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Cultural Viewpoint of the End of Life: Chinese Culture

In the profession of nursing, nurses take care of patients with a variety of different

cultures. To provide culturally competent care to patients and families of different cultures

during end of life care, it is critical to be educated about different cultures and to be self-aware of

personal cultural beliefs. Nurses need to be aware of their own feelings, attitudes, preferences

and biases in relation to culture (Matzo & Sherman, 2015, pg. 101). A thorough understanding

of personal beliefs allows nurses to be aware of how their beliefs impact and influence care to

patients of different cultures. Cultural education and awareness is a continuous aspect of nursing.

The focus of this discussion is the Chinese culture and end of life care. Chinese culture

influences dying, death, and grieving during end of life care. It is important to understand the

cultural differences during the end of life process in order to be able to explain them to the

family.

Chinese Culture

Chinese culture is based on power and paternal hierarchy with a primary focus of

centrality of family (Kemp & Chang, 2002). Instead of patients thinking solely about their own

personal needs, the patient is going to be more mindful about how their actions influence their

family. Chinese patients often internalize pain and only reveal pain through nonverbal cues. In

Chinese culture, the oldest adult male is the primary decision maker (Matzo & Sherman, 2015,

pg. 95). Health care decisions are going to be made by the oldest male and are typically based

around what is best for the family. As a nurse, it is important to have open communication with

the family about their culture and wishes. The nurse should communicate with the oldest male

present in the family and ask specific questions about the patient and family’s cultural needs.

Dying
Chinese families often withhold information from patients because they believe that a

person’s final days should be characterized by a sense of calm (Matzo & Sherman, 2015, pg. 95).

This aspect of the Chinese culture can be difficult in nursing, because typically all parts of care

are communication are done with the patient. It is important to respect this aspect of Chinese

culture and not directly communicate with the family member if it goes against the family’s

wishes. No information should ever be misconstrued or altered if the patient askes about their

prognosis. During the dying process, the family and patient as a whole need to be taken into

consideration. It is important to be mindful of pain management and explain options of pain

control with the patient even if the patient is not verbally expressing pain. It is a cultural ideal

for the family to provide care for the patient during the dying process (Kemp & Chang, 2002).

The family might prefer to take care of the patient themselves. If this is the case, the nurse needs

to know what the family does and does not want help with.

Death

In Chinese culture, patients prefer to die in their own home. It is common in the Chinese

culture to seek care in a hospital until death is near, and then be discharged home to die in the

comfort of their own home (Kemp & Chang, 2002). Chinese patients prefer this because there

are a lot of traditional religious rituals that are performed that aid in the spirit departing from the

word after death. After death, it is common for the family of the deceased to want to stay with

the body for eight hours or more (Kemp & Chang, 2002). The family should be provided with

maximum privacy in order to give them time to perform traditional rituals and prepare the body

for burial as needed. It is common in the Chinese culture to hang a white cloth on the outside of

the door or a red cloth if the patient is older than 80 years old after a death.

Grieving
The Chinese culture influences the grieving process. In the Chinese culture, it is common

to not express feelings or discuss the death of a loved one. In traditional Chinese culture,

individuals treat death as a taboo and often avoid talking about death or feelings in public (Chu

et al., 2015). This often leads to repression of feelings and not physically dealing with the loss of

a loved one. Grieving also occurs as a family. Respects are paid to the family as a whole. Even

though death is not openly discussed, relatives and friends show support by stopping by to pray

with the family.

Conclusion

It is important to be culturally competent in order to effectively communicate with

patients and families of a different culture about end of life care. Cultural competence is gained

through self-awareness and open communication about what patients and family’s need to meet

their cultural and religious needs. The Chinese culture has a variety of influences that impact

dying, death, and grieving during end of life care. As a nurse, it is vital to understand the Chinese

culture in order to provide culturally competent care to both the patient and family during end of

life care.
References

Chu, H., Sterling, Sean, & Schultz, Donald. (2015). The Meaning of Death: A Phenomenological

Study of Chinese Adults Who Have Lost a Loved One, ProQuest Dissertations and Theses.

Kemp, C., & Chang, B. (2002). Culture and the End of Life: Chinese. Journal of Hospice &

Palliative Nursing, 4(3), 173-178.

Matzo, M., & Sherman, D. W. (2015). Palliative care nursing: Quality care to the end of life.

New York: Springer Publishing Company.