which family members and friends celebrate the life of a person who has passed away by keeping vigil over the decreased person (Parkes, 2016). Quite often eating and drinking accompany this event as well as story regaling and dancing. For a nurse during this difficult time if a patient’s family wishes to perform the wake in the hospital before cremation or burial it would be important to supply adequate space as well as privacy for the family. Asking questions as well as providing family with required materials to perform this last request should be paramount.
Following death Christian believers follow several routes of burial as well as celebration, to determine the family’s wishes surrounding burial a nurse must always inquire as to the family’s wishes. Quite often Christian believers may opt to have a person buried in a classic funeral whilst others may choose to cremate the family member (Davies, 2017). In the case of premature death or death under suspicious circumstances autopsy for the most part is not condoned but neither is it discouraged. This being said an autopsy is considered a charitable act for a family as long as the body is treated with upmost respect (Davies, 2017). After death tissue and organ donation is considered charity, and for the most part is condoned by most sects of the Christian faith (Davies, 2017). For a nurse who approaches a family or family member surrounding organ and tissue donation it would be important to note what sect the family practices as well as the family’s opinion on the matter. In a nonjudgmental fashion as well as in a passive manner of speaking a nurse could approach a family member on this topic. Again it would be advised to assess the situation as well as to provide empathy as this could be a very difficult time for family members. As a whole the Christian faith is a dynamic as well as complex religion that allows followers to explore many different aspects of faith. The previous ideas on nursing care barely scratch the surface of what a nurse could encounter in his or her travels throughout nursing.
The Islamic culture surrounding death and dying is one of rich originality as well as the complex interplay between faith and personal beliefs. People of the Islamic faith believe in one god or Allah as well as believe in the prophet Muhammed (Bjordal, 2013). Muslims believe extensively in the existence of an afterlife as well as the day in which judgement will be passed upon its believers (Bjordal, 2013). The scripture read by the Islamic Culture is the Koran, which again heavily dictates the cultural practices and norms surrounding death and burial practices. When a patient is actively dying the Talqeen is performed in order for the patient to be spiritually ready to pass on into afterlife (Bjordal, 2013). After the patient has passed away the Ghusl or the practice of washing the deceased patient’s body is performed. Once the Ghusl has been performed the patient’s body is shrouded (Bjordal, 2013). Throughout these stages of the funeral process prayer is encouraged by the Imam or the spiritual leader following a strict set of rules and practices that must be followed. The funeral prayer in the Islamic faith is called the Salat al-Janazah (Bjordal, 2013).
For the nurse who is charged with taking care of this patient it should not come as a surprise if several members of the Islamic community arrive to visit the patient during this time. As in Islamic Culture this is considered an obligation as well as a respectful act allowing passage into the next life (Bjordal, 2013). Adequate space as well as privacy should be offered to the grieving family members and religious figures as the Salat al-Janazah is an exceptionally important part of the funeral process. Once this prayer has been complete, present individuals can line up and observe the body before it is transferred to the burial site (Bjordal, 2013).
As in the case of any ritual or practice it is important for the nurse as well as healthcare worker to inquire and ask questions when involved in a decreased patient’s care. Providing adequate material as well as space is exceptionally important to provide care for family members of the deceased. Therapeutic silence as well as empathy must be employed when handling this complex ritual as it is extremely important to those of the Islamic Culture. By providing materials as well as space to family members, emotional support is provided allowing individuals to grief and mourn in their own particular way.
When researching the topic of Jewish customs surrounding death, dying, and bereavement a fascinating culture surrounding death emerges. Once a patient has been confirmed as being deceased the funeral process begins swiftly and is led by a rabbi. Quite often once the news of passing has been received by a family member the tradition of tearing the garments occurs (Halkin, 2016). The funeral process follows the tradition of k’vod hamet or the honoring of the decreased victim (Halkin, 2016). Although funeral processes can differ amongst patients of the Jewish faith, quite often the funeral process follows a similar route. Dependent on the sex of the deceased, washing of the body occurs either by men in the case of a decreased male patient or women in the case of a deceased female patient (Halkin, 2016). After washing has occurred the body is wrapped in a simple white burial shroud or the tachrichim which forgoes the need to distinguish between a rich or poor deceased person (Halkin, 2016). After the body has been shrouded shemira occurs or the guarding and watching over the deceased. Quite often psalms are sung during this period of time until the deceased is ready for funeral. Not only can family members watch over the deceased but a Chevra Kaddisha member or a person appointed by the funeral home (Halkin, 2018)
Nursing implications for this culture seem to follow that of cultures previously described. A patient’s family expresses his or her own emotions through a set of cultural practices that respect the family’s faith as well as the life of the deceased person. Adequate space and time must be provided by the nurse as well as any pre-requisite materials. Open ended questions as well as therapeutic silence must be implemented removing the nurses own cultural background and opinion from the situation. Adequate space and privacy must be supplied for this practice especially if shemira occurs over the space of a large amount of time. Empathy during this emotional time could include speaking with family members about the life and history of the patient as well as by providing food and drink allowing for celebration if required. By removing personal opinions about grief and suffering a nurse can become culturally competent allowing for greater care to occur.
The three cultures listed above are of different backgrounds and beliefs but the nursing implications surrounding culturally competent care for their members are remarkably similar. Open ended questions, empathy, and therapeutic silence regardless of the situation presented would allow the nurse to receive adequate insight into the family’s culture needs. By providing an environment that is supportive and free from personal opinions. A nurse can perform culturally competent care whilst simultaneously providing care to the spirit of the deceased patient’s family members. Adequate space and materials may need to be provided to the patient’s bereaved. Simple food and drink if needed for members or friends can aid in both spiritual healing as well as provide a healthy outlet for the release of emotions in a positive manner. Time and privacy are as well paramount, adequate time may be needed to provide adequate funeral processes as well as cultural practices. All of which can be elucidated by the asking of simple questions on behalf of the nurse. Through communication, insight can be gained allowing for cultural competent care to be performed. This allows for the expression of cultural values which are inherent to humans around the world.
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