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Embracing Difference:Enhancing Care for Diverse

CommunitiesRev. Dr. Martha Rutland, Director of CPE, VITAS Healthcare, Martha.Rutland@vitas.comRev. Dr. Cheryl Barnes-Neff, VITAS Healthcare, Cheryl.Barnes-Neff@vitas.comRabbi Dr. Maurice S. Kaprow, VITAS Healthcare, Maurice.Kaprow@vitas.comChaplain Tahara Akmal, Tower Health, Tahara.Akmal@towerhealth.orgMs. Lissette Fernandez-Medina, Volusia County Schools, lsfernan@volusia.k12.fl.usRev. Vonshelle Beneby, VITAS Healthcare, Vonshelle.Beneby@vitas.com

Objectives(Rev. Martha Rutland, D.Min., BCC, ACPE Certified Educator)

• Objective 1: Engage voices from underserved communities

• Objective 2: Develop practices that honor the marginalized

• Objective 3: Implement tools to educate staff, expand outreach, heighten awareness of the sacred

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Spiritual Care and Business Acumen• Those who perceive diversity as exclusivity as a moral imperative or a societal

goal are missing the larger point. Workforce diversity is a competitive business opportunity

• Press-Ganey study for Joint Commission of 1.5 million patients shows the meeting of emotional /spiritual needs shows lowest post hospital satisfaction rate

• Forbes Magazine: • Companies can capitalize on the diversity they already have by including

more diverse employees in business decisions at all levels.• Inclusive teams make better business decisions up to 87% of the time.• Inclusivity is the single factor with the highest impact upon business

performance• https://hbr.org/2016/11/why-diverse-teams-are-smarter

(Harvard-facts, depth, creative – less comfortable)

If you place two living heart cells from different people in a Petrie dish, they will in time find and maintain a third and common heart.

Molly Vass

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DAVID’S STORY(Rev. Cheryl Barnes-Neff, PhD, MDiv, RN )

What Matters to You?• Spiritual Assessment

• Remember mixed or blended families

• Cultural Considerations• All religions and cultures are internally diverse• Buddhism often blends the culture of the country/group

• Build trust• The “nones” are skeptical of religious folk• Find the common threads

• Rarely, if ever, does a theological or doctrinal discussion ease the burden of suffering for a person

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SPIRITUAL CARE CERTIFYING AGENCIES(Rabbi Maurice S. Kaprow, Ed.D., BCC)

• Association for Clinical Pastoral Education (ACPE) – for Spiritual Care Educators

• Association of Professional Chaplains (APC)

• Canadian Association for Spiritual Care (CASC)

• National Association of Catholic Chaplains (NACC)

• Neshama: Association of Jewish Chaplains (NAJC)

Jewish End-Of Life Concerns

• Nutrition, hydration, withdrawal, withholding, pain, treatment limitations

• Fear of being proselytized

• Need to be able to consult with a Jewish chaplain

• Jewish prayer

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MERCY AT END-OF-LIFE(Chaplain Tahara Akmal, MA, BCC, ACPE Certified Educator)

“A visitor walking to visit a sick person will be wading in the mercy of God. When the visitor sits with the sick one, they will be immersed in mercy until his or her return home.” (Prophet Mohammed)

When End-of-Life Care Decisions are Difficult

In the Islamic tradition the final moments of an individual’s life on earth is sacred time. It is to be a time of peace, tranquility, safety, harmony, and respect.

Death is to be as dignified as possible out of respect for the individual in their final moments as they no longer can care for themselves.

A primary consideration is the respect owed a human being’s body and soul, as a “trust” from The Divine, and God’s role as the giver and taker of their life: “From the (earth) did we create you, and into it shall We return you, and from it shall We bring you out once again.” (Q. 20:55)

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When End-of-Life Care Decisions are Difficult• Loved ones remind the dying person about God’s Grace, Mercy and Love for them.

The dying person or someone on their behalf asks the Divine for forgiveness of his/her mistakes and shortcomings.

• The goal is to ease the fear and anxiety of the dying person by having family and other loved ones present when death is imminent. The presence of clergy can be comforting if the individual can and wants to talk about their life and what they are experiencing as death nears.

• The overall goal is that the dying person does not feel alone, nor do they feel pain or discomfort.

Legal rulings about Islamic bioethics help families when making sensitive end-of-life care decisions. My family had to look to bioethics when deciding about my Aunt Diane’s care plan when she was on hospice in 2009.

LawNecessity overrides

prohibition

Harm is to be removed

Accept lesser of two harmsif both can not be avoided

Public interest can override individual interest

ExampleStarvation vs. eating pork

Withdrawal of life-sustaining Rx if futile or causing harm

Pain meds may hasten death

Use of scarce resources i.e., ICU space, organs

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“…This (weeping) is the mercy that God has placed in the hearts

of His servants.” Prophet Mohammad

HISPANICS AND END-OF-LIFE PROCESS(Ms. Lissette Fernandez-Medina, LCSW, MSW )

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HOLA MY NAME IS______________

WHAT IS THE DIFFERENCE BETWEEN HISPANIC AND LATINO?

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CULTURAL HUMILITY

Cultural Humility is a term coined by Melanie Tervalon and Jann Murray-Garcia in 1998, to describe a way of infiltrating multiculturalism into their work as healthcare professionals.

Cultural humility is based on the idea of focusing on self-reflection and lifelong learning.

(source: Wikipedia)

• The majority of Hispanics are Roman Catholics. The church teaches that the soul is eternal and continues on after the physical body has died. Ideas of heaven and hell can be explored.

• The Power of the Rosary - My Story

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TALKING POINTS• Remember values, beliefs, religious faith and high regards for family -

including extended family.

• In traditional Hispanic families family members (usually females) become the main care givers. Typically, they have difficulty asking for help.

• Some Hispanic families may resist the idea of placing a seriously ill family member in a nursing home or other type of facility. Judgement by extended family can be experienced if family member is placed in nursing home or facility.

• The Hispanic culture shares some common belief systems but remember the differences in their personal history and country of origin.

• Remember “one size fits all” looks different on everyone.

• Remember to approach interactions with awareness of the individual’s personal identifiers and experiences, such as demographics, environment, country of origin, religion, history of oppression or privilege.

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THE OVERLOOKED “COMMUNITY”(Rev. Vonshelle J. Beneby, MDiv, MPA)

(Projected Similarities: Assuming people are similar may lead us to act inappropriately.)

African American: Countries of Origin

• Sub-Saharan Africa➢ Nigeria, Ghana, Ethiopia, Eritrea, Egypt, Somalia

• Caribbean Islands➢ Bahamas

• Haiti

• Latin America➢ Mexico➢ Panama

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African-Americans: Cultural Perspectives

• Wide range of:➢ Belief systems, traditions and practices➢ Socioeconomic classes and educational levels

• Shared Experiences and Behaviors:➢ History (victims of the slave trade)➢ Distrust of medical establishment➢ Healthcare disparities (e.g. 1932 Tuskegee experiments - men

with syphilis were intentionally untreated for 40 years➢ Importance of direct eye contact➢ Large extended families (May include non-blood ‘relatives’)

African American – Spiritual Perspectives• Church/Places of worship are a vibrant part of the

community (dictates actions and guides behaviors)• Strong belief in the healing power of God/Creator• Care for loved ones at home• May view hospice services as “giving up” and going

against spiritual and religious teachings

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Our JourneysCulture Within The Culture

Lesbian, Gay, Bisexual, Transgendered, Queer, Intersexual, and Asexual Persons (LGBTQIA)

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Terms Specific to Gender Identity

• Sexual Orientation

• LGBT (Q – I – A)

• Queer

• Intersex

• Asexual

• Homosexual

• Heterosexual

• Bisexual (Pansexual)

• Gay

• Lesbian

Terms Specific to Gender Identity (Cont.)

• Bigender

• Gender Nonconforming (GNC)

• Genderqueer

• FTM

• MTF

• Transgender/Trans

APPREHENSIVE/FEAR-BASED INTERACTIONSFear and intolerance may also include verbal, physical and system injustices towards persons

• Homophobia (“Gay bashing”)

• “In the closet”

• Coming out (self-disclosure)

• Outing (deliberate or accidental)

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JUNE 12, 2016

Interacting and Caring for LGBTQIA Persons

• Take the person’s direction (for addressing and no assumptions in being “out”)

• Persons may present themselves differently

• Create a welcoming and safe environment for LGBTQIA patients

• Use inclusive language

• Use gender-neutral language or preferred pronoun

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The Guest HouseThis being human is a guest house.

Every morning a new arrival.

A joy, a depression, a meanness,some momentary awareness comes

as an unexpected visitor.

Welcome and entertain them all!Even if they’re a crowd of sorrows,

who violently sweep your houseempty of its furniture,

still, treat each guest honorably.Who may be clearing you out

for some new delight.

The dark thought, the shame, the malice,meet them at the door laughing,

and invite them in.

Be grateful for whoever comes,because each has been sentas a guide from beyond. – Jelaluddin Rumi

Resources

Pew Charitable Trust:• Statistics on religious trends in the population

https://www.pewtrusts.org/en/topics/religion

Books:• Good Without God by Greg Epstein• No Death, No Fear by Thich Nhat Hanh• Graceful Passages: A Companion for Living and Dying produced by Malcom &

Stillwater (includes CD of spoken word and music)

Websites:• The Religious Literacy Project at Harvard’s Divinity School

https://rlp.hds.harvard.edu/• Humanist Celebrants and Chaplains

https://www.thehumanistsociety.org/celebrants• Further resources on Buddhism and the “Nones”

https://barnesneff.com/nhpco19

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Resources (Cont.)

Websites:• https://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf

(check lists--admission-workforce-patient care)• https://www.healthcarechaplaincy.org/docs/publications/landing_page/cultural_sensitivi

ty_handbook_from_healthCare_chaplaincy_network_8_15_2014.pdf(reviews many religious traditions)

• https://www.nhpco.org/access-outreach/inclusion-and-access-toolbox(support for all staff--administration, marketing, care, etc.)

• https://www.nhpco.org/diversity (videos-outreach and access guides)• https://www.forbes.com/sites/eriklarson/2017/09/21/new-research-diversity-inclusion-

better-decision-making-at-work/#d0b8ff24cbfa• https://hbr.org/2016/11/why-diverse-teams-are-smarter

Resources (Cont.)

Andrews, Janice D. Cultural, Ethnic, and Religious Reference Manual. Winston-Salem, NC: JAMARDA Resources, Inc. 1995 – 2005. www.jamardaresources.com

Barrington, V., (2015). LGBT Older Adults Still Face Discrimination, Justice in Aging

Cohen, K. (2010). LGBT Older Adults in Long-Term Care Facilities: Stories from the Field. Justice in Aging.

Culture Care Connection Clinics Implementing Action Plans (2009) [WWW page]. URL http://www.stratishealth.org/documents/CCCNewsFall2009_092309.pdf

Diversity and End-of-Life Care Tip Sheet. Hospice Foundation of America, 2009

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Resources (Cont.)

Quappe, Stephanie, Cantatore, Giovanna. What is Cultural Awareness Anyway? How Do I Build It? Culturosity.com, 2007. www.culturosity.com

VITAS Healthcare (n.d.) Things Hospice Innovators Need to Know (THINK)About: Diversity About: Lesbian, Gay, Bisexual, and Transgendered Persons(Unpublished internal documents)

Witten, Tarynn (2014). End of Life, Chronic Illness, and Trans-Identities. Journal of Social Work in End-of-Life & Palliative Care. Vol. 10, Issue 1, 2014.

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