14 Cultural and Spiritual Aspects of Patient Care

Question 1

Key terms

holistic (hō-LĬ-stĭk, p. 196)
**kosher **(KŌ-shŭr, p. 191)
**matriarchal **(MĀ-trē-ăr-kăl, p. 195)
**patriarchal **(PĀ-trē-ăr-kăl, p. 195)
prejudice (PRĔ-jŭ-dĭs, p. 194
race (rās, p. 188)
racism (RĀ-sĭ-zŭm, p. 194)
religion (rĭ-LĬ-jĕn, p. 189)
rituals (RĬ-chĕ-wĕl, p. 189)
spiritual disconnection (SPĬR-ĭ-chĕ-wĕl dĭs-kŭ-NĔKT-shŭn, p. 199)
spirituality (SPĬR-ĭ-chĕ-WĔL-ĭ-tē, p. 189)
stereotyping (STĔR-ē-ō-tīp-ing, p. 194)
subcultures (SŬB-kŭl-chĕrz, p. 188)
transcultural nursing (trănz-KŬL-chĕ-rĕl NĔRS-ĭng, p. 188)
values (VĂL-yūz, p. 188)
worldview (WĔRL(D)-vyū, p. 188)
yang (yăng, p. 196)
yin (yĭn, p. 196)

Answer 1

agnostic (ăg-NŎS-tĭk, p. 189)
**atheist **(Ā-thē-ĭst, p. 189)
**baptized **(băp-TĪZD, p. 190)
beliefs (bŭ-LĒFS, p. 189)
**circumcision **(sŭr-kŭm-SĬ-shŭn, p. 192)
communion (kŭ-MYŪ-nyĕn, p. 190)
cultural awareness (KŬL-chŭr-ăl a-WĀR-nĕs, p. 193)
cultural competence (KŬL-chŭr-ăl KŎM-pĕ-tĕns, p. 193)
cultural sensitivity (KŬL-chŭr-ăl sĕn-sĭ-TĬ-vĭ-tē, p. 193)
culture (KŬL-chĕr, p. 188)
curandero (kŭr-ăn-DĔ-rō, p. 196)
dialect (DĪ-ă-lĕkt, p. 194)
egalitarian (ē-găl-ĭ-TĂR-ĭ-ăn, p. 195)
enculturation (ĕn-KŬL-chŭrə-rā-shŭn, p. 188)
ethnic (ĔTH-nĭk, p. 188)
ethnicity (ĕth-NĬ-sĭ-tē, p. 188)
ethnocentrism (ĕth-nō-SĔN-trĭsm, p. 194)
faith (fāth, p. 189)
generalization (jĕn-ĕr-ăl-ī-ZĀ-shŭn, p. 194)

Question 2

beliefs related to health care I

Answer 2

Birth
Holy Communion or Holy Eucharist
Anointing of the sick
Diet
Death
Birth control
Organ donation
Religious articles
Reference for Roman Catholic information

Anointing of the sick
Holidays
Birth control and abortion
Reference for Eastern Orthodox

Muslim Beliefs and Health Care
Birth
Diet
Death
Birth control and abortion
Other practices
Care of women

Orthodox Judaism /ˈȯr-thə-ˌdäks /
/ ˈjü-dē-ˌi-zəm ˈjü-də- ˈjü-(ˌ)dā- /
Birth
Care of women
Dietary
Sabbath /ˈsa-bəth /
Death
Birth control and abortion
Organ transplantation
Shaving
Hats
Prayer

Reform Judaism
Birth Control, Abortion, and Birth
Care of women
Dietary
Sabbath
Death
Organ transplantation
Hats

Question 3

Culture

Answer 3

Culture is a collection of beliefs, values, and assumptions about** life that is shared and maintained by a group of people and transmitted** intergenerationally (Giger, 2017).

Question 4

worldview

Answer 4

A worldview is a comprehensive system of beliefs used by individuals and groups to explain and interpret reality.

Question 5

enculturation

Answer 5

Cultural beliefs and norms are transferred from a group to the individual group members, who may adopt them and incorporate them into their personal values and beliefs. This process is known as enculturation.

Question 6

Personal values and beliefs

Answer 6

Personal values and beliefs are based on the** messages** communicated and reinforced within the person’s sociocultural context from an early age.

Question 7

features of culture

Answer 7

There are four distinguishing features of culture:
* Culture is learned and acquired in a social context through the process of enculturation, which starts at birth and continues throughout life as a seamless and unconscious process. Members of a culture perceive their cultural norms as “normal” and “natural,” even though culture is learned and is not genetic. The best example of this is language acquisition: infants adopt and learn the language of their families and primary caregivers regardless of their ancestry.
* Culture is shared by a group. Examples of cultural groups include families, tribal groups, regional populations, nations, professional groups, and distinct subgroups within a wider society.
* Culture is incorporated into individuals’ identity. Through the process of enculturation, individuals adopt the identity of their cultural group and see it as an intrinsic part of self. Consequently, culture defines individuals’ perception of self and others.
* Culture is dynamic and changes under the influence of shared experience. Cultural norms, however, tend to evolve at a slow pace. This can be a source of conflict within a cultural group. An example of this is intergenerational conflict, where an older generation resists cultural norms promoted by a younger generation.

Question 8

Ethnicity and ethnicgroup(s)

Answer 8

Ethnicity and ethnicgroup(s) are terms used to define a group of people who share the common and distinct culture based on shared ancestry, social experience, and regional and/or national history. /ˈan-ˌse-strē/

Examples of ethnicity include Japanese, German, and Armenian.

Question 9

Race

Answer 9

Race is a social classification that assigns a group membership based on physical characteristics.

For example, people are assigned racial labels based on skin color.

Question 10

subcultures

Answer 10

In addition to the traditional cultural groups, the United States and Canada are home to many subcultures: smaller groups within the culture whose members have similar views and goals in addition toor in place of those of the main culture.

A subculture is based on characteristics such as socioeconomic status, education, occupation, political beliefs, sexual orientation, or residence in a rural versus urban area.

Question 11

People living in poverty

Answer 11

People living in poverty constitute a subculture because of their shared beliefs and practices. The focus is on day-to-day survival. People in poverty, especially males, are at high risk for substance use disorder (van Draanen, 2020). Adults who experience chronic poverty are at risk for experiencing severe emotional stress and post-traumatic stress disorder (Substance Abuse and Mental Health Services Administration, 2020). Emotional and physical disorders can impair the ability to take care of basic needs for shelter, food, and clothing, leading to homelessness. People in poverty are more vulnerable to illnesses and diseases (Office of Disease Prevention and Health Promotion, 2021). Chronic conditions and disorders affecting them may become worse because they go untreated as a result of a lack of resources. Inadequate access to health care limits their ability to use preventive care services or seek care for acute illnesses. The net result, called “health disparities”, is that these individuals have worse health statuses compared with the general population (Centers for Disease Control and Prevention, 2021).

Question 12

spirituality

Answer 12

The word spirituality has its origins in Latin and can be translated as “breath of life.”

It is a deeply subjective experience that tries to explain one’s relationship to the wholeness of the physical and non-physical world and ** the meaning of one’s life**.

Question 13

Religion

Answer 13

Religion is a formalized system of belief and worship.

Question 14

Rituals

Answer 14

Rituals (ceremonial acts) are practices related to health, illness, birth, and death, and prescribed behaviors that are part of organized religion and sometimes spirituality.

Question 15

Religious beliefs

Answer 15

Religious beliefs are convictions or opinions derived from religious **doctrine **that one considers true.

Question 16

Faith

Answer 16

Faith is a belief that cannot be proven or for which no material evidence exists.

Question 17

atheist

Answer 17

A person who does not believe in a high power or powers or does not subscribe to any religious doctrine is an atheist.

Question 18

agnostic

Answer 18

This is different from an agnostic, a person who neither believes in nor denies the existence of a higher power or powers because it cannot be completely proved or disproved through existing knowledge systems.

Question 19

Major Religions in the United States and Canada

Answer 19

There are many religious communities in both the United States and Canada, including (but not limited to)
Christianity,
Islam,
Judaism,
Buddhism,
Hinduism,
Confucianism,
and Taoism.

Question 20

Christianity
/ ˌkris-chē-ˈa-nə-tē/

Answer 20

Christianity has three main branches:
Roman Catholic, /ˈkath-lik/
Eastern Orthodox, /ˈȯr-thə-ˌdäks/
and Protestant. /ˈprä-tə-stənt/

Each branch has multiple denominations with many subgroups within each denomination.

Regardless of the differences between various denominations, there are common themes and features:
* Strict monotheism expressed as a belief that there is only one God who is the creator of everything. /ˈmä-nə-(ˌ)thē-ˌi-zəm/
* The Bible is the primary text and resource.
* Most Christian churches have a specified and hierarchical organizational structure. /ˌhī-(ə-)ˈrär-ki-kəl /
* Most Christian denominations have an organized set of rituals or sacraments to address life events such as marriage, birth, holidays, and death. /ˈri-chə-wəl/

Question 21

religious official

Answer 21

The best way to find out the specifics of a particular group is by consulting a religious official from that group.

Question 22

beliefs related to health care II

Question 23

pastoral care department

Answer 23

Practicing Christians may wish to see a spiritual leader while hospitalized, or in some cases they may want to use specific religious texts. Contact the pastoral care department to make the appropriate arrangements.

Question 24

Islam

Answer 24

• Strict monotheism expressed as a belief in one God named Allah. /ˈä-lə ˈa-lə, ˈä-ˌlä ä-ˈlä /
• Islamic teachings are contained within the holy book, the Koran (Qur’an), which should not be touched by anybody who is considered ritually unclean. /kə-ˈran kə-ˈrän ˈkȯr-ˌan/
• Religious officials are called imams and are regarded as authorities on theological questions. /i-ˈmäm ē-, -ˈmam /
• Pork and its derivatives are prohibited, and alcoholic beverages and drug abuse are forbidden.
• Modesty in dress is important, and applies to all Muslims.
• The body is washed at the time of prayer, and privacy is required. The process of washing, called Wudu, involves specific action and order.
  The Five Pillars of Islamic faith (Salim, 2020) are (1) shahada: to proclaim the shahada (confession of the faith); (2) prayer (salat): a prayer ritual five times daily at dawn, noon, late afternoon, sunset, and night, facing the direction of Mecca; (3) fasting (sawm): to fast from dawn to sunset during the month of Ramadan, the ninth in the lunar calendar, from dawn to sunset; (4) charity (zakat): to give 2.5% of one’s income to the poor and needy; and (5) pilgrimage (hajj): to travel to Mecca, at least once in a lifetime if an individual is physically and financially able.
  In the traditional Muslim culture, women may defer to their husband to make health care and financial decisions (Attum et al, 2021). They may have limited ability to make health care decisions, and sometimes the husband’s presence is required when they sign health care documents. Beliefs and practices related to health care are listed in Box 14.2.

Question 25

Judaism

Answer 25

Judaism, a way of life encompassing theology, culture, and law (Pines et al, 2021), has several branches: Orthodox, Conservative, Reform, and Reconstructionist. The religious leader in Judaism is called a rabbi, and the primary place of worship is the synagogue. Judaism began when the one God revealed himself to Abraham, Moses, and Hebrew prophets (Pines et al, 2020). Strict rules regarding hygiene, diet, ethical behavior, social justice for the powerless, and religious ceremony were passed down orally and later written down in the Torah, which is the basis for both the Hebrew Tanakh, the Jewish sacred text, and the Christian Old Testament. Orthodox Jews follow the strictest interpretation of Jewish law. Food is prepared according to Jewish dietary laws during slaughter, processing, and packaging and is then labeled kosher Orthodox Union (2021). Jewish religious laws may be relaxed during illness. Consult with the patient to be certain that the desired processes are followed. There are rituals regarding care of a dead body and burial, and the rabbi should be consulted.
Circumcision is a Jewish religious ritual performed by a man called a mohel on the eighth day of a boy’s life. It involves the ceremonial removal of the penile foreskin. Box 14.3 presents the major Jewish beliefs to be considered when planning health care.

Question 26

Cultural Competence

Answer 26

Nurses must develop cultural competence to deliver care that meets standards of culturally congruent care. Developing cultural competence is a lifelong process. It begins with the development of cultural awareness and cultural sensitivity. /kən-ˈgrü-ənt/

Cultural competence involves knowing yourself and examining your own values, attitudes, beliefs, and** prejudices**. It **entails ** keeping an open mind and trying to see the world from a different cultural perspective.

There are many ways to develop cultural competence.
Literature written by authors from other cultures can provide a wealth of information and insight into others’ views of the world.
**Respect differences ** among people, recognizing that every group has its strengths and weaknesses.
Be open to experiential learning: each contact with an individual from another cultural group is a perfect learning opportunity.
Learn to communicate effectively while being mindful of nonverbal communication such as body movements, use of personal space, and gestures (Hans & Hans, 2015).
**Be resourceful **and creative in modifying nursing interventions in culturally competent ways.
Consider your nursing actions carefully when interacting with a patient from another culture.

Question 27

Cultural awareness

Answer 27

Cultural awareness involves understanding that health is expressed differently across cultures and that culture influences an individual’s response to health, illness, disease, and death.

Question 28

Cultural sensitivity

Answer 28

**Cultural sensitivity ** is the ability to engage and communicate with an individual from another culture in a manner that demonstrates respect for their cultural norms and beliefs (Fig. 14.2).

Question 29

Cultural Aspects to Consider

Answer 29

The following should be considered when caring for a patient from a different culture:
* Form of address considered appropriate within the culture
* Whether an interpreter is needed
* Whether** eye contact** is considered polite or rude
* Amount of space between speakers considered appropriate when conversing
* The meaning of nonverbal gestures such as head nodding, smiling, and hand gestures, as well as unacceptable gestures
* When, where, and by whom **touch is acceptable
* Who the traditional decision makers **are within the culture and family
* Manner and dress of a person considered a “professional,” one whose instructions are valued

Question 30

Barriers to Cultural Competence

Answer 30

There are six major barriers to cultural competence: stereotyping,
prejudice and racism,
ethnocentrism,
cultural imposition,
cultural conflict, and
cultural shock.

Question 31

Stereotyping
/ˈster-ē-ə-ˌtīp/

Answer 31

Stereotyping ** is applying certain beliefs and behaviors about a culture to an individual or group without assessing individual needs. Although stereotypes can be either positive or negative, they are problematic because they block nurses’ ability to learn about specific individuals or groups. Stereotypes should not be mixed with generalizations, which identify common trends, patterns, and beliefs of a group. **Whereas generalizations may be true for the group, they may not necessarily be true for an individual. ** Ask the patient to provide additional information to determine if a generalization is true. Failure to conduct that assessment may lead to stereotyping.

Question 32

Prejudice & racism
/ˈpre-jə-dəs/ /ˈrā-ˌsi-zəm/

Answer 32

Prejudice can be defined as an emotional manifestation of negative stereotypes and deeply held beliefs about a group. Racism is a form of prejudice that takes place when individuals, groups, and/or institutions exercise power against groups that are judged inferior.

/ˌma-nə-fə-ˈstā-shən /

Question 33

Ethnocentrism
/ ˌeth-nō-ˈsen-ˌtri-zəm/

Answer 33

Ethnocentrism is the belief that one’s own cultural group determines the standards by which other groups’ behavior should be judged. Cultural blindness is an inability to recognize the differences between one’s own cultural beliefs, values, and practices and those of another culture.

Question 34

Cultural imposition

Answer 34

Cultural imposition is the act of imposing one’s own cultural beliefs, values, and practices on individuals and groups from another culture. It is different from cultural relativism, which is an ability to recognize that each cultural group has its own set of beliefs and that each culture should be evaluated on its own merit. Nurses must be careful to not impose their personal values on patients.

Question 35

Cultural conflict

Answer 35

**Cultural conflict ** is a perceived threat arising from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because they are unfamiliar with the practice. Cultural conflicts are unavoidable, but nurses should do whatever is necessary to minimize their effect on the delivery of culturally congruent care.

Question 36

Cultural shock

Answer 36

Cultural shock is the **feeling **of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are **radically **different from the individual’s culture.

Question 37

Cultural Differences

Answer 37

Particular areas in which cultural differences are evident include
communication,
view of time,
personal space,
family and social organization and structure,
nutritional practices,
issues related to death and dying, and
health care beliefs.

Question 38

Family Organization and Structure

Answer 38

Family households may be male dominated (patriarchal), /ˌpā-trē-ˈär-kəl/ˌfemale dominated (matriarchal)/ˌmā-trē-ˈär-kəl/, or **egalitarian **(equal share between spouses).
/i-ˌga-lə-ˈter-ē-ən/

Question 39

Spiritual disconnection

Answer 39

Spiritual disconnection may be related to **feelings of guilt and unworthiness **if the patient views illness as punishment for wrongdoing or sin. Other indications of spiritual disconnection are feelings of abandonment, anger, despair, or hopelessness as the patient questions the presence of their higher power.

Question 40

Data Analysis/Problem Identification

Answer 40

• Anxiety
• Denial
• Decreased hope
• Spiritual disconnection

Question 41

Expected outcomes related

Answer 41

• Express comfort with the designed care plan with minimal anxiety.
• Express needs and opinions through an interpreter.
• Cope with cultural differences of agency routines.
• Develop, reestablish, or continue the spiritual practices that nurture a relationship with God or a higher power.
• Express comfort with the patient’s relationship to their higher power and significant others.
• Express feeling peace.
• Identify and use spiritual supports: prayer, reading, visits from a religious or spiritual representative, or engagement in religious or spiritual rituals.

Question 42

Cultural and Spiritual Assessment

Answer 42

To assess cultural aspects that may affect health care, ask the following questions:
* What do you think caused this illness?
* What problems has the illness created for you?
* What has been done to treat the illness so far?
* What do you fear about this illness or its treatment?
* What type of treatment do you think is appropriate?
* What benefits do you expect from treatment?
* What traditional remedies or rituals have you used, or do you wish to use, to treat this illness?

Some simple questions can identify spiritual aspects that need further exploration or referral to a spiritual or religious counselor:
* Is there anything we (the nursing staff) should know about your cultural and spiritual practices and needs?
* How can we support your cultural or spiritual practices?
* Do you have any culture- or religion-specific food requirements?
* Do you need a quiet space or dedicated time for your spiritual practice?
* Is there a spiritual or religious leader (priest, rabbi, pastor, or imam) with whom you would like to meet? Would you like to talk with the chaplain?
* What helps you cope with this illness? What worries you or frightens you?

Question 43

Susceptibility to Disease