Practices following the death of a loved one reported by adults from 14 countries or cultural/ethnic group

Abstract

Aims
The purpose of this study was to examine the reported ritual practices (dealing with the deceased's remains, wake, funeral, burial and celebration) of White non‐Hispanic, Black non‐Hispanic and Hispanic/Latino adults in their country of origin or ethnic or cultural group in the United States following the death of a loved one.

Design
This descriptive study is a secondary analysis from a longitudinal mixed‐methods study that examined parents' health and functioning following the death of a child.

Methods
Adult parents whose child died in neonatal intensive care units or paediatric intensive care units were recruited from four hospitals and from death records. Data were collected from 61 adult parents at 7 and 13 months postinfant/child death using semi‐structured interviews about the child's death. Only those parents who responded to questions about usual death practices in their country of origin or cultural group were included in the data analysis.

Results
Thirty‐two adults from 14 countries reported practices in their country or cultural group after a loved one's death including keeping the front door closed, walking funeral processions with a band playing, the deceased in a car accompanied by family and friends, fireworks, making home altars for deceased spirits with food and water for adults, toys and candy for children and no TV or radio for sometime.

Relevance to clinical practice
For community health nurses, understanding these practices is important in being sensitive and appropriate around the death. Asking the family about specific practices they hope to carry out and noting this in the family's record will help alert providers to the family's wishes at this challenging time.

Full text

Nursing Open. 2021;8:453–462.
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453wileyonlinelibrary.com/journal/nop2
Received: 21 September 2019
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Revised: 6 August 2020
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Accepted: 3 September 2020
DOI: 10.1002/nop2.646
RESEARCH ARTICLE
Practices following the death of a loved one reported by adults
from 14 countries or cultural/ethnic group
Ivette Hidalgo | Dorothy Brooten | JoAnne M. Youngblut | Rosa Roche |
Juanjuan Li | Ann Marie Hinds
This is an op en access article under the ter ms of the Creative Commons Attribution-NonCommercial-NoD erivs License, which permits use and distrib ution in
any medium, provided the original work is properly cited, the use is non-commercial and no modificat ions or adaptations are made.
© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.
Resear ch Repor ting Checkli st: The EQ UATOR checkl ist used i s COREQ.
Florida International University Nicole
Wertheim College of Nursing & Health
Science s, Miami, FL, USA
Correspondence
Ivette Hidalgo, Nicole Wertheim College of
Nursing and Health Sciences, AHC 3, Rm
337. Florida International Universit y, 11200
SW 8th Street, Miami, Florida, 33199, USA.
Email: Ihidalgo@fiu.edu
Funding information
National Institutes of Health; National
Institute of Nursing Research, G rant/Award
Number : R01 NR0 09120
Abstract
Aims: The purpose of this study was to examine the reported ritual practices (dealing
with the deceased's remains, wake, funeral, burial and celebration) of White non-
Hispanic, Black non-Hispanic and Hispanic/Latino adults in their country of origin or
ethnic or cultural group in the United States following the death of a loved one.
Design: This descriptive study is a secondary analysis from a longitudinal mixed-
methods study that examined parents' health and functioning following the death
of a child.
Methods: Adult parents whose child died in neonatal intensive care units or paedi-
atric intensive care units were recruited from four hospitals and from death records.
Data were collected from 61 adult parents at 7 and 13 months postinfant/child death
using semi-struc tured interviews about the child's death. Only those parents who re-
sponded to questions about usual death practices in their country of origin or cultural
group were included in the data analysis.
Results: Thirty-two adults from 14 countries reported practices in their country or
cultural gr oup after a love d one's death including keepin g the front door clos ed, walk-
ing funeral processions with a band playing, the deceased in a car accompanied by
family and friends, fireworks, making home altars for deceased spirits with food and
water for adults, toys and candy for children and no TV or radio for sometime.
Relevance to clinical practice: For community health nurses, understanding these
practices is important in being sensitive and appropriate around the death. Asking
the family about specific practices they hope to carry out and noting this in the fam-
ily's record will help alert providers to the family's wishes at this challenging time.
KEY WORDS
bereavement, child death, communit y, cultural practices, death

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1 | INTRODUCTION
Death of a loved one is a painful experience for most people. Af ter
a death, those with common bonds, such as religion or ethnic origin,
perform rituals to recognize the death and honour the deceased and
the family. Rituals can legitimize grief, provide an arena where the
death is acknowledged and its finality is accepted, create a safe place
for mourners to express emotion, maintain a connection with other
family and friends and with the deceased and help the bereaved
to continue their own functioning (Baloyi, 2014; Gudmundsdottir
& Chesla, 2006). Ritual practices after the death of a loved one in-
clude dealing with the deceased's remains, holding wakes, funerals,
burials and gathering celebrations that can differ across cultures,
religions, race and ethnicity, socio-economic group and ages of the
deceased (Reeves, 2011). Attending these death events is often seen
as a family obligation (Baloyi, 2014; Schoulte, 2011). Family mem-
bers unable to attend often experience feelings of loneliness and
isolation (Contro et al., 2010). Knowledge of these ritual practices is
important for community health nurses in providing support that is
sensitive and appropriate for the remaining immediate family mem-
bers and friends.
2 | BACKGROUND
For most families accepting that a loved one's death is approaching
is difficult no matter the culture, ethnicity or religion. Even when
there is no hope of living, Hispanics and African Americans have
difficulties accepting a Do Not Resuscitate (DNR) or Allow Natural
Death (AND) option, deciding to end a loved one's life or donate the
loved one's organs (Bullock, 2011; Lobar et al., 2006; Youngblut &
Brooten, 2012). Hispanic Americans and African Americans usually
consult with other family members before these important decisions
are made (Schoulte, 2011). Af ter the death, wakes, funerals, burials
and gathering celebrations occur. While there are recurring practices
from the wakes or viewings to the burial or cremation and postdeath
gatherings, ritual practices vary within and between racial/ethnic
groups and are influenced by religion and socio-economic status.
Latinos are mainly Catholic (Clements et al., 2003). McGoldrick
et al. (2004) suggest that Latinos prefer death to occur at home sur-
rounded by family and friends with care for the dying done by women
in the family. Their formal mourning has an open casket where the
rosary is recited during the service. The mourners pay their respects
to the deceased by wearing black or dark colours. Group prayers
are done for the soul of the deceased before the funeral service by
family members and friends. A funeral mass is usually done at the
church followed by a procession to the graveside service where a
priest or deacon blesses the grave with holy water before the burial
(Diaz-C ab ello, 200 4). Latino rituals in clude novenas for 9 days (pray-
ing the rosary each day after the burial), a mass for the deceased on
the deceased's birthday and 1 year after the death and lighting of
candles (Clements et al., 2003; Doran & Hansen, 2006). The period
of mourning for older Latinos may last for years. Some from Puerto
Rico view the afterlife as a spirit world where spirits evolve until they
reach moral perfection and are detached from the earth. Their role
is to care for the living (McGoldrick et al., 2004). Mexican families
report maintaining an ongoing relationship with the deceased in
dreams, storytelling and building home altars. The altars for children
sometimes include pictures of the deceased, keepsakes and dressing
of dolls in the deceased child's clothing, to entice deceased spirits to
return home (Doran & Hansen, 2006). Familismo, importance of the
family, is stressed and expected.
African Americans gather for prayer and meditation to help the
dead transition to the afterlife and to the spirit world (Baloyi, 2014).
Death is viewed as transitioning to a new type of life. Easing the
transition is dependent on the family preparing food, chanting,
singing and praying to ancestral spirits for the entrance of the dead
into the spirit world. In African American communities in the United
States, the wake is the first occasion when comfor t and assistance
are given to the bereaved families (Holloway, 2002). Open caskets
are usual. The amount of food and the attention given to its prepa-
ration were impor tant in past decades and seen as signs of respect
for the bereaved family. Bringing prepared food from the store was
frowned on by the African American culture. Fried chicken has been
a staple during these occasions with a bucket from a food store chain
replacing older traditions for younger generations (Holloway, 2002).
The tradition of providing meals to the grieving family starts with
the wake and concludes with a formal meal after the funeral service.
Attending the funeral is a uniting factor, an obligation and in African
tradition, not attending may bring misfortune (Baloyi, 2014).
In keeping with African American beliefs, a soul will not go to
heaven if the body is cremated (Lobar et al., 2006). The traditions
of West Africa, the mourning and dancing, remain strong in Black
America in the jazz funerals of New Orleans with the performance
of music from legendary brass bands (Holloway, 2002). Kongolese
slaves brought to Louisiana would express the soul's sorrow with
customary weeping and wailing before they accompanied the dead
with much jubilation to the burial sites. The mourners sing beat the
drum and dance the deceased's soul to its new home. Elaborate fu-
nerals still demonstrate the importance and worth of the deceased
in the African American communities (Hope, 2010). In Jamaica,
African and European religions and traditions have blended. There,
funerals are often held 2–3 weeks after the death to provide time for
preparations and family to arrive from afar (Paul, 2007). At the fu-
nerals, free expressions of “falling out,” dizziness, fainting and wail-
ing are allowed and often encouraged to demonstrate closeness to
the deceased. In contrast, such emotional expressions by whites at
funerals are viewed as disruptive (McIlwain, 2001).
In Jamaica, funeral rituals vary and depend largely on socio-eco-
nomic status, religious affiliation and rural versus urban residence
(Paul, 2007; Marshall & Sutherland, 2008). Before the use of mor tu-
ary services, family members maintained the corpse in the home for
3 days and prepared it for burial. Ice was used to slow deterioration,
cotton plugged the nostrils and a weight on the abdomen prevented
swelling (Burrell, 1996). Well-attended and elaborate funerals sym-
bolize a life well lived. Plush coffins, lavish clothing for the attendees

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HIDALGO et A L.
and for the deceased are important and signif y status (Hope, 2010).
The funeral service is usually conducted in churches. Hope (2010)
comments that two beliefs shape funeral practices: individuals con-
stitute body, soul/spirit and duppy or shadow, and death marks the
end of the physical body beginning the journey of the soul/spirit
to rejoin the Supreme Creator and other spirits. Wandering of the
duppy (shadow) can harm the living and requires rituals to put the
duppy to rest. While family plots are still used in some rural areas
in Jamaica, a custom from West Africa, burials generally take place
in cemeteries (Burrell, 1996). The “nine night” after the death marks
the completion of the spirit to the spirit world. The large celebration
that follows includes much food, alcohol, music by DJs and dancing.
When children have died, practices may differ based on each cul-
ture's beliefs about where children come from before they are born
and where they go after they die. However, the research on ritual
practices after death of an infant or child is very limited. In many
cultures, children are considered pure and innocent and their un-
timely death guarantees them heavenly status (Brooten et al., 2016).
Puerto Ricans dress their children in white, paint the face to resem-
ble an angel and place flowers outside and inside the coffin (Parkes
et al., 1997). Some Latinos believe that the novena done for adults
after their death are not needed for infants because they are inno-
cent angels and there is nothing to be forgiven (Brooten et al., 2016;
Parry & Shen Ryan, 1995). Therefore, deceased infants are dressed
in white as a symbol of their religious purity and innocence. There
is no specific funeral ser vice for miscarriage, but a funeral service
can be arranged by a priest to decrease the parent's distress. In
some cultures, infants are buried exclusively in reserved parts of the
cemetery or, as in Japan, may have their own cemeteries and family
members may or may not be expected to visit the grave thereafter
(Parkes et al., 1997). The family members dress in white clothing or
wear white head bands.
The purpose of this study was to examine the reported ritual
practices (dealing with the deceased's remains, wake, funeral, burial
and celebration) of White non-Hispanic, Black non-Hispanic and
Hispanic/Latino adults in their country of origin or ethnic or cultural
group following the death of a loved one.
3 | METHODS
3.1 | Design and sample
This descriptive study is a secondar y analysis from a longitudinal
mixed-methods study that examined parents' health and functioning
following the death of a child ( Youngblut & Brooten, 2006–2012).
Adult parents (White, Black, Hispanic/Latino) whose child died in ne-
onatal intensive care units (NICUs) or paediatric intensive care units
(PICUs) were recruited from four hospitals and from death records
from the State's Department of Health's Office of Vital Statistics.
Data for this secondary analysis were collected from 61 adult par-
ents at seven and 13 months postinfant/child death using semi-
structured interviews.
Families were identified by clinician co-investigators at each
study site. A letter was sent to each family (in Spanish and English)
describing the study. Three bilingual health professional students
called the families, screened for inclusion and exclusion criteria, de-
scribed the study in Spanish or English, answered their questions,
obtained verbal consent and scheduled the first data collection visit
where written consent was obtained. Inclusion criteria are as fol-
lows: adult parents able to understand spoken English or Spanish,
had a singleton pregnancy, a neonate who lived for more than 2 hr
in the NICU or a deceased child (18 years or younger) who lived at
least 2 hr in the PICU. Exclusion criteria are as follows: a multiple
gestation pregnancy with a deceased newborn, child living in a fos-
ter home before hospitalization and death of a spouse in the illness/
injury event (e.g. car crash).
Sixty-one parents (44 English speaking, 17 Spanish speaking)
of 47 deceased children participated in semi-structured interviews
about the child's death. For this study, only those parents who re-
sponded to questions about death practices in their countr y of
origin or cultural group were included in the data analysis. All 30
participating parents now lived in the United States. Adult parents'
mean age was 35 years (SD 9.01); 33% were Black, 27% White and
40% Hispanic; most were married (65%), 49% had incomes above
$25,000, 33% had some college or technical school, and 36% were
coll ege grad uat es. Pare nts id entif ied the ir nati ve co unt r y or cu ltu ral /
ethnic group as Jamaican (2); Haitian (2); Cuban (2); Puerto Rican (5);
Dominican Republican (1); Bahamian (3); Mexican (2); Nicaraguan (1);
El Salvadorian (1); Honduran (2); Ecuadorian (2); Chilean (2); Peruvian
(2); and Colombian (3).
3.2 | Measures
At the seven- and 13-month interviews, parents were asked whether
the practices they experienced around the death of a loved one in
the United States were the same as those regularly practised for de-
ceased loved ones in their country of origin or cultural/ethnic group.
Interviews using a standardized protocol with core questions and
probes were based on the study purpose, the literature, our own
clinical expertise and discussion with two study consultants with
expertise in qualitative research and interviewing. Interviews were
conducted at a time convenient for the parent(s), in their homes, took
one and one half to 2 hr and were audio-recorded and transcribed
verbatim in the language of the interview. Parents were inter viewed
separately and out of hearing range of each other.
3.3 | Analysis
Transcripts were compared with audio recordings for transcription
accuracy by English- and Spanish-speaking PhD and master's stu-
dents in health disciplines and any discrepancies resolved by the
research team. Content that included discussion of rituals practised
for deceased loved ones in their country of origin or cultural/ethnic

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group including dealing with the loved ones' remains, wakes, funer-
als, burials and celebration practices postdeath was then abstracted
and presented in table format. The Equator checklist that was used
cont ain ed all of the consolidated criteria for reporting qualitative re-
search (Appendix S1).
4 | RESULTS
Practices dealing with the remains of the deceased, wakes, funer-
als, burials and celebrations after the death of a loved one varied
by countr y of origin, cultural/ethnic group, religion and age of the
deceased (Table 1). In the Caribbean, wakes or viewings were done
in the home, funeral homes or church, usually with an open casket.
The funeral is attended by family and friends with older persons
wearing black while younger ones wear a lighter appropriate colour.
Adults from Haiti reported coming down the street with the body
in a car, accompanied by family and friends and a band playing. A
mass or service is usually at the church followed by a processional
to the burial site where prayers and singing are common. A gather-
ing of family and friends is held at the family home after the burial
with food, drink, songs, talking and games of cards and dominoes.
Family and friends bring food to the bereaved family sometimes for
a week. For some families, there is no TV or radio for a period and
black may be worn for 6 months to 1 year after the death. Novenas
(rosary prayers for 9 days) are done for the deceased's soul to be at
peace. In the Dominican Republic, the front door is closed until the
ninth day after the death. Recognition of the deceased is commonly
held on the one-year anniversary of the death. Burial is usual, and
cremation is not.
In Mexico, many of the ritual practices reported were like those
conducted in the Caribbean. The wake is usually done in the home.
People dress in black, and younger persons in other colours. Burial is
used, not cremation and fireworks are lit to say goodbye to the de-
ceased. The novena (9 days of prayer) is done with each day making
mention of Jesus' sacrifices on the cross (lifting of the cross). Altars
are made in the belief the deceased spirit visits the altar. For adults,
food and water are placed on the altar, toys and candy for children.
Practices reported by adult parents from Central America
have many of the same activities. The wake is done in the home.
In Honduras, if the death occurred in the hospital, the deceased is
taken to the family home in a coffin and placed on a table for the
wake. Ice is placed under the table to keep the body fresh for the
viewing. The burial is within 3 days and family members dig the
grave. Black is worn commonly. The “nine-night” prayers (novenas)
are done.
Many of the same death rituals are conducted in South America
according to the adult responses. In Chile, the body or ashes are in
the home for 1 day then buried. There is a procession by car or on
foot to the cemetery. In Peru, by law, the deceased must be buried
within 3 days of the death. The wake is held in the family home, fu-
neral home or special place known as a club for special groups such
as teachers and military. In some regions, it is customary to shoulder
the coffin and walk to all the places the deceased had lived as one
last visit, then to the cemetery. In Colombia, the deceased may be in
the house up to 7 days and prayers are of fered 24 hr per day for the
7 days. Mass is at a funeral home, open casket, then burial or crema-
tion. A one-month mass is held after the burial.
Overall, ritual practices for child deaths differ from those con-
ducted for adults. For deceased children, a mass or service is shorter
or eliminated and prayers are fewer or eliminated since deceased
children are viewed as without sin and are now angels in heaven.
Black clothing is not worn for children's services in favour of lighter
colours.
5 | DISCUSSION
McIlwain (2001) comparing death rituals of Blacks and Whites found
few differences in their rituals but found statistically significant
differences in the emotional expressions of persons attending the
wakes and funerals. Blacks demonstrated more outward emotional
expressions including weeping, wailing, falling out and dizziness.
Black pastors were accustomed to these expressions and stated that
they ‘let the family handle it.’
In the wakes and funerals of Whites, such emotional expressions
were viewed as disruptive and White pastors routinely took persons
with these behaviours to a private room to calm down. These differ-
ences can also be found in East Asian countries where weeping and
wailing of bereaved family members are expected and encouraged.
For the Chinese, not showing grief or not enough grief is perceived
as being unfilial and opens the person to gossip and back-biting
(Kim, 2015). Gamliel (2017) conducted 28 interviews with 18 female
and 10 male Yemenite-Jewish wailers and concluded that wailing
brings forth compassion and understanding with those that take
part in this tradition and fosters mutual support among community
members. At times, wailing enables the mourner to momentarily
bond with the deceased (Gamliel, 2014).
The Japanese, however, hardly cry out at funerals. A Buddhist
priest explained that if you drop your tears on the dead, the dead
river will be flooded, and the deceased cannot go to the other world.
If the deceased spirit wanders this world, the wandering ghost may
cause harm to the living (Kim, 2015). This belief is like that of the
duppy in the Caribbean who may cause harm to the living if not
appeased.
Practices may also differ by the religion of the deceased and the
deceased's family. In heavily Catholic countries, cremation is not al-
lowed, as our study participants commented, novenas are done com-
monly and the lighting and carrying of candles is common. However,
Glass and Samuel (2011) found that the use of cremation is becom-
ing more common due to cost and land use. In their study, they also
found that reasons to reject cremation included absence of closure
and lack of a sense of place. Participants in our study indicated that
burial was preferred but cremation was also an option in Colombia.
Practices differ by age or generation of the mourner. Study
participants indicated that adults usually wear black to the death

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HIDALGO et A L.
TABLE 1 Adults' repor ts of rituals practised in their native countries
Wake Funeral/Burial After the burial
Caribbean
Jamaica – Viewing is done on the same day of the
death
– Viewing takes place at church
– Gathering will take place the night
before the funeral with neighbours
and friends and in remembrance of the
deceased
– Family members attend. Singing,
reading letters, and life stories
– People dress in colours (many in
black or white) and celebrate that
the deceased is going to a better
place. No cremation.
– Play dominoes, drink, and talk
– Songs are sung nine nights (night is
spent singing and cooking)
Haiti Person stays in morgue 1 week
– Viewing is held
– Casket left open
– Service at church depends on the age
of the deceased
– Black and white clothing are worn
– Celebrate the life with a party
Come down the street with the body
in the car and band plays. Ever yone
walks down with car
– No pregnant women or children at
the funeral
– Mother who loses a child does not
go to the funeral or cemeter y
– If child dies, black does not
have to be wornNo cremation
– People come to the house and bring
food and drink and spend time with
the bereaved family members
– Black is worn from 6 months to 1 year
after the death of a loved one
– Anointing the deceased's head
Cuba The dead are viewed in the home or in
funeral homes
Adult family members make all
arrangements
A mass is done at church
Prayers during the burial
– No specific colour of clothing is worn
(appropriate colours)
Family visits the dead in the cemeter y
– Candles are lit in recognition of
the deceased (i.e. birthday, 1 year
anniversary). Flowers are placed to
commemorate the dead
– Some families mourn by not turning
on the radio, TV, wear black clothing
for 1 year
Puerto Rico – Wake is usually for the family and is all
night
– Open casket and viewing is done for
2 days
– Speak to deceased. Write a letter and
place in casket
– If a baby death, family view baby
before everyone arrives then casket is
closed
– For other families, if baby death,
no viewing only a mass then to the
cemetery
– Funeral does not need to be planned
so quickly. The deceased is usually
taken to church for a service before
being taken to the cemetery
– Older people wear black, but the
younger usually do not believe in
wearing black
– Prayers and songs while in cemetery
– Close family members and friends
go to the home of the bereaved and
spend some time there
– After someone dies, you do novena
(pray for 9 days). The novena is done
for the person's soul to be at peace
– Family and friends help with cleaning
of home and bring food
– Food is brought over all week to the
home
Dominican
Republic
– Viewing usually done in the home – Ever yone is buried
– Everyone dresses in black (no red or
happy colours)
– Front door of the house is closed
until the 9th day when front door is
opened—9 days of prayer af ter burial
(1 hr of praying per day)
– An altar is placed with a picture and
candles, as well as flowers and saints,
and this is where people pray every
day until the 9th day-refreshments are
served
– I year anniversary (a holy hour of
prayer is done and family does the
rosary). Everybody get s together and
goes to the cemeter y and goes to
mass
– No TVs or radios are turned on
– People visit the grieving family after
the loss for a long period of time
BAHAMAS – Wake is done until the next morning of
the burial
– People dress in black
– A lot of people at tend the funerals
– People eat and are sociable
(Continues)

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HIDALGO et AL.
Wake Funeral/Burial After the burial
North America
Mexico Deceased infants are baptized
– The rosary is not done for infants
because they are free from sin
– A wake is done for the entire night, and
the family talks all night
– Wake is usually done in the home, and
the candles that the 4 priests carry are
rented
– The rosary is done
– Family members and closest friends
attend the wake
For deceased adults, people dress in black
– A wake is usually not performed for
infants because they have no sins
– Deceased infants are dressed in
baptism clothes during the wake
– For infants, white flowers and candles
are used
– For children, dress in white since
children are believed to be angels
Family members purchase place of
burial for person
Burial day after wake
– Veladoras (candles) are placed in
person's 4 corners
– Family members and friends are
present
– Mass is done at the burial, and
fireworks are lit to say goodbye
– People dress in black for deceased
adults and in light colours for
deceased infant s
– Deceased infants are buried not
cremated
– Catholics do not believe in cremation
Rosary for 9 days (novenas)—during this
time is the lifting of the cross, psalm
sung/prayed, cross lifted and placed
in cardboard boxes and placed in
pantheon. People bring food, flowers
and candles
– Pantheon's made of dirt and
cement. Altar is madeOfferings are
made: Candy is placed for child and
food is placed for adults. Water, salt and
food are placed for an older person
Central America
Honduras – A bow is placed on the front and back
door of the home so people know that
the family is mourning
– Wake is done in the home all night until
the morning
Prayers are done in the home
– If person dies in the hospital, he is
taken in a cof fin to the house and
placed on a t able. Ice is placed under
the table to keep the body fresh.
Flowers, candles are placed around
the body to make it pretty. An altar is
prepared. People stay with the body
for 24 hr then go to the cemetery
– Food, coffee is served at the wake.
People play cards, dominoes within the
first 24 hr
Evangelist—when someone dies there is
no more praying. They only pray for the
ones living because the f amily members
are the ones that need God to give them
streng th (no 9 day prayer)
– Family members help with all the
arrangements so the closest family
could be with the deceased
– Person is buried within 3 days
– Family members dig the hole and can
decorate it with a tree, flowers or
fence
– Cars and people move to the side
when there is a funeral procession
out of respect to the dead and the
family
– Mother dresses in black, ever yone
else dresses normal
After the death, Catholics meet at 3p−4p
for 9 days to pray for the body
– Believe God takes care of everyone,
those who do well in life are taken
care of by God
– People give you their condolences
Nicaragua – People are supposed to pray
– If an infant dies, people do not have
to pray and no masses or novenas are
done bec ause the infant is an angel and
has no sins
– Funeral is done in the home
– People wear black
El Salvador – Dirt is thrown on the cof fin
– People dress in black
– Nine night is done. Food is cooked and
people stay up the whole night playing
dominoes and drinking till daylight
TABLE 1 (Continued)
(Continues)

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HIDALGO et A L.
events; however, persons often wear lighter colours and “regular
clothes,” a change Wouters (2002) indicated is becoming more
common. Older adults may carry out traditional practices while
the reasons for the practice may have long been forgotten. One
such practice may be the throwing of soil into the grave by hand
as mentioned by study participants. In African traditions, men dug
the grave and covered it after the funeral using shovels. Women
did not participate in these activities and did not use shovels, thus
throwing handfuls of dirt into the grave allowed women to partici-
pate. While this practice continues in some countries, today people
generally throw flowers instead (Baloyi, 2014). Younger genera-
tions also have undertakers prepare the loved one's body for the
viewing. In the African American and Afro-Caribbean cultures, the
family often carries out these activities which are important death
rituals. Family members (usually same sex) wash the body, groom
the hair an d dre ss th e dea d loved one. Duri ng th e vie wi ng, laying-o n
of hands, touching, kissing and conveying one's grief are usual and
encouraged (Baloyi, 2014).
In Haiti, Catholic and West African-based burial rituals are con-
ducted together (Huggins & Hinkson, 2019). A Christian priest and
a Vodou priest conduct the ceremony. In the remote villages, day-
long celebrations take place with individuals singing and dancing.
After the funeral celebration, pigs, cows and goats are slaughtered
for the meal. The family then organizes a West African tradition
called “nine-night ” celebration. Food is prepared, and visits from
the villagers are customary. Praying is done every night, and it is
believed that the soul will depart to its destination on the ninth
night. Our study findings are similar, with study participants sharing
Wake Funeral/Burial After the burial
South America
Chile – Body or ashes exposed in the home for
1 day
– After death but before the burial family
sits around and talks and shares stories
to suppor t each other. Everyone comes
at night to talk and eat . Friends, family
members, and neighbours spend all
night
– Burial is within 1 day
Cemeter y procession either by car or
foot
– Place ashes in family niche where
other family members are buried
– People dress in black or white or
dark clothes
Family supports each other
– Family is invited to spend weekends
together
– No loud noises, watch T V with very
low volume, no music
– Take ashes to church and have priest
ordain mass
Peru – Evangelist do not pray for the dead;
they only pray for the living (family
members so that God can give them
strength)
– Family members help with all the
arrangements so that the immediate
family could be with the deceased
– Wake in the family home, funeral home
or special place (club) for military,
teachers, etc.
– People are given cookies, coffee and a
typical liquor
Everyone wears black, and it is customary
to wear glasses
– People send wreaths
– The dead have a lot of flowers all kinds
(roses, tulips). Special bouquets are
made for children
– According to law, the person needs
to be buried within 3 days after their
death
– Funeral is held the day after the
wake
– Mass held at church or funeral home.
Mass with the body present
– Funeral procession is done
– In some regions, it is customar y to
carry the coffin on shoulders to all
of the places where the person had
lived, and finally, to the cemetery.
People pray and sing through the
streets
– All of the family attend the burial
– No one leaves until the body is
buried
– Family members congregate at the
house and may stay as long as 1 week
to provide suppor t to the family
– Mass is held 7 days, 1 month and
1 year after the death. Meal is offered.
Keepsakes such as rosaries, crosses
and religious images are given out
Colombia – When people die they can be in the
home for up to 7 days. During this
time, prayers are said and blessings
occur 24 hr/day, 7 days/wk (prayers for
the soul of the person)
– People sit and gather at the wake until
the mass is done
– Attendees dress in black
– Mass at the funeral home
– Funerals are usually done with open
casket
– Family attends burial
– Cremation
– Mass 1 month after the burial
– Yearly mass done for the deceased
– Novena or mass not done for children
since they are angels
– Santos Oleos (holy oil) is used on the
deceased for purification. It is believed
that once the deceased is purified with
holy oil, then they can enter into the
spirit world. Santos Oleos not done for
children, only for adults since children
are angels
Ecuador – Open casket is customar y and people
can stay as long as they want
– Crying seen more in funerals in
Ecuador compared to the United
States
TABLE 1 (Continued)

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HIDALGO et AL.
common celebrations after the death including music, singing, food
and gatherings, as well as a novena or a rosary prayer for 9 days
seen in the Catholic relig io n an d in the Wes t Af rican tra di ti on called
“nine-night” celebration. Even though 98% of Haitians are C atholic,
they also believe in Vodou, a West African religion (Huggins &
Hinkson, 2019).
Study participants noted that practices conducted for children
differ from those conducted for adults. Services were reported to
be shorter with fewer prayers, fewer family and friends attend-
ing and fewer family gatherings after burials. Cremation may be
used , and find in gs we re consis te nt wi th th e res ea rch of Cac ci at or e
and Ong (2011–2012). Our study findings were somewhat dif-
ferent from Asian death rituals. In a study conducted by Tseng
et al. (2018), 16 Taiwanese women who experienced loss of their
infant due to stillbirth were interviewed about the significance of
death rituals for them and their families. In the Taiwan culture,
speaking about death is a taboo. Parents who have suffered a
stillbirth are unable to speak openly about the event, and public
mourning and burial ceremonies are non-existent in this society.
A few of the ritual activities that mothers participated in were
praying for the child; burning food, clothes and incense as an of-
fering to the deceased infant; consulting spiritual mediums; and
participating in Chao-du ceremonies for the child's spirit to reach
heaven. The families participated in rituals for the benefit of the
deceased child and their own. They felt that these rituals would
help protect the child from suffering, improve their reincarnation
and send their spirit off. Themes that were prevalent within the
families were that the rituals help the family cut bonds, do what is
best for the deceased infant, avoid bad luck and pray for a success-
ful subsequent pregnancy.
A study limitation is its small sample size with only three racial/
ethnic groups represented and interviews from limited participants
from each country of origin or cultural group. However, the groups
represent a broad range of participants from the Caribbean or Latin
American countries, thus adding to our knowledge of death ritual
practices in these areas. The focus of the manuscript is to report
what the participants identified as ritual practices in their country
of origin or in their cultural group. The United States was not their
country of origin. While the participants lived in the United States,
some of their extended family members did not. Participants re-
ported current ritual practices in their country of origin or in their
cultural group that have been carried out generation after gen-
eration, across time. Describing rituals in country of origin shows
how different the practices of countries of origin are from typical
practices in the United States. These practices were continued by
participants who now live in the United States. Those traditions are
important in clinical practice for providers to deliver culturally sen-
sitive care.
A commonality across cultures is that death rituals help with
the grieving process. Based on responses from our study partic-
ipants, death ritual practices acknowledge the death, legitimize
grief, create a safe place for mourners to express emotion and
bring together family and friends in support of the bereaved.
Bringing together of family and friends with reminiscences of the
deceased has been shown to be more helpful to the bereaved
than professional counselling (Castle & Phillips, 2003; Doran &
Hansen, 2006). A study by Aksoz-Efe et al. (2018) showed that
the bereaved receiving benefits from ritual practices is not only
evident in Western culture but is more probably a universal finding
which emphasizes how important death ritual practices are after
the death of a loved one.
Our study participants shared common celebrations after
the death which included music, singing, food and gatherings.
Differences were found in the emotional expression of Blacks and
Whites, as well as in people from East Asian countries. Our study
highlights that practices also differ by religion of the deceased and
deceased's family and by the age or generation of the mourner.
Of impor tance is that practices conducted for children differ from
those for adults. However, the body of research comparing death
rituals across cultures is very scant and speaks to the importance of
this study.
The ethnic mix in the United States is changing, making an un-
derstanding of different families' practices around major life events
even more important. Community health nurses care for families
from many different countries and cultures. Nurses who have more
understanding of death ritual practices among diverse cultures
can be more effec tive in helping family members feel comfortable
in expressing their emotions and feelings (Castle & Phillips, 2003;
Robertson et al., 2018). Before and after a patient's death, nurses
may become aware of practices that are important to the family and
often to the wishes of the deceased.
Family members may feel a lack of understanding and support
after their loved one dies if death rituals important to them fail to
be acknowledged by the healthcare team. Emphasizing the signif-
icance of personal rituals for healthcare providers after the death
of their patient s may increase their sensitivity with regard to the
importance of death rituals for families that have experienced
the death of a loved one. Results of a study by Montross-Thomas
et al. (2016) showed that hospi ce st af f and vol un teers ex per ie nced
greater compassion and lower burnout through the use of per-
sonal rituals.
A study by Brooten et al. (2016) mentions how difficult it is for
parents and family members who have suffered the death of an in-
fant or child to make decisions about the implementation of rituals
during such a difficult time. Nurses who have appropriate under-
standing of practices among different cultures and religions and in-
corporate family traditions can provide the family with much needed
support during this challenging time. Understanding these practices
is important in being sensitive and appropriate around the death and
in helping other providers understand the practices and not inter-
fere with those that may cause disruption in the families' coping and
grieving process.
Acknowledging to the family that families from different coun-
tries and cultures often have different practices at this time can help
family members feel more comfortable in sharing practices that dif-
fer from those common in the United States or by other ethnic/racial

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HIDALGO et A L.
or religious groups. Asking the family about specific practices they
hope to carr y out and noting this in the family's record will help alert
providers to the family's wishes at this challenging time, and nurses
may gain insight into additional community support needed by the
family (Aksoz-Efe et al., 2018). Nurses can then guide family mem-
bers to the resources they might have overlooked to help them cope
with their grief.
ACKNOWLEDGEMENTS
This work was suppor ted by the National Institutes of Health,
National Institute of Nursing Research under grant R01 NR0 09120.
CONFLICT OF INTEREST
All authors have indicated they have no potential conflicts of interest
to disclose.
ETHICAL APPROVAL
The study was approved by Florida International University and
study site Institutional Review Boards (IRBs) and conformed to US
Federal Policy for Protection of Human Subjects.
DATA AVA ILAB ILITY STATE MEN T
Data are not publicly available due to privacy and ethical restrictions.
ORCID
Ivette Hidalgo https://orcid.org/0000-0001-8377-7453
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SUPPORTING INFORMATION
Additional suppor ting information may be found online in the
Supporting Information section.
How to cite this article: Hidalgo I, Brooten D, Youngblut JM,
Roche R, Li J, Hinds AM. Practices following the death of a
loved one reported by adults from 14 countries or cultural/
ethnic group. Nursing Open. 2021;8:453–462. ht t p s : //doi.
org/10.1002/nop2.646