Ethics and advance care planning in a culturally diverse society

Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds. An important aim of this article is to redress this oversight.<br /

The (un)-certainties of district nurses in the context of cultural diversity

Aim. This paper is a report of part of a study exploring district nurses' understanding and practices in relation to discrimination and inequalities issues. Background. Clients from minority ethnic groups continue to experience inequalities in health status and care provision. District nurses work with a wide range of clients, yet research has demonstrated inequities in service provision to clients from minority ethnic groups due to organizational, professional and personal constraints. Methods. A qualitative methodology was used to explore district nurses' understanding of discrimination and equalities issues in the context of their work. Semi-structured interviews were undertaken during 2003 with 18 district nurses employed in two primary care organizations in England providing healthcare services to a large and culturally diverse population. Findings. District nurses' accounts were marked by uncertainty, suggesting that many lacked confidence when discussing issues of ethnicity and cultural difference. There were marked differences in the extent to which they appeared to recognize or engage with clients' experiences of discrimination or inequalities, or to recognize inequitable service provision to clients from minority ethnic groups. Key issues were a lack of provision of district nursing services to some clients, and failures to meet clients' language and communication needs, and although reflecting organizational constraints, such continuing inequities were largely unquestioned. Conclusion. There is a need for further educational and practice developments to enable district nurses to provide more equitable care to clients from culturally diverse communities, ensuring that the key professional discourse of individual care and advocacy are fully realized in their work with all clients.</p