Cultural Religious Competence in Clinical Practice - StatPearls ...

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Continuing Education Activity
The diversity of religion within our world's population brings challenges for health care providers and systems to deliver culturally competent medical care. Cultural competence is the ability of health providers and organizations to deliver health care services that meet the cultural, social, and religious needs of patients and their families. Culturally competent care can improve patient quality and care outcomes. Strategies to move health professionals and systems towards these goals include providing cultural competence training and developing policies and procedures that decrease barriers to providing culturally competent patient care. This activity highlights the importance of cultural competence in clinical medicine and its consequences.
Introduction
The diversity of religions around the world creates challenges for health care providers and systems to provide culturally competent medical care. Cultural competence is the ability of health providers and organizations to deliver health care services that meet the cultural, social, and religious needs of patients and their families. Culturally competent care can improve patient quality and care outcomes. Strategies to move health professionals and systems towards these goals include providing cultural competence training and developing policies and procedures that decrease barriers to providing culturally competent patient care.[1][2][3][4]
Consequences of Cultural Competence Deficiencies
If providers and health care systems are not working together to provide culturally competent care, patients may have untoward health consequences, receive poor quality care, and be dissatisfied with the care they receive. The quality of patient-health professional interactions is decreased. Lower-quality patient-health professional interactions are associated with decreased satisfaction in the healthcare provider. In fact, African Americans, Asian Americans, Latinos, and Muslims report that the quality of their care was diminished because of their ethnicity or race.[5][6][7][8]
Why should providers and systems be culturally and spiritually sensitive? The Joint Commission (TJC) requires hospitals to be accountable for maintaining patient rights, including accommodation for cultural, religious, and spiritual values. Healthcare professionals and systems must care for patients as whole persons; this includes the body, mind, and spirit.
It is important for healthcare to include the cultural and spiritual needs of the patient. Healthcare professionals should be empowered with the knowledge and skills to respond to the needs of patients and their families at an intensely stressful time. Institutions that seek or maintain TJC accreditation need to demonstrate expertise in cultural and religious competence.
Health systems and healthcare providers are developing strategies and techniques to respond to the religious and spiritual needs of patients and families for a number of reasons. One reason is that, in addition to TJC, state and federal guidelines encourage institutional responsiveness to population diversity. These strategies are essential to meeting the federal government's Healthy People goal of eliminating ethnic and racial health disparities.[9][10][11][12]
Culturally Competent Medical Care
Patient's beliefs, behaviors, and values are shaped by factors such as ethnicity, gender, language, mental ability, nationality, occupation, race, religion, sexual orientation, and socioeconomic status. Cultural competence is the provider and systems able to understand and integrate cultural intelligence into the delivery of healthcare. The goal of providing culturally competent health care services is to provide consistent quality of care to every patient, regardless of their cultural, ethnic, racial, or religious background.
Strategies for improving cultural competence in individuals and systems include:
Encouraging family to participate in healthcare decision making.
Incorporating culture-specific values into health promotion
Providing cultural awareness training
Providing an environment that allows traditional healers
Providing interpreter services
Recruiting minority staff
When individuals and systems are able to provide a positive environment of cultural competence that meets the religious and spiritual needs of those who are cared for, the outcome for patients improves, and the healthcare system as a whole becomes a more positive environment.
Religion and Healthcare
Why are religion and spirituality important in healthcare? Religion and spirituality are important factors in the majority of patients seeking care. Unfortunately, health providers may not take religious beliefs into account when they are dealing with difficult medical decisions for patients and their families.
In the history of man, religious leaders and health providers were often the same. Only within recent times has medicine taken on a scientific approach that has resulted in a separation between medicine and religion.
The challenge for health professionals is in understanding that patients often turn to their religious and spiritual beliefs when making medical decisions. Religion and spirituality can impact decisions regarding diet, medicines based on animal products, modesty, and the preferred gender of their health providers. Some religions have strict prayer times that may interfere with medical treatment.
Healthcare providers should be respectful of a patient’s religious and spiritual needs. Many patient’s anxieties are reduced when they turn to their faith during healthcare challenges. Because many patients turn to their beliefs when difficult healthcare decisions are made, it is vital for healthcare professionals to recognize and accommodate the patient's religious and spiritual needs. Health professionals should provide an opportunity for patients to discuss their religious and spiritual beliefs and tailor their evaluation and treatment to meet their specific needs.[13][14][15]
Issues of Concern
Religion and spirituality play an important role in the medical decisions of many patients. The following is an alphabetical list of the religious and spiritual groups most commonly encountered in a healthcare environment and a summary of their views. Knowledge of these beliefs can affect patient-provider communication, resulting in more culturally sensitive care and improved quality of treatment and outcomes.[16][17][18][19]
Baha'i
Baha'i teaches the essential worth of all religions and the equality and unity of all people.
Beliefs
Abandonment of all prejudice: race, religion, gender, or community
Education for all children
Abolition of extreme wealth and poverty
Individual responsibility to search for the truth
The oneness of God, the unity of humanity, and the essential harmony of religion
Religion is a divine revelation that is continuous and progressive.
Religion and science exist in harmony.
Sexual equality is a spiritual and moral standard.
Humanity's oneness and the wholeness of human relationships
Unity among diverse groups is possible
God is in every force in the universe.
One God has a single plan within the teachings of the major world religions.
The promise of world peace
Death
An individual’s reality is spiritual, not physical.
The body is the throne of the soul, worthy to be treated with honor and respect even when dead.
The soul is eternal and progresses to the next stage of existence, closer to God.
Organs may be donated
The body should be buried, not cremated, preferably without embalming unless required by law.
The body must not be transported more than one hour’s journey from the place of death.
For children over 15 years old, the Prayer for the Dead is recited at the burial.
Diet
Patients over age 15 and in good health abstain from food and drink from sunrise to sunset during the month of Ala (meaning Loftiness) from March 2 through 20.
Eating is for health.
Abstain from drugs when health is good, but may take them when necessary, including narcotic pain medicines, if prescribed by a clinician.
Blood transfusion is acceptable.
Consumption of alcohol and mind-altering drugs is forbidden.
Holy Tenets
Daily prayer and reading of sacred writings.
Seven Holy Day festivals per year during which one does not go to school or work.
Work performed in the spirit of service is the highest form of worship.
Pregnancy
Circumcision of males is a family decision.
Do not believe in abortion.
No requirements; rarely use birth control.
Sexual intercourse only between husband and wife.
Rituals
Daily private prayer and annual fast lasting throughout the day from sunrise to sunset during the month of Ala from March 2 through March 20.
Symbols and Rites
The nine-pointed star is the symbol of the faith.
Local, national, and international representatives perform special religious rituals.
Prayers for private worship.
Clinical Issues
Avoid sterilization procedures unless needed for the preservation of the mother.
Believe prayer assists in healing; allow uninterrupted time for prayer.
Believe a balanced and nutritious diet helps prevent disease.
Blood transfusion acceptable.
Will most likely avoid birth control.
Buddhism
Buddhism encompasses a variety of beliefs, spiritual practices, and traditions based on original teachings attributed to the Siddhartha Gautama, the Buddha.
Beliefs
Buddhists follow the path to enlightenment by developing his or her wisdom, morals, and meditation.
Personal insight replaces belief in God with the study of the laws of cause and effect, karma.
Spiritual enlightenment through conscious living and meditation.
Rebirth is based upon the actions of a person, and insight and the extinguishing of desire bring freedom.
Three major Buddhist traditions: Mahayana, Theravada, and Tibetan.
5 Lay Vows: no intentional killing, no stealing, no lying, no sexual misconduct, and no intoxicants.
Death
Avoid mind-altering medication while dying.
Buddhist representatives should be notified in advance to see that the appropriate person presides over the care.
Chanting and prayers.
Rebirth in the next life and avoid lower lifeforms of rebirth.
The state of mind at death influences rebirth, so they want to be calm and peaceful.
Unexpected death may require special rituals.
Diet
Usually vegetarian
Avoid alcohol, coffee, and tobacco.
Health
Do not believe in healing through faith.
Healing and recovery are by awakening to the wisdom of Buddha.
Health is holistic; mental cures are important.
Illness is a result of karma or the law of cause and effect, an inevitable consequence of actions in a prior life or this life.
Medications are acceptable if they do not affect the state of mind.
No restrictions on autopsy, blood or blood products, organ donation, or procedures.
Mary Baker Eddy developed Christian Science, teaching that sickness can be healed by prayer alone, as Jesus healed.
Beliefs
A Bible-based Christian religion, the Christian Science church was founded to “commemorate the word and works of our master Jesus Christ which should reinstate primitive Christianity and its lost element of healing” (Church Manual, p. 17).
Following the example of Christ Jesus, Christian Scientists rely on consecrated prayer to God, the eternal good, and rooted in a faith lifted to spiritual perception, as a practical and reliable method to care for all human needs, including their health.
Death
There is no church policy on burial, but the body is best prepared for burial by one of the same sex. An autopsy may be sought in cases of sudden decease.
There is no church policy on euthanasia, but Christian Scientists revere life and strive to overcome and heal suicidal tendencies.
There is no church policy on organ donations, blood donations, or transfusions.
Diet
Avoid tobacco and food or drink which contains alcohol and sometimes caffeine.
If brought to a medical provider involuntarily, adherents may wish to choose to rely solely on spiritual means for healing. But they are free to decide.
Once subject to medical care, they would not normally second-guess medical expertise.
They may prefer minimal intervention where it is an option.
Holy Tenets
Science and Health with Key to the Scriptures, by church founder Mary Baker Eddy, is the definitive statement of Christian Science teachings. This book includes six religious tenets or key points of Christian Science, summarized in 1894 by a Chicago journalist in the Daily Inter-Ocean: “The ‘confession of faith’ [of Christian Science] includes the declaration that the Scriptures are the guide to eternal Life; that there is a Supreme Being, and His Son, and the Holy Ghost, and that man is made in His image. It affirms the atonement; it recognizes Jesus as the teacher and guide to salvation; the forgiveness of sin by God, and affirms the power of Truth over error, and the need of living faith at the moment to realize the possibilities of the divine Life.” The final Tenet, not represented in this summary, takes the form of a sacred Christian commitment: “And we solemnly promise to watch, and pray for that Mind to be in us which was also in Christ Jesus; to do unto others as we would have them do unto us; and to be merciful, just, and pure.” (SH p. 497)
Rituals
Church services are simple and Bible-centered.
Patients might appreciate access to online resources such as church services, weekly topical Bible lessons, or church periodicals.
Members typically pray and study the Bible and other religious teachings daily.
No traditional ritual sacraments, though there is a simple communion service and a special Thanksgiving Day service.
The Bible is central to Christian Science. It is interpreted in the Christian Science textbook, Science, and Health, the authoritative guide for adherents.
Lay readers conduct church services. There is no clergy.
Clinical Significance
Christian Scientists and their children have often availed themselves of religious belief accommodations for vaccination, but the choice is individual, and members are encouraged to comply with applicable public health laws (including vaccination and quarantines where required). They are taught not to fear vaccines.
Usually do not seek immediate medical care.
They may prefer no, or minimal, medical intervention and drugs
during pregnancy, labor, and birth – and they may request a midwife. Abortions are likely not favored. But church policy does not dictate any of this, nor does it cover birth control.
Medical professionals will want to be sensitive to members’ preference against too much description of the severity, dangerousness, and fixed reality of the disorders or traumas treated – including matters of mental health.
Church of Jesus Christ of Latter-day Saints (Mormon)
Mormons are a religious group of the Latter Day Saint movement of Restorationist Christianity, initiated by Joseph Smith. The Mormons followed Brigham Young to the Utah Territory. Mormons dedicate time and resources to serving in the church, and many young Mormons choose a full-time proselytizing mission.
Beliefs
The building of temples where personal and sacred covenants can be entered into with the Lord.
Daily Prayer and reading of Scriptures.
Jesus Christ is the Firstborn of God.
Members are spiritual daughters and sons of a living Father in Heaven.
They tend to be family-oriented and have strong connections to their extended family, reflective of their belief that families are connected after death.
Mortality on earth is a probationary period to test to see if members will obey the Lord’s commandments given through current and ancient prophets.
Death
All individuals will be resurrected and attain a degree of glory in heaven for acts during their mortality.
Autopsy permitted.
Euthanasia is not allowed.
Organ donation permitted.
Promote dignified death, if inevitable.
Diet
Alcohol, coffee, tea, and tobacco are discouraged.
Fasting is required once each month; ill people are not required to fast.
Health
Blood and blood products acceptable.
Faith in Jesus Christ to heal with medical.
Holy Tenets
Follow basic Christian holidays.
Pregnancy
Procreation is a central purpose of life.
Abortion is forbidden except in the case of rape or when the mother’s life is in danger.
Artificial insemination acceptable between husband and wife.
Birth control is a decision left to the couple; per the LDS Church, "the decision as to how many children to have and when to have them is extremely intimate and private and should be left between the couple and the Lord."
Rituals
Blessing and naming of children.
Family home evenings once a week.
Two elders are required for the blessing of the sick.
Symbols and Rites
Designated leaders for specific roles, including Bishops and Elders.
King James Version of the New and Old Testaments the Bible, the Book of Mormon, and scriptures.
No formal clergy.
Clinical Significance
May avoid drugs containing alcohol and caffeine.
Eastern Orthodox
The Eastern Orthodox Church or Orthodox Church is the second-largest Christian Church, with over 250 million members. The Eastern Orthodox Church teaches the One, Holy, Catholic, and Apostolic Church was established by Jesus Christ.
Beliefs
A person’s communion with God is expressed in love; where there is no love, God is absent, and no spiritual life exists.
All are saved through Christ’s death and resurrection, are still being saved through participation in the church, and will be saved again in the future second coming of Christ.
Christ is the Son of God, both fully divine and fully human, and the Holy Spirit enables humanity to apprehend God’s presence in the world.
God reveals Himself in the Bible as living and present. It is considered to be the “Word of God,” though not considered inerrant or literal.
The Nicene Creed is recited at every Divine Liturgy, which summarizes the beliefs of the Church.
In the Orthodox view, the Trinity is three persons, one in essence and undivided.
The veneration of Mary is referred to as the Theotokos or God-bearer as she carried the New Covenant in the person of Christ.
Consecration invoked by a priest that bread and wine become the body and blood of Christ.
Death
The departed soul is affected by intercessory prayers; redemption and reconciliation with God may be possible even after death.
Holy Unction anointing with oil is administered to the sick by Orthodox clergy on the Wednesday of Holy Week between Palm Sunday and Easter.
The church offers prayers for the dead on the 3rd, 9th, 40th and upon the one-year anniversary of the death.
When a person passes, the traditional saying is “Memory Eternal.”
Diet
Fast from meat, dairy, and oil for a 40-day period during Great (beginning seven weeks before Easter ) and Christmas (November 15 through December 24) Lent. After the Divine Liturgy, the fast is broken with a joyous community feast.
Fast from meat, dairy, and oil on Wednesdays and Fridays.
Fasting is flexible if pregnant and for those with health concerns.
Health
Allow blood transfusions and blood products.
God is the “Divine Physician,” the healer of our bodies and souls, which is facilitated through prayer and Church participation.
The followers of Islam are Muslims who believe in one God, Allah, and his prophet Abraham. They believe Adam, of the Bible's Old Testament, was the first prophet. Other prophets include Abraham, David, Jesus, Moses, and Noah.
Beliefs
Complete submission to God
Judgment day
Life after death
Muhammad God's messenger
Required to pray 5 times a day
Give 2.5% to a charitable cause once each year.
Oneness of God, his angels, scriptures, and messengers
Pilgrimage to Mecca is required at least once in their lifetime.
Ramadan is a month-long fast of drink, food, and no sexual intercourse during daylight.
Reward and punishment
The Quran is the final revelation of humanity.
One God, Allah
Death
Autopsy only for legal or medical reasons
Confession of sins and begging forgiveness may occur before death.
Death in God’s plan
Euthanasia prohibited
Organ donation acceptable
Prayer for the deceased led by a male within 72 hours after death; death certificate should be signed quickly to facilitate the process.
Diet
Children, women who are pregnant, and those who are ill may be exempt from fasting.
Ramadan is during the ninth month of the Islamic lunar calendar and lasts 29 or 30 days, depending on the year.
Wash face, hands, and feet before prayer.
Pregnancy
Abortion is prohibited except in cases of incest, rape, or when the mother's life is threatened.
A fetus is considered a human being after 25-weeks of gestation.
Symbols
Only symbols the Holy Quran
Some women are required to wear a burqa, covering the head, face, and entire body, including hands and feet, or a hajib, a veil covering the head but leaving the face uncovered.
Clinical Significance
Find the same-sex practitioner if not an acute emergency.
Shia Muslims
Approximately 15% of Muslims are Shia. Iran and Iraq have a majority of Shia Muslims.
Shia means Party of Ali.
Shia Muslims are a minority in the rest of the world. Shia Muslims pray three times a day; Sunni Muslims pray five times a day.
Shia Muslims believe that when Muhammad died, it was his wish that Ali, his cousin, would be the new caliph. They believe that the leaders of Islam should be direct descendants of the Prophet Muhammad.
Shia Muslims ignore the elected Sunni leaders and instead follow their leaders, which are direct descendants of Muhammad called Imams.
Sunni Muslims
Most Muslims are Sunni.
Sunni means the words and actions of the Prophet Muhammad.
Sunni Muslims believe that Muhammad's wish upon his death was that the next leader would be elected.
Sunni Muslims believe the leaders of Islam should continue to be elected.
Jehovah’s Witness
Jehovah's Witnesses believe that the destruction of the present world system is imminent. The establishment of God's kingdom over the earth is the solution for all problems faced by humanity.
Beliefs
The world will be restored to a state of paradise; beneficiaries of Christ will be resurrected with healthy physical bodies and inhabit the earth.
Do not give gifts on holidays and do not recognize birthdays or national holidays.
God is the Father, and Jesus Christ is his son.
The Holy Spirit is God’s motivating force.
Reject the doctrine of the Holy Trinity
Do not salute the national flag or sing the national anthem and refuse military service.
Death
Autopsy acceptable if legally required
Body organ donation is a personal choice.
Death is a state of unconsciousness.
Euthanasia is forbidden
Diet
Avoid any food that contains blood.
Meat products must be properly drained of blood.
Health
Refuse blood transfusion and blood products
Whether to prolong life or the right to die is an individual choice.
Holy Issues
An annual congregational celebration of the memorial of Christ’s sacrificial death changes annually
Prayer and reading of scriptures
Meetings are held three times a week in local Kingdom Halls with a focus on education.
Pregnancy
Abortion is forbidden
Artificial insemination by donors is forbidden.
Birth control is an individual choice.
Rituals
Adult baptism
Shunning of those who fail to live by the group's standards and doctrines
Symbols
None
Clinical Significance
Refuse all blood products
Judaism
Judaism is the expression of the covenant that God established with the Children of Israel. Judaism includes texts, practices, theological positions, and forms of organization.
Beliefs
One all-powerful God who created the universe
God communicated the commandments to Moses on Mount Sinai, and they are written in the Torah.
Commandments, commitments, duties, and obligations have priority over individual pleasures and rights.
Sanctity of life overrides religious obligations.
Orthodox Jews: Strict interpretation of the Torah. The Torah is divine and unalterable. Following the code of Jewish Law
Protestantism originated with the Reformation, a movement against what followers believed to be errors in the Roman Catholic Church. They emphasize justification by faith alone rather than by good works and the highest authority of the Bible alone in faith and morals.
Beliefs
Community worship is important.
Emphasis on the Holy Bible and Scriptures
Jesus of Nazareth is the son of God.
Two Sacraments: Baptism and Communion.
Death
Autopsy, organ donation acceptable
Euthanasia is generally not acceptable.
Diet
No restrictions
Health
Blood, blood products are an individual choice.
Holy Issues
Daily prayer and Scripture reading
Traditional holidays observances
Pregnancy
Baptism of infants practiced in some denominations
Birth control and artificial insemination are individual choices.
Rituals
Anointing, prayer, Eucharist, and other rituals
Prayers for healing, individual prayer, and the Sacraments
Symbols
Bible
Cross
Most ordain both men and women while some only men.
Clinical Significance
No clinical issues that inhibit healthcare
Rastafarian Movement
Both a religious movement and a social movement developed in Jamaica. It lacks any centralized authority. Rastafari refer to their beliefs as "Rastalogy." It is a monotheistic belief in a single God—Jah—who partially resides within each.
Beliefs
African civilization and culture are superior.
Being as close to nature as possible
Dream of returning to Africa
Following the Old Testament
Jah is the Messiah promised in the Bible.
Love and respect for all living things
One God, Jah, the former emperor of Ethiopia, incarnated
Spiritual use of marijuana
Believe in everlasting life; may not talk about terminal illness or impending death.
Diet
Limited or no meat, pork, or shellfish
May be vegan
Avoid alcohol
Caribbean food is popular with fruits and vegetables.
May only want to eat natural foods.
Health
The body is seen as a church and may be hesitant to put anything unnatural into it.
Daily Practices
Buttons and pins with images of Haile Selassie or the Lion of Judah
Dreadlocks common
May wear robes, headscarves, and knit hats.
Pregnancy
Birth control individual choice but may not want non-natural drugs.
Rituals
Dancing, singing, and marijuana use
Old Testament readings
Symbols
Local, national, and international representatives may perform special religious rituals.
Marijuana is common during ceremonies and is seen as cleansing spiritually and is written about in the Bible.
May avoid taking non-natural drugs.
Often use green, red, and yellow colors.
Spiritual use of marijuana
Clinical Significance
Maybe mistrusting of medications or drugs that contain alcohol.
Roman Catholicism
The Catholic Church or Roman Catholic Church is the largest Christian church. The Catholic religion teaches that it is the One, Holy, Catholic, and Apostolic Church founded by Jesus Christ, its bishops are successors of Christ's apostles, and the Pope is the successor to Saint Peter to whom Jesus Christ conferred primacy.
Beliefs
Belief in Apostolic leaders that are male successors of the original apostles of Jesus
The Seventh-day Adventist Church is a Protestant Christian that observes Saturday, the seventh day of the week in Christian and Jewish calendars, as Sabbath. The religion also emphasizes the imminent Second Coming of Jesus Christ. The Seventh-day Adventist Church teachings correspond to common Protestant Christian teachings, such as the Trinity and the infallibility of Scripture. Unique teachings include the unconscious state of the dead and the doctrine of an investigative judgment. Religion emphasizes diet and health, its "holistic" understanding of the person, conservative principles, lifestyle, and promotion of religious liberty.
Beliefs
Bible is interpreted literally.
The body is the temple of God and must be kept healthy.
Duty to warn others to prepare for the second coming of Christ.
Death
Autopsy and organ donation acceptable.
Death is a state of unconsciousness with a return to consciousness with the Second Advent or coming of Christ.
Euthanasia is not practiced.
Diet
Consuming alcohol, coffee, and tea is a matter of individual choice, although most refrain.
May practice fasting
Vegetarian diet
Health
Emphasize rehabilitation and therapeutic diets.
Healing is accomplished through medical intervention and divine healing.
Many avoid narcotics or stimulants.
No restrictions on blood or blood products.
No restrictions on surgical procedures.
Physicians and chaplains are inseparable.
Holy Issues
Daily Prayer
Saturday is the Sabbath.
Pregnancy
Abortion is discouraged.
Birth control is acceptable.
No infant baptism.
Rituals
An ill person anointed with oil; elders and Pastors and elders may pray.
Symbols
Pastors and elders may be male or female.
Clinical Significance
May require a special restricted diet.
Sikhism
Sikhism originated in the Punjab region of India. It is one of the newest of the major world religions. The fundamental belief is faith and meditation in the name of one creator, unity of all humankind, engaging in selfless service, striving for social justice, and honest conduct.
Beliefs
All people are equal.
God is eternal, formless, and unobserved.
God is the supreme Guru, guide, and teacher.
The ideal life is charity, work, and worship.
Reincarnation is a cycle of rebirth.
Salvation is achieved through disciplined meditation and union with God.
Salvation is liberation from the cycle of rebirth.
There is a tension between God’s sovereignty and human free will.
Death
The body is bathed, dressed, and then cremated.
The floor is washed and covered with white sheets; shoes are not worn room.
Diet
No restrictions
Health
May not cut the hair on any part of their body.
Holy Issues
Meet as a congregation for prayer service on six holidays
Morning and night private worship
Following the 10 Sikh gurus and the Holy Scriptures
Pregnancy
A member of the family gives a drop of honey to the newborn to give the child his character later in life.
There are no rituals connected with the birth of a child.
Symbols
Guru Granth Sahib is a collection of religious writing.
A turban is worn as a symbol of personal sovereignty and symbolizes responsibility to others.
Symbolic objects include a cloth around the chest, an iron bracelet, and a wooden comb.
Khanda reflects fundamental concepts of the faith.
Clinical Significance
Hair removal may be an issue for surgery.
Spirituality - Hawaiian
Hawaiian spirituality teachings reflect the daily practices of oneness and self-greatness, known loosely as the "aloha spirit." The sense of connection to oneness includes all those who have departed from the physical world. In Hawaiian spirituality, there is no death, just “changing address” from human to spirit form.
Beliefs
"Aumakua" are family guardians and are respected.
A basic sense of community
Inter-connectedness of all-natural things
Death
Body treated with respect.
Burial is a family decision.
Funerals are not attended by pregnant women.
Diet
After a prayer ceremony, foods consumed provided by the family.
Fasting is a regular practice.
No dietary restrictions
Specific foods used to depend on the ceremony.
Health
Bad health results from not living in harmony with nature.
Healthcare is interconnected with cultural and religious beliefs.
Health is the connection between the body, mind, and spirit.
An individual is responsible for becoming healthy.
Medications acceptable for pain as long as they do not affect the state of mind.
Prayers, fasting, and silence promote healing.
Holy Issues
Closely related to the moon and seasonal changes
Daily prayers
Observance occurs throughout the lunar calendar.
Pregnancy
Avoid wearing Lei or garlands in a full circle as this is believed to ward off unfortunate circumstances.
Massaged to avoid early labor
A newborn name may be delayed because the mother relies on dreams, signs, and visions to obtain a name.
Rituals
Ceremonies are done to connect to elements and self for value and respect.
Chanting for ceremonies.
Menstruating females are observers during ceremonies and have a separate responsibility.
Performed with the intent of seeing, obtaining, or understanding a vision of clarity related to one’s self and others.
Symbols
Cleansing before the ceremony may start days to weeks prior and may include fasting and physical cleanse.
Offerings are called ho’okupu, which is valued from the time it is gathered to the time it is given.
Respect for male and female elders.
Respect of caretakers and protectors of images.
Silence is golden, and observation is key.
There are no written scriptures or writings; everything is handed down by stories.
Traditional ceremonial wear is expected.
Clinical Significance
No clinical issues that inhibit healthcare.
Spirituality – Native American
Native American religious, spiritual practices can vary widely and are based on the differing histories of individual tribes. Theology may be animistic, monotheistic, henotheistic, polytheistic, or some combination thereof. Traditional beliefs are passed down in the form of oral histories.
Health care practices are related to cultural and religious and beliefs.
Ill health occurs from failure to live in harmony with nature, social, and supernatural environments.
Holy Issues
Related to the moon and seasons
Pregnancy
No special issues
Rituals
Prayer accompanied by the burning of cedar, sage, sweetgrass, or tobacco.
Seeing and understanding a vision of clarity for oneself.
Symbols
A woman should not come near-sacred objects during menstrual periods.
Include elder, medicine person, or spiritual leader in assisting in healing.
A medicine bag is a leather pouch worn around the neck that should not be touched.
No written scriptures
No one other than the elder should not touch religious articles.
Clinical Significance
No clinical issues that inhibit healthcare.
Voodoo
The Voodoo religion is elaborate, steeped in secret languages, spirit-possessed dancing, and special diets that are usually eaten by the voodoo priests and priestesses. The ancestral dead are thought to walk among the living during dances. Touching the dancer during this spirit-possessed trance is considered dangerous enough to kill the offender.
Beliefs
All creation is considered divine and contains the power of the divine.
Ewe asks for help and change.
Ewe rule the world and decide the fate of everything.
One God, Bondye, and other spiritual beings, called Ewe.
Health
Medicines such as herbal remedies and objects in religious rituals may be used for healing.
Rituals
Animals are sacrificed to thank the spirits.
Ceremonies include animal sacrifice, drums, and dancing.
Ceremonies may be held in secret.
Clinical Significance
Maybe mistrusting of modern medicine.
Wicca
Wicca is a neo-pagan, earth-centered belief.
Beliefs
Concern for ecological issues
Consecrated items should not be removed or handled by anyone but the wearer.
Multiple gods and goddesses
No action occurs without significant repercussions throughout the world, eventually affecting the original actor (Law of Nature).
Pre-Christian civilization worship practices
The principal deity is Mother Nature.
Death
No restrictions on autopsy
Diet
Variable
Health
May want to contact coven to request a healing rite.
Holy Issues
Individual study daily
Worship is called a circle or ritual.
Pregnancy
The ritual blessing of pregnancy is held every trimester.
Ritual of blessing and naming children
Rituals
The full moon is a time of great magical energy.
Rituals are a large part of the faith.
Symbols
A consecrated pendant in the form of a pentacle or pentagram is often worn, which should only be removed by the individual.
Clinical Significance
The care of patients requires meeting the needs of individuals and families' cultures and beliefs. Religion often provides spiritual guidance as well as an emphasis on maintaining health. Religious beliefs often affect patient attitudes and behavior. It is important for healthcare professionals to have an understanding of these issues so they can provide culturally appropriate care. It is important to remember that preservation of life overrides guidelines; in a life-threatening situation, there are usually no restrictions on medications or surgical interventions. When caring for a patient, it is important to understand why adherence or non-adherence to treatment may occur given their religious beliefs.[20][21][22]
Enhancing cultural competency by providing patient-centered care is the means by which healthcare challenges are ameliorated. Efforts aimed to improve provider-level cultural enhanced care will go a long way to facilitate cross-cultural communication and respond to patient needs by tailoring healthcare.
Understanding the values and reasons for special requests for healthcare will improve cultural competence and provide culturally sensitive health care that is good for the patient and their families.
The culture and religion of an individual can greatly influence their perspectives about healthcare and healthcare providers. Healthcare providers need knowledge and understanding of these patients’ backgrounds and beliefs to provide culturally sensitive healthcare.
Recommendations:
Apologize for cultural mistakes
Ask the patient and family how you can help make their experience more comfortable.
Avoid being judgmental
Avoid making assumptions and be patient.
Avoid employees serving as interpreters for other employees.
Be aware of the uniqueness of their religion and their special needs.
Be respectful
Observe body and facial language
Recognize how values, behaviors, and beliefs may affect others
Train staff about cultural competence
Use medically competent and fluent interpreters with training in cultural competence.
Enhancing Healthcare Team Outcomes
Healthcare organizations need to empower their clinical staff with a sense of awareness through education and training on the world's religions and their potential impact on patient care. Provider education makes possible a respectful dialog with their patients about their religion and the impact it has on evaluation and treatment.
Religion and spirituality should be incorporated into the healthcare practitioner’s armamentarium of knowledge in communicating with patients. Listening to a patient’s beliefs along with how those beliefs are tied to the patient’s health can help build and positive relationship between the health practitioner and patient. Knowledge of religious and spiritual beliefs and practices can result in decreased medical errors, earlier patient release, and reliable communication between patient and healthcare provider that results in improved healthcare delivery.
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