Spirituality, Culture & Diversity

Three spiritual needs common in all people

-Need for meaning and purpose

-Need for love and relatedness

-Need for forgiveness

Influences of spirituality on everyday living

-Dietary requirements

-Restrictions

-Birth control methods

-Alcohol and tobacco restrictions

Influences of spirituality on health

-Source of strength and healing > positive outcomes with positive outlook

-Source of support - Reaching out to spiritual connections for guidance and support (prayer, devotional reading, practices) (ex: Chaplin, clergy members, faith community)

Influences of spirituality on illness

-Some groups see illness as a passion of God

-May feel like they're getting punished

Life-affirming influences of religious beliefs

-Enhance life

-Give meaning and purpose

-Strengthen feelings of self-worth

-Encourage self-actualization

-Health giving

-Life sustaining

Life-denying influences of religious beliefs

-Restrict or enclose life patterns

-Limit experiences and associations

-Place burdens of guilt on people

-Encourage feelings of worthlessness

-Health denying

-Life inhibiting

Spiritual beliefs and practices of religions

Jehovah's Witness

-Blood transfusions = unaccepted

-Do not want others' blood

Judaism

-Circumcision on eighth day

-Dietary: not eat pork, they eat what bible talks about

-Fish must have scales

-Not accepting anything porcine (pork) (ex: heparin)

Islam

-Same dietary restrictions as Judaism

-Women cannot be taken care of by male and must have female nurses/CNA

-Only husbands can take care of them

-Ramadan fast (order food and put it aside so patient can fast)

-Some moments peoples' conditions can be excused from fasting

Hinduism

-Dietary restrictions: cattle is sacred (no beef)

-Taboos about fingers touching lips when giving medications and feeding

-Specific rights surrounding death (favor cremation)

Buddhism

-They don't take drugs

-Don't accept blood transfusions or vaccines

-Certain days are reserved

5 factors that influence spirituality

-Developmental stage: in adolescence, they have their own spiritual life, either accept or reject it or add to it

-Family: Extended and community

-Ethnic background: Family and community we grow up in and how things are practiced

(ex: Worship services are different such as Adventist to BSU)

-Formal religion

-Life events: Birth, circumcision, celebrations of birth, coming of age (ex: age 13 for Judamism), death has symbolism and traditions

Nursing assessment of spiritual health

H: Sources of hope, comfort, strength, peace, love, and connection

O: Organized religion

P: Personal spirituality and practice

E: Effects on medical care and end of life planning

-Best to do at end of assessments

ex: What spiritual practices are important to you when you have this illness?

Nursing diagnoses that correctly identify spiritual problems

-Spiritual distress: conflict between beliefs and what is happening to them, other people are pressing their beliefs on them

-Impaired spiritual status

-Suffering

-Risk for conflicting religious belief

-Ineffective coping

-Spiritual pain

Strategies to promote spiritual health

-Support religious practices

-Be aware of potential limitations

-Lead to better health outcomes and patients will feel involved

Plan, implement, and evaluate nursing care involving spiritual problems

Ineffective coping r/t son passing away and abdominal pain AEB lost 10 lbs and the will to live

Plan:

-Pt will state 3 things in her life she is grateful for by the end of shift

Interventions:

-Give pt 10 minutes of time

-Listen to pt

-Chaplin and social-worker

Spiritual distress r/t belief of spiritual punishment AEB feeling written off by Yahweh

Plan:

-Pt will state 3 blessings present in his life related to his religion by the end of the shift

Interventions:

-Meet with Chaplin

-Being available for pt

-Clergy visit

Concepts of cultural diversity

-Culture: Behaviors/ways of thinking learned in social groups, including customs, beliefs, values, language and social patterns > learned, shared, knowledge r/t language (speak a language but blended), ethnicity (cultural group geographical but not always), religion, geographic location

Cultures are connected to certain foods and can tell when someone has an accent

Ex: people came to America and brought their culture with them

-Diversity: Array of differences among individuals, groups, and communities

We may have preconceived ideas based on how they present

Important to be open to how people express and aware of assumptions/biases

Concepts of respect

-Honoring others' cultural beliefs

-If pt knows we are caring and listening to them, they

feel heard and gives them more hope (ex: ask if pt has a

folk healer and arrange folk healer to come and what

they need to do to support pt (oxygen in room, no

burning of incense, safety restrictions))

-Nurses deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients > reduce health disparities and improve access to high-quality health care

Influences that affect culturally respectful health care

-Languge (communication) (professional interpreters to help pts who don't speak English) (we have vids for dementia pts)

-Stereotypes

-Bias (implicit - don't express outwardly but hold it internally)

-Cultural imposition - one culture imposes their culture onto another (ex: 1800s in the US and Europe)

-Cultural blindness: the way they interact with others might end up like cultural imposition and are unaware of cultural differences

-Cultural conflict (ex: conflict between Western medicines and beliefs)

Examples of how diversity affects health and illness care

-Dismissiveness (age, mental status)

-Reactions to pain (our perception of how people react to pain, also dismissiveness)

(ex: 8/10 pain > guarding and grimacing, but not everyone will react like this and are not drug seeking)

-Herbal medicine interactions

-Biological gender roles (ex: husband makes decisions for his wife, but we want the woman to make her own decisions) (if husband gets sick, then grandma makes the decisions)

-Language + communication (personal space, eye contact)

-Orientation to space and time

-Food/nutrition (certain conditions for food, not gonna be harmful to medical care, we should allow patients to bring food to show we care about their beliefs) (ex: someone prepares a chicken soup when someone in the family gets a cold, honey can be used medicinally and used in wound care)

-Family and support

-Socioeconomics (affect ability to afford treatment) (healthcare disparities, access, timeliness, substandard)

Factors commonly included in a transcultural assessment of health-related beliefs and practices

-How pt views illness

-What they call the illness (pneumonia used to be called consumption due to loss of strength and weakness and no antibiotics)

-Cultural beliefs around illness/health > body image

-Religious affiliation (understand pt's spirituality)

-Cultural healers (do they regularly see a cultural healer, what practices are important)

-How is Western medicine viewed (might be an access issue)

-How are mental disorders viewed

Practicing cultural respect when assessing and providing nursing care for patients from diverse cultural groups

-Awareness -> reflection

-Knowledge -> asking questions

-Listening

-Being considerate/open-minded

-Accommodating

Factors in the health care system and in nursing that facilitate or impede culturally competent nursing care

-Develop cultural self-awareness (examine your own beliefs, values, practices, and family experiences)

-Develop cultural knowledge (learn as much as possible about the belief system and practices in your community)

-Accomodate cultural practices (patient's cultural practices involved in health care) (ex: dietary practices)

-Respect culturally based family roles

-Avoid mandating change (be mindful of health practices that are part of the culture and provide support if it is necessary to change health practice for their culture) (pt forced to accept such care > feelings of guilt and alienation from a religion/culture)

-Seek cultural assistance from family member, clergy member, or traditional healer > pt more likely to accept health care services (ex: knowing role of traditional healer builds trust, folk medicine practitioners work with professional health practitioners in the interest of the patient and family) = mutual understanding, respect, and cooperation