Cultural Diversity, Spirituality & Sexuality in Patient Care

Culture & Cultural Diversity

• Culture: shared system of beliefs, values, behavioral expectations.
  • Shapes daily life: language, non-verbal cues, music preference, food, family roles, health practices, decision-making.
  • Example: Instructor raised on 1980s hair bands → music taste still influenced.
• Cultural Diversity: coexistence of multiple cultural identifiers (ethnicity, sex, sexual orientation, occupation, geo-location, socioeconomic status, etc.).
  • Encountered “all day every day” in health-care settings.
• Ethnicity vs. Race
  • Ethnicity = sense of identification with a cultural group; rooted in shared heritage, dialect, religious practice, behavior patterns.
  • Race = externally assigned category often based on physical traits; not interchangeable with ethnicity.
• Ageism (& other “-isms”): stereotyping based on age, race, gender, etc. can lead to incorrect clinical assumptions.

Cultural Competence in Nursing

• Impossible to master every belief system → focus on cultural humility & inquiry.
  • Ask specific questions: “What aspect of your belief influences this decision?” rather than generalizing.
• Patient-Directed Spiritual Interventions
  • Offer prayer only if patient requests and nurse is comfortable; otherwise facilitate alternative support (chaplain, family member).
• Avoid visual-cue assumptions
  • A Spanish-speaking doctor & Mexican patient may still have very different cultural needs.
  • Preference matching (e.g., female doctor) is valid but must be patient-driven.

Pain, Illness & Cultural Expression

• Cultural variation in pain perception & expression
  • Some groups consider pain a rite of passage (e.g., unmedicated childbirth as spiritual duty).
  • Failure to assess leads to undertreatment or overtreatment.
• Evidence base often Western-centric → broaden research & care strategies.

Communication & Social Values

• Literacy, educational level, and cultural norms affect verbal communication.
• Dominant family roles vary (male-headed, matriarchal, elder-led). Nurses must identify the true decision maker.
• Health-promotion messages (prevention, lifestyle counseling) must align with patient’s future-orientation and belief in controllability.

Transcultural Assessment: ESFT Model

1. E – Explanation
   • “What do you think is going on?”
2. S – Social & Spiritual factors
   • Family, community, faith practices influencing health.
3. F – Fears & Concerns
   • Worries about treatment, stigma, side effects, cost.
4. T – Therapeutic Contracting & Collaboration
   • Negotiating a care plan that honors beliefs while meeting clinical goals.

Spirituality, Faith & Religion

• Universal spiritual needs
  • Meaning/purpose, love/relatedness, forgiveness.
• Higher Power can be deity, cosmos, universe, Mother Earth, etc.
• Faith = confidence without empirical proof.
• Religion = organized system of beliefs, rituals, worship.
• Nursing role
  • Help patients derive meaning from illness and maintain spiritual practices (arranging sacred texts, diet, rituals, clergy visits).

Sexuality & Sexual Health

• Sexuality expressed through diverse identities & behaviors; strongly affected by gender norms, power dynamics, culture, environment.
• Genderbread Person model
  • Gender Identity: woman ↔ man ↔ non-binary/androgynous.
  • Gender Expression: feminine ↔ masculine spectrum perceived by others.
  • Biological Sex: chromosomal & anatomical attributes XX (typically female) vs. XY (typically male) with natural variations.
  • Sexual Orientation: attraction to genders (heterosexual, homosexual, bisexual, asexual, etc.).
• Developmental trajectory
  • Sexuality forms from birth; intellectual disability ≠ lack of sexual development → need education on consent & safe sex.

Factors Influencing Sexuality

• Developmental stage (childhood, adolescence, adulthood, older adulthood).
• Culture & Religion
  • Cultural “norms” dictate acceptable behaviors, partner choice, expression.
  • Many religions valorize virginity; sexual expression sometimes framed negatively.
• Physical Health
  • Menstruation, menopause, chronic illness (cardiac, diabetes, pain disorders) can alter sexual functioning.
• Mental Health
  • Depression, anxiety may reduce libido; conversely, sexual dysfunction can worsen mental distress.
• Relationship quality & power dynamics

Sexual Dysfunctions & Health Problems (selected)

• Erectile dysfunction, premature or delayed ejaculation.
• Dyspareunia (painful intercourse), vaginismus.
• Orgasmic disorders, hypoactive sexual desire.
• Risk of STIs increases with unprotected contact in any orifice; comprehensive sexual history essential.

Medications Impacting Sexual Expression

• Antihypertensives (e.g., beta blockers, ACE inhibitors).
• Antidepressants (SSRIs, SNRIs, tricyclics).
• Narcotics / opioids
• Counsel patients: sexual health still matters; adjust regimen or add interventions when problems arise.

Nursing Assessment & Care Strategies

• Holistic history: culture, spiritual beliefs, sexual orientation, practices, partner status, contraceptive use.
• Open-ended, non-judgmental questions; use inclusive language (“partner” instead of “husband/wife”).
• Respect privacy & confidentiality
• Provide resources: interpreters, chaplaincy, sexual health education, support groups.
• Document patient preferences to guide all interdisciplinary team members.

Ethical & Practical Implications

• Autonomy & dignity: honoring belief systems while ensuring evidence-based care.
• Non-maleficence: avoid harm from stereotyping or cultural imposition.
• Beneficence: facilitate optimal spiritual and sexual well-being, recognizing both impact overall health.
• Justice: equitable care across diverse cultural and sexual identities.