End-of-Life Consideration – Nigerian Culture

Beliefs, Rituals, and Practices at End of Life

According to the Nigerian culture, deeply rooted in traditional African beliefs and Abrahamic religions, death is just a continuation of life onto another dimension. The concept of death and dying from a Nigerian perspective implicates an individual actively within their communal framework during their last stages, especially when the extended family and community are to play an active part in the process. Most Nigerians are bound by deep spiritual beliefs concerning death, often viewing illness and death in spiritual terms and, at times, ascribing such life experiences to some supernatural causes like curses or evil spirits (Alberta Health Services, 2017). These spiritual interpretations play a key role in shaping attitudes toward end-of-life care and decision-making.

The involvement of spiritual leaders and traditional healers together with the hospital-based medical staff is usually done by the families during the terminal phase of a patient’s life. Family nature and respect for the elders are an important predictor of decision-making that will influence preferences in end-of-life care. Most Nigerians would prefer to die at home when the family is around them; dying at home will enable appropriate traditional rituals and practices to be performed. Elaborate funeral ceremonies are held after death, which, besides showing respect to the deceased, also help the bereaved family recover from their grief. Most of these rituals include certain customs that depict status, age, and the role of the individual in society (World Cultural Encyclopedia, 2020).

Giger-Davidhizar and Huff Cultural Assessment Model (Coolen, 2012)

Communication

During the delivery of palliative care among Nigerian patients, communication norms have to be handled with much care, especially when it relates to matters concerning death and dying. The healthcare provider should be conscious of indirect communication and how often such communication occurs through intermediaries among family members when dealing with grave issues. Furthermore, practicing respect for cultural communication, understanding the right eye contact for the elders, and understanding the right interpretation that covers both language and culture is vital. This might include religious leaders and traditional healers in care discussions when families request their involvement, as often, their perspective carries great weight in decision-making processes.

Space

Traditional Nigerian concepts of personal space in palliative care settings call for thoughtful consideration in making room arrangements so as to accommodate large family gatherings. The care environments should be made in such a way that there is room for traditional healing practices and prayer rituals while setting appropriate boundaries and privacy. This would maintain culturally appropriate physical distances, particularly between different genders, and provide private quarters where consultations with the family and family decision-making processes are necessary. This spatial arrangement supports the communal nature of Nigerian health decision-making by considering cultural norms.

Time

The principle of Nigerian palliative care in regard to time is flexibility in visiting times so that the facility can allow extended family gatherings. A care plan must take into consideration religious observances and times of prayer, as spiritual practices are essential in the treatment process. Decision-making processes always take more time for consultations among family members, and discussions of end-of-life care must be done in several sessions to allow the family to take proper consideration and involvement. Respect for cultural preferences about time helps in gaining confidence and thus ensures more efficient delivery of care.

Environmental Control

The care environment should support traditional healing practices while maintaining modern medical standards. This would include accommodations in the care setting to allow for spiritual items and religious symbols that provide comfort and spiritual support to the patient and family. Room conditions, including temperature and lighting, should be aligned with cultural preferences. When feasible, access to outdoor areas should be provided for traditional ceremonies. Besides, a culturally sensitive environment promotes healing and comfort during the end-of-life journey (Agbede et al., 2024).

Social Organization

The social structure in Nigerian palliative care focuses on respect for the family hierarchy in decision-making. This further incorporates an appreciation of the active role community and religious leaders may play in care planning. Care providers should support family meetings in a way that embodies all members and acknowledges gender-specific roles in caregiving and decision-making processes. The incorporation of such social structures into the care plan ensures appropriate, effective delivery of end-of-life care.

Biological Variation

Biologically, the care would involve the integration of both traditional and current methods of pain management, keeping in mind that, culturally, the expression and treatment preference for pain differs. Other culturally sensitive healthcare provider considerations are those regarding organ donation or handling of the body, as these things are deeply cultural and spiritual (Agbede et al., 2024). Dietary considerations should be reflected in cultural and religious needs, especially in observance of religious holidays, making sure that nutritional support is in alliance with culturally sensitive modalities and beliefs.

Conclusion

The provision of effective palliative care will entail understanding and incorporating cultural beliefs and practices into care delivery for Nigerian patients. With attention to each component of the cultural assessment model, care planning can be appropriately developed to respect traditional values while attending to medical needs. The value of such a culturally competent approach is that in providing end-of-life care, the physical and spiritual dimensions support each other during death and dying; this allows patients and their families to transition in a manner that is culturally congruent.

References

Agbede, G. T., Emezirinwune, D., Adedokun, T. L, & Idowu-Collins, P. (2024). Vaccine hesitancy in Nigeria: Overcoming cultural, linguistic and religious obstacles. Information Impact: Journal of Information and Knowledge Management, 15(1), 153-168.

Alberta Health Services. (2017). Health care and religious beliefs (2nd ed.). https://www.albertahealthservices.ca/assets/programs/ps-1026227-health-care-religious-beliefs.pdf

Coolen, P. R. (2012, May 1). Cultural relevance in end-of-life care. EthnoMed. https://ethnomed.org/resource/cultural-relevance-in-end-of-life-care/

World Cultural Encyclopedia. (2020). Countries and their cultures. https://www.everyculture.com/index.html

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End- of- life consideration

Getting Started

As the end of life draws near, patients reflect upon the meaning and value of life and contemplate their eventual death. Oftentimes, the patient and family fall into the throes of despair and depression. As Christians and professional nurses, it often falls upon us to offer a message of hope and peace. The hope we offer is not necessarily for a physical cure, but for spiritual healing.

Nurses caring for individuals experiencing end-of-life issues must acknowledge that the beliefs and mores of the patient and family, as well as their own past experiences, are important to assess. The combination of cultural traditions and practices allow caregivers to help the patient and family adapt to their circumstances, find meaning in life, and cope with impending death.

Upon successful completion of the course material, you will be able to:

• Describe approaches for end-of-life considerations specific to different cultures.

Resources

• Textbook: Spirituality in Nursing: Standing on Holy Ground
• Web Article: “Cultural Relevance in End-of-Life Care“
• Website: EthnoMed

End-of-Life Consideration – Nigerian Culture

Instructions

1. Review the rubric to make sure you understand the criteria for earning your grade.
2. Read Chapter 11 & 12 in the O’Brien text
3. Visit the EthnoMed website (http://ethnomed.org/) and review the contents.
4. Review the article entitled, “Cultural Relevance in End-of-Life Care.” You can access this web-based article at: http://ethnomed.org/clinical/end-of-life/cultural-relevance-in-end-of-life-care
5. Website: EthnoMed Online students, navigate to the threaded discussion and respond to the following: (Onsite students will discuss the following in class)
   1. Utilizing the cultural group you researched in assignment 3.3, discuss the beliefs, rituals, and practices at the end of life.
   2. Utilizing the components of the Giger-Davidhizar and Huff cultural assessment model as described in the Coolen article (Communication, Space, Time, Environmental control, Social organization and Biological variation), describe palliative care interventions that may be offered to a patient of your chosen culture from Workshop Three.
      Need to list each element of the assessment model and and describe palliative care interventions for each element.
      1. Communication-
      2. Space-
      3. Time-
      4. Environmental control-
      5. Social organization-
      6. Biological variation-
6. Cite and reference at least one current scholarly source to support your discussion.
7. Your initial post to the discussion forum is due by the end of the fourth day of the workshop.
8. Your initial posting should be a minimum of four paragraphs in length that include a minimum of three sentences each.
9. Read and respond to at least two of your classmates’ postings, and consider responding to all instructor follow-up questions directed to you, by the end of the workshop.
10. Your postings should also:

1. Be well developed by providing clear answers with evidence of critical thinking.
2. Add greater depth to the discussion by introducing new ideas.
3. Provide clarification to classmates’ questions and provide insight into the discussion.
4. Be posted on a minimum of two days during the workshop.