I have always had a passion for both travel and palliative care, and never really thought the two would collide until my experience in Nepal. Although most of my end-of-life care has been in Canada, shaped by the Canadian healthcare system, I admired how the Nepali culture integrated family into care. Specifically, the family support and involvement, especially around death and dying practices. The way I see the palliation process in Canada is focusing on symptom management, comfort and prolonging life or ending suffering, whether that be through Medical Assistance in Dying or medical sedation. Many of the palliative patients I have cared for were in a long-term care home or a hospice setting. In these settings, privacy, autonomy, documentation and standardized care are considered the gold standard. Family involvement in Canadian culture is valued, but I feel it is not prioritized enough for various reasons, including limited visiting hours, visitor capacity, or not enough physical space. In contrast, Nepal faced similar challenges, but the system accommodated families and patients and was seen as an essential part of healing.
Before I left for my summer practicum in Nepal, I had a very narrow mindset and attitude, believing that the Canadian healthcare system represented the highest quality of care. I assumed that health care providers took on a significant responsibility for all aspects of care, especially when a patient is palliating. I believed that the Western way of thinking was universal and that the biomedical model was the best way to care for patients.
In Nepal, I was exposed to a totally different way of care, especially around death. I saw that families were heavily involved not only in physical bedside care but also in emotional and spiritual care. It was common to have multiple family members at the bedside, and when physical space was limited, they often waited outside, rain or shine.
Religious prayers and rituals are deeply rooted in the Nepali culture, and after death, families organize ceremonies according to their faith, as they would in Canada. However, the focus seemed to be less on the legalities of the death and more on the person’s transition to the afterlife. I had the great opportunity to witness a Hindu cremation ceremony at the Pashupatinath Temple along the riverbank of the Bagmati River in Kathmandu. The ceremony included prayer, chanting, and a ritualistic bath by the chief mourner, typically the eldest son. The ceremony traditionally takes place the following day after death. Unlike in Canada, where there are legalities and a longer process before one can be at its final resting place. Furthermore, the family is not heavily involved in the actual cremation.
Initially, I felt uncomfortable in the unfamiliar environment and way of thinking, especially around care and death practices. I often questioned if people were receiving adequate care and worried that limited resources or poor access to care would result in unnecessary harm or prolonged suffering. These thoughts reflected my implicit bias and assumptions that Western healthcare was the only way to ensure quality care. I was also unsure about my role as a nursing student from Canada. I never wanted to come across as judgmental or disrespectful, but I wanted to learn and gain a new perspective on family involvement and different practices.
Nepal has allowed me to gain insight into care and the dying process in a culture defined by religion, family, and social values. I understand that in Nepal, death is a shared spiritual experience, while in Canada, it can be seen as a deeply personal and autonomous experience. I no longer see one approach greater than the other, but I understand that each represents the priorities and values of the society in which it exists. I believe I have developed deeper cultural humility through this realization, which has sparked curiosity, respect, and openness to culture in healthcare.
My attitude shift is an important part of both personal and professional growth as a nurse. As a nurse coming from a multicultural country like Canada, it is important to recognize one’s cultural humility and be open and curious, especially in a person’s most vulnerable moments. Without cultural humility, one may unintentionally impose one’s own beliefs or cause misunderstandings, leading to mistrust in the healthcare system. The experiences in Nepal demonstrated how, when we assume practices are universal, we leave room for error. My attitude toward family involvement has also shifted. By witnessing the success in Nepal of family involvement, I am encouraged to involve families in care as much as possible and to look at how the system can better support family-centred care. Going forward, as a registered nurse, I will be more intentional about asking about family involvement, patients’ beliefs, practices, and final wishes. I will advocate for flexible care plans that respect the patient’s wishes. I will also continue to promote family involvement that supports holistic and medical care. As a nurse leader, I will continue to advocate for policies that support culturally safe care and palliative care, and encourage colleagues to reflect on their cultural humility whenever possible.
Through continuous reflection and repeated exposure, my perspectives and attitude have shifted and will continue to evolve regarding family-centred care. The global health learning experience in Nepal has challenged my assumptions and deepened my understanding of family-centred and holistic care, while strengthening my cultural humility and guiding my personal and professional practice as a lifelong learner.