Todd’s Background and Health Journey
Cultural factors related to end of life considerations with Native Americans and how it influences Todd and his family:
The cultural perceptions of death vary from culture to culture, each having its unique way to understand death, which are also influenced by their religious beliefs. In the western culture, time and death are considered as linear concepts, which have milestones which are to be passed, as an individual is born, as they live and followed by death, which marks the final milestone (Chapple et al., 2015). However, among several Native American cultures, the perception of time is circular instead of linear. Such a perception implies that time has no specific starting point, and death is only a point on this cycle of birth, life, death and rebirth. Hence death is not considered the absolute end, but instead a passage to the next life or the next world. Even though there exists an incredible diversity among Native American tribes in terms of their beliefs, cultural practices, and lineages, a common perception exists about the time being circular and death being only a point in this infinite journey the soul takes (Irish et al., 2014). Beliefs of reincarnation is also common among several tribes, which considers souls to be eternally present, and only moves from one body to another, after death, and never leaving the world (Griffiths, 2018). Among other tribes, death is considered as the doorway or passage to another world, where the soul moves on and joins the ancestors of the tribe who died before them. Such perspectives lead to death being viewed as a more acceptable concept, compared to the western culture, where death is a source of grief. In Native American cultures, death is not really mourned, but instead celebrated, as the soul of their loved ones becomes free of their earthly bodies, and move on to the next world (Grande, 20915). Todd, who is nearing his end of life, is thinking about death, and how terminal patient death with their own death. His family however did not wish to discuss this matter, showing that they are not fully prepared to give up hope for Todd. This also shows that for Todd’s parents, the importance of Todd’s life is way more important than the safe ‘passage’ of this soul, which is why Todd also refrained from discussing this topic in the presence of his parents. Todd’s mother also prevented the social word consultants to discuss his end of life considerations, stating he didn’t want to discuss about that (Yang, 2018).
Engaging Todd in a discussion about end of life using family’s cultural narratives:
It was evident from Todd’s curiosity that he was actually anxious about what was going to happen when he died, and he needed somebody to talk to regarding his death. It is possible that he avoided the discussion regarding his death in the presence of his family, considering how that though could be hurting them, which is why he chose a moment when his mother was not near to raise such questions. Discussing his family’s cultural narratives, how death is perceived in his culture, and using native storytelling methods to elaborate the native perceptions of death can be a useful strategy to engage Todd in a discussion about his end of life (Bird, 2018; Miller et al., 2018). Storytelling can also be very useful method to bring Todd closer to his cultural roots and heritage. The stories can includes Native American legends about death, such as how death has been portrayed historically in their culture, the origins of those stories, how death and life were considered eternal, stories of afterlife and the passages of soul (Saiyed et al., 2017; Larson, 2017). Such stories can give hope to Todd, giving him something to look forward to, and view death not with grief but with acceptance. Helping Todd to become more acceptable towards his end of life, can also help to reduce the anxiety towards the uncertainty of the future, and thus any adverse effects such anxiety might be having on his already ailing health (Palacios et al., 2015; Slater et al., 2017). Several authors have suggested that stress and anxiety can have negative impacts on the physical and mental health of people (Liu, 2017; Gerber et al., 2014). It is therefore important that sources of any possible anxiety and stress for Todd be promote addressed and reduced, and help him to be more comfortable as possible to support a peaceful and painless death (Alliance & World Health Organization, 2014; Wiener et al., 2015). It has also been supported that storytelling has very important cultural significance for Native Americans, since they project important ideas, beliefs, and values in a form that is simple, entertaining and engaging. Such methods can be useful to promote wellbeing (both physical and mental) among the Native American Communities, and thus can be used to support Todd’s family as well, to help them accept the eventuality of Todd’s frail health, and discuss Todd’s end of life considerations more openly and freely (Yang, 2018).
Cultural Factors related to End-of-Life Considerations for Native Americans
Effect of my biases on the discussion and ways to manage those biases:
My cultural beliefs biased my views and perceptions about death quite differently than what is believed by the Native Americans. I believed that death is the end of the existence of a person, and after death the soul either goes to heaven or hell, or leaves this plane of existence. In essence the person who dies is forever gone, and thus is a source of grief, morning and unhappiness (Shiraev & Levy, 2016). This also led to me feeling sad for Todd, since he was a young person, nearing his end of life due to his frail health and the faint chance of him ever getting the right donor for lung transplantation. Such bias have also led to me trying not to have the discussion about death with Todd or his family, and thus when Todd wanted to discuss about the subject, I did not know how to respond, as I did not want my perceptions about death to make Todd more anxious and afraid than he already was (Norenzayan et al,, 2016). I also was unable to console Todd or his family effectively, since I believed in the eventuality of Todd’s condition, and due to my perception of death as the final outcome. I also did not believe in re incarnation, and that the souls take up another body and stays in this world, which was a common belief among the Native American Tribes. All such perceptions prevented me from having an effective discussion about end of life with either Todd or his family. However, such biases can be overcome through storytelling that included Native American legends, folklores and philophies about life and death, telling stories about passages of souls and eternal existence of life. Involving these storytelling sessions can also increase the cultural competencies of the end of life care, and help to engage both Todd and his family in the discussion apart from helping to overcome my own bias and how it affected the discussion (Tan, 2016). I could also reduce the bias by learning more about Native American cultures and views about life, death and reincarnations, comparing it to my own beliefs and appreciating the diversities in how death is perceived in different culture, thereby helping to understand how differently we think about death (Slater et al., 2017).
Whether Reginald is experiencing delirium, depression or dementia:
Reginald is 74 years old male, an army veteran who was honorably discharged and had his own business in automobile repairing, which was later handled by his son. He suffered bereavement of his wife, with whom he was happily wed for 40 years, and they both were very close to each other, and very active in the community. After his wife’s death, his daughter, Candice did not want him to stay alone, and Reginald moved in to life with Candice and her family. Due to this, Reginald had to give up his social interactions, as he relocated to a new place, leaving the place where he stayed for 30 years. Reginald have shown signs of memory issues, as he stopped remembering the days of the week, entering the room and forgetting why he entered there, getting lost while driving to the grocery store and forgetting to put water into the pot while cooking pasta. These are significant symptoms of dementia and memory problems. However, the Mini Metal State Examination (MMSE) showed a score of 23/30, which showed that Reginald has mild to no cognitive impairment or construction problems and thus suggests that Reginald does not have dementia (Creavin et al., 2016). It should however be noted that the signs of memory problems should not be taken lightly, as it clearly indicates the early warning signs of dementia.
Implications for Todd and his Family
The Geriatric Depression Scale on the other hand showed a value of 8, which shows that Reginald might be significantly depressed. Interview with Reginald also suggested that he might be depressed, since he mentioned that he feels sad as he is not longer able to talk to his wife anymore and did not get enough time with his children either. Moreover, moving to a different city, he had to five up his social circle and friends, and spends most of time alone, not doing anything. He felt that he was wasting his time by being idle all the day, which might be adding to his depression. This can be supported by the views of several authors who suggested that lack of physical activities, isolation from social circles or social life , being alone, and episodes of bereavement can significantly increase the risks of depression, as well as dementia at an old age (DiNapoli & Scogin, 2017; Pocklington et al., 2016).
Recommendations for treatment: (including local resources that can be used):
Considering that Reginald is showing the signs of depression as well as the early warning signs of dementia, it is vital that both the conditions are addressed in his treatment plan. It is important that Reginald be helped to cope up with the bereavement of his wife, helping him to accept and move on with such an adverse life experience (She & Prigerson, 2018). He can also be supported to build his social circle, and be involved more in social interactions and with the community, the way he used to be engaged in his previous community. He can be recommended to increase his physical activities such as walking, gardening, playing board games or visiting relatives, and avoid sitting at home idle (Morris & Blocks, 2015).
Strategies to reduce depressive symptoms can include the involving of daily exercise routines (such as walking, or gardening or oriental techniques such as yoga, tai chi or qi gong), ensuring healthy diet and dishes that Reginald likes to eat, ensuring that Reginald gets sufficient amounts of sleep, picking up new hobbies or activities or engagements and getting out of the house more often (Karlsson et al., 2016). Also, Reginald can be assisted to deal with the negative emotions and his sadness caused by his wife’s death, helping him to deal with it in a better manner. This suggestion is mainly supported by Reginald’s avoidance to engage in this topic with anyone. If the depression is significantly affecting Reginald’s life and mental well being, consultation with a psychologist is also recommended as well as a pharmacologic intervention, which can help to alleviate any clinical signs of depression (Davenhill, 2018).
Many of the strategies to reduce depression can also be useful to prevent the onset of dementia and reduce the early warning signs. Researchers have shown that social interactions, games, physical activities and healthy diet can be useful to treat the symptoms of dementia and alleviate the effects. It is also important that hazards of falling be assessed in Reginald’s home, considering that he already experienced a fall and the nature of attire he wears at home, which can increase fall risks. Physical activities and exercise can also help to increase his sense of balance and reduce fall risks, while engaging in social interactions and playing board games with friends and community members can help in the better retention of memories, which has been supported by many studies (Jahn et al., 2015; Groot et al., 2016).
Engaging Todd in Conversation about End-of-Life
Explaining the recommendations to Reginald’s daughter, Candice:
Considering how Reginald mental health might be getting affected since moving away from his home, to relocate to a different state, it is important that he either finds a way to renew or re develop his social ties in the new community, or moves back to his old home, where he was social active, and can revert back to old lifestyle. Reginald also might need community assistance, which can help him and support his engagement in the community, assist him to increase his physical; activities such as going for a walk, visiting friends or playing board games with them. Through community services, trainers can be appointed who can provide classes on yoga, tai chi or qu gong, all of which can help to improve balance, cardiovascular functions and also improve the mental well being (Bunn et al., 2016). Healthy diet recommendations can also be used to help Reginald select healthier diet options and avoid unhealthy ones. It is also important to highlight the fact that moving away from his community and not being able to socialize with his friends have also affected Reginald’s depression, as he feels that he is wasting his time away, and feeling miserable about it. Reginald understands though that his daughter is worried about him, and for good reasons, but being at the position where he is not really helping Reginald’s health, and might be even adversely affecting him. Relocating back might therefore be the best option for him, and f such is not possible or feasible, the nest best thing would be to help Reginald to build his social ties anew, and also helping him to engage his time in a more meaningful manner, that would keep him mentally and physically engaged (Kilmova & Kuca, 2018). Also, environmental hazards of falling at home should be assessed and minimized, and necessary modifications be made to his home, to reduce the risks of falling and thus prevent any avoidable injuries (Booth et al., 2015).
References:
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Effectively Incorporating Cultural Narratives
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Yang, J. (2018). Storytelling and Cross-Cultural Communication
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