CULTURAL CONSIDERATIONS
Although all people grieve for lost loved ones, rituals and habits
surrounding death vary among cultures. Each cul-ture defines the context in
which grieving, mourning, and integrating loss into life are given meaningful
expression. The context for expression is consistent with beliefs about life,
death, and an afterlife. Certain aspects of the experience are more important
than other aspects for each culture.
Universal reactions include the initial response of shock and
social disorientation, attempts to continue a relation-ship with the deceased,
anger with those perceived as responsible for the death, and a time for
mourning. Each culture, however, defines specific acceptable ways to exhibit
shock and sadness, display anger, and mourn. Cul-tural awareness of rituals for
mourning can help nurses understand an individual’s or a family’s behavior.
As people immigrate to the United States and Canada, they may lose
rich ethnic and cultural roots during the adjust-ment of acculturation (altering cultural values or behav-iors as a way to
adapt to another culture). For example, funeral directors may discourage
specific rites of passage that celebrate or mourn the loss of loved ones, or
they may be reluctant to allow behavioral expressions they perceive as
disruptive. Many such expressions are culturally related, and health care
providers must be aware of such instances. For example, the Hmong (people of a
mountainous region of Southeast Asia) believe that the deceased person enters
the next world appearing as she or he did at the time of death. This may lead
to a request for removal of needles, tubes, or other “foreign objects” before
death.
Because cultural bereavement rituals have roots in sev-eral of the
world’s major religions (i.e., Buddhism, Christi-anity, Hinduism, Islam,
Judaism), religious or spiritual beliefs and practices regarding death
frequently guide the client’s mourning. In the United States, various mourning
rituals and practices exist. A few of the major ones are summarized next.
Most ancestors of today’s African Americans came to the United
States as slaves and lived under the influence of European-American and
Christian religious practices. Therefore, many mourning rituals are tied to
religious tra-ditions. In Catholic and Episcopalian services, hymns may be
sung, poetry read, and a eulogy spoken; less formal Bap-tist and Holiness
traditions may involve singing, speaking in tongues, and liturgical dancing.
Typically, the deceased is viewed in church before being buried in a cemetery.
Mourn-ing also may be expressed through public prayers, black clothing, and
decreased social activities. The mourning period may last a few weeks to
several years.
Islam does not permit cremation. It is important to follow the five
steps of the burial procedure, which specify wash-ing, dressing, and
positioning of the body. The first step is traditional washing of the body by a
Muslim of the same gender (Facing bereavement, 2009).
Some Haitian Americans practice vodun
(voodoo), also called “root medicine.” Derived from Roman Catholic rit-uals and
cultural practices of western Africa (Benin and Togo) and Sudan, vodun is the
practice of calling on a group of spirits with whom one periodically makes
peace during specific events in life. The death of a loved one may be such a
time. This practice can be found in several states (Alabama, Louisiana,
Florida, North Carolina, South Carolina, and Virginia) and in some communities
within New York City.
The largest Asian population in the United States, the Chi-nese have strict norms for announcing death, preparing the body, arranging the funeral and burial, and mourning after burial. Burning incense and reading scripture are ways to assist the spirit of the deceased in the afterlife journey. If the deceased and family are Buddhists, meditat-ing before a shrine in the room is important. For 1 year after death, the family may place bowls of food on a table for the spirit.
Buddhist Japanese Americans view death as a life passage. Close
family members may bathe the deceased with warm water and dress the body in a
white kimono after purifica-tion rites. For 2 days, family and friends bearing
gifts may visit or offer money for the deceased while saying prayers and
burning incense.
Most Filipino Americans are Catholic, and, depending on how close
one was to the deceased, wearing black clothing or armbands is customary during
mourning. Family and friends place wreaths on the casket and drape a broad
black cloth on the home of the deceased. Family members commonly place
announcements in local newspapers ask-ing for prayers and blessings on the soul
of the deceased.
Vietnamese Americans are predominately Buddhists, who bathe the
deceased and dress him or her in black clothes. They may put a few grains of
rice in the mouth and place money with the deceased so that he or she can buy a
drink as the spirit moves on in the afterlife. The body may be displayed for
viewing in the home before burial. When friends enter, music is played as a way
to warn the deceased of the arrival.
Hispanic or Latino Americans have their origins in Spain, Mexico,
Cuba, Puerto Rico, and the Dominican Republic. They are predominately Roman
Catholic. They may pray for the soul of the deceased during a novena (9-day
devo-tion) and a rosary (devotional prayer). They manifest luto (mourning) by wearing black or black and white while behaving
in a subdued manner. Respect for the deceased may include not watching TV, going to the movies, listen-ing to the radio, or
attending dances or other social events for some time. Friends and relatives
bring flowers and crosses to decorate the grave.
Guatemalan Americans may include a marimba band in the funeral
procession and services. Lighting candles and blessing the deceased during a
wake in the home are com-mon practices.
Ancient beliefs and practices influence the more than 500 Native
American tribes in the United States even though many are now Christian. A
tribe’s medicine man or priestly healer, who assists the friends and family of
the deceased to regain their spiritual equilibrium, is an essential spiritual
guide. Ceremonies of baptism for the spirit of the deceased seem to help ward
off depression of the bereaved. Perceptions about the meaning of death and its
effects on family and friends are as varied as the number of tribal
communities.
Death may be viewed as a state of unconditional love in which the
spirit of the deceased remains present, comforts the tribe, and encourages
movement toward life’s purpose of being happy and living in harmony with nature
and oth-ers. Belief in and fear of ghosts and believing death signi-fies the
end of all that is good are other views. Yet another view is the belief in a
happy afterlife called the “land of the spirits”; proper mourning is essential
not only for the soul of the deceased but also for the protection of community
members. To designate the end of mourning, a ceremony at the burial grounds is
held during which the grave is covered with a blanket or cloth for making
clothes. Later, the cloth is given to a tribe member. A dinner featuring
singing, speech-making, and contributing money com-pletes the ceremony.
An Orthodox Jewish custom is for a relative to stay with a dying
person so that the soul does not leave the body while the person is alone. To
leave the body alone after death is disrespectful. The family of the deceased
may request to cover the body with a sheet. The eyes of the deceased should be
closed, and the body should remain covered and untouched until family, a rabbi,
or a Jewish undertaker can begin rites. Although organ donation is permitted,
autopsy is not (unless required by law); burial must occur within 24 hours
unless delayed by the Sabbath. Shivah is a 7-day period that begins on the dayof the funeral. It represents time for mourners
to step out of day-to-day life, and to reflect on the change that has occurred
(Weinstein, 2003).
The diverse cultural environment of the United States offers nurses
many opportunities to individualize care when working with grieving clients. In
extended families, varying expressions and responses to loss can exist
depend-ing on the degree of acculturation to the dominant culture of society.
Rather than assuming that he or she under-stands a particular culture’s
grieving behaviors, the nurse must encourage clients to discover and use what
is effec-tive and meaningful for them. For example, the nurse could ask a
Hispanic or Latino client who also is a practic-ing Catholic if he or she would
like to pray for the deceased. If an Orthodox Jew has just died, the nurse
could offer to stay with the body while the client notifies relatives.
Acculturation may have caused some people to lose, mini-mize,
modify, or set aside specific culture-related rituals. Many Americans, however,
have experienced a renewed and deepened awareness for meaningful mourning
through rit-ual. An example of such awareness is the creation of the AIDS
quilt. The planting of a flag in the chaotic debris at Ground Zero during the
immediate aftermath of the terrorist attack on the World Trade Center in
September 2001 signaled the beginnings of such a ritual. As bodies were
recovered and removed, the caring diligence and attentive presence of those
facilitating their transport continued this meaningful rite of passage. Through
the media, the United States and much of the world became companions in grief.
In April 2000, a memorial was dedicated for the 168 persons who died in the
bombing of the Alfred P. Murrah Federal Building in Okla-homa City. During the
ceremony, a police chaplain delivered a message to grieving family and friends
to “live in the pres-ent, dream of the future.” Memorials and public services
play an important role in the healing process.
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