Worldviews vary from one culture to another and influence cultural practices, including health care practices or beliefs. The views of a culture regarding what is good and useful are known as values. What are the predominant values of your culture?
Health and health care choices are heavily influenced by lifestyle choices. What cultural beliefs or practices may pose health risks? (excessive tattoos and body piercings, smoking ceremonial pipes with tobacco or other substances, etc.)
Religion is an organized practice of beliefs and traditions based on values. Can a person be spiritual but not religious? (Yes; a person may not belong or practice an expressed religion but still be concerned with issues of the spirit.) Can a person be religious without being spiritual? (usually no, because most religions are built around issues of the spirit)
Because practices and beliefs vary among religions, it is important to inquire about the patient’s religion or religious background (or if he or she is no longer active in the faith). Most organized religions have rituals and traditions built around significant life events: birth, death, illness, and even for specific illnesses. Faith-based rituals or healing prayers may be used as remedies for disorders, illnesses such as cancer, or something as common as a headache. What are some examples of faith-based healing rituals?
Why is it essential to perform a spiritual assessment to ascertain what needs and concerns the patient might have? Beliefs of individuals within each denomination vary, and specific spiritual assessment regarding the various issues relevant to health care is essential.
Even within a single religion such as Christianity, many variations in worship and practices may be exhibited. Catholicism is only one type of Christian worship. Ethnicity or culture can also affect the practices and traditions within a type of worship, such as Catholicism. What are some examples of how ethnicity or culture influences religious practices?
Religious beliefs can greatly influence the health choices of the patient as well as others. In what ways could beliefs about birth control or organ donation affect a patient’s long-term health and well-being?
If the baby is ill, baptism should occur as soon as possible. If death is imminent, an abbreviated sacrament may be done in the hospital setting by a priest or deacon. Only an ordained Orthodox priest or deacon can administer the sacrament of Holy Communion.
The sacrament of the sick is also known as Holy Unction, which consists of the application of oil (that has been blessed with prayers) to the face and hands of the patient. At times, this may be done by a layperson. The application of Holy Water to the face of the patient may also be done. Sometimes the Holy Water is applied to the actual afflicted part of the body or is ingested for spiritual cleansing. Many Orthodox groups now follow the Julian calendar, matching holidays such as Christmas and New Year with those of Catholicism and other religions.
How would you expect these beliefs to affect health, illness, and the healing process of an individual?
These traditions are strictly adhered to by Jehovah’s Witness believers. How might the nursing staff’s role conflict with the religious beliefs of a Jehovah’s Witness or another religion?
Even among Protestant sects, many ritual differences exist between denominations. In addition, individual differences and practices may occur within a specific denomination.
What implications might these practices have within a health care setting? (Patient food tray may arrive with unacceptable choices for the patient, etc.) What other practices or beliefs are associated with Seventh-Day Adventists?
What are some other Protestant denominations? An individual spiritual assessment should be done to best understand the views of each patient. What would you do if the patient were unable to answer important questions regarding faith and practices? (Ask a spouse or other immediate family member, if available. A close friend may also be able to provide some insights.)
Most prevalent in the Middle East, Africa, South Asia, and parts of Eastern Europe. Muslims are required to pray five specific times throughout the day. The body is usually kept covered in front of members of the opposite sex. This can make health care delivery challenging. A female should not be touched by a male who is not part of her family. How can care be properly delivered when adhering to strict Muslim traditions?
Dietary restrictions of Muslims are also influenced by ethnicity and culture, not just religion. The Muslim faith is practiced in many countries with a variety of cultures such as Morocco, Indonesia, and Saudi Arabia. Each of these ethnic cultures is also integrated into the specific faith practices.
It is particularly important to adhere to strict Muslim traditions in the case of death. If the practices surrounding death are not followed, they can be a source of great stress, guilt, and conflict for the family members.
The worldwide population of Muslims is growing rapidly. What are some reasons for this growth? Because the religion is growing, it is more common to encounter practicing Muslims within a U.S. health care setting.
Muslims are required to pray five specific times throughout the day. The body is usually kept covered in front of members of the opposite sex. This can make health care delivery challenging. A female should not be touched by a male who is not part of her family. How can care be properly delivered when adhering to strict Muslim traditions?
The religious leader in Judaism is called a rabbi, and the main place of worship is the synagogue. What is a circumcision? Males can only be circumcised by a practicing mohel. Some Jewish physicians are also trained as mohels and can perform the ritual within the health care setting. The modern U.S. birthing center with family-centered care and the practice of incorporating the husband in the caregiving tasks can be at odds with those that practice traditional Judaism.
Males can only be circumcised by a practicing mohel. Some Jewish physicians are also trained as mohels and can perform the ritual within the health care setting. The modern U.S. birthing center with family-centered care and the practice of incorporating the husband in the caregiving tasks can be at odds with those that practice traditional Judaism.
Rules surrounding the Sabbath are taken very seriously by Orthodox Jews. How would these rules affect the delivery of care? How would these rules affect staffing decisions?
What should be done with the body of an Orthodox Jewish patient who dies on the day before the Sabbath?
In preparing an Orthodox Jewish patient for surgery, it is important to remember the rules regarding shaving. Hair must be clipped, not shaved. This information should be conveyed to the OR staff as well.
Can a patient’s head be kept covered at all times? What allowances can be made in the health care environment? How do you facilitate a quiet environment and privacy for prayer in a health care setting?
These religious guidelines are much more lenient or relaxed than those practiced by an Orthodox Jew. It is difficult to know which traditions and guidelines are practiced unless you ask the patient (or the patient’s spouse, family members, or guardian) in specific terms. Some Reformed Jews may still observe a kosher diet; others may not.
Rules about organ transplantation apply not only to the organ recipient but to the organ donor as well. In the case of death or imminent death of a potential organ donor, it is important that a rabbi be contacted to be available for the family.
There is a strong belief that life is controlled by God and that the individual has little control over what happens.
There is a strong belief that life is controlled by God and that the individual has little control over what happens.
Dr. Leininger described human caring as what all people need most to grow, remain well, avoid illness, and survive or face death.
How does race differ from skin color among groups? (Race is a biologic way of categorizing people. It includes color, as well as skin texture, facial features, and body proportions.) How does race compare to ethnicity? (Race includes various ethnic groups within each category.)
Subcultures also exist within each of these major cultural groups. What are some examples of subcultures for each of these cultural groups?
Cultural competence involves knowledge of one’s own values, beliefs, and attitudes first. Some values, beliefs, and attitudes are driven by religion, some by ethnicity, some by race. What else might influence values, beliefs, and attitudes? (gender, age, family traditions, education level, life experiences)
An orientation toward the future and change is not valued or held by all cultures. Some may value the past more than the future. It is important to understand the patient’s view of time and how this may conflict with the view of time in the health care setting. In some cultures, forces associated with illness may not be in congruence with the traditional medical model. What are some cultural beliefs involving forces or influences that affect health and illness? (Chinese yin and yang, Middle Eastern evil eye, etc.)
Language and communication traditions are important to understand. In which cultures is eye contact considered impolite? The concept of personal space can also become a barrier to care if the patient perceives the health care professional as being rudely within the patient’s space.
An orientation toward the future is a European American dominant cultural value in the United States. There is a sense of time urgency (not enough time), and importance is placed on punctuality and schedules. What cultures focus on the here and now and without a feeling of urgency to be someplace on time?
Cultural differences must be respected without trying to impose an egalitarian viewpoint, which is prevalent in the United States. In some cultures , the elderly are considered wise and are revered.
Each culture has its own set of foods that are viewed as “hot” or “cold.” That effect is used to counteract illness or disease—cold foods are used to treat “hot” illnesses or diseases, and hot foods are used to treat “cold” illnesses or diseases.
How would strict visitation rules affect different cultures?
How might a matriarchal family structure affect health or health care delivery?
Many Asian Americans and Pacific Islanders follow their traditional practices for healing and restoring well-being. Some of these practices are thousands of years old and highly respected by followers. Herbal and traditional remedies are also used for illness and are usually specific to the ailment. Western medicine does not always respect or incorporate these practices.
A growing number of Muslims are included in this group. Members of this ethnic group may not express feelings or complaints readily. They might consider it disrespectful to disagree with their caregivers, and might give consent for care or procedures even when they don’t really agree.
Hispanic Americans includes people of many different national and cultural backgrounds. Not all of their health beliefs are the same. Use of traditional herbs and concoctions often relied on heavily. These are not always compatible with the medication regimen prescribed by physicians. What should the nurse do if the patient is using an herbal preparation, such as a brewed tea, that the family brought? (Ask the patient or family to identify the preparation. Talk with the pharmacist about it. The pharmacist can determine if it is compatible with the patient’s medications.)
Men are usually encouraged to be stoic and not vocalize pain or complaints. Women may actually be encouraged to readily vocalize their pain, issues, etc. This varies by ethnicity and by individual or family.
This group includes people of many different ethnic heritages. Traditions may vary widely. How might a matriarchal family structure affect health or health care delivery?
Numerous diseases are genetically transmitted or associated with a genetic predisposition. In addition, many more conditions occur predominantly in one specific population. The scientific connection between these conditions and ethnicity is not always known.
What are some other examples of diseases or conditions that occur with greater frequency in a specific population? (thalassemia, etc.)
It is not always practical or possible to find an interpreter for the patient. When privacy issues are considered, the use of an interpreter can become even more limiting. How do you resolve a language barrier with a patient who speaks an obscure language or dialect?
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