1. Chapter 21: Culture and Spirituality

2. Learning Objectives Cite cultural demographic trends in United States.
Discuss the importance of assessing health literacy and usage of translation services.
Discuss various interventions to provide culturally aware care to elders from culturally diverse groups.
Differentiate between religiosity and spirituality.

3. Learning Objectives
Identify how nurse’s attitudes and beliefs about spiritually impact nursing practice in relation to holistically caring for the older client.
Identify strategies that could assist the nurse to be productive in conducting a spiritual assessment with the older client.
Recognize resources available to the professional nurse working with an older client assessed and diagnosed with a “loss of spiritual integrity.”

4. Culture and Cultural Awareness
Cultural diversity in the U.S.
Patients have better outcome when their culture is considered
Characteristics of the five major ethnic groups in the united states
European Americans
African Americans
Hispanic Americans
Asian Americans
Native Americans

5. European Americans
Presenting a stoic attitude about illness not to be a burden on others.
Tend to rely on science rather than rely on God.
Individualistic
Tend to follow advice of healthcare providers
The top five health disparities (white non-Hispanic):
smoking by pregnant women
drug-induced deaths
deaths from poisoning
deaths from melanoma
deaths from chronic lower respiratory disease before age 45

6. African Americans
The role of religion and spirituality plays an important part in wellness belief system.
Have less control over their health than God.
The top five are:
1, 2. new cases of gonorrhea
3. congenital syphilis
4. new cases of AIDS
5. deaths due to HIV infection
None of the above top 5 diseases are even in the top 10 for European Americans. – health disparity

7. Hispanic Americans Hi value on family, religion, and community
The top five health disparities are:
congenital syphilis
new cases of tuberculosis
new cases of AIDS
exposure to particulate matter
cirrhosis deaths (Keppel, 2007)
Diabetes and Heart disease are two health problems that have an increased prevalence and mortality in Hispanic Americans.

8. Asian Americans Silence is gold.
Avoid eye contact since it means disrespect
Hardly say “no”. Nodding head doesn’t mean he/she agree but etiquette.
The top five are:
new cases of tuberculosis
congenital syphilis
no Papanicolaou (Pap) test among females older than 18
exposure to particulate matter
carbon monoxide exposure

9. Native Americans Naturalistic approach to health and illness
Health is a balance of the mind, body, spirit
The top five health disparities are:
fetal alcohol syndrome
smoking by pregnant women
alcohol-related motor vehicle deaths
cirrhosis deaths
new cases of gonorrhea

10. Special groups (P )
Mormon: avoid coffee & tea, alcohol, caffeine; apply olive oil to patient
Islam: Fasting during certain times: Ramadan-holy month of fasting
Orthodox Judaism: Hold Tx schedule on Saturday; Kosher food; Avoid eating milk and meat together; Avoid leave dead body alone and family will stay; Avoid eating pork, crab, lobster, shell, octopus; Avoid autopsy

11. Special groups Christian science: “Sickness is an illusion
that can be corrected by prayer alone.”
- Avoid medical care; prayer is most effective
See Appendix A, pp.786 – 791 Spirituality and culture: Roman Catholics, Buddhist, Christian Science, Islam, Jehovah’s Witnesses, Judaism

12. Culture and Cultural Awareness
English language proficiency – do not ask family member, specially a child, to interpret
Limited English Proficiency (LEP)
Speak only English – 79.4%
Speak language other than English – 20.6%
Speak English “very well” – 11.9
Speak English less than “very well” – 8.7%
Translation services required for LEP patients; inadequate interpretation is a form of discrimination. Needs interpreter or sign language, or phone interpretation.

13. Culture and Cultural Awareness
Culture and nursing care history
Transcultural Nursing Society (TNS)
Awareness of cultural patterns and factors is essential for evidence-based care of older adults (Ethnogeriatrics)

14. Culture and Cultural Awareness
Care interventions and cultural awareness
Cultural congruence: understand different cultural and religious preferences, customs, and restrictions; use this knowledge in planning and providing care.
Dietary needs
Economic diversity
Religion and faith practices
Health care

15. Interventions To promote diversity in the Health Care Team:
Avoid stereotyping
Learn about other cultures
Learn from each others strengths
Overcome racism
Decrease language barriers
Educate self and others

16. Racist comments from Patients
Reporting
Educating
Redirecting
Providing culturally competent care
Educate self about the culture that is unfamiliar
Provide culturally appropriate care.

17. Spirituality and Religiosity
Spirituality and the nursing profession
Facilitating the client’s spiritual well-being
Holistic nursing practice mandates addressing client’s spiritual needs
Nurses must make time to first assess their own personal attitudes, values, and beliefs regarding spirituality.

18. Spirituality and Religiosity
Providing spiritually competent care
Spirituality related to a sense of well being in the elderly (faith, values, ethics, rituals, religion,…)
Many use prayer and faith as successful coping strategies
Provide opportunity to practice religion
Incorporate spiritual leader into the team if needed
Religiosity is religious activity, dedication and belief.

19. Summary
Holistic nursing practice requires a complete client picture through careful assessment
Culture and spirituality reflect client’s core values
Cultural assessments, spiritual screening, spiritual health histories, focused spiritual assessments help identify spiritual strengths
Plan with client for spiritual needs that impact health