Cross-cultural beliefs, ceremonies, and rituals surrounding death of a loved one

Pediatric Nursing, Jan-Feb, 2006 by Sandra L. Lobar, JoAnne M. Youngblut, Dorothy Brooten

Grieving and death rituals vary across cultures and are often heavily influenced by religion (Chachkes & Jennings, 1994; Younoszai, 1993). How and when rituals are practiced vary depending on the country of origin and level of acculturation into the mainstream society. The duration, frequency, and intensity of the grief process may also vary based on the manner of death and the individual family and cultural beliefs (Clements et al., 2003). Although cultural practices surrounding the death of a loved one have been described, there are limited research descriptions from key informants within cultures. The purpose of this qualitative study was to describe beliefs and practices of death and dying in selected cultural groups living in the United States (U.S.). Nurses from those groups were interviewed to gather data about their personal experiences with death and their experiences with deaths of patients from the selected cultural groups. Similarities and differences in the beliefs and practices of death and dying among these groups were identified.

Researchers have found greater outward expression of grief and more physiologic reactions among Mexican American college students compared to Anglo college students (Oltjenbruns, 1998) and greater grief intensity among Latinos from Puerto Rico who experienced a sudden unexpected death than other Latinos and Anglos (Grabowsky & Frantz, 1992). However, Brandhorst (2000) found no differences in bereavement for White, Black, and Hispanic adult children whose parent died from cancer. Talamantes, Lawler, and Espino (1995) identified similarities during the period preceding the death in case studies of a Mexican American family, a Cuban American family, and a Puerto Rican family experiencing the death of a family member, including the caregiver's not wanting to burden or impose on family; experiencing depressive symptoms; and relying on faith, hope, and prayer to cope with the impending death.

In another case study report, Rivera-Andino and Lopez (2000) reported that Hispanics believe it is detrimental to patients to let them know about the seriousness of the illness in order to spare them unnecessary pain and that it is the family's obligation to take over control of the situation. African Americans may hold mistrust of the health care system, especially regarding advanced directives and end-of-life care, and both Mexican Americans and African Americans verbalize a preference for decision making as a family (Perkins, Geppert, Gonzales, Cortez, & Hazuda, 2002; Waters, 2001).

Latino death rituals are described as heavily influenced by Catholic beliefs where spirituality is very important and there is a continuing relationship between the living and the dead through prayer and visits to the grave. Grief is expressed by crying openly where women may wail loudly but men may act according to "machismo" where there is a belief that men should act strong and not show overt emotion. There is preference for burial rather than cremation, novenas for 9 days, mass for the deceased during the first year and then yearly, family gatherings with food (like a wake), and lighting candles. (Clements et al., 2003; Munet-Vilaro, 1998).

Descendents from Caribbean nations and Mexico may practice a blend of Catholicism and African or indigenous folk medicine known as Santeria in Cuba, Kspiritismo in Puerto Rico, or Voodoo in other Caribbean nations, and Curanderismo in Mexico (Grossman, 1997; Spector, 2000; Younoszai, 1993). Santeria death rituals are governed by the saints (orishas) as told by the santero (a clergy or holy man) and often include animal sacrifice (Grossman, 1997). Younoszai (1993) asserts that Mexicans have more understanding and acceptance of death because their country is primarily rural, poor, religious, and very young on average. Death is portrayed in Mexican statues, art, literature, and history, and Mexican children are socialized early to accept death, giving Mexicans a "cultural familiarity with death." Mexicans and other Latinos celebrate "Dia de los Muertos" (Day of the Dead) to remember and honor the dead (Talamantes et al., 1995).

Death rituals for Black Americans vary widely, perhaps because of the diversity in religious affiliations, geographic region, education, and economics (Perry, 1993). Researchers suggest that emotional expression varies, with some Black Americans crying and wailing while others are silent and stoic (Hines Smith, 2002). Perry describes large gatherings and an expressed obligation to pay respects to the deceased as common. Southern and rural blacks may maintain the custom of having the corpse at the house for the evening before the funeral. Friends and family gather at the house to help out where they can. Church "nurses" help family members to view the body. Women "flower girls" escort the casket with the pallbearers and pay special attention to the family (Perry, 1993). Strong religious beliefs--seeing the death as a reflection of God's will or plans, believing the deceased is in God's hands, and being reunited in heaven after death--help many Black Americans to grieve while maintaining a connection with the deceased (Hines Smith, 1999, 2002). Bereaved African Americans are more likely to seek help from clergy than health care professionals (Neighbors, Musick, & Williams, 1998). For Baptists, heaven is a place where the redeemed go to and it is described as filled, a beautiful place, and there is belief in resurrection (Spector, 2000).