BELIEFS, SPIRITUALITY, PATIENT CENTERED CARE (FINAL)

How Culture Relates to Spirituality

Culture shapes how people understand and express spirituality; culture provides the framework to learn what is sacred and meaningful, how to pray/worship/reflect, rituals around birth/illness/suffering/death, and ideas about the afterlife and moral values

Culture

The shared values, beliefs, behaviors, traditions, and norms of group that are learned and passed down through a community

How Culture Shapes Health Beliefs

Unique views on what causes illness, who should be involved in care, acceptable treatments, and pain expression

Culture Shapes Health Belief Example: Hispanic/Latino Families

May prefer family-centered decision-making; illness may be understood as an imbalance of hot and cold

Culture Shapes Health Belief Example: Chinese Culture

Traditional chinese medicine focuses on the balance of yin and yang, cosmic forces, acupuncture, and massage

Culture Shapes Health Belief Example: Indigenous Culture

Healing may involve connection to land, community, herbal medicines, spiritual rituals, and sweat lodges

Culture Shapes Health Belief Example: Western Biomedicine

Emphasis on diagnosis, medications, surgery, and evidence-based treatment

Areas of Healthcare Practice Affected by Culture

Diet, nutrition, home remedies, traditional healers, attitudes toward mental health, childbirth practices (positions, rituals), pain (management, expression), views on preventative care (vaccines, screening)

Culture: Nursing Considerations

Avoid assumptions, use open-ended questions, collaborate with the patient and care team

Spirituality

A person's search for meaning, connection, purpose, and value; may or may not involve religion

How Spirituality Impacts Health

Provide comfort, hope, coping mechanisms; influences end-of-life decisions; can affects beliefs about suffering, healing, and death

Sacred Symbols

Medals, clothing, body ornamentation, tattoos worn or presented as a symbol of faith

Prayer & Meditation

Communicating with a higher power to ask for strength, petition for a cure, reflecting in silence; should provide a quiet, private environment for practice

Spirituality Shapes Health Belief Example: Buddhism

Most illnesses can be cured through the mind and herbs

Spirituality Shapes Health Belief Example: Judaism

Participate in prayer three times a day; rabbi requested to be present at the time of death; must be buried within 24 hours of death

Spirituality Shapes Health Belief Example: Catholicism

Confess sins to a priest; require the priest to administer sacrament of Anointing for the sick, ill, or dying

Spirituality: Nursing Role

Conduct a spiritual assessment (faith, importance, community); understand patient and family expectations; facilitate access to spiritual leaders or chaplains; respect practices such dietary choices and prayer times

Components of Religion

Holy days, sacred writings, sacred symbols, prayers and meditation

Holy Days

A special day set aside for religious observance

Holy Day: Judaism

Yom Kippur, Sabbath

Holy Day: Catholicism

Easter, Christmas

Holy Day: Buddhism

Birthday of Buddha

Holy Day: Islam

Ramadan

Sacred Writing

Scriptures that are thought to be the word of higher power(s) that set forth rules to live by and can be a source of strength

Sacred Writing: Judaism

Torah

Sacred Writing: Catholicism

Bible

Sacred Writing: Islam

Quran

Decision-Making Models Across Cultures

Individual autonomy, family-centered, paternalistic, religious-based

Individual Autonomy Decision Making Model

Patient makes decision independently

Family-Centered Decision Making Model

Family elders or collective decision making

Paternalistic Decision Making Model

Health provider or authority figure decides; patient decision making is limited

Religious-Based Decision Making Model

Decisions guided by spiritual leaders or doctrines

Factors That Affect Decision Making

Health literacy, trust in the health system, cultural norms about authority and communication, language barriers, economic or social constrains

Nursing Strategies to Promote Decision Making

Provide clear and simple examples, use interpreters, ask who the patient would like included in decisions (family, clergy), avoid imposing personal values

Taboo

Prohibited or forbidden actions or behaviors based on culture and/or religious beliefs

Conditions Commonly Considered Taboo

Depression, suicidal thoughts, ADD/ADHD, AIDS/HIV

Key Elements of Patient Centered Care

Respect and dignity, information sharing, participation, collaboration

Patient-Centered Care

Care that respects the patient's preferences, needs, and values; involves patient in decision making; builds partnership and trust; recognizes the patient as a whole person

Behaviors that Support Patient Centered Care

Active listening, building rapport, using the patients preferred name and pronouns, asking about goals and expectations, supporting cultural practice when possible, providing unbiased and non-judgemental care

Considerations of Spirituality and Older Adults

May use prayer as a coping strategy, rely on loved ones for emotional comfort, reflect on the past and may have regrets

Spirituality: Asessment

Determine the patient's beliefs and needs; use open-ended questions regarding treatment, tests, and spiritual needs; make referrals to chaplain if patient expresses doubt in their commitment to religious beliefs

Spirituality: Implementing

Recognize sources of strength; facilitate reunion with distant loved ones; navigate policies and procedures for visitation; help family overcome fear or overwhelm of machinery; actively listen to the patient; provide quiet and relaxing atmosphere for the patient to engage in spiritual practices; encourage patient to relax and maintain calm