and beliefs that significantly differ from their parents’ or grandparents’. An adolescent may feel more comfortable expressing emotions with friends than family.
Providers need to offer culturally competent support for bereaved families, which includes (Purnell, 1998)
• being aware of their own cultural traditions and beliefs, giving special thought to those related to death and dying;
• learning about the cultural beliefs and customs of the community they serve; • genuinely appreciating and respecting the cultural diversity of that community;
• being empathic, flexible and prepared to tailor their care and/or institutional practices to meet the individual needs of bereaved family members.
Healthcare providers tend to view the actions of others through the filters of their own culture. The challenge in these cross-cultural interactions is to be sensitive to the belief system of the grieving family while not imposing one’s own beliefs and biases on them. Providers must be able to identify their own cultural expectations and separate them from the needs of the bereaved family. This process takes careful thought and introspec- tion. One tool providers can use to think about their skill in dealing with culturally diverse families is the continuum of cultural competence, which is adapted from Borkin and others, and includes the following phases or steps (Borkin, 1991):
• Overcoming Denial that culture and class differences do exist • Resolving Fear of unfamiliar cultural beliefs and values • Conquering the belief that the provider’s own ethnic group is Superior to others
• Avoiding Minimization of cultural differences by rationalizing that deep down people are “all the same”
• Demonstrating Relativism, in which the provider knows and respects cultural differ- ences but has not applied this knowledge to the healthcare setting
• Progressing to Empathy, in which the provider understands the client’s cultural knowledge, attitudes, and beliefs and their relationship to health, and has some expe- rience applying this knowledge in the healthcare setting
• Advancing to Cultural Integration, in which the provider understands the client’s cultural knowledge, attitudes, and beliefs and their relationship to health, and has skill and extensive experience applying this knowledge in the healthcare setting.
Even if providers do not have in-depth knowledge about every culture, they can still be extremely helpful if they approach family members with a supportive, nonjudgmental attitude, ask families what will be important to them in their grief process, and then modify care based on the family’s input.
Families frequently are willing to discuss cultural traditions that may help them cope with the loss, and will answer gentle, non-invasive questions about their needs. The healthcare provider can use active listening skills to learn about the culture and provide
vi VOICES FROM THE COMMUNITY: CROSS CULTURAL EXPRESSIONS OF GRIEF AT THE LOSS OF AN INFANT
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