Posted by: ayrshirehealth | January 22, 2014

Cultural differences by @poppletonp

 Surrounded by family

I started 2014 thinking about integration with its challenges and great opportunities and intended for this to be the topic of this blog.  However early on the first Monday in January I received a phone call to say my Aunt had become ill and was admitted to hospital in Ireland where she lived in hope of rehydrating her.  It soon became apparent that death was inevitable. Tea 2She died surrounded by family, coming around on occasion to chat to them in her lucid moments. Nursing and medical staff in the ward were on hand to ease her discomfort and provide tea and sympathy for family. My aunt had a longstanding wish to die at home surrounded by family and although she died in hospital, as there was some hope she could have been treated, she achieved her wish of being surrounded by family.

It has been 11 years since death of my mother and I had forgotten different culturally death is for my Irish extended family. I travelled with my family to the wake and funeral- another request of my aunts and was met by my uncle her husband of 65 years, cousins, their children and grandchildren. On arrival we were ushered in to where she lay in an open coffin looking peaceful and serene and still surrounded by family. My cousin’s daughter was holding her five month old baby held over coffin to say good morning to granny and her 3 year old son was asking if this was granny’s new bed.

MapShe stayed there until her funeral with family keeping her close until she was buried. Not, in my unaccustomed and inexperienced way, half expecting her to wake but in the acceptance that in death she needed her family, friends and community to the end. My sister and I spent two days of making seemingly endless cups of tea for whole town as they queued to view my aunt and console family with shared memories. Her children knew that this was what she wanted for her death and for her family as death was an accepted topic of conversation throughout her life.

This experience was to me in sharp contrast to death and funerals experienced here where people often culturally find comfort in solitude and are given “space” to grieve.  Routinely a body will be taken straight to funeral parlour until service. Grief in the community in which I grew up is private and hidden but feels right for many in our culture.

I can make no judgement about what is right or wrong as different individuals and cultures seek their own comfort and grieve in their own way. As healthcare professionals though we need to support them to achieve this. We can’t support achievement of their ambitions for the end of life if we don’t talk to people while they are living nor can we assume to know how or where they wish to die.

Anticipatory care planning

There has in recent years across all societies been an increasing professionalization and medicalisation of death.


Fear of talking about death and breaching a taboo topic means we often don’t know the wishes of our patients in their last days and hours leading to last minute decision making that can be distressing for patient and family.

Too often people die transferred in ambulances or in accident and emergency department.

Death is the one inevitability in life and yet we cannot discuss it openly as a society and struggle even within professions who have the honour of being with people in their dying hours on a daily basis.

We have in Scotland recently agreed to phase out the Liverpool Care Pathway as in some areas it was at the very least perceive as the giving up of hope and any associated effort to prolong life. We have put in place advanced and anticipatory care planning but uptake of this has been slow. So how do we broach the taboo topic of death with each other? How do we as healthcare professionals achieve a level of comfort with discussions about death in order to ensure we can provide the sort of unobtrusive but skilled and comforting care received by my aunt when death was inevitable?

Person centred care

I have no doubt as the year progresses as is natural my focus will shift once again to ensuring high quality person centred care for those living within our communities and in ensuring protection of the vulnerable through maximising opportunities presented by integration. For these first few weeks in January however my hope is that we can individual by individual with our families, as professionals and in our communities be the start of a movement to reclaim death and dying.  True person centeredness is ensuring that those who are at the end of their lives and their families are supported to achieve their version of a dignified peaceful death in the place of their choosing. As healthcare professionals and as people this may mean by putting aside our own needs and instinct to intervene to prolong life and facing up to the inevitability of death.

We cannot banish dangers, but we can banish fears.  We must not demean life by standing in awe of death.  ~David Sarnoff

This week’s blogger was @poppletonp (Ann Gow) Associate Nurse Director, Primary Care and Community Nursing, NHS Ayrshire & Arran


  1. […] Cultural differences by Ann Gow on the Ayrshire Health blog […]

  2. […] Health Blog. Ann shares with us a recent sad time for her family following the death of an Aunt. In Cultural differences Ann describes how due to culture, alongside the wishes of her Aunt, the family reacted to the […]

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