Introduction
Cultural perspectives play a critical role in shaping attitudes of different cultural groups with respect to end of life care. This assertion stems from the fact that people use culture to perceive and define the environment surrounding them. More often, the end of life caregivers portray a different culture from their clients/patients, while their family members take a different direction that has the potential of creating barriers between the patient and the end of life caregivers. Thus, culture can be used to enlighten us on illness and death during the end of life care.
Even though an end of life period is a time of displaying emotions relative to traditions and cultural beliefs, the hospice care providers in the U.S. do not reflect a health care system that takes into account the cultural values relative to end of life care for the Chinese community (Yu, 2007). For this reason, care teams should be enlightened on cultural practices and beliefs in order to relate better to diverse cultures and religious differences. This paper analyses Chinese end of life program using the Neuman Systems Model. It does so by providing a scenario of a Chinese end of life, which forms the center stage of the analysis.
Case Study
Mr. Ching is an 80-year old widower who lived with his eight surviving children in a secluded estate in the United States. Mr. Ching depended on these children for shopping Chinese foods and getting medication from Chinese pharmaceuticals. However, Mr. Ching was in a position of attending Buddhist religious functions. As Mr. Ching was in his last stage of cancer, it came to the attention of his children that the hospice care would add value to his end of life period by providing tolerable pain and symptom administration.
After the arrival of the hospice care team, Mr. Ching was intubated and later ventilated following extremely unfavorable respiratory condition. However, the hospice care team noted that Mr. Ching was suffering from respiratory problem from a historical point of view. However, it was not easy for the care team to assess the causes of cancer from the genetic sphere because Mr. Ching could not communicate about the trend of the disease with the caregivers. More so, a language barrier between the hospice care team and all the Chinese family members was evident.
Given that Mr.Ching was suffering from the last stage of cancer, his health status deteriorated as time advanced. Even though the hospice care team knew about this, it was not in a position of weaning him to a point where he could receive quality death. With this in mind, the eldest son aired his view to the physician, claiming that his father should not be informed of the critical condition he was suffering from since this could worsen his condition.
Analysis
This scenario involves a family member who was ailing from his last stage of cancer, a disease that has provoked scientific groups to study the nutritional value of food with regard to its prevention (Edlin & Golanty, 2009). In this respect, consumption of fruits and vegetables is recommended since it plays a key role in eliminating toxins emanating from consumption of inorganic foods. More so, a number of research studies have been carried out to assess other environmental factors contributing to cancer.
With respect to such kind of a disease, Mr. Ching’s children had the overall responsibility of taking care of Mr. Ching since the Chinese community upholds filial piety (Chan & Kayser-Jones, 2006). This means that children are tasked with the role of taking care of their parents’ physical, social, psychological, as well as other facets of health during their end of life period. However, using the four Metaparadigm concepts, the Newman system model can best analyze the efficacy of Mr. Ching’s end of life care.
The Four Metaparadigm Concepts of Neuman Systems Model
Human Concept
The four Metaparadigm concepts of Neuman system model, which includes human, environment, health, and nursing, can be used in an attempt of providing a dying patient with good death (Zerwekh, 2006). According to Neuman & Fawcett (2011), five spheres characterize the human concept: the physiological, the psychological, the socio-cultural, the developmental, and the spiritual sphere. In this scenario, Mr. Ching portrays physiological variable as he was suffering from excessive pain that called for additional attention from qualified personnel. However, this pain could not be assessed from genetic point of view. Psychologically, Mr. Ching was guilty conscious because Chinese patients should never talk with the family members or healthcare providers regarding their critical conditions (Bowman & Singer, 2001). Social- culturally, Mr. Ching could not speak English because he and his family lived in a secluded area in the United States, making it hard to interact with the English-speaking people. This posed a challenge in the end of life treatment options from the hospice care providers.
Developmentally, Mr. Chin was never brought up in a community that embraces consumption of fruits that counter cancer infection. Instead, his children provided him with Chinese foods and drugs from Chinese pharmaceuticals during his last stages of life. A clear indication that the family embraced divine faith is the fact that Mr. Ching and his children attended Buddhists religious functions. Therefore, providing Mr. Ching with death that is characterized by a feeling of sense of control could have been facilitated by religious gatherings aimed at carrying out religious rituals with Mr. Ching.
Environmental Concept
The environmental Metaparadigm concept can be addressed by taking into account the internal as well as the external factors that affect Mr. Ching as he was in his last stage of cancer. However, it is important to verify whether the end of life care was faced with internal factors as well as the external factors of the environmental Metaparadigm. According to the case study, the end of life care was faced with internal environmental stressors, as Mr. Ching was guilty conscious for airing his views concerning end of life treatment. Additionally, the end of life care experienced the external environmental stressors since the hospice care team lacked caregivers who were endowed with knowledge on Chinese language and culture, thus stressing every member of the family.
Health Concept
The health Metaparadigm takes into account that health encompasses a combination of disease and lack of disease. According to Newman & Fawcett (2011), for one to acquire emerging health, he/she must be aware of pattern recognition of person-environment. In this scenario, the end of life care has been compromised in relation to the environment since the patient feels guilty for the entire program. Lack of controlling such a threat has the capacity of making the patient face death without being affirmed as a unique and a worthy person.
Nursing Concept
The nursing concept facilitates physical, mental, social, as well as psychological wellbeing (Zerwekh, 2006). This holistic approach is essential because it calls for recognition of physical, social, emotional, vocational, as well as the spiritual needs that human have. If the care team neglects this, then their ability to provide quality end of life care may be jeopardized. This stems from the fact that the hospice care providers have the ultimate responsibility of making sure that the patient and the family experiences enough preparation for death, which does not violate their customs and traditions. This necessitates responses from a number of questions while carrying out the diagnosis tests:
- Is your view towards cancer purely based on biomedical view?
- Is your view towards cancer based on the perception that the care providers can influence the time of death?
- Is your view towards end of life program similar for all age groups?
- Do you prefer personal decision making to family decision making?
- Do you have any personal or cultural practice relative to a critical illness such as cancer?
- Do you have any personal or cultural belief relative to death?
These questions help me evaluate whether the end of life care for Mr. Ching is based on an individual, hierarchical, or autonomy level. Hence, this helps us understand that in as much as the hospice caregivers embrace patient’s autonomy, the eldest son makes the end of life decisions for elderly people (Yu, 2007). More so, during the end of life period, the Chinese community treats elder patients with dignity despite the equality principle upheld by the hospice care team.
With this information at hand, the primary care involves coming up with a framework that would help to strike a balance between the Chinese culture and the hospice culture in a bid to find a common ground of a good end of life program (Neuman & Fawcett, 2011). This can be achieved by intensifying the flexible lines of defense such as highlighting the importance of patient’s autonomy and the right for the patient to know the truth concerning his/her health status. This helps to reduce the intrapersonal stressors.
In this scenario, the secondary care intervention involves taking into account that for every intervention made, the possible benefits should be reflected alongside probable undesirable effects, thus helping to eradicate the negative interpersonal stressors (Neuman & Fawcett, 2011). This can be achieved by providing the patient with the right Chinese medication and respecting cultural diversity while providing this care.
According to Neuman & Fawcett (2011), the tertiary intervention should aim at supporting positive cultural practices depicted by the Chinese community. This may include providing the family members with an opportunity to involve spiritual leaders in the end of life care notwithstanding the fact that death in Chinese community is more of a family affair. However, all these should be done in a manner that portrays respect of the Chinese cultural backgrounds and religious beliefs.
Conclusion
Using the Neuman systems model, the Chinese end of life program necessitates self-reflection, reasoning, as well as understanding the root causes of every negative and positive stressors. As demonstrated in this case study, an in-depth understanding of other people’s cultures facilitates a good end of life program that creates an avenue for reducing the negative internal and external environmental stressors. Therefore, analyzing the stressors using the Neuman systems model helps to carry out a reflection on how the dying patient should be liberated from intolerable pain and how he/she should increase association with his/her loved ones. In turn, this provides enough preparation for death for both the patient as well as the loved ones.
Newman Systems Model Diagram
References
Bowman, K. W., & Singer, P. A. (2001). Chinese seniors’ perspectives on end-of-life decisions. Social Science & Medicine (1982), 53 (4), 455-64.
Chan, J., & Kayser-Jones, J. (2006). The experience of dying for Chinese nursing home residents: cultural considerations. Journal of Gerontological Nursing, 31(8), 26-32.
Edlin, G., & Golanty, E. (2009). Health and wellness. Sudbury, Mass: Jones and Bartlett.
Neuman, B., & Fawcett, J. (2011). The Neuman systems model (5th ed.). Upper Saddle River, NJ: Pearson.
Yu, X. (2007). Death and Dying in the Chinese Culture: Implications for Health Care Practice. Home Health Care Management & Practice, 19 (5), 412-414.
Zerwekh, JV (2006). Nursing and Palliative Care at End-of-Life. Philadelphia, PA: F.A. Davis Company.