The document discusses concepts of cultural diversity and spirituality in India. It notes that India has a diverse population with over 82% following Hinduism and smaller percentages following other religions like Islam, Christianity, Sikhism, Buddhism, and Jainism. It defines key concepts like culture, ethnicity, race, acculturation, assimilation, and discusses how culture can influence health beliefs and practices. It emphasizes the importance of cultural competence and respect for diverse populations when providing nursing care.

1. CONCEPTS OF CULTURAL
DIVERSITY AND SPIRITUALITY
By
Mrs. Swathy B
Faculty
GCON SRD

2. INTRODUCTION
 2023 census of India reveals that various cultures have flourished India
altogether. India is a diverse country where Hindus, Muslims, Christians,
Sikhs, Buddhists, and Jains live together. As per the census 2023,
 over 82.41% citizens follow Hinduism,
 whereas 11.6% citizens follow Islam,
 2.32% follow Christianity,
 1.99% follow Sikhism,
 0.77% follow Buddhism, and
 0.41% follow Jainism.
 In the health care setting, while providing nursing care nurse must be aware
of cultural diversity in our country. The essential knowledge and skills for
understanding cultural diversity and providing person-centered culturally
respectful care have become essential components of nursing practice.

3. CONCEPTS OF CULTURAL DIVERSITY AND
RESPECT
 Cultural diversity can be defined as the coexistence of different ethnic,
biological sex, racial, and socioeconomic groups within one social
unit.
 These groups include, but are not limited to, people of varying
religion, language, physical size, sexual orientation, age, disability,
occupational status, and geographic location.
 Culture is an integral component of both health and illness because
of the cultural values and beliefs that we learn in our families and
communities.
 Nurses and other health care providers must be familiar with the
concepts of cultural diversity in order to understand characteristics
common to certain populations.

4. Cont…
Nurses must also be sensitive to cultural factors in
order to provide culturally respectful care to people
from diverse backgrounds.
The concept of cultural respect enables nurses to
deliver services that are respectful of and responsive
to the health beliefs, practices, and cultural and
linguistic needs of diverse patients.
Moreover, cultural respect is critical to reducing
health disparities and improving access to high-
quality health care.

5. Cont..
It is also vital to remember that each person may
be a member of multiple cultural, ethnic, and
racial groups at one time.
Therefore, different cultural values may guide a
person in different situations based on what is
most important to that person at the time.
 In addition, any person should be viewed
foremost as an individual, not as a representative
of a cultural group.

6. DEFINITION:
CULTURE:
 Culture may be defined as a shared system of beliefs, values, and
behavioral expectations that provides social structure for daily living.
-Potter & Perry
 The NIH defines culture as the combination of a body of knowledge, a
body of belief, and a body of behavior.
- National Institute of Health

7. Cont..
Elements include personal identification, language,
thoughts, communications, actions, customs, beliefs,
values, and institutions that are specific to ethnic, racial,
religious, geographic, or social groups.
For nurses who practice person-centered care, these
elements influence beliefs and belief systems
surrounding health, healing, wellness, illness, disease,
and delivery of health services.

8. The characteristics of culture include the
following:
 Culture helps shape what is acceptable behavior for people in a specific group.
 It is shared by and provides an identity for, members of the same cultural group.
 Culture is learned by each new generation through both formal and informal life
experiences.
 Language is the primary means of transmitting culture.
 The practices of a particular culture often arise because of the group's social and physical
environment.
 Cultural practices and beliefs may evolve over time, but they mainly remain constant as
long as they satisfy a group's needs.
 Culture influences the way people of a group view them-selves, have expectations, and
behave in response to certain situations. Because a culture is made up of people, there
are differences both within cultures and among cultures.

9. SUBCULTURE:
Within most cultures are subcultures.
A subculture is a large group of people who are
members of the larger cultural group but who have
certain ethnic, occupational, or physical characteristics
that are not common to the larger culture.
For example, nursing is a subculture of the larger health
care system culture.

10. CULTURE GROUPS:
Most societies include both dominant culture groups and
minority culture groups.
The dominant group has the most ability to control the
values and sanctions of the society. It usually is (but does
not have to be the largest group in the society.
The Minority groups usually have some physical or
cultural characteristic (such as race, religious beliefs, or
occupation) different from those of the dominant group.

11. ACCULTURATION:
Cultural modification of an individual, group, or
people by adapting to or borrowing traits from
another culture.
Acculturation occurs when the minority culture
changes but is still able to retain unique cultural
markers language, food and customs.

12. ASSIMILATION:
 When a minority group lives within a dominant group, many
members may lose the cultural characteristics that once made
them different, and they may take on the values of the dominant
culture. This process is called cultural assimilation.
 For example, when people immigrate and encounter a new
dominant culture as they work, go to school, and learn the
dominant language, they often move closer to the dominant
culture.
 The process and the rate of assimilation are individualized.

13. Cont..
 Mutual cultural assimilation also occurs, with both groups taking
on some characteristics of the other. We all gain from the many
cultures with which we live. Although we seldom think about it,
the clothes we wear, the foods we eat, the music we enjoy, many
of the words we use, and the leisure activities we practice are all
influenced by acculturation.
 The main difference between acculturation and assimilation is the
degree of change. Acculturation involves adopting some aspects
of the new culture, while assimilation is a complete adoption of
the new culture and rejection of one’s previous identity.

14. CULTURE SHOCK
 A person may experience culture shock when placed in a different
culture he or she perceives as strange.
 Culture shock may result in psychological discomfort or
disturbances, because the patterns of behavior a person found
acceptable and effective in his or her own culture may not be
adequate or even acceptable in the new culture. The person may
then feel foolish, fearful, incompetent, inadequate, or humiliated.
 These feelings can eventually lead to frustration, anxiety, and loss
of self-esteem.

15. ETHNICITY:
 Ethnicity is a sense of identification with a collective cultural group,
largely based on the group members' common heritage.
 One belongs to a specific ethnic group or groups either through birth
or through adoption of characteristics of that group.
 People within an ethnic group generally share unique cultural and social
beliefs and behavior patterns, including language and dialect, religious
practices, literature, folklore, music, political interests, food preferences,
and employment patterns.
 Ethnicity largely develops through day-to-day life with family and
friends within the community.

16. RACE
 Although the term ethnicity is often used interchangeably with race,
these terms are not the same.
 Racial categories are typically based on specific physical
characteristics such as skin pigmentation, body stature, facial
features, and hair texture.
 Because of the significant blending of physical characteristics
through the centuries, however, race is becoming harder to define
using simple classifications, and physical characteristics are not
considered a reliable way to determine a person's race.

17. FACTORS INHIBITING SENSITIVITY TO
DIVERSITY
A variety of factors may affect a person's sensitivity to others.
 Stereotyping-When one assumes that all members of a culture, ethnic group,
or race act alike, stereotyping is at work. Stereotyping may be positive or
negative.
 Negative stereotyping includes racism, ageism, and sexism. These are mistaken
beliefs that certain races, an age group, or one biological sex is inherently
superior to others, leading to discrimination against those considered inferior.
Many of us aren't even aware of biases that influence our ability to create
respectful, trusting relationships.
 Cultural imposition -Also affecting cultural sensitivity are cultural imposition,
which is the belief that everyone else should confirm to your own belief
system.

18. Cont…
 Cultural blindness- which occurs when one ignores differences and
proceeds as though they do not exist.
 Cultural imposition and cultural blindness can be observed within
the health care system, especially in regard to non-traditional
methods of care.
 Culture conflict- Culture conflict occurs when people become
aware of cultural differences, feel threatened, and respond by
ridiculing the beliefs and traditions of others to make themselves
feel more secure about their own values.

19. CULTURAL INFLUENCES ON HEALTH CARE
 India is rich with various culture groups. Therefore, nurses must be aware of,
and sensitive to, the needs of a diverse patient population.
 Most people interpret the behaviors of others in terms of their own familiar
culture.
 This process usually works both ways; for example, in a health care setting,
the patient evaluates the attitudes and actions of the health care provider at
the same time the health care provider interprets the behavior of the
patient. What may seem reasonable and important to a patient may seem
ridiculous and irrelevant to an insensitive nurse. The reverse is also true:
practices a nurse perceives as logical and effective may seem senseless or
even dangerous to a patient.

20. GENERAL CONSIDERATIONS IN PROVIDING
CULTURALLY COMPETENT CARE

21. Physiologic Variations:
 Studies have shown that certain racial and ethnic groups are
more prone to certain diseases and conditions.
 For example, a hereditary disorder, Tay-Sachs' disease, is
associated with people of Eastern European Jewish descent.
Although the incidence of this disorder has declined over the
years owing to improved and earlier testing, it is still a concern.
 Use knowledge of such risk factors when interviewing a patient
to complete a health history.

22. Reactions to Pain:
 Health care researchers have discovered that many of the expressions and behaviours
exhibited by people in pain are culturally prescribed. Some cultures allow or even
encourage the open expression of emotions related to pain, whereas other cultures
encourage suppression of such emotions.
 You should not assume that a patient who does not complain of pain is not having
pain. If you make this assumption, you may overlook the pain-reduction needs of a
patient who deals with pain quietly and stoically. To avoid this error, be sensitive to
nonverbal signals of discomfort, such as holding or applying pressure to the painful
area, avoiding activities that intensify the pain, and uncontrollable, spontaneous
expressions of discomfort, such as facial grimacing and moaning. You also should not
consider patients who freely express their discomfort as constant complainers with
excessive requests for pain relief. Pain is a warning from the body that something is
wrong. Pain is what the patient says it is, and every complaint of pain should be
assessed carefully.

23. Mental Health:
 Most mental health norms originate in research and observations made of
White, middle-class people. But many ethnic groups have their own norms
and acceptable patterns of behavior for psychological well-being, as well as
different normal psychological reactions to certain situations.
 For example, in India, family members and friends play an important role in
the treatment of mentally ill people. In rural India, mental illness is linked
with social stigma and brings shame to the family. Practices such as kala
jadu, jhadphook, tonatotka are practiced to heal mental illness. Some
traditional Chinese people consider mental illness a stigma and seeking
psychiatric help a disgrace to the family. Be aware of these variations and
accept them as culturally appropriate.

24. Biological Sex Roles:
 In some cultures, the man is the dominant figure and generally makes
decisions for all family members. For example, if approval for medical care
is needed, the man may give it regardless of which family member is
involved. In male-dominant cultures, women are often passive. On the
other hand, there are cultures in which women are dominant.
 Knowing who is dominant in the family is important when planning
nursing care. For example, if the dominant member is ill and can no
longer make decisions, the whole family may be anxious and confused.
 If a non-dominant family member is ill, the person may need help in
verbalizing needs, particularly if the needs differ from those the dominant
member perceives as being important.

25. Language and Communication:
 When people from another part of the world move to India, they may speak their own
language fluently but have difficulty speaking regional language. This is especially
true for women or older adults in the family who do not work outside the home and
for people who live in proximity to others who speak their primary language.
 Assimilation is likewise slower for people who stay at home, especially if they live in
communities of their ethnic and cultural background. Children usually assimilate more
rapidly and learn the language of the dominant culture quickly if they leave home
each day to go to school and make new friends in the dominant culture.
 Wage earners also tend to learn a new language more quickly through the work
setting.
 One of the most culturally variable forms of nonverbal communication is eye contact

26. Orientation to Space and Time:
 Personal space is the area around a person regarded as part of the person.
 If others do not consider a person's personal space, that person may become
uncomfortable or even angry.
 When providing nursing care that involves physical contact, you should know
the patient's cultural personal space preferences. Many people and almost all
institutions in India value privacy while providing care.
 Understanding the patient's orientation to time is important as you
communicate, for example, the need to be on time for appointments for
health care procedures and when taking medications.

27. Food and Nutrition:
 Food preferences and preparation methods often are culturally influenced. Certain
food groups serve as staples of the diet based on culture and remain so even when
members of that culture are living in a different country.
 Patients in a hospital or long-term care setting often do not have much choice of
foods. This means that people with cultural food preferences may not be able to select
appealing foods and thus may be at risk for inadequate nutrition.
 When assessing the possible causes of a patient's decreased appetite, try to determine
whether the problem may be related to culture.
 Dietary teaching must be individualized according to cultural values about the social
significance and sharing of food.

28. Family Support:
 In many cultural and ethnic groups, people have large, extended families and consider
the needs of any family member to be equal to or greater than their own.
 They may be unwilling to share private information about family members with those
outside the family (including health care providers).
 Other cultural groups have great respect for the elders in the family and would never
consider institutional care for them.
 Including the family in planning care for any patient is a major component in nursing
care to meet individualized needs, especially if those needs can be met only through
consideration of all members of the family.
 In Indian scenario, mostly patriarchal families (male dominating families) are present
except in some regions of Northeast and South India

29. Socioeconomic Factors:
 Low income is a major problem in India and is often described as having created a
culture of poverty.
 Poverty has long been a barrier to adequate health care. It prevents many people from
consistently meeting their basic human needs.
 Accessing health care facilities frequently requires trans-portation, which often is neither
affordable nor available to poor people.
 Their access to health insurance also is frequently limited, and they often must choose
between purchasing food and obtaining health care.
 Those in upper-income groups tend to live longer and to experience less disability than
those in lower-income groups.
 Other barriers to health care include isolation, language or communication difficulties,
seasonal occupations, migration patterns, depersonalization, and institutional prejudice

30. Health Disparities:
The term health disparities refer to health differences
between groups of people; they can affect how
frequently a disease affects a group, how many people
get sick, or how often the disease causes death.
Many different populations are affected by disparities,
including racial and ethnic minorities; residents of rural
areas; women, children, and the older adult; and
persons with disabilities.

31. CULTURAL INFLUENCES ON HEALTH
AND ILLNESS
People's values and beliefs about health, illness, and health
care are influenced by cultural and ethnic groups. For
example, in some groups, illnesses are classified as either
natural or unnatural.
"Natural illnesses" are caused by dangerous agents, such as
cold air or impurities in the air, water, or food.
"Unnatural illnesses" are punishments for failing to follow
God's rules, resulting in evil forces or witchcraft causing
physical or mental health problems.

32.  In some cultures, the power to heal is thought to be a gift from
God bestowed on certain people. People in these cultures
believe that these folk or traditional healers know what is wrong
with them through divine intervention and experience. A patient
accustomed to traditional healers may think that health care
providers are incompetent because they have to ask many
questions before they can treat an illness.
 Traditional healers speak the patient's language, often are more
accessible, and are usually more understanding of the patient's
cultural and personal needs.

33. Cont…
People from different cultures may also have different
beliefs about the best way to treat an illness or disease.
For example, herbs are a common method of treatment
in many cultures.
Other traditional therapies include the use of cutaneous
stimulation, therapeutic touch, acupuncture, and
acupressure.
Cutaneous stimulation by massage, vibration, heat, cold,
or nerve stimulation reduces the intensity of the
sensation of pain.

34. Cont…
Therapeutic touch is an intentional act that involves
an energy transfer from the healer to the patient to
stimulate the patient's own healing potential.
Acupuncture, long used in China, is a method of
preventing, diagnosing, and treating pain and
disease by inserting special needles into the body at
specified locations.
Acupressure involves a deep-pressure massage of
appropriate points of the body.

35. CULTURALLY RESPECTFUL NURSING CARE
 Providing culturally respectful nursing care means that care is planned
and implemented in a way that is sensitive to the needs of individuals,
families, and groups from diverse populations within society. Among
the elements of cultural competence are the following:
 • Developing an awareness of one's own existence, sensations,
thoughts, and environment to prevent them from having an undue
influence on those from other backgrounds
 • Demonstrating knowledge and understanding of the patient's
culture, health-related needs, and culturally specific meanings of
health and illness

36. Cont..
 • Accepting and respecting cultural differences in a manner that
facilitates the patient's and family's abilities to make decisions to meet
their needs and beliefs
 • Not assuming that the health care provider's beliefs and values are the
same as the patient's
 • Resisting judgmental attitudes such as "different is not as good"
 • Being open to and comfortable with cultural encounters
 • Accepting responsibility for one's own education in cultural
competence by attending conferences, reading professional literature,
and observing cultural practices
 These elements suggest that becoming culturally competent is a life-long
challenge, and that nurses should strive to be culturally humble-
recognizing what we don't yet know about those entrusted to our care
and being willing to learn what we need to know.

37. ESFT model (Explanatory model of health and
illness, Social and environmental factors, Fears
and concerns, Therapeutic contracting)
 The health care system is itself a culture with customs, rules, values, and
a language of its own, with nursing as its largest subculture. As you
progress through your education, you will be acculturated into the
culture of the health care system and will develop values related to
health and health care.
 The ESFT model is a cross-cultural communication tool that helps health
care professionals strengthen communication and identify potential
threats to treatment adherence. Nurses can use this model to improve
health care outcomes and address health disparities.

39. Guidelines for Nursing Care Cultural
Assessment
 When caring for patients from a different culture, it is important
to first ask how they want to be treated based on their values and
beliefs. An effective way to identify specific factors that influence
a patient's behaviour is to perform a cultural assessment. The
primary informant should be the patient, if possible. If the patient
is not able to respond to the questions, a family member or a
friend can be consulted.
 Remember, however, that information about any culture is
general, and that it must be individualized for the specific patient
once the actual interaction begins.

40. TRANSCULTURAL NURSING
Transcultural nursing, now both a specialty and a
formal area of practice, originated from work by Dr.
Leininger, a nurse-anthropologist.
Her theory provides the foundation for providing
culturally respectful care for patients of all ages, as well
as families, groups, and communities.
Leininger has presented the Sunrise Model to visualise
the different dimensions of her Culture Care Theory.

42.  The upper half of the circle represents a part of the whole socio-
cultural structure and world view factors.
 These factors influence the care, patterns and expressions towards
health and well-being of an individual, families, groups and
institutions through language and environment.
 The same factors also influence folk and professional nursing,
bridged by the nursing subsystem which can be seen in the lower
half of the model.
 With the aid of the three types of nursing care, decisions and
actions cultural congruent nursing care can be possibly achieved
which is meaningful, beneficial and satisfying to people

43. Develop Cultural Self-Awareness
 Before you can provide culturally competent care to patients
from diverse backgrounds, you'll need to become aware of the
role of cultural influences in your own life.
 Objectively examine your own beliefs, values, practices, and
family experiences. As you become more sensitive to the
importance of these factors, you'll also become more sensitive to
cultural influences in others' lives.
 Identify your biases.
 How do they affect your feelings about others? How could they
affect your nursing care of others?

44. Develop Cultural Knowledge
 Learn as much as possible about the belief system and practices of
people in your community and of patients in the area in which you work.

45. Accommodate Cultural Practices in Health Care
 Incorporate factors from the patient's cultural background into health care
whenever possible if the practices would not be harmful to the patient's health.
 Modify care to include traditional practices and practitioners as much as possible,
and be an advocate for patients from diverse cultural groups.
 Accommodate the cultural dietary practices of patients as much as possible.
Dietary departments in many hospitals and long-term care facilities can provide
meals that are consistent with special dietary practices.
 Families may be encouraged to bring food from home for patients with particular
preferences when this practice does not violate policy.
 Teaching patients and families about therapeutic diets may also be appropriate
within the framework of particular cultural practices.

46. Respect Culturally Based Family Roles
 Consider the cultural role of the family member who makes most
of the important decisions.
 In some cultures, it is the husband or father, whereas in others it
may be a grandmother or another respected elder.
 To disregard this person's role or to proceed with nursing care
that is not approved by this person can result in conflict or in
disregard for the patients and family's values.
 Be careful to involve this person in the nursing care planning.

47. Avoid Mandating Change
 Keep in mind that health practices are part of the overall culture and
that changing them may have widespread implications for the
person.
 Provide support and reinforcement for the patient if it is necessary
to change a health practice with a cultural basis.
 Do not force patients to participate in care that conflicts with their
values.
 If a patient is forced to accept such care, resulting feelings of guilt
and alienation from a religious or cultural group are likely to
threaten that patient's well-being.

48. Seek Cultural Assistance
 Seek assistance from a respected family member, or priest, as
appropriate, so that the patient is more likely to accept health care
services.
 Acknowledging the role of the person's traditional healer can be
an important way of building trust.
 Such efforts promote mutual understanding, respect, and
cooperation.

49. SPIRITUALITY

50. Introduction
 Spiritual beliefs directly influence patients' responses to illness and suffering, self-care practices
such as diet and hygiene, birth and death rituals, biological sex roles, spiritual practices, and
moral codes.
 Although nurses may differ in their beliefs about how involved they should become in meeting
patients spiritual needs, it is impossible to nurse patients well while ignoring the spiritual
dimensions of health.
 Nurses can assist patients to meet spiritual needs by offering a compassionate presence;
assisting in the struggle to find meaning and purpose in the face of suffering, illness, and death;
fostering relationships (with a higher being or other people) that nurture the spirit; and
facilitating the patients expression of religious or spiritual beliefs and practices.
 Nurses often need guidance in assessing spirituality in their patients, and in providing spiritual
care.

51. One simple guide for eliciting a spiritual history is
Anandarajah and Hight's HOPE acronym:
• H-Sources of Hope, meaning, comfort, strength,
peace, love, and connection
• O- Organized religion
• P- Personal spirituality and practice
• E- Effects on medical care and end-of-life issue

52. CONCEPTS RELATED TO SPIRITUALITY
 Spirituality, faith, religion, hope, and the influence of these elements on everyday
living and health and illness are important concepts to understand when caring for
patients.
Spirituality
 Spirituality is anything that pertains to a person's relationship with a nonmaterial life
force or higher power.
 While one person describes spirituality in terms of coming to know, love, and serve
God, another speaks of transcending the limits of body and experiencing a universal
energy.
 Spirituality is experienced as a unifying force, life principle, essence of being. It is
expressed and experienced in and through connectedness with nature, the earth, the
environment, and the cosmos. Spirituality shapes self-becoming and is reflected in a
person's being, knowing, and doing.

53. Faith
 Faith generally refers to a confident belief in something for which there is no proof
or material evidence. It can involve a person, idea, or thing, and is usually followed
by action related to the ideals or values of that belief. For example, if I have faith in
my doctor, nurse, or healer, I am more likely to adhere to a prescribed regimen or
care plan and to experience benefits.
 Similarly, patients who believe in a loving and all-powerful being who knows them
and cares for them are often better able to cope with the suffering related to injury
and illness.
 An atheist is a person who denies the existence of a higher power; an agnostic is
one who holds that nothing can be known about the existence of a higher power.
Atheists and agnostics deserve respect for what they choose to believe, just as do
those who accept a particular religious creed.

54. Religion
 Religion can be defined as an organized system of beliefs about a higher power that often
includes set forms of worship, spiritual practices, and codes of conduct.
 Although it is impossible for nurses to be knowledgeable about all religions. understand
their religious beliefs and practices.
Hope
 Closely related to spirituality, faith, and religion, hope is the ingredient in life responsible for
a positive outlook, even in life's bleakest moments. It enables a person both to consider a
future and to work to actively bring that future into being.
 Hope originates in imagination but must become a valued and realistic possibility in order
to energize action. Hope allows a person to embrace the reality of suffering without
escaping from it (false hope) or being suffocated by it (despair, helplessness, hopelessness).
 Hope is unique to each person.

55. Spiritual Well-Being
 Spiritual health, or spiritual well-being, is the condition that exists when the
person's universal spiritual needs for meaning and purpose, love and
belonging, and forgiveness are met.
 O'Brien's conceptual model of spiritual well-being in illness identifies three
empirical referents of spiritual well-being:
 personal faith,
 spiritual contentment, and
 religious practice.

57. Factors Affecting Spirituality
Among the many factors that can influence a
persons spirituality, the most important are
developmental considerations
family,
formal religion, and
life events.

58. 1) Developmental Considerations
 Because spirituality involves the nonmaterial realm of being, child must have
developed some capacity for abstraction in order to understand the spiritual self
self
 As the child matures, life experiences usually influence and mature the child's
spiritual beliefs. With advancing years, the tendency to think about life after
death prompts some people to re-examine and reaffirm their spiritual beliefs.
2) Family
 A child's parents play a key role in the development of the child's spirituality.
What parents explicitly teach a child about spirituality and religion is generally
less important than what the child learns about spirituality, life, and self from
the parents' behavior.

59. 3) Formal Religion
Several characteristics of religion are:
 Basis of authority or source of power
 Scripture or sacred word
 An ethical code that defines right and wrong
 A psychology and identity, so that its adherents fit into a group,
and the world is defined by the religion
 Aspirations or expectations
 Ideas about what follows death

60. 4) Life Events
 Both positive and negative life experiences can influence spirituality, and they
in turn are influenced by the meaning a person's spiritual beliefs attribute to
them.
 For example, if two women who believe in a loving God both lose a child in a
car accident, one may bitterly deny God's existence, whereas the other may
spend more time in prayer, asking God to help her.
 Similarly, a chain of successful life experiences (marriage, promotion) may
cause one person to assume success and experience no need for God,
whereas for another it occasions deep gratitude and rejoicing

61. Spiritual care in illness
 A variety of interventions are available to help patients meet their spiritual
needs.
 Like other nursing skills, these interventions need to be practiced before they
can be used confidently, competently, and at the right moment.
 These interventions can be used in the home, hospital, or care centre to help
patients meet their spiritual needs.
 When implementing spiritual care, nurses work closely with other spiritual
care givers and patient's family members.
 Often the most important Intervention is a well- timed referral to a
professional spiritual Caregiver. Next slide illustrates an inpatient spiritual
care Implementation model.

63. Offering Supportive or Healing Presence
 A nurses gift of supportive presence must underlie all other types
of intervention to meet the patient's spiritual needs. The aim of
this intervention is to create a hospitable and sacred space in
which patients can share their vulnerabilities without fear.
 Promoting Love and Relatedness
 Treat the patient with respect, empathy, and genuine caring.
 Encourage the patient to talk about relationships with others and
to identify the origin of any negative beliefs about people.

64. Promoting Forgiveness
 Offer a supportive presence to the patient that demonstrates your acceptance
of the patient. Explore with the patient the importance of learning to accept
self and others, including both strengths and limitations. Explore negative
feelings that make it difficult for the patient to seek forgiveness and to believe
that he or she is forgiven.
 Explore the patient's self-expectations and assist the patient to determine how
realistic these are. Allow the patient to verbalize shame, guilt, and anger, and
counsel about the importance of expressing negative emotions in healthy
ways.
 Refer the patient to a spiritual adviser, if appropriate. Offer the patient
examples of how not forgiving others can end up hurting only the person who
cannot forgive.

65. Praying With Patients
Patients accustomed to regular periods of prayer but
who feel too ill to pray as they would like or who enjoy
praying with others may ask the nurse to pray with
them or hope that the nurse will suggest this.
 Consider the patients religious background along with
the type of prayers that have been meaningful in the
past.
Ask whether the patient has a particular prayer request.
request.

66. Resolving Conflicts Between Spiritual Beliefs and Treatments
 Both the patient and members of the patient's family may
experience conflict between a particular spiritual belief or religious
religious law and a proposed medical treatment or health option.
 The patient may want assistance when conferring with the
spiritual adviser about a particular procedure.
 The nurses role is to help the patient obtain the information
needed to make an informed decision and to support the patient's
decision making. Because what the nurse says and way it is said
may powerfully influence the patient's decision, it is important to
maintain objectivity.

67. Spiritual Distress
 Spiritual distress results in inability to experience and integrate
meaning and purpose in life through connectedness with self,
others, art, music, literature, nature, or a power greater than oneself.
 Spiritual distress may be further specified as spiritual pain,
alienation, anxiety, guilt, anger, loss, or despair).
 Common aetiologies for spiritual distress include inability to
reconcile a current life situation (e.g., illness, death of loved person,
divorce) with spiritual beliefs ("God is all-powerful, all-loving, all-
wise, and He cares about me") or separation from the religious
community or supports.

68. Addressing Spiritual Distress
 Goals and expected outcomes for patients in spiritual distress need
to be individualized and may include a patient achieving some of
the following.
 Exploring the origin of spiritual beliefs and practices.
 Identifying factors in life that challenge spiritual beliefs.
 Exploring alternatives given these challenges: denying, modifying, or
reaffirming beliefs; developing new beliefs.
 Identifying spiritual supports (e.g., spiritual reading, faith, community)
 Reporting or demonstrating a decrease in spiritual distress after successful
intervention.