How Has Our Culture Evolved Regarding Death and What Is the Impact of These Changes on Healthcare?
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Many of the first quantitative models of cultural evolution were modified from existing concepts in theoretical population genetics because cultural evolution has many parallels with, as well as clear differences from, genetic evolution. Furthermore, cultural and genetic evolution can interact with one another and influence both transmission and selection.
To address these gaps in the literature, this study explored the impact of death and dying on the lives of key leaders and frontline professionals in palliative and hospice care — individuals who arguably provide society and health care practitioners with the most authoritative discourse on end of life and its effect on life in general.
Such understandings, which will depend on better data and research than now exist, will help provide the basis for steps to remove the impediments to good care and to fortify the foundations for reliably excellent care. In general, care systems—both as discrete organizations and as unevenly connected arrays of community institutions and services—require people (supported by facilities and processes) who are prepared to determine what care is appropriate, to arrange its provision, and to monitor performance for consistency with organizational and external norms. More generally, the committee heard some concerns from hospice or ganizations about the practices (actual or feared) of managed care organizations. One concern expressed to the committee involved the "micromanagement" by some HMOs of care for non-Medicare patients enrolled in hospice (Brown, 1983). Practices mentioned included denial of certification for appropriately intensive home care or for appropriate hospitalization for palliative care. Such practices have quality as well as financial implications. They may reflect that newer managed care organizations serving mainly younger patients are unfamiliar with hospice. Thus, just as those in fee-for-service medicine may need education about palliative care and hospice programs, so may those in managed care (Brown, 1983).
Transcutlural concepts in nursing care have made cultural competency an expected standard and it is the duty of every nurse to help maintain this standard.
Brown, 1983; IOM, 1993a, 1996b, 1997; Miles et al., 1995; Jones, 1996b.
U.S. Bureau of Labor Statistics, there were 666,000 "degreed Human Services Workers" in 1995 (Gibelman, 1997)
42 CFR Section 418.70[e]