1. 1 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Chapter 21 Cultural and Spiritual Awareness

2. 2 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Cultural and Spiritual Awareness  Define cultural competence  List practice issues related to cultural competence  Identify challenges in defining spirituality  Determine cultural and spiritual beliefs of clients in the health care setting  Assess spiritual needs of clients in the health care setting

3. 3 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Culture and Spirituality  What is meant by cultural competence?  Code of Ethics states—When planning health care, consider lifestyles, values, and religious beliefs  Cultural competence Awareness of own existence, sensations, thoughts, and environment Having no undue influence on others Understanding others’ cultures; accepting and respecting cultural differences

4. 4 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Culture and Spirituality (cont’d)  What is meant by cultural competence?  “The process in which the healthcare professional continually strives to achieve the ability and availability to work within the cultural context of a client—individual, family, or community” (Campinha-Bacote, 2003) Cultural awareness Cultural knowledge Cultural skill Cultural encounter Cultural desire BOX 21-1: Culture- A Nursing Approach

5. 5 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Culture and Spirituality (cont’d)  What practice issues are related to cultural competence?  Barriers to cultural competence Provider barriers—for example, lack of information about a culture Systems barriers (exist within an agency)—for example, structure/policies not designed to support cultural diversity  Nurses need to assess/determine their strengths and weaknesses

6. 6 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Culture and Spirituality (cont’d)  What practice issues are related to cultural competence?  Health and health care disparities Inequalities in disease morbidity and mortality, due to:  Genetic variations  Environmental factors  Health behaviors Inequalities in income and education  Low income and education levels

7. 7 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Culture and Spirituality (cont’d)  What practice issues are related to cultural competence?  Health and health care disparities Provider variables  Provider/client relationships  Provider bias and discrimination  Lack of minority providers Client variables  Refusal of treatment  Mistrust of the health care system

8. 8 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Culture and Spirituality (cont’d)  Health and health care disparities  Possible solutions Increase health care provider diversity Ensure access to basic health care for all clients Promote wellness and healthy behaviors Strengthen provider/client relationship Conduct research Increase cultural competency of health care providers

9. 9 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Culture and Spirituality (cont’d)  What is the meaning of spirituality?  No clear definition  Should not to be equated with religion  Spiritual nursing care Intuitive Interpersonal Altruistic Integrative Contingent on nurse’s awareness of transcendent dimension of life, reflects the client’s reality

10. 10 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Culture and Spirituality (cont’d)  Spiritual nursing interventions  Prayer  Presence  Scripture reading  Meditation  Validation of client’s thoughts  Music  Pastoral care  Active Listening  Peaceful environment  Trusting relationship

11. 11 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. ASIAN PACIFIC ISLANDER  Extended Family  Older Male Family Members Honored  Avoid Conflict  Respect Authority  Medicine Man

12. 12 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. CHINESE  Do not discuss mental illness  Use Herbalists

13. 13 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. JAPANESE  Contact with blood, skin diseases cause illness  Improper care of body causes illness  Believe in healers  Group discussion  Disability is a family shame, Mental illness is Taboo  Pain is not expressed

14. 14 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. HINDU AND MUSLIM Emotional and mental retardation is not acknowledge Use Modern and traditional practice

15. 15 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. VIETNAMESE  Slow to trust authority  Patriarchal society

16. 16 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. HISPANIC  Consult with older family members, usually older men.  Illness is God’s Will  Home Remedies  Hot and Cold Therapy

17. 17 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. AMERICAN INDIAN  Oriented to present  Value family and spiritual belief  Strong ties to family and tribe  State of health with harmony  Medicine man, distrust healthcare providers

18. 18 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Cultural and Spiritual Assessment  Cultural and spiritual beliefs about illness and cures can involve various types of therapy:  Complementary  Alternative  Integrative modalities

19. 19 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Cultural and Spiritual Assessment (cont’d)  How do you assess spiritual need?  Use specific spiritual assessment tools  Integrate tools into assessment document (cont’d)

20. 20 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc.  How do you assess spiritual need?  Consider the seven spiritual dimensions Experience of God or transcendence Spirit-enhancing practices or rituals Involvement in a spiritual community Sense of meaning Giving and receiving love, or connectedness to self Sources of hope and strength Link between spirituality and health Cultural and Spiritual Assessment (cont’d)

21. 21 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc.  Spiritual Assessment Tool (by Dossy and Guzzetta)  MEANING AND PURPOSE Questions assessing a person’s ability to seek meaning and fulfillment in life, manifest hope, and accept ambiguity and uncertainty  INNER STRENGTHS Questions assessing a person’s ability to manifest joy and recognize strengths, choices, goals, and faith  INTERCONNECTIONS Questions assessing a person’s positive self-concept, self-esteem, and sense of self; sense of belonging in the world with others; capacity to pursue personal interests; and ability to demonstrate love of self and self-forgiveness Cultural and Spiritual Assessment (cont’d)

22. 22 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc.  It gives me a deep comforting sense that “things seen are temporal and things unseen are eternal.” –Helen Keller