What is Cultural Sensitivity?
To be "culturally sensitive" is to be respectful of differences among people and to recognize the significance of the culture-based practices, values, beliefs, expectations, and experiences of each person. While it is important to understand cultural difference, remember that even within a culture, individuals will respond uniquely to the dying experience. For example, grandparents who immigrated as adults may have different responses than their children, and grandchildren born in the United States.

Learning About Differences and Uniqueness
Learning about different views of death and dying, we expand our own world and ways of perceiving. As much as you may learn about another culture, however, remember that no culture is homogenous. Within each culture, multiple variations can be seen. Because culture is learned, it is never static but in constant flux. Every culture, like every family and individual, is unique. When providing ministry to the sick and dying, restrain from applying an overly simplistic and standard model of care to everyone.

Universal Protocol for Care of the Dying
Rather than trying to become an expert on each culture, apply spiritual principles of care to help the dying person and his/her loved ones feel supported and cared for. Consider this "universal protocol" when caring for the dying:

• Be Non-Judgmental. Don't let your beliefs, values, and opinions get in the way. Be with the dying person and his/her loved one on their own terms, not yours. This is a time and place to affirm and support the person who is dying.
  
• Treat Each and Every Person with Dignity and Respect. All people have the right to be treated compassionately within the environment and belief system they feel comfortable in.
  
• Be Authentic. Do not pretend to be an expert on a person's culture, religion, or illness. Your lack of understanding will be quickly revealed. Those who are nearing death have a keen sense for genuineness.
  
• Listen From the Heart. Opening your heart to others allows you to offer the gift of understanding and love. It decreases the tendency to project your own biases, opinions, and beliefs upon others. You may experience inner reactions to what you are seeing and hearing, particularly if belief systems are different from your own. This is not the place to react outwardly to what is being experienced inwardly. Let the dying be your teachers. Process your own feelings later, outside of the caregiving setting.
  
• Don't Take Over…Focus on Watching and Learning. Be sensitive and alert to the many cues in the environment. The dying person, family, and minister or spiritual advisor can provide valuable guidance. When in doubt, always ask before you act. It is a good practice to check with the family first regarding special needs and how they would like things to be done. Be attentive to both spoken and unspoken messages, including body language.
  
  Other Helpful Tips:
  
  
• Don't think that it is impossible for you to care for the family because they are culturally different than you. Often, it is because you are different that they appreciate the expressions of your care. In counseling situations, people may open up because they trust your commitment to confidentiality, being that you are not of their particular ethnic community. If you would like to learn more about the dying person's cultural beliefs and practices, you may be able to ask directly. Talking to someone else from this culture may be helpful as well.
  
• Be dignified in your care giving. Build up the "face" of the family during this time of stress.
  
• Rely on the spiritual "brothers and sisters" who surround the family. If you have questions, take them aside and ask them for their evaluation of how the family is holding up.
  
• When language is a barrier. In the last stages of dying, your silent presence may be all that is needed. But in early stages of dying, the dying person may want to talk and an interpreter will be needed.

Remember, when talking through an interpreter, the dying person may not be told the full story. Information may be limited to what the interpreter thinks the dying person should hear. Some information may be left out or modified.

Even when information is translated accurately, hearing can be selective. People may just hear what they want to hear or what they expect to hear. Words, especially medical ones, carry different meaning for different people.

What to Look For and What to Ask

When working with families of differing cultures, be alert and sensitive to the following dynamics within the culture and the family:

• Attitudes toward life and death
• How pain, suffering, and grief are expressed
• The acceptance or rejection of outside authority (religious, medical, other)
• Expectations and responsibilities of family members
• Rituals that are followed when someone is sick, dying, or has died

Sometimes the only way to learn is to ask questions. Use open-ended questions to find out more about the situation, beliefs, and decision-making styles. Open-ended questions are non-judgmental and require a "long answer." In contrast, close-ended questions can be answered with a "yes" or "no" with a single word or phrase. When learning about others and caring for people who are facing death, open-ended questions are preferable.

Be sensitive, however, in asking them. Consider the dying person's and family's communication style (direct or round-about) and their readiness to address these questions. When listening to responses to these questions, follow the Universal Protocol.

What to Ask the Client and Family

To learn what is known about the condition or illness
What do you know about the condition?
What does this mean to you?
What do you think will happen?

To learn about decision-making styles
How much do you know about the condition and options?
What else do you want to know?
Who else should be involved in decisions?

To learn about beliefs about death
What do you think death is?
What do you think will happen after death?
Are there questions about dying that you would like to ask a minister or a doctor?

To learn about important rituals
What do families in this culture normally do when someone dies?
What plans have been made for a funeral or memorial service, for example certain prayers or flowers?

Role Play: Use the above questions for role play. Divide into groups of 3 people each. In each group, one person plays the dying person, one plays a family member, and the third plays the service provider. The service provider should try to find out the answers to these questions, interviewing either the dying person or the family member or both together, depending on what seems comfortable for this family.

Talking Points

• Don't think that it is impossible for you to care for the family because they are culturally different than you.
• Be dignified in your care giving
• Rely on the spiritual "brothers and sisters" who surround the family.
• Ask open-ended questions, those that cannot be answered with "yes" or "no".

What to Look For and What to Ask

When working with families of differing cultures, be alert and sensitive to the following dynamics within the culture and the family:

• Attitudes toward life and death
• How pain, suffering, and grief are expressed
• The acceptance or rejection of outside authority (religious, medical, other)
• Expectations and responsibilities of family members
• Rituals that are followed when someone is sick, dying, or has died
  

Questions for the client and family

• To learn what is known about the condition or illness
• What do you know about the condition?
• What does this mean to you?
• What do you think will happen?

• How much do you know about the condition and options?
• What else do you want to know?
• Who else should be involved in decisions?

• What do you think death is?
• What do you think will happen after death?
• Are there questions about dying that you would like to ask a minister or a doctor?

• What do families in this culture normally do when someone dies?
• What plans have been made for a funeral or memorial service, for example certain prayers or flowers?