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I learned that appalachians are people who live in the mountains and they typically have 4 interacting values or beliefs: independence, neutrality, familism, and personalism. These people often have a mistrust of outsiders and value privacy. Natural or herbal medicine is a common practice among these people. This culture is comfortable with long silences and often takes eye contact as a form of aggression. They also may like to be addressed by their first name with a Ms. or Mr. in front of it.

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I chose the Puerto Rican community because I witnessed a Puerto Rican patient's family performing rituals that I was unfamiliar with. I learned that they were performing death rituals of wake (velorio) and prayer (novenario). They normally have an extended family that lean in on the patient and perform multiple of these prayers. In between the prayers they conversated between each other about the patient and deceased family. Another fact that I found interesting is that they consider autopsy to be a violation of the body because of their belief of the body as sacred and that one should meet God with bodily integrity. Overall I thought this culture was very interesting.

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              Orthodox Jews                                    In the Orthodox Jew community, great emphasis is placed on life and death is viewed as a natural part of life. Caring for these individuals at the end of life should include care and compassion. What I did not know about this community is that they seek rabbinical advice at the end of life. This is done when they are competent and if they are not, they assign a health proxy who is advised to seek rabbinic advice on the dying patient’s behalf. I also did not know that they bury their dead within 2 days of dying. Additionally, many individuals who experienced loss can attest that there are different stages of mourning which may last days, months or even years. However, for the orthodox Jews there are customs that must be observed and there is a period/time established for mourning.

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              Orthodox Jews                                    In the Orthodox Jew community, great emphasis is placed on life and death is viewed as a natural part of life. Caring for these individuals at the end of life should include care and compassion. What I did not know about this community is that they seek rabbinical advice at the end of life. This is done when they are competent and if they are not, they assign a health proxy who is advised to seek rabbinic advice on the dying patient’s behalf. I also did not know that they bury their dead within 2 days of dying. Additionally, many individuals who experienced loss can attest that there are different stages of mourning which may last days, months or even years. However, for the orthodox Jews there are customs that must be observed and there is a period/time established for mourning.

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I chose to read about the Guatemalans and something I learned is that they believe that the spirit of the dying person makes a strange noise as it leaves the body (death rattle). Knowing that this is a normal process for the dying patient this helps put into perspective that we must be there to educate the family and support them through this process. I also learned that the believe death enters through the feet so no one should bed at the end of the bed. The most interesting thing about this culture I learned was that to prevent pain they consume lime juice which they believe speeds up the process of dying. It's important to know that different cultures believe different things, respect patients' beliefs

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I chose to look at end of life from the Arabic culture. I know nothing about Arabic culture so I thought it would be interesting. The Arabic community are normally hesitant when it comes to discussing death. Autopsy is prohibited because it is perceived as showing disrespect to the body. Organ donation, however, is viewed positively because it is a lifesaving measure. I could understand this point of view personally. Families may request that the patient's bed be positioned facing east. After death, the deceased's body should be covered with a sheet and handled gently. The family may want to provide postmortem care, most often performed by the same gender. Muslims wash and perfume the deceased's body and wrap it in white linens. Jews have the nearest relative close the deceased's eyes and mouth and place a sheet over the deceased's face after death. Christians may want to wash and dress the deceased. Arabs have a unique and respectful ritual to honor the deceased and I enjoyed learning something new.

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The Irish place a high value on family privacy and do not discuss family matters openly. As a result, they may not share feelings openly. They also highly value hard work and resiliency. The Irish refrain from saying "no", especially to professionals, like doctors, because they think it is disrespectful. Instead, they will often say "yes" or "we'll see". In addition, they tend to understate their problems. The nurse should observe their style of communication in order to ensure that they are communicating effectively.

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I learned that in the Cherokee community, it is very important that the physical body remains intact after death. This means that most do not participate in organ donation, although some make an exception for this, or cremation. I also learned that it is important to communicate with the patient and family member if you know death is approaching as they may want a spiritual leader or healer to be present at the time of death in order to help perform rituals that are important to their culture. Something else I found interesting is that they like to have large groups of people/gatherings when a person is passing which may require an exception to be made to the visitor policies if the patient is in the hospital.

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Death is seen as natural and not to be feared. Seminoles believe they will rejoin with past ancestors. The body should be kept as whole and burials should be performed within 4 days of death.

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In the Italian communities, most families are Roman Catholic so Italian families will intiate "Last Rites" with a priest, prior to their loved one's death. For Italian Roman Catholics, this is very important, as the prayer is asking for you to be saved, to raise you up to heaven. Then there is a three part funeral which includes the wake, the funeral mass, and then the burial.  For this population, it would be extremely upsetting if their loved one did not receive the "Last Rites" as it would be concerning to think that their loved one may not go to heaven. As with any other ritual concerning Italians, the community comes together to take care of the grieving with plenty of donations of food and/or wine. Since the Roman Catholic church reviews donation of organs as an act of charity or good work, Italians often participate in donating their own organ(s), in a morally acceptable manner. SH

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Chinese customs vary from one family to another depending on the religious orientation and adherence to the tradition of the family members. A few things I found out in their approach to the end of life particularly to older generations is that they believe that dying at home will bring bad fortune to the family. In the home of the person that died all the statues of gods will be covered in red paper. They also hang a white cloth outside their house as a symbol that the family is mourning. Three days after the burial, they believe that the spirit of the person will visit the family, and they'll prepare some of the person's favorite foods. They also have the customs that mourners are not allowed to participate in any form of entertainment for 100 days. The period of mourning depends on their relationship to the deceased. If a child or parent, they'll mourn for 3 years, a year for a spouse.

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Death rituals and beliefs amongst this population can differ depending on the individual's religion and family traditions. However, I did find it interesting that older Germans may wear black or dark colors for up to a year after their loved ones death in order to demonstrate respect for the deceased.

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I chose to read about Japanese end of life care. I learned that they prefer to die at home, and rarely complete advance directives. Instead, family members, ideally the eldest son, makes end-of life decisions. Family plays a very big part in Japanese culture. It is expected that the family takes care of their sick and elderly, and this brings honor to them. End of life care is not always discussed, because it is believed that discussing death may cause the individual to lose hope and hasten the death. This wish must be respected. Preferences also are influenced by religion. In Shinto religion, death is considered impure. Buddhists believe in reincarnation, and the body must be fully intact for reincarnation to be possible. Many Japanese Americans are Christians. They believe in eternal life and may require a priest or chaplain.

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Salvadorans are the largest group of immigrants from Central America because of this it is important to understand their cultural beliefs related to end-of-life care. In particular, end-of-life care for Salvadorans is influenced by their religion, which is predominantly Roman Catholic. Death and dying are topics that families may be reluctant to discuss. Overall many people of this culture prefer less information when someone is critically ill and the family may maintain secrecy about a serious diagnosis/prognosis. The decision to continue ineffective treatment may represent not wanting to interfere with God's will. In regard to religious practices related to end-of-life, many Catholics devote 9 nights of prayer for deceased persons so that the souls of the dead can be purified and can rise from purgatory to heaven.
Understanding the beliefs and practices of a specific culture helps me as a nurse to deliver patient-centered care, especially at such a sensitive time for patients and families.
Source: Lippincott advisor for education.

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Some Navajos may refuse to speak about sickness or end of life matters because they believe that speaking of death may cause it to happen. According to policies belonging to some reservation facilities, it is likely that advance directives will only be spoken of if the patient requests. Navajos also require a body to be buried whole. However, if a body part were amputated previously, it can be saved and buried in the same spot with the body.

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I chose to research about Filipino culture. I had not thought about the end-of-life care for specific cultures before so I have learned a lot through research. I learned that Filipino culture has attitudes toward death that is influenced by religious beliefs. They believe that death may be because it was God's plan. Family and friends visit at the bedside for final goodbyes and support each other through the tough time. I also found it interesting that prayer novenas may be held and may continue in the deceased's home for several days after the patient dies. The novenas is an ancient devotion that consists of 9 days of prayer. In addition to this, the patient may also wear religious items and may have religious articles placed nearby during the end of life care.

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This culture views the end of life as inevitable and predetermined. In this case, prolonging life measures may be seen as pointless and unnecessary. It is believed that when an individual of Vietnamese culture dies outside of their home their soul wonders and is unable to rest. For this reason, these individuals prefer to diet at home. It is also believed that discussing and or planning for death speeds up that process. Lastly, family members wear white clothes for fourteen days. Then, black armbands are worn by males while white headbands are used by women.

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I chose to look further into the Colombian culture. There was not too much under the end-of-life care and concerns. However, I did learn some things from that section nonetheless. The first thing I learned was that the Colombian culture is more likely to both prefer life-sustaining interventions and to more likely die in the hospital compared to non-Hispanic white patients. Colombian patients are also less likely to participate in advance directives such as living wills or POA (power of attorneys). The last thing I learned about Colombian patients is that the family is more likely to request that a religious authority visit the patient and family in the hospital (or facility) at bedside.

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Catholicism is the second most common religion in the US and one that I do not know much about. After reading the material, it is similar to my protestant beliefs with some differences. Near the end of life, a priest usually comes to perform sacraments including the Anointing of the Sick and Reconciliation to provide peace and comfort to the dying patient. Assisted suicide is not accepted by this religion while organ donation is okay.

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I decided to look further into the Amish Community, hoping to learn something new about their end-of-life practices. I learned that the Amish do not want extraordinary life-saving interventions, even for newborn children and babies. They also do not believe in organ donation and believe that the body should be buried intact. The Amish are reserved when expressing grief and will lean on their family for support. Death is viewed as a natural process that brings one closer to God and dying at home is preferred over dying in a hospital. Amish funerals are simple, and individuals are buried in a wooden coffin in Amish community centers.

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I learned that have different end of life care options for different religions, such as Buddhists, Muslim, and Christians. For Buddhists, they believe that an individual returns multiple times to earth until they have reached full enlightenment and reach the state of Nirvana. What I found most interesting is that after the person dies, only male family members wash and wrap the body in cloth, tie their thumbs together using the hair of a family member, they also place a coin on the head and in the loved ones mouth and finally place a flower next to the body. Some also always remains with the body after death and after 4 days, a funeral is held and then the body is cremated. For all 3 religions, organ donation is not prohibited. For Muslims, postmortem care is provided by a provider of the same gender and they try to bury the body within 24 hours.

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I decided to look further into the Spanish culture, since I have provided care to the patients in the past. The Spanish culture have strong beliefs on family involvement and the power or prayer. The Spanish culture seem to have alot of the same cultures as Americans. The new information that I learned about the Spanish culture was that cremation is not done.

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I unfortunately have to admit that I know little on different cultures and have always planned on learning more so I can be better culturally aware of members within my community. When reading on the Muslim culture, I realized that due to their religion, we as nurses will need to cater to their schedule. If they follow the basic tenet "Salat," then they will be praying five times a day at specific times. As a caregiver, I would want to check with my patient so that I can cluster their care around this schedule in an effort to not interrupt their sacred time. I will most definitely read much more on each of the most commonly interacted cultures and then continue to diversify my knowledge as time goes by.

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I chose this community because it is a group of people that I am not as familiar with and I wanted to learn more about their culture. I learned that speaking directly and using words such as "yes" or "no" can be considered rude and do not mean the same thing as in American culture. Also, it is good to know that avoiding eye contact and physical contact is showing a sign of respect. It is important as a healthcare provider to understand that this culture values modesty and to respect that whenever possible. It is important to assess cultural beliefs in order to provide the best care possible for every patient.

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Being from rural north Georgia, I chose to research information regarding end of life care for the Appalachian culture. I'd like to share one thing that I already knew from being part of that culture along with one thing I learned that would help us best care for these patients.  According to advisor, I learned this culture typically has MANY loved ones with them at death. While advisor mentions verifying the organ donation status and end of life wishes, I can share the fact that many families from this culture have a negative views of organ donation and cremation due to potentially negative spiritual consequences. As a nurse, it's important that we never insert our bias when assessing and discussing end of life matters.

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I chose their culture because I didn't know who they were. It turned out that they're an Indian tribe that occupied the southern part of the Great Plains. I found it interesting that some of them are Christians and that they use all three traditional practices, Western, and herbal medicines. I learned that Cardiovascular is the number one cause of death, and that they have higher rates of diabetes, ESRD, and cancer in comparison to the general US population. They also prefer same-sex providers, and that a man might only allow the women in his family (wife or daughters) to braid his hair. The younger Comanche typically provides care to their elders at home instead of long-term care facility, and that they rarely cremate because they believe the physical body after death needs to remain intact. Lastly, the family may want to bury their loved ones in the tribal cemetery. To summarize, it's important to ascertain the following things as part of the end-of-care processes: the patient and family decision regarding advance directives, arranged services with their chosen religious leader, space to accommodate large number of visitors and finally, their preference regarding the release of the body after death.

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I chose the Alaskan Natives culture, due to family I have whom live there and their stories are always very interesting to hear. I learned on Lippincott that this culture of people prefer to pass at home with those there are comfortable with; their family and/or clan members. They will also want either what they call "traditional healers" or a Christian pastor present to say prayers over the ill. When trying to discuss advance directives prior to end of life, it can be hard to do. I also learned that the Tlingit and Haida people would cremate the ones that passed, however now they choose to bury instead of cremate. For this group, you should try to include everyone in end of life care. All family and clan members want to be present to know what will happen and will feel more comfortable and grateful with their inclusion on decisions.

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Cremation is rarely practiced since the body should remain intact after death with an exception of organ donation
Community contribute to preparing meals to feed many people after the prayer service and funeral
There is a prayer service the night before the funeral
They bury their loved ones in a family or tribal cemetery
Christian/tribal spiritual healers provide support at EOL
If it is a prominent member of their community, tribal offices are closed and meetings cancelled on the day of the funeral

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I learned that they:
Refrain from open grieving
Place coins on the eyelids of their dead loved one to avoid bad omens
Desire to have mirrors covered at time of death
Always have a family member present with their dying loved one
May want to have a religious article present
Will make decisions about patients care as a family unit
There is a family spokesperson designated

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I have always had an interest in Hawaiians and their amazing culture. I never thought about looking into their end-of-life traditions. I found out some interesting things about their end-of-life rituals. I found it interesting that family may want dogs to be at the patient's bedside. They believe that the dogs will alert the family of the presence of evil spirits. It is similar to what my great grandmother thought me but with one variation. Dogs and cats can tell you if a spirit is near. I also found it interesting how the family caregivers will cleanse themselves in the ocean. I notice that their end-of-life practices involve cleansing of the spirit, singing at the client's bedside, and celebrating the life of their dearly departed Ohana with songs, gifts, and blessings.

ND

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I chose Chaldeans because I had actually never heard of this ethnic group. Chaldeans are people descended from ancient Babylonians and Macedonians, emigrating from the Iraq area. These are peoples who were converted to Christianity in the early days of Christianity, and they ascribe to Roman Catholic doctrine. In general, they believe that death is the will of God, and they may be resistant to discussion of end of life. Organ donation is not expressly forbidden by the religious authorities, but their view of it may be influenced by more traditional views (in other words, they may not be accepting of organ donation... but then again, they might be). They may very well wish to have the Sacrament of Anointing the Sick performed. It is very possible that a priest may be involved in their care.

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I chose to read about the Salvadoran end of life care because I have people close to me that are from that country. Something new I learned about the culture is in general, Salvadorians do not want to know everything about their illness/ condition as opposed to informed-consent that is more common in majority of the USA. Salvadorans also maintain secrecy about a serious diagnosis. As a nurse it is critical to assess and ask questions regarding their culture, practices, and their preferences to have a better nurse-patient relationship and provide better care.

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I learned that in the Orthodox Jewish community there are different laws that have to be followed concerning end of life care and that their rabbi is often included in decision making. The body has to be prepared a certain way after death by a special committee and there are different periods of mourning and laws that are followed within those different periods.

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I learned that family members often want to give last sips of water to their dying loved one and that families usually want to be involved with preparing the body for cremation and organ donation is a personal choice. Cremation is preferred as soon as possible. Overall, family involvement is very important regarding many matters of life and death.

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I chose the Greek community because of my interest in that culture. I never looked into the end of life part, therefore I was able to learn a lot. They may view illness and suffering as God's will and accept it as just that. The family may request a religious leader at the bedside. That seems to be a common practice among many cultures. I learned that family members make the sign of the cross over the patient along with reciting prayers and openly cry. I also learned it is very important to explain whether treatment is necessary or life extending, as having a "good death" / natural death is very important them.  Community support is also an important factor during end of life.
VB

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I learned that family members refrain from grieving and from discussing the patient's condition in front of the patient. I found it interesting that loud moaning is appropriate when a person dies. Also, family members may close the eyes and mouth of the deceased and place coins on the eye lids to avoid bad omens. The family may have any mirrors covered at the time of death in accordance of their religious practices.

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I learned many things reading about end-of-life care in the Muslim community. I found it interesting that autopsies are discouraged unless they are medically necessary. This may be discouraged because they believe that death is predestined and the will of God. Another interesting point is that in some cultures, family pictures in a patient's room are thought to prolong death and should be removed with the patient's permission. Understanding different beliefs will help customize care to each patient's preferences.

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I was aware that the Jehovah faith believe that receiving blood (whole blood, red blood cells, white blood cells, platelets, plasma) would lead to removal or excommunication and damnation. What I learned was they may not wish to donate organs because another's blood would flow through them. However, Cornea donations are acceptable, but it does state that all blood must be removed from the organ and tissues before being transplanted. I noticed a lot of cultures have very specific care that they desire.

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Something interesting I learned about the Amish community is that when an individuals time has come they wish to only talk about the prolongation of life with their family members, bishop, and minister. Another interesting fact is that the Amish do not believe in organ donation and that their body should be buried intact. It is always important to know your patients beliefs so that you can give them the best individualized care.