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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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  • Clergy and Faith Communities
  • Additional Links
    Site Index
    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Subculture
    Traditional Medicine
    Body Language
    Bad News
    Meaning of Illness
    Alternative Medicine
    Imminent Death

    Touch and Gender (Sex and the Palliative Care Worker)

    Is touching always comforting? Maybe

    • Health care givers are instructed that touch conveys concern. This is not so cross-culturally. Even within families, touching may be restricted
        For Example
        Adult Orthodox Jewish and Muslim men do not touch women of reproductive age, even their daughters, even to shake hands. A female nurse or physician’s concerned pat on the shoulder could cause awkward discomfort
        Buddhist Southeast Asians for entirely different reasons do not want to be touched, especially on the head, unless it is part of an exam
        Navajos for other reasons may be very upset if they or their family member are touched on the head. Nurses and physicians are taught to examine patients from the head down. In the Navajo creation myth, people were created from the feet up. If you examine from the head down, you are, in effect, taking them apart. This is the opposite of healing. This belief is not held among other Native American groups
        Muslim women prefer not to be examined by male physicians
    • ASK if your patient requires a physician or nurse of the same sex. If you cannot accommodate this, explain why and ASK if a chaperone is required during the exam and who this should be
    • Explain necessary physical contact through the interpreter
    • Be especially careful of draping. The interpreter may remain behind the curtain or discreetly turn her back during an exam. “May I see the sore in your groin that you told me about Mr. Ismaili? It will help me decide how to treat it.” OR “I will see if Dr. B can come in. HE has a great deal of experience in this too”
    • If the patient, or family member, remains uncomfortable, this is not a challenge to your competence and authority. It is a deeply ingrained value about propriety and modesty
        For Example
        A severely cognitively impaired Arab man became uncontrollably agitated in the nursing home and was admitted for evaluation. He was calm and easy to care for until the TV was turned on. Even though he was no longer able to speak, it was immediately obvious that the semi-nude women in theTV ads were the problem. He had lived all his life in a country where women only showed their hands and eyes. To see unclothed women was a placing him at risk of his soul
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