Diversity/Culture & Spirituality,Ethical Dimensions,Genetics/Genomics,Palliative/Hospice Care; Advance Directives, Loss/Grief, Complementary & Alternative Therapies/Herbals

Cultural Humility

lifelong self-reflection; reduces power imbalance; no assumption of knowing culture(an ongoing process of self-reflection and learning that helps nurses provide respectful, patient-centered care without assuming they fully understand a patient's culture)

Acculturation

adapting new culture while retaining identity(the process by which individuals adopt some aspects of a new or dominant culture while maintaining elements of their original culture.)

Assimilation

full absorption into dominant culture at expense of original identity (when a person fully adopts the dominant culture and gives up most or all of their original cultural practices.)

Cultural Imposition

forcing own beliefs on patient; unethical

Cultural Sensitivity

neutral language, avoids stereotyping

Cultural Competence

deliver care within beliefs, values, practices of patient

Health Disparities

systemic differences due to bias, access, social determinants

Social Determinants

income, education, housing, access → shape health outcomes

Implicit Bias

unconscious stereotypes affecting care decisions & outcomes

Bias Reduction Strategy

pause, question assumption, use patient-centered language

LEARN Model

Listen, Explain, Acknowledge, Recommend, Negotiate

Interpreter Use

no family unless emergency; trained interpreter only

Jehovah's Witness

refuse blood; offer volume expanders, EPO, iron

Orthodox Jewish

no mixing dairy + meat; Sabbath care restrictions vary

Muslim

Halal diet; Ramadan fasting considerations

Hindu

no beef; modesty needs same-sex caregiver

Buddhist

vegetarian; meditation preference in care plan

Faith

trust/relationship to higher power

Spirituality

purpose, connection, meaning; not same as religion

Religion

organized faith practices

Spiritual Distress

hopelessness, questioning meaning, anger at higher power

Appropriate Spiritual Response

sit in silence, presence, offer chaplain, ask preferences

Inappropriate Response

"I know how you feel" "At least he is in heaven now"

FICA

Faith, Importance, Community, Address in care

HOPE

Hope sources, Organized religion, Personal practice, Effects on care

Autonomy

right to choose; informed consent

Beneficence

do good; relieve suffering

Nonmaleficence

do no harm; risk vs benefit

Justice

fair distribution of resources

Veracity

must tell the truth

Fidelity

keep promises; confidentiality

Moral Distress

know right action but cannot act due to constraints

Moral Injury

deep ethical violation; long-term emotional residue

Ethics Committee

advises in conflict, EOL, withdrawal of treatment

Double Effect

intent to relieve suffering acceptable even if resp depression occurs

Paternalism

making decisions for patient "for their good"; violates autonomy

Palliative Care

relieve suffering; can continue curative treatment

Hospice Care

< 6 months; no curative treatment

Life-Sustaining

treatments prolong life w/out reversing disease (dialysis, tube feed)

Life-Supporting

maintain vital function (ventilator, CPR)

Life-Enhancing

completely comfort (oral food, O2, pain meds)

Good Death

completed life review, dignity, comfort

Palliative Sedation

relieve refractory suffering; not to hasten death

Futile Care

risk > benefit; no improvement in function or comfort

Late Hospice Referral

<7 days before death; poorer QOL

POLST

portable DNR at home for EMS

DNR

inpatient only order; no CPR

Advance Directive

doc outlines wishes before losing capacity

Durable POA

best form; appoints decision-maker

Living Will

lists what to accept/refuse at EOL; only when incapacitated

Surrogate Hierarchy

spouse → adult children → parents → siblings → friend

Family Education on Dying

mottling, ↓ intake, Cheyne-Stokes, apnea periods normal

Cheyne-Stokes

irregular breathing with apnea; sign of nearing death

Bereavement

period after loss

Mourning

outward expression of grief

Normal Grief

sadness, fatigue, appetite change, crying

Anticipatory Grief

grieving before the loss occurs

Complicated Grief

persists >12 months, unable to function, suicidal ideation

Signs of Imminent Death

cold extremities, ↓ urine output, mottling, terminal secretions

Therapeutic EOL Phrases

"There is no rush" "I am here with you" "You are not alone"

Nontherapeutic EOL

"They're in a better place" "Stay strong"

Complementary

used with conventional treatment

Alternative

used in place of conventional treatment

Integrative Medicine

evidence-based mix of both

Mind-Body

prayer, meditation, imagery, biofeedback

Manipulative

chiropractic, massage

Energy Medicine

Reiki, healing touch

Whole Systems

TCM, Ayurveda, Naturopathy, Homeopathy

Echinacea

immune boost; avoid in autoimmune; ↓ effect of immunosuppressants

Garlic

antiplatelet; ↑ bleeding risk w warfarin/ASA; ↓ cholesterol

Ginkgo

vasodilates; ↑ bleeding risk; caution seizures

Ginseng

↑ energy; ↓ glucose; mania with MAOIs; avoid anticoagulants

St. John's Wort

mild depression; ↓ OCPs; serotonin syndrome risk with SSRIs/MAOIs

Saw Palmetto

BPH; mild benefit; ↑ bleeding risk

Kava

severe liver toxicity; avoid sedatives & alcohol

Probiotics

restore gut flora; caution immunocompromised

Herbal Stop Before Surgery

2 weeks; risk of bleeding & anesthesia interaction

Herbal Label Must Say

not intended to diagnose, treat, cure, or prevent disease

Herbal Red Flags

>65, <18, pregnancy, multiple herb combos, sedation + alcohol

CBD

anti-seizure; sedation, hypotension risk

THC

pain, nausea, appetite; impaired cognition & coordination