Transcultural Nursing Care

Meeting the spiritual needs, and religious differences of your

patients.

Spirituality and Religion

A person’s spirit: is the very essence of the person, the life force, and includes the beliefs and values which provide strength and hope for that person

Religion tries to make rules and capture the experience of spirituality into a defined system

Providing Spiritual Care

Involves helping patients develop awareness and maintain the following: Inner strength Self awareness Life’s meaning and purpose Relationship to others Relationship to higher power

Identifying your patient’s spiritual care needs Crisis situations often arise in acute

care areas. Patients beliefs and values affect how

they respond to these crisis, their attitude towards treatment and their rate of recovery.

Nurse’s should be alert to the following when assessing for spiritual needs Hospitalization Patients who are in pain Patients with chronic or incurable disease Patients who are dying Families who have experienced the death of

a loved one Patients who are facing an undesirable

outcome of illness, such as amputation Patients who have lost control of themselves

Spiritual Care Interventions

Ask open ended questions Actively listen to the patient, sit beside the

patient and maintain eye contact Be nonjudgmental of patients and their

responses Avoid giving advice or a lecture to patients Be aware of nonverbal messages from the

patient Expect to learn from patients

Spiritual Care Interventions

Understand the feelings of your patients but avoid adopting those feelings for yourself

Stay with patient after the person has received an unfavorable diagnosis

Assist the patient to participate in desired religious/spiritual rituals

Protect the patient’s religious/spiritual articles

Western Religions in the United States and Canada Judaism, Christianity, and Islam are

common western religions that patient’s often practice

Judaism

Oldest faith to have belief in one God. The Holy Books of the Jews are the

Torah and the Talmud Followers of Judaism are called Jews Jewish clergy are called rabbis Jews worship in buildings called

temples or synagogues

Judaism

The major divisions of Judaism are the following three: Orthodox Judaism – follow the traditional faith and

strictly adhere to rituals, including kosher diet and keeping of the Sabbath, they do not completely integrate into modern society, Jewish identity is passed on through the mother

Conservative Judaism – follows most traditional practices but adapt traditions to modern world

Judaism

Reform Judaism – stress the ethical and moral teachings of the prophets and autonomy of the individual. Rituals are performed which will promote a Jewish God filled life. Allow Jewish identity to be passed on from the fathers side as well – largest and fastest growing segment of Judaism

Judaism

General beliefs Believe in God but not in Christ Avoid references to heaven and Jesus Sabbath is from sunset Friday until after

sunset Saturday if observed. Dietary rules are Kosher – separate

utensils for preparing and serving meat and milk dishes

Judaism

Meat may be consumed a few minutes after drinking milk, but 6 hours must pass after eating meat before drinking milk

Some Jews will avoid eating pork, ham, Canadian bacon, eel, oysters, crab, lobster, shrimp, or eggs with blood spots

Christianity

Belief that Jesus Christ is the Son of God Followers are called Christians The Bible is the sacred book and is divided

into the Old and New Testament Baptism is the rite of admission to the

Christian community and may be performed if an infant is felt to be near death by anyone with the right intention

Judaism

Dying patient – family and friends may want to be with the patient at all times

Some do not believe in autopsies, embalming, or cremation

Some Jews will not want the nurse to touch the body of a dead Jew and will want the Burial Society to complete the preparation

If nurse must touch body wear gloves

Christianity

Three major divisions: Catholicism

Clergy are called Priest

Protestantism Clergy are called ministers, pastors

Eastern Orthodox Clergy are Bishops, Priest, and Deacons

Roman Catholic

Baptism is necessary for salvation Dietary Restrictions: if 14 years of age or

older are to abstain from meat on Ash Wednesday and all Fridays during Lent. Catholic from 14 – 59 are to fast (eat one full meal and two lighter ones on Ash Wednesday and Good Friday

Fasting and abstaining is excused during hospitalization

Roman Catholic

Death – patients may wish to receive the last sacrament of the Christian, in addition to the anointing of the sick by a Priest

Cremation and organ donation are allowed

Eastern Orthodox

Baptism is necessary for salvation Dietary restrictions: abstain from meat and

dairy products on Wednesdays and Fridays during Lent. Ill Patients are excused from this requirement

Dying patient – Last Rites are obligatory and performed by Priest, preferably while patient is conscious.

Autopsy and organ donation are not encouraged Euthanasia and cremation are discouraged

Protestant

Old Order Amish Assembly of God Baptist Episcopalian Lutheran Methodist Presbyterian Quakers Seventh Day Adventist United Church of Christ

Protestants

Emphasize individual responsibility and conscience over following tradition or religious authority

Follow the Bible Food is individual choice Death – Personal choice of patient and

family, clergy my visit. Organ donation, autopsy, burial, and cremation individual choice

Islam

Muslims believe in one God called Allah Holy Book is the Koran Muslims pray in Arabic and worship in

Mosques The Imam is the leader of the Muslim

population

Islam

Follow the Five Pillars of Faith The Profession of Faith – verbal pledge that there is only one

God, Allah and that Muhammad is the messenger of Allah. (Muslims mothers may whisper this pledge into a newborn’s ear.)

Prayer – called to prayer 5 times per day Almsgiving – annual payment of a certain percentage of a

Muslim’s wealth and assets and is distributed among the poor Fasting – During Ramadan, the 9th month of the Islamic

calendar, adult Muslims abstain from dawn to sunset from food, drink and sexual activity

Pilgrimage – adult Muslims who are physically and financial able are expected to perform pilgrimage to Mecca at least once in lifetime

Islam

Pray to Allah 5 times per day (after dawn, at noon, in mid afternoon, after sunset and at night

If patient request to face Mecca, bed or chair may be positioned in a southeast direction from the United States

If the Koran is in the room do not touch it or place anything on top of it.

Islam

If Muslims wear writings from Koran on a black string around the neck, arm, or waist, these writings need to be kept dry and remain on the patient

Rules of cleanliness may include eating with the right hand and cleansing self with the left hand after urinating and defacating

Islam

Dietary – some Muslims will not eat pork and pork products, eel, oyster, crab, lobster, shrimp, and meats from animals that have not been bled to death by a Muslim

Islam

Death practices: Women may be barred from the room of a dying family

member Family may pray for dying member and Imam usually reads

from the Koran for the patient after death After death family washes the body including all orifices Nurse may touch body only after donning gloves Body is wrapped in white cloth for burial Family may not permit organ donation, autopsies, or

cremation No embalming after death Try to bury the dead within 24 hours

Important points on other various Religious groups Christian Scientist –

No clergy – but may request a Christian Scientist practitioner to give treatment with prayer

No baptism Consider the Lord’s Supper a spiritual communion

with God and may sit quietly during this time. No smoking or drinking alcohol Do not accept blood transfusions or surgery Feel studying Eddy’s book and the Bible will heal

them

Jehovah Witness

Baptism necessary for salvation Beliefs based on the Bible No ordained ministers No churches but worship in Kingdom Halls Publications include Awake and Watch Tower Refuse blood products including plasma, will accept blood

transfusion alternatives Alcohol and tobacco are discouraged Believe soul dies at death Autopsy decided by family Cremation is acceptable Organ transplants personal decision – must be cleansed with

non blood solution

Mormons

The Book of Mormon is considered complimentary to Bible Worship in temples and tabernacles No ordained clergy High priests are members of the Church and form the Council of

Twelve and exert spiritual leadership May avoid alcohol, tobacco, coffee and tea Baptism is necessary for salvation No restrictions on blood, or medications, may use herbal

medicines, organ donation permitted Promote dignified death, organ donation personal choice,

autopsy permitted with consent of family, burial in temple clothes

Eastern Religions in the United States and Canada Buddhist

Illness result of Karma (cause and effect) Foods – extremes are to be avoided –many do not

eat meat No restrictions on blood or medical therapy, organ

donation is allowed Death – body is shell(treat with respect), autopsy

and burials are personal wishes – burial and cremation allowed, ensure calm and peaceful death – it is important for family members to relate that patient had calm and peaceful death

Hindu

Some may wear a thread on the torso that should not be removed except in annual ceremony

Daily bathing but not after a meal Most are vegetarians Right hand used for eating, left is used for

cleansing Medication, blood and blood products,

donation, and receipt of organs acceptable

Hindu

Patient should be allowed to die peacefully Believe in rebirth Autopsy and organ donation acceptable Immediately after death priest may pour water

into mouth of corpse and family may wash body

Cremation common, ashes disposed of in holy river

Priests unlikely to be involved with illness