Pain is a central component of end-of-life care, and nurses are in a prime positionto re
lieve pain and suffering throughout the dying process. But as the United Statescontinues to become more ethnically and culturally diverse, healthcare providers faceincreasing challenges as they care for patients with different cultural values.
Cultural competence is especially important in end-of-life care because culturalbeliefs, values and experiences shape each patients definition of a"good death.”
Cultural beliefs surrounding pain and death affect patients’ attitudes and preferences in end-of-life care. In some cultures, openly discussing death is inappropriate. Forexample, Cheng et al. conducted a survey of East Asian palliative care physicians. Seventypercent of participants from Taiwan reported that patents’ Family members were reluctantto discuss end of life. Fifty-six percent identified the cultural belief ”bad things happen after you say them out loud” as a reason family members avoid end-of-lifediscussion. Consequently, families may avoid discussing death to avoid bad luck or tempting fate.
Certain cultural groups may request that healthcare providers withhold disclosure of a terminal diagnosis to protect the patient. In some Asian cultures, these requests stemfrom a desire to preserve hope or to prevent emotional suffering in the dying patient.Healthcare providers must consider such beliefs before approaching patients with news of a poor prognosis.
These beliefs can be a significant barrier to the initiation of pain management at the end of life. Researchers have found that oncologists often cite family reluctance todiscuss end-of-life issues with patients as a major barrier to initiating pain managementin dying patients. Providers may misinterpret a reluctance to discuss impending death asa refusal of pain treatment.
Similarly, cultural beliefs about the origin, role, and meaning of pain can affect how a patient perceives pain. Many beliefs regarding pain stem from religion and spirituality.For example, some religious groups believe pain is a part of God's plan, a penance forsins or a test of faith. In contrast, other cultures ascribe positive meanings to pain. Forexample, some patients may believe in the mantra "No pain, no gain. "These patientsmay view pain as a sign of progress toward recovery. Chinese patients may believepain results from an imbalance between yin and yang, which has its roots in TaoismBuddhism and Confucianism.
Similarly cultural beliefs affect how patients express pain. Many cultures havenegative attitudes toward expressing pain outwardly. For example, Black American,Hispanic American, Asian American, and American Indian patents may be reluctant tocomplain of pain due to strong cultural beliefs in stoicism. As a result, these patients mayprefer to keep a neutral face and avoid grimacing, crying or moaning, even if their pain issevere Stoic pain behavior. can lead to inaccurate pain assessments if nurses interpret the lack of observable cues such as facial expression, body posture, crying or moaning as theabsence of pain.
In addition. cultural beliefs may affect self-report of Pain. A study of cancer painexperience found that Asian Americans reported significantly lower pain scores thanBlack Americans, Hispanic Americans and non-hispanic White Americans. Interestingly,there were no differences in severity of symptoms associated with cancer pain, such aslack of energy, shortness of breath or difficulty in sleeping. Asian Americans may believe that they should endure pain bravely to serve as a role model for others or to improve their standing in life after death.In this cultural groups, decreased pain expression may lead providers to assume the absence of pain,causing under or non-treatment of symptoms.
46、What bring healthcare providers including nurses in the US increasing challenges？
A.Different definitions of a“ good death”
B.Diverse cultures from different ethnic groups
C.End-of-life pain care and management.
D.Patients with similar cultural values
47、According to the survey, why were some family members in Taiwan reluctant to discuss end of life？
A.They wanted to avoid bad luck or tempting fate
B.They were too sad to have end-of-life discussion
C.They believed the disease could be cured completely.
D.They trusted the palliative care physicians
48、What does the word "prognosis"(in the 3rd sentence of the 4th paragraph)probably mean？
A.Signs or symptoms of a disease
B.Identifying the cause of some disease
C.A prediction of the course of a disease
D.Doctor's order and prescription
49、Which of the following statements is not true？
A.Taoism, Buddhism and Confucianism influence Chinese patients' view of pain
B.Different cultural beliefs are no huge barriers to end-of-life pain management
C.In some Asian cultures, openly discussing death is not welcomed
D.People with dissimilar cultural beliefs understand pain in different ways
50、How do some religious groups perceive pain？
A.Pain tests a person's faith in God
B.Pain is a penance for sins
C.All of the above
D.Pain is a part of god's plan
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