Living and dying between cultural traditions in African & Caribbean Heritage families: a constructivist grounded theory.

BACKGROUND: Ethnic differences influence end-of-life health behaviours and use of palliative care services. Use of formal Advance care planning is not common in minority ethnic heritage communities. Older adults expect and trust their children to be their decision makers at the end of life. The study aim was to construct a theory of the dynamics that underpin end-of-life conversations within families of African and Caribbean heritage. This is a voice not well represented in the current debate on improving end-of-life outcomes. METHODS: Using Charmaz's constructivist grounded theory approach, a purposive sample of elders, adult-children, and grandchildren of African and Caribbean Heritage were recruited. In-person and online focus groups were conducted and analysed using an inductive, reflexive comparative analysis process. Initial and axial coding facilitated the creation of categories, these categories were abstracted to constructs and used in theory construction. RESULTS: Elders (n = 4), adult-children (n = 14), and adult grandchildren (n = 3) took part in 5 focus groups. A grounded theory of living and dying between cultural traditions in African and Caribbean heritage families was created. The constructs are (a) Preparing for death but not for dying (b) Complexity in traditions crosses oceans (c) Living and dying between cultures and traditions (d) There is culture, gender and there is personality (e) Watching the death of another prompts conversations. (f) An experience of Hysteresis. DISCUSSION: African and Caribbean cultures celebrate preparation for after-death processes resulting in early exposure to and opportunities for discussion of these processes. Migration results in reforming of people's habitus/ world views shaped by a mixing of cultures. Being in different geographical places impacts generational learning-by-watching of the dying process and related decision making. CONCLUSIONS: Recognising the impact of migration on the roles of different family members and the exposure of those family members to previous dying experiences is important. This can provide a more empathetic and insightful approach to partnership working between health care professionals and patients and families of minority ethic heritage facing serious illness. A public health approach focusing on enabling adult-children to have better end of life conversations with their parents can inform the development of culturally competent palliative care.

The importance and meaning of prayer rituals at the end of life.

Death rituals, such as the ritual of prayer, can offer cultural comfort to people who are grieving the loss of their own life or that of another. This article explores the meaning of ritual, how rituals are structured and how prayer rituals are used at the end of life from a cross-cultural perspective. Facing death can be a challenge to a person's sense of identity and their understanding of their world around them, beginning a process of spiritual suffering. Prayer rituals can help maintain a sense of control and identity during this time of crisis, offering comfort, meaning and structure. Despite varying outward appearances, prayer rituals from different cultures follow similar structures that can be deconstructed, allowing nurses to decipher their meaning and deepen the quality of care they provide to the dying person and those left behind.

Perspectives of elders and their adult children of Black and minority ethnic heritage on end-of-life conversations: A meta-ethnography.

BACKGROUND: People of Black and minority ethnic heritage are more likely to die receiving life supporting measures and less likely to die at home. End-of-life care decision making often involves adult children as advance care planning is uncommon in these communities. Physicians report family distress as being a major factor in continuing with futile care. AIM: To develop a deeper understanding of the perspectives of elders of Black and minority ethnic heritage and their children, about end-of-life conversations that take place within the family, using a meta-ethnographic approach. DESIGN: Systematic interpretive exploration using the process of meta-ethnography was utilised. DATA SOURCES: CINAHL, MEDLINE, PubMed and PsycINFO databases were searched. Inclusion criteria included studies published between 2005 and 2019 and studies of conversations between ethnic minority elders and family about end-of-life care. Citation snowballing was used to ensure all appropriate references were identified. A total of 13 studies met the inclusion criteria and required quality level using Critical Appraisal Skills Programme. RESULTS: The following four storylines were constructed: 'My family will carry out everything for me; it is trust'; 'No Mum, don't talk like that'; 'I leave it in God's hands'; and 'Who's going to look after us?' The synthesis reflected the dichotomous balance of trust and burden avoidance that characterises the perspectives of Black and minority ethnic elders to end-of-life care planning with their children.

Using family sculpting as an experiential learning technique to develop supportive care in nursing. A contemporary issue paper.

This article explores the use of family sculpting as an educative tool to achieve a better I-thou awareness of the patient's support needs from a family and social system approach. Ensuring we provide appropriate and effective opportunities for nurses to develop compassion when caring for patients facing ill health is a complex challenge that faces nurse education at all levels. The piece explores a sculpting exercise developed in nurse education which engages students' awareness of the complicated nature of peoples' social networks and through attitudinal learning, helps nurses to provide compassionate care that integrates family support.

Disenfranchised grief following a non-fatal road traffic incident: a case study exploring a mother's experience.

This case study explores a scenario that was observed by a final year nursing student on placement in a paediatric emergency department, in a busy London teaching hospital. A mother appeared distressed following the news that her son who had survived a road traffic incident with minimal impact to his cognitive and physical abilities, was stable enough to be transferred to the children's medical ward. Whilst this appeared to be positive for supporting figures in her life and the emergency practitioners involved, observation and discussion with the mother revealed that her distress was related to her experience of losses that were undetected by those around her. This included losses related to her son's future and the loss of her previous world. Amongst the plethora of theories about how we as humans react to loss and change, one theory which could explain the mother's grief suggests that it was disenfranchised, i.e. it was not acknowledged or validated by society. There are consequences of disenfranchised grief, such as a lack of social support leading to a higher risk of adverse psychological outcomes. Nurses in the emergency department can help resolve negative outcomes for patients and families experiencing disenfranchised grief. The key steps are to have knowledge of disenfranchised grief to be able to detect it, and then to validate it as a form of grief.

Influence of heparin or the presence of cumulus cells during fertilization on the in vitro production of goat embryos.

Considerable research has been focused on in vitro production (IVP) of goat embryos to improve its efficiency. In Experiment 1, the effect of the cumulus cells by comparing slaughterhouse-oocytes denuded on purpose (DOP) prior to IVF to intact COC, and the effect of heparin during IVF were assessed. In Experiment 2, oocytes that were already denuded at collection (DOC), DOP and intact COC were studied. Three treatments used oocytes denuded at collection: DOC oocytes were cultured alone for both IVM and IVF; DOC and COC were cultured together for both IVM and IVF or DOC were IVM alone and then mixed with COC for IVF. In other treatments, COC were allocated to four IVF treatments: Intact COC; COC were denuded prior to IVF; COC were denuded and IVF with added cumulus cells; COC were denuded and IVF mixed with intact COC giving two sub-treatments: Denuded oocytes that were IVF with COC; and COC that were IVF with denuded oocytes. After fertilization, all presumptive zygotes were cultured for 8 days. In Experiment 1, the yield of blastocysts as a proportion of total oocytes was greater (P<0.05) for COC that were IVF in the presence of heparin (54%) than without heparin (42%) or oocytes already denuded at collection that were IVF with or without heparin (41%; 38%; respectively). In Experiment 2, the developmental potential of oocytes denuded at collection was reduced (cleavage and blastocyst rates calculated from total oocytes: 34%; 11%, respectively) as compared to COC (77%; 59%, P<0.05). However, when equal numbers of both were mixed at the start of IVM, the rates were not significantly different to COC alone (68%; 45%), but when both were mixed equally only for IVF, the rates were reduced (57%; 40%, P<0.05). Denuded oocytes co-cultured with cumulus cells were not significantly different to intact COC (76%; 55%). The effect of adding COC during IVF to oocytes denuded after IVM was similar to adding cumulus cells to the same type of oocytes. In conclusion, both the use of heparin and the association of oocytes with cumulus cells, either detached or in intimate contact, during IVM and/or IVF significantly improve IVP of goat embryos. Furthermore, some oocytes that are already denuded at collection will develop satisfactorily to blastocysts when matured and fertilized with intact COC.