Culture & Spirituality

The integration of patient values and expectations for holistic care.

Diversity in Nursing

Definitions

Culture

Transcultural Nursing

Culture is learned through life experiences from birth and is transmitted from parents to children over generations. Culture is communicated through both verbal and nonverbal communication forms. Culture is social and it develops as it is communicated through people, families, groups and communities.

Cultural habits only last as long as they are needed, otherwise, the habits are adapted or discarded. Cultural change occurs slowly and in response of needs of the group. These habits/beliefs are satisfying and this gratification strengthens habits and cultural beliefs. Culture is difficult to articulate and many values and beliefs are carried out subconsciously.

Culture exists at many levels, but is most easily identified at the material level (art, tools, clothes,…) while values, beliefs, and traditions are more difficult to identify.

For further information, read the article and take the quiz provided below. Be sure to watch for the difference between diversity awareness and diversity self-awareness.

The Dynamics of Diversity: Becoming Better Nurses Through Cultural Awareness

The Provider's Guide to Quality & Culture Quiz

Cultural Assessment

Information obtained from performing a cultural assessment can help the nurse work more effectively and comfortably with persons of different cultural backgrounds. Cultural assessments can promote an understanding of patient behavior that might otherwise be misjudged in a negative manner. The nurse’s most important tool in performing a cultural assessment is the ability to project a non-judgmental interest in the patient.

A Cultural Assessment should include the following areas:

Ethnicity and Race

Genetic and environmental factors cause some diseases to be more prevalent in certain racial and ethnic groups, such as Sickle cell disease among African Americans, and Tay-Sachs among Jewish people.
Values & Beliefs

Major values and beliefs because it is important for the nurse to be aware of different value orientations among cultural groups. For example the dominant American culture values punctuality and places a high priority on adhering to a strict time schedule, while many black and Hispanic persons have a more flexible orientation of time where the needs of friends and family may take precedence over being on time for an appointment.
Health Beliefs & Practices

Health beliefs and practices vary in the way each culture views illness, health and how healing takes place. For example, the dominant American culture is based on Western Scientific Thought, which views illness as a breakdown in a body part because of invasion by an organism. Thus, instead of treating the whole person, Western medicine treats the disease.

In contrast, Eastern cultures view illness and disease as a disturbance in their “chi,” which is a flow of energy through the body and healing involves treating the whole person and attempting to restore harmony to the whole person. Western society only recently is beginning to recognize the importance of a holistic approach to health care, whereas Eastern and Native American cultures have used this approach for centuries.
Religious Practices

Religious influences or special rituals may have a strong impact on health and illness. There are certain medical practices that may be forbidden because of religious beliefs and practices. In certain cultures suicide is acceptable, while in others it is not. The nurse should evaluate the patient and their families cultural rituals particularly in birth and death.
Language Barriers

Language barriers and communication styles are important to assess. Non-English speaking patients may have learned some English words but may not have developed enough command of the language to understand complex topics such as those involved in health education and the nurse may need an interpreter.

Non-verbal expressions may have different meanings or social significance in other cultures. For example, nodding the head is usually perceived as a sign of comprehension in this country, but many Eastern Asians may nod during a conversation to indicate respect and deference.
Family Culture

Parenting styles and role of family vary from culture to culture. The family is the basic unit of society, but child rearing practices are very different. In the dominant American culture a high value is placed on self-expression and independence in children and physical punishment for misbehavior is discouraged. The patient may be from a patriarchal culture where the oldest male makes all the family health decisions.
Dietary Practice

Dietary practices are influenced by culture. The style of food, the preparation, the consuming of the food, the time of eating, and the types of eating utensils are varied. In some cultures it is considered rude to clean your plate since it means your host did not give you enough to eat.
Pain & Suffering

The meaning of pain can be very different. For some cultures, for example, pain is a punishment for sin (the patient may refuse pain medication in order to accept God's will), while in others pain is seen as the body's warning system that something is wrong and the pain should be alleviated.

Spirituality

Why is it Important?

Read the following articles for several perspectives on how spirituality relates to healthcare.

Spirituality and Religion in Health Care: The Bravewell Collaborative

University of Maryland Medical Center: Spirituality

Spiritual Distress

Spiritual Distress is a disturbance in the individual’s belief or value system that was a personal source of strength and hope. Spiritual Distress maybe accompanied by an inability to carry out religious practices.

Occurrences that can bring on spiritual distress are health problems (heart attack/stroke), terminal illness, chronic pain, accidents, natural disasters (floods/hurricanes), near death experiences, etc.

Hope

Hope is the feeling that what is wanted can be had or that events will turn out for the best. Hope provides comfort during stressful events and is a resource when the person is challenged or faces a loss. Hope is closely linked to faith and is invaluable to the person surviving illness or other difficult events.

Spiritual Assessment

Includes

The patient's beliefs, faith and practices
The patient's involvement in spiritual and religious activities or rituals and the frequency of participation
Determining if the patient's beliefs or faith are being challenged by the current situation
Exploring how faith and rituals give meaning to daily life (costs and benefits)

Questions to Ask

What is your source of strength and hope?
What is your religious affiliation and how important is this in your life? Any recent changes?
Is there a minister or other appropriate religious leader available to you while in the hospital?
Are there any religious or spiritual articles that are important to you while in the hospital?
Is there any spiritual literature that is important to you while in the hospital?

Addressing Spiritual Needs

Practices of Select Groups

Christian
Jewish
Muslim
Hindu

Christian

Most Christians accept modern health practices and use complementary and alternative medicines (meditation/yoga). In general Christians appreciate visit from clergy, use prayer, and some use laying on of hands. Life support varies and organ donation is acceptable. Common Christian rituals include Holy Communion, Baptism, and Last Rites. In general Christians prefer burial to cremation.

Roman Catholic

Jehovah Witness

Christian Scientist

Jewish

The Jewish approach to healthcare is to create a partnership relationship between the patient, family, and health care provider placing the life of the patient above all else. Anything that can be done to ease the suffering of the patient is highly recommended. An abortion can be done in all cases if the woman’s life is physically at risk. Generally cremation is discouraged and autopsies are permitted but all body parts must be buried. Organ donations are permissible. Questions about keeping a patient on life support vary among different Jewish denominations.

Religious rituals include:

Circumcision which may be done eight days after the birth of the boy by a trained and ritually knowledgeable person in the Jewish community (mohel)
When a patient is nearing death, they should be surrounded by family and friends and allowed to unburden themselves. A person should not go into death alone. They are encouraged to read a confessional and say the Shema (the creed of faith of Judaism) and if they cannot talk then it can be said for them.
After Death a rabbi should be consulted immediately because there are very detailed preparations for the body and the body must be buried as soon as possible.

Dietary Regulations include Kashrut (keeping Kosher). Some only refrain from eating pork, others will refrain from a variety of foods and food mixtures. Still others will not be able to eat any hospital food unless it is certified Strictly Kosher and cooked in a Kosher Kitchen.

Personal Devotions include the Jewish/Hebrew prayer book known as Siddur. When praying, many Jewish men and some women wear kipot or yarmulkes (small head coverings) and prayer shawls, tallit. Prayer occurs on the Sabbath Friday night at sundown to Saturday evening when it gets dark.

Muslim

Muslims perform prayers five times a day facing Mecca (east from the U.S.), bowing down on hands and knees, and the provision of privacy is important (especially for women). If the patient is able to wash it is necessary. Prayer rug and the Koran are kept by the Muslim patient and must not be touched by anyone that is not clean (such as blood or urine on hand). It is preferable that nothing should be placed on top of the Prayer Rug or the Koran.

Ramadan is a period of 30 days of fasting from sunup to sundown to honor the first revelations to the Prophet Muhammad. Pregnant women, nursing mothers, elderly and ill do not need to fast.

The Koran is a book of sacred writing accepted by Muslims as revelations made to Muhammad by Allah through the angel Gabriel. An amulet, a string or chain on which sections of the Koran are attached, may be worn by the patient. The nurse should not remove the amulet and it must remain dry. Women are very modest and the nurse whenever possible should be female.

No pork or pork products, such as lard, are allowed and all permissible meat is slaughtered in a special way known as halal or zabiha. Alcoholic beverages or any food prepared with alcohol are prohibited, but medications with alcohol are permitted.

A baby is bathed immediately after birth, before giving it to the mother and then the call to prayer in whispered in the child’s ears so that the first sounds it hears are about the Muslim faith. Circumcision of the male child is recommended within the first seven days.

Autopsies performed for medical research and training are allowed. The use of life support and abortion (when the mother’s heath is in imminent danger) are permitted. The dying Muslim patient may wish to sit or lie with his/her face towards Mecca and moving the bed to make this possible is appreciated. As soon as death occurs the body should be covered completely and placed, if possible, with feet towards Mecca. There are special procedures for washing and shrouding the body and Muslims are required by their religious law to prepare the body for burial.

Hindu

Hinduism is the primary religion of India and they believe in Karma (the law of cause and effect) and non-violence. They practice meditations and mantras. They believe in many gods, but these gods are forms of one supreme God. Some believe that illness is God’s punishment for sin and some may believe in faith healing.

Life in all forms is divine (lowing to people with hands in a prayer position means, “I salute the divine within you.”). Abortion is strongly prohibited in scripture, except when the mother's life is in danger. The eating of meat is forbidden (beef especially, including gelatin) with many following a vegetarian diet. Eggs, onion, and garlic are avoided by some. Fasting is a common practice.

Hindus believe in reincarnation, and perform cremation instead of burial. Prolonged life support may be seen as interrupting the reincarnation cycle or interfering with karma, and patients may wish to die conscious at home. There are no religious laws that prohibit organ donation.

There are no special accomodations needed for prayer or required visits from clergy. Certain bracelets, necklaces, and other jewelry have important significance and consultation should happen with the patient if there is a need to remove them.

Spiritual Nursing Interventions

Listen to patients concerns and feeling regarding spiritual health
Allow time for the practice of religious rituals observances
Provide privacy for prayer, meditation, music, and/or reading religious materials
Provide appropriate diets
Provide opportunity to maintain religious items (icons, statues, beads,…)
Educate patient in the use of relaxation/meditative activities

A woman prays with her friend who lays in a hospital bed.

References

U.S. Navy, via Flikr. (23 Jun. 2012). Hospitalman Hector Hernandez and a local nurse show a patient how to do knee stretches. Image. Public Domain. Retrieved from https://flic.kr/p/cktcMS. Accessed 9 Mar 2016.
U.S. Air Force, via Flikr. (4 Feb. 2012). Captain Roderick Reid, a flight nurse from the 775th Expeditionary Aeromedical Evacuation Flight Travis Air Force Base, Calif., administers pain medication to a patient on board a C-17A Globemaster aircraft. Image captured by Master Sgt. Rick Sforza. Public Domain. Retrieved from https://flic.kr/p/8e19DZ. Accessed 9 Mar 2016.
U.S. Army Medicine, via Flikr. (4 Apr. 2006). DA-SD-06-11876: US Army (USA) Private First Class (PFC) Jaimie Jones (left), Medic, 7th Special Forces Group (SFG), checks the blood pressure of a local Afghani woman. Image. Public Domain. Retrieved from https://flic.kr/p/akNpGh. Accessed 7 Mar 2016.
U.S. Dept. of Health & Human Services, via Flikr. (15 Jan 2012). Secretary Sebelius in front the of the Primary Health Center with traditional birth attendants trained to do neonatal resuscitation. Image. Public Domain. Retrieved from https://flic.kr/p/beuJbn. Accessed 7 Mar 2016.
The National Guard, via Flikr. (5 Jun. 2009). Sgt. Jim Croft (right), of Chouteau, Okla., consults with a patient during a routine examination at the K’ima:w Medical Center in Hoopa, Calif. Image. Public Domain. Retrieved from https://flic.kr/p/6RhuKB. Accessed 7 Mar 2016.
The Republic of Korea, via Flikr. (27 Sep. 2013). World Traditional Medicine EXPO in Sancheong, Korea 2013. Image. CC Att-SA License. Retrieved from https://flic.kr/p/6RhuKB. Accessed 7 Mar 2016.
U.S. Dept. of Defense, via Flikr. (10 Jun. 2013). U.S. Navy Hospital Corpsman Herber Gutierrez, right, prescribes a pair of reading glasses to a resident of the Little Sisters of the Poor nursing home in Apia, Samoa. Image. Public Domain. Retrieved from https://flic.kr/p/eHVDps. Accessed 7 Mar 2016.
U.S. Dept. of Defense, via Flikr. (20 Jun. 2012). U.S. Army Cpt. John McInerney, with the 67th Forward Surgical Team (FST), prepares a bag of blood that will be given to an improvised explosive device victim. Image. Public Domain. Retrieved from https://flic.kr/p/cky3jE. Accessed 7 Mar 2016.
The National Guard, via Flikr. (9 May 2013). Capt. Marian Myron (R), a New York Air National Guard nurse, talks with a patient in Guinea with the help of a Guinea Army nurse at center during an April, 1992 mission to the West African nation. Photo by Master Sgt. Jerry Bratten, Missouri Air National Guard. Image. Public Domain. Retrieved from https://flic.kr/p/ehMwtv. Accessed 7 Mar 2016.
U.S. Navy, via Flikr. (17 Nov. 2013). A Sailors provides medical support during Operation Damayan. Image. Public Domain. Retrieved from https://flic.kr/p/hDBhKC. Accessed 7 Mar 2016.
U.S. Air Force, via Flikr. (20 Mar. 2014). Airman Robbie Day restocks the dessert fridge with fruit. March 20, 2014, at the Airey Dining Facility on Grand Forks Air Force Base, N.D. Image. Public Domain. Retrieved from https://flic.kr/p/pDZmrL. Accessed 7 Mar 2016.
U.S. Dept. of Health & Human Services, via Flikr. (31 May 2013). MentalHealth.gov, Nurse interviews patient. Image. Public Domain. Retrieved from https://flic.kr/p/eyUder. Accessed 7 Mar 2016.
U.S. Dept. of Defense, via Flikr. (10 May 2014). U.S. Air Force Capt. Norman Jones, a chaplain with the 20th Fighter Wing, prays over a draped casket. Image. Public Domain. Retrieved from https://flic.kr/p/nCDKGp. Accessed 7 Mar 2016.
michael_swan, via Flikr. (4 Aug 2009). Mary Pocock receives therapeutic touch from Maureen Smith. It's a moment of prayer for both women. Image. CC-BY-ND Licence. Retrieved from https://flic.kr/p/7q6NUa. Accessed 7 Mar 2016.

<< Previous Page