Cultural and Spiritual Nursing Care

Cultural and Spiritual Nursing Care

• Cultural and spiritual backgrounds and belief systems differ among clients
• Some people identify with multiple groups and their traditions, values, and practices
• Transcultural nursing involves comparing cultures to give culturally sensitive care
• Spirituality is one's process of self-discovery, coping, and health maintenance
• Spirituality is personal and subjective

Culture

• Culture contains similarities shared among a group's members
• Culture includes ways of thinking, language, customs, and communication
• Cultural commonalities can be linked by ethnicity, race, nationality, language, religion, and location
• Cultural concepts include sexual orientation, class, and gender
• Culture influences health beliefs, practices, responses to, and treatment of illness
• Culture evolves and is shared by members who share needs and life experiences
• Ethnicity is the shared identity, bond, or kinship with one's country of origin
• Race has traditionally been connected to shared origin, genetic, or biological traits
• Races cannot be scientifically identified, but the concept is used to identify groups
• Subcultures are smaller groups sharing cultural values with a larger group
• Acculturation is adapting practices of a dominant culture when exposed to it
• Assimilation is adopting a predominant culture, forming a new cultural identity
• Multiculturalism includes multiple cultural group influences, preferences, and shared values
• Avoid stereotyping by assuming group generalizations are true for everyone in the group

Assessment/Data Collection

• Cultural awareness requires nurses to know their own cultures and other cultures
• Cultural awareness aids in understanding, eliminating, and identifying potential bias
• Bias can be unconscious or implicit, impacting care delivery
• Unconscious bias is a non-self-controlled judgement, influenced by heritage and encounters
• Implicit bias involves self-awareness of personal judgements

Cultural Assessment/Data Collection

• Cultural assessment needs interviewing skills, health history, and physical assessment
• Cultural assessment requires a shared language or approved medical interpreter
• Always inform the interpreter of questions to be asked
• Focused, open-ended, nonjudgmental questions are to be used
• Listen and paraphrase to decrease misinterpretations
• Avoid assumptions
• Observe clients and their environment for cultural relevance
• Therapeutic relationships can be hindered by communication misinterpretations

Nonverbal Communication

• Nonverbal behaviors vary among cultures
• Gestures, vocal tones, and inflections should be assessed
• Interactions with visitors can cue the nonverbal communication style
• Be aware of personal nonverbal behaviors and how they might be interpreted
• Cultures differ in their tone of voice
• Culture varies on the comfort level of direct eye contact
• Gazing downward can demonstrate authority
• Equal eye level while sitting can demonstrate respect
• Facial expressions can vary among cultures
• Permission is needed before touching anyone
• Spatial preferences range from valuing large personal space to closeness
• Mirror the client's use of distance during interactions
• Silence can indicate respect, agreement, and providing privacy
• Posture and gesturing can vary across cultures
• Hand symbols should not be used unless you have seen that client make this gesture
• Erect posture indicates self-confidence
• Slouched posture could be interpreted as the opposite, or a health problem
• Body posture should be observed when the client is sitting, lying, and interacting with friends

Patient-Centered Care

• Care should promote health equity for all
• The LEARN assessment tool can promote culturally competent care
• Listen, Explain problem perceptions, Acknowledge difference, Recommend treatments, Negotiate

Culturally Responsive Nursing Care

• Culturally responsive care transcends cultural boundaries and considers beliefs
• Client decision-making ensures respect, sensitive care, and effective treatment plans
• Cultural awareness means nursing awareness of personal cultural attitudes
• Cultural sensitivity means nurses are knowledgeable about cultures
• Cultural appropriateness means nurses apply awareness of client's cultures to care
• Cultural competence involves understanding and addressing the whole cultural context
• Competence is developed through varied client encounters
• Cultural imposition is ethnocentrism, where nurses impose their culture onto others
• Cultural imposition can be referred to as cultural blindness

Pain

• Cultural and religious beliefs influence the meanings of pain
• Pain reactions, displays, and relief vary by cultures
• An alternate pain sclae should be used rather than (0-10)

Other Nursing Considerations

• Nutrition: Provide food choices consistent with client's cultural beliefs
• Nutrition: Allow clients to eat foods viewed as treatment for illness
• Nutrition: Ethnicity-related allergies/intolerances should be given to dietary staff
• Family/Gender: Include decision-makers and the role of family members
• Life Transitions: Assist families as they mark cultural rituals and values
• Repatterning: Accommodate beliefs and try to repattern in favor of health promotion
• Communication: Improve nurse-client communication by establishing rapport with the client/family
• Interpreters: Use a facility-approved interpreter
• Allow time for the interpreter and family to be introduced
• Speak clearly and slowly and avoid metaphors
• Questions should be directed toward the client, not the interpreter
• Observe the client’s verbal and nonverbal communication
• Get client feedback
• Do not interrupt anyone
• Stop and address a conversation that doesn't seem to be going well
• Nonverbal communication should be used cautiously
• Apologize if any cultural beliefs or traditions are violated
• Explain: Ask the clients to express thier perception of a problem
• Treat: How was the problem treated before
• Healers: Alternate type of practitioners sought for treatment
• Negotiate options
• Intervene with possible alternate treatments
• Collaborate with family, client, health team, healers, and available resources
• Personalize cares such as language, healthcare, personal beliefs and treatment
• The National Culturally and Linguistically Appropriate Services (CLAS) guide health care
• The National Culturally and Linguistically Appropriate Services (CLAS) require:
  • Providing language assistance
  • Informing clients of language services
  • Learning materials in their preferred language

Health Disparities

• Health disparities are differences in health status when populations are compared
• Health disparities are linked to cultural groups, lower socioeconomic status, and age
• Low-income groups have less access to health care than high income groups
• Black and Mexican American children are more likely to be hospitalized for asthma
• Scientific practices not adopted when a lack of understanding medical terminology exists

Barriers to Culturally Responsive Nursing Care

• Language discrepancies cause communication issues
• Some tests can be culturally inappropriate leading to misdiagnosis
• Ethnic variations can be due to varied drug metabolism

Other Considerations

• Discrimination involves unfair treatment based on group association
• Prejudice means making assumptions without considering all of the information available
• Ethnocentrism is the belief that your own culture is more superior than another one

Spirituality

• Spirituality balances and maintains one’s health when coping with illnesses
• Hope, faith, and transcendence are integral parts of spirituality
• Connectedness empowers clients through life's stressors
• Intrapersonal: within one's self
• Interpersonal: with others and the environment
• Transpersonal: with an unseen higher power
• Faith is a belief in something or a relationship with a higher power defined by culture/religion
• Hope is optimism, providing comfort
• Transcendence is a superior force beyond the person/material world
• Self-transcendence is an authentic inner self connection
• Spiritual well-being can promote connectedness
• Coping with healthcare issues can come from spiritual practices and the basis systems
• Questioning or lack of support from a belief system causes distress
• Spiritual distress is a challenge to belief systems that can cause hopelessness
• Nursing interventions identify, restore, and connect clients to strength
• Religion expresses spirituality outwardly via worship, sect, or spiritual denomination

Assessment/Data Collection of Spiritually

• A spiritual assessment includes self-reflection, religion, and risk identification
• Spirituality requires rapport/trust among the client, family, and provider
• Spiritual screening requires the following questions:
  • How important is your religion and faith?
  • How can spiritual well-being be supported?
  • Would they like someone from spiritual services to visit?
• The FICA model can be used to understand beliefs
  • Faith: what gives you a sense of purpose
  • Influence: how do your beliefs affect you
  • Community: who shares these beliefs
  • Address: how to incorporate and make treatment choices
• Prayer books, expression, behavior, and attitude are initial cues
• Beliefs, culture, satisfaction, and rituals need to be looked at

Patient-Centered Care and Spirituality

• Honor/respect the client and interfaith practices
• Care includes:
• Identifying perception of a higher power
• Facilitating connecting
• Assess the environment
• Allow time for rituals
• Pastoral care is appropriate
• Promoting healing
• Support: -Holistic -Identification
• Awareness of diet
• Icons
• Statues
• Prayer rugs
• Devotional reading
• Music
• Restorative: -Prayer -Meditate -Grief work
• The evaluation of care is continuous