Culture & Spirituality

Cultural Diversity

• Cultural Groups

• Subculture

• Multiculturalism

• Ethnic groups

• Race

Cultural Groups

Racial, ethnic, religious, or social groups with specific group behaviors and characteristics that are learned and shared, including language, customs, beliefs, and values.

Subculture

Minority groups characterized by specific norms, beliefs, and values that coexist with a dominant culture.

Multiculturalism

Characterized by many subcultures coexisting within a given society in which no one  culture dominates.

Ethnic groups

Group of individuals who have common racial characteristics and share a cultural heritage.

Race

A term used to describe socially defined populations that share genetically transmitted physical characteristics, such as skin color and bone structure.

Culture

The patterns of behavior and thinking that people living in social groups learn, develop, and share.

Diversity

The unique variations among and between individuals that are informed by genetics and cultural background, but that are refined by experience and personal choice.

Values and Beliefs

• Cultural values

• Worldview

Cultural values

Preferred ways of behaving or thinking that are sustained over time and used to govern a cultural group’s actions and decisions.

Worldview

The way in which people in a culture perceive ideas and attitudes about the world, other people, and life in general.

Cultural Transmission

• Enculturation

• Assimilation

• Acculturation

Enculturation

The process by which children learn culture from adults. Also called cultural transmission.

Assimilation

• The process of adapting to and integrating characteristics of the dominant culture as one’s own.

• The process by which humans encounter and react to new situations by using the mechanisms they already possess.

Acculturation

The process of adapting to the majority culture and accepting it as one’s own.

Diversity

• Gender

• Race

• Social Class

• Sexual orientation

• LGBTQ Community

• Disability status

• Age

Gender

• Men

• Women

• Transgender

Social Class

Socioeconomic variations contribute to a society stratification based on money and access to resources.

Sexual orientation

The sexual attraction of an individual to the same sex, the opposite sex, or both sexes.

LGBTQ Community

lesbian, gay, bisexual, transgender, and queer/questioning

Disability status

• Intellectual disabilities

• cognitive disabilities

• Poorer healthcare

• Coexisting complex and chronic conditions

• Physical disabilities

Age

Children, older adults

Vulnerable populations

Social groups with inadequate access to healthcare because they lack resources and are exposed to more risk factors.

Greater risk for diseases and reduced lifespan in Vulnerable populations

• Poverty

• Age

• Disability

Poverty

A lack of income to meet basic needs that include food and nutrition, education and other basic services, productive resources for income, and healthcare.

Disability

a physical or mental health impairment that restricts a person's ability to function.

Social Differences

People learn social behaviors practiced in their cultures, communities.

Social differences related to culture

• Communication

• Environment

• Religion

• Space and time

• Biological difference

• Susceptibility to disease(ethnicity)

• Skin color

Communication

Cultural groups and subcultures may speak a unique language or a variation of another language.

Environment

Relationship to the environment varies among cultures.

Personal Space

the distance individuals prefer to maintain between themselves and others during interactions, and it varies widely across different cultures.

Time

The concepts of time, duration of time, and points in time vary among cultures

Biological difference

People differ genetically and physiologically

Susceptibility to disease(ethnicity)

Certain ethnic groups or races may tend toward developing specific diseases

Skin color

a significant biological variation influenced by melanin

Cultural Competence

Ability to apply knowledge, skills to provide high-quality care to clients of diverse backgrounds

Competencies for culturally competent care

• Apply knowledge of social and cultural factors

• Use relevant data sources and best evidence

• Promote achievement of safe, high-quality outcomes

• Advocate for social justice and eliminate health disparities

• Cultural competence development

Models of Cultural Competence

• Culture Care Diversity and Universality Theory

• HeritageChain

• LEARN model

• Purnell’s12 domains of culture

Culture Care Diversity and Universality Theory

This theory emphasizes understanding cultural differences to provide high-quality care.

LEARN model

• Listen to the patient’s perception of the problem.

• Explain your perception of the problem and of the treatments ordered by the provider.

• Acknowledge and discuss the differences and similarities between these two perceptions.
  Review the ordered treatments while remembering the patient’s cultural parameters.

• Negotiate agreement. Assist the patient in understanding the medical treatments ordered by the provider and have the patient help to make decisions about those treatments as appropriate

Purnell’s 12 domains of culture

• Overview, inhabited localities, and topography

• Communication

• Family roles and organization

• Workforce issues

• Biocultural ecology

• High-risk behaviors

• Nutrition

• Pregnancy and childbearing practices

• Death rituals

• Spirituality

• Healthcare practices

• Healthcare practitioners

Providing Culturally Competent Nursing Care

• Noticing/ Assessment

• Common Problems

• Planning/ Implementation

• Reflecting / Evaluation

Noticing/ Assessment

• Communication

• Decision maker

• Assessment of cultural influences and practices imperative

Common Problems (patient needs and/or nursing priorities may include)

• Powerlessness

• Interrupted religious practice

• Fear

• Lack of knowledge about healthcare options or healthcare system

• Anxiety

• Hopelessness

• Inadequate family coping skills or resources

• Potential for compromised human dignity.

Planning/ Implementation

• Promoting Safety

• Providing Nutrition

• Promoting Mobility

Reflecting / Evaluation

• Goals should include that patient

• Goals that include a culture component

• Evaluating how successfully patient can follow treatment regimen while observing cultural practices

Promoting Safety

• The nurse must create an open channel of communication with family members and the patient to provide safe and culturally sensitive care. 

• Additional assessment and patient teaching regarding safety procedures, medication side effects and interactions, and other areas of care may be necessary.

Providing Nutrition

Regardless of the patient’s background, carefully assess patient and family expectations and practices regarding foods and beverages and incorporate these into the plan of care when it is safe to do so.

Promoting Mobility

The nurse can take this opportunity to educate as well as collaborate. The nurse should collaborate with the family to implement a plan that does include mobility, but also appreciates the cultural need for rest.

Goals for evaluation of the nurse’s plan of care

• The patient expresses that cultural needs were met.

• The patient is able to verbalize understanding of medical diagnosis and treatment plan.

• The patient is able to collaborate with the care team when using complementary therapies.

• The patient is able to meet nutritional needs.

Interrelated concepts

• Communication

• Professional behaviors

Communication

It is important to understand that patients use language differently, speak different languages, and recognize nonverbal cues differently.

Professional behaviors

• must be built on a moral and ethical code.

• Nurses must understand collegial and regional differences to effectively work collaboratively with diverse interprofessional teams.

Spiritual health

The overall feeling of strength, hope, and fulfillment that encourages people to find

life-sustaining and enriching opportunities.

Spiritual Wellness

A feeling of inner peace and of being generally alive, purposeful, and fulfilled; the feeling is rooted in spiritual values and/or specific religious beliefs.

Spiritual Distress

A challenge to the spiritual well-being or to the belief system that provides strength, hope, and meaning to life; a feeling of being separated from interconnectedness with others or with a higher power.

Spirituality

The part of being human that seeks meaningfulness through personal connection, which may include belief in or relationship with some higher power, creative force, driving being, or infinite source of energy.

Religion

A set of doctrines accepted by a group of people who gather together regularly to worship that offers a means to relate to God or a higher power; an organized system of beliefs and practices

Traditions

• Holy days

• Sacred scriptures

• Religious symbols

• Prayer and Meditation

Practices

• Support religious practices

• Clothing

• Diet

• Healing

• Birth

• Death

Beliefs and Healthcare

• Buddhism

• Christianity

• Hinduism

• Islam

• Judaism

Spiritual Care Resources

• Spiritual care department

• Faith Community Nurse

• Chaplain

• Critical incident stress management

Spiritual care department

oversees spiritual and pastoral care services for patients and their families, visitors, and facility staff who need spiritual care.

Faith Community Nurse

A nurse who works in a church, social service agency, or nonprofit organization, or independently, providing holistic nursing care, healing, and spiritual care to members of a community.

Chaplain

help patients, family members, visitors, and medical staff who are experiencing spiritual discomfort to find and use inner sources of spiritual strength and courage, regardless of their religious preference or beliefs.

Critical incident stress management

to help first responders in the community and employees of healthcare facilities cope with traumatic situations that may occur in the community or in the facility itself.

Spirituality though the Lifespan

• Children

• Adolescents

• Adults

• Older Adults

Children

• Identify with spiritual traditions

• Develop own spiritual practices and beliefs

• Parent–child bonding

Adolescents

• Remain in religious groups

• Form independent identity

Adults

• Young adults prefer nontraditional belief systems

• Spiritual than religious

• Joy, peace, and meaning in life

Older Adults

• Physical and mental health and longevity

• Socialization

• Health promotion

Nursing Process

• Noticing/ Assessment

• Diagnoses

• Planning

• Implementation

• Reflecting /Evaluation

Noticing/ Assessment

• Initial Assessment

• Recognizing spiritual decline

Diagnoses

• Maintain spiritual wellness

• Identify emotional distress

Planning

Provide Spiritual care

Implementation

Support Religious practices

Reflecting /Evaluation

Outcomes of care

Initial Assessment

SPIRIT

• Spiritual belief system

• Personal spirituality

• Integration and Involvement in a spiritual community

• Ritual practices and Restrictions

• Implications for medical care

• Terminal events planning (advance directives)

Recognizing spiritual decline

• Explore preferences

• Recognize spiritual health decline

• Environment

• Language

• Behaviors

Provide Spiritual care

• The patient will resume spiritual practices while hospitalized.

• The patient will verbalize acceptance of and start to make peace with the medical diagnosis before being discharged.

• The patient will state feeling a sense of hope and purpose.

Support Religious practices

• Provide spiritual care actions

• Support religious practices

• Reconnection

SPIRIT

• Spiritual belief system

• Personal spirituality

• Integration and Involvement in a spiritual community

• Ritual practices and Restrictions

• Implications for medical care

• Terminal events planning (advance directives)

Concepts Related to Spirituality

• Comfort

• Culture and Diversity

• Legal Issues

• Nutrition

• Sexuality

• Stress and Coping

Comfort

Spiritual / religious beliefs may dictate how to interpret and relieve pain and discomfort.

Culture and Diversity

Religion, an expression of spirituality, is often intertwined with culture.

Legal Issues

Western cultures, such as those in North America, have federal laws protecting personal religious liberties.

Nutrition

Spiritual / religious beliefs often have specific guidelines for dietary foods and beverages (e.g., vegetarianism, abstinence from alcohol). Some religious holidays are observed with fasting from all or certain specified foods and beverages.

Sexuality

Practices related to sexuality, such as family planning/birth control, may be influenced by spirituality.

Stress and Coping

People can use positive and negative religious coping strategies. Negative religious 

coping is associated with spiritual discomfort and poor outcomes.