Multi-cultural and multi-ethnic considerations and advanced directives: developing cultural competency.

Attention to culturally specific rituals germane to end-of-life rituals are important for the nurse who is delivering culturally competent care. The Patient Self-Determination Act implemented in the United States in 1991 brought with it some specific assumptions of values related to end-of-life care involving patient autonomy, informed decision making, truth telling and control over the dying process (USC, 1990). The assumptions and values assumed in this act are not necessarily shared by persons in the United States who are from a minority culture, particularly one other than White of European descent. This manuscript considers the values of the Patient Self-Determination Act passed in the United States and specific cultural beliefs which may pose a conflict for the care giver in the delivery of culturally competent care. The Giger and Davdihizar (2004) Transcultural Assessment Model is used as a way to assess patient and the family in an effort to plan culturally appropriate care that recognizes the uniqueness of each individual at the end of life.