1. Spirituality and Religion in Pharmacy Practice
Essentials of Cultural Competence in Pharmacy Practice: Chapter 14 Notes
Chapter Author: Dr. Amy Werremeyer

2. Learning Objectives:
Articulate the religious/spiritual involvement of the U.S. population.
Identify the impact of religion/spirituality on health care practices.
Explain the impact of religion and spirituality on nutrition and health care–seeking behaviors.

3. Religious Beliefs More than thirty major religions worldwide.
All of the major and many of the minor faiths of Europe and other parts of the globe have been transplanted to the United States.
According to the 2001 United States Census,
81% of Americans reported adhering to Christian beliefs.
3 to 4% of the United States population classify themselves as non- Christian, belonging to Jewish (1.4%), Muslim (0.6%), Buddhist (0.5%), Hindu (0.4%), Unitarian Universalist (0.3%), or other non-Christian (0.7%) faiths.
15% reported being atheist, agnostic or adhering to no religion.
Many of these major religions are further divided into branches and sects, likely bringing the number of organized religious/spiritual entities into the thousands.

4. Stats on Religion in the U.S.
2006
58% of those surveyed were "absolutely certain" that God exists.
36% to 38% reported that they were "somewhat certain" or "unsure" regarding the existence of God
6% were "absolutely certain" that God does not exist.
82% of those surveyed believed in God
9% believed in "some other universal spirit or higher power"
8% believed in neither
1% were unsure
In the same poll, more than half of Americans indicated they pray often and consider religion an important part of their lives. Gallup International indicates that 41% of Americans report that they regularly attend religious services, though some contend this figure, saying actual attendance is lower.

5. Religion in the U.S.
The United States is one of the most religious of those considered to be “developed countries.”
According to a 2002 survey the U.S. was the only developed nation in the survey where a majority of citizens reported that religion plays a "very important" role in their lives.

6. Who Is Religious in the U.S.?
National samples of Americans of all ages indicate that persons who find personal comfort and support from religion are more likely to be:
older
female
black
less educated
widowed
employed in manual or unskilled occupations
more economically deprived, and
affiliated with conservative Protestant religious denominations.
Women are more likely than men to describe their outlook as "religious."
Older Americans are more likely than younger to describe their outlook as "religious."
African Americans are least likely to describe themselves as secular while Asian Americans are most likely to do so.

7. Religion in Health Care
Many Americans believe there is a link between religion and health.
In a study of 177 ambulatory care patients, 90% stated they believed prayer may sometimes influence recovery from an illness.
45% stated that religious beliefs would influence their medical decisions should they become gravely ill.

8. Religion in Health Care (continued)
Numerous studies have indicated that spirituality and religion may affect health care outcomes.
Survey results on whether physicians should inquire about patients’ spiritual and religious beliefs.
In the health care setting, it is essential for the optimal care of the entire person that spiritual and religious influences, in addition to biologic influences, be assessed and accounted for in the treatment plan.

9. JCAHO and Pharmacy with Religious/Spiritual Beliefs
JCAHO attends to the importance of meeting patients’ spiritual and religious needs, as well as what should be included in a spiritual history.
Standard PC designates that an assessment must include the patient’s religion and spiritual orientation.
The standards indicate that patients deserve care that respects their spiritual values.
Pharmacists can meet treatment and service needs by being respectful of patients’ spiritual beliefs.

10. Communication Styles
The spoken language of an individual patient may be influenced by his or her religious or spiritual identity, past or present.
The spoken language of an individual patient can have a large influence on the pharmacist-patient relationship.
A language barrier between the pharmacist and patient, whether it is due to spiritual/religious differences or not, can create lapses in communication and leave the patient at risk of medication-related harm.
Careful consideration should be given to the effectiveness of the verbal communication between the pharmacist and the patient in the pharmacy practice setting.

11. Nonverbal Communication Styles
Touch is a commonly used form of nonverbal communication that has significance in several spiritual/religious ceremonies, especially those ceremonies involving blessing or anointing of the sick.
In some faiths touch, or “laying on of hands,” is thought to enhance the healing power of prayer, as in the Catholic faith.
In predominantly Hindu and Muslim countries public contact between men and women is often forbidden.
Men and women with these religious backgrounds may shy away from touch, especially that which is initiated by the opposite sex.
Other forms of nonverbal communication such as eye contact, facial expressions, and posturing are less likely to be influenced by a particular spiritual/religious practice, but may be influenced by the culture of an individual’s country of origin.
In providing care to patients in the pharmacy practice environment, it is important to ascertain the individual patient’s level of comfort and use of nonverbal communication.

12. Health/Health Care Practices
Christian Science holds that human imperfection, including physical illness and sin, reflects a fundamental misunderstanding of creation and is therefore subject to healing through prayer and spiritual regeneration.
Many Christian Science members rely solely on faith healing. A follower of Christian Science would likely seek a specially trained Christian Science practitioner.
No medication is given and physical application is limited to the normal measures associated with hygiene. The term healing applies to the entire spectrum of human fears, grief, wants, and sin as well as to physical ills.

13. Health/Health Care Practices (cont’d)
Buddhists and Hindus often believe that people who are spiritually focused and follow a faithful regimen of meditation, diet, and exercise will not become sick.
Many Buddhists believe that 80% of the time illness can be cured using the mind and 20% of the time it can be cured by herbs. Western medicine is thought to weaken the body and is generally avoided by Buddhists.
In the Islamic tradition, illness is seen as a part of life and not as a punishment or sign from God. Many followers of Islam believe that, in combination with the will of God, physicians have the power to heal and, therefore, faith healing alone is not acceptable.
Often Muslims believe that every illness has a cure, and multiple treatment avenues should be explored.

14. Health/Health Care Practices (cont’d)
In many Christian traditions, medical care from a physician is seen as imperative to the healing process.
In many cases, reading of scripture, individual or group prayer, and/or blessing or anointing of the sick by a member of the clergy are thought to comfort the individual and possibly lead to enhanced healing.

15. Health/Health Care Practices (cont’d)
In Native Americans’ spiritual beliefs, disease may be attributed to intrusive objects, soul loss, spirit intrusion, breach of taboo, or sorcery.
It may also be attributed to natural or supernatural causes. Native Americans also balance “modern theories of disease” with longstanding tribal beliefs or customs.
Therefore, during illness, Native Americans may ask to see a priest or minister as well as a tribal “medicine man.”
A medicine man (shaman), can be male or female and is able to communicate with the spirit world. The main task of the shaman is to diagnose and cure severe illnesses.

16. Religion and Spirituality’s Effects on Health
Hundreds of studies have reported significant relationships between religious participation and improved physical and/or mental health.
A significant positive association between religious beliefs and practices and improved mental health, greater well-being, and lower substance abuse
Greater longevity, fewer deaths from heart disease and fewer complications and better survival after surgery have all been shown to be related to religious involvement
The effect of regular religious attendance on longevity approximates that of not smoking cigarettes, adding an additional seven years to the lifespan.

17. Health, Religion and Pharmacy
A pharmacist in the pharmacy practice setting should avoid making assumptions about a patient’s health and health behaviors based on his or her religious/spiritual affiliation alone.
Even for those religious/spiritual paths that do not specifically prohibit certain activities and behaviors, religious participation may have a general moderating effect on health behaviors.
Most, if not all, religions encourage followers to take care of and respect their bodies. One manifestation of this teaching may be improved physical and mental health.

18. Social Support
Social support has consistently predicted improved health outcomes in the medical literature.
One of the consequences of religious involvement may be access to and opportunities to develop social ties with more people with whom one shares a worldview than are available to nonreligious persons.”
Religious communities frequently promote the caring for others as an expression of faithfulness within their tradition, regardless of the self-sacrifice and/or inconvenience this may pose to the individual.

19. Positive Coping
Positive religious coping methods such as “the belief in a just and loving God, the experience of God as a supportive partner, involvement in religious rituals, and the search for spiritual and personal support” were significantly related to better outcomes, such as improved mental health status and spiritual growth.
Specific spiritual/religious practices such as prayer, meditation, and relaxation may contribute to an individual’s health and enhance his or her ability to cope.
By reducing stress levels and providing a sense of peace, the religious/spiritual practices of prayer and meditation may offset the harmful effects of stress on the body and contribute to better health.

20. End-of-Life Care
In Christian and Islamic traditions, the current life is simply a trial preparation for the next realm of existence and death is the beginning of the life that will never end.
In Native American traditions deaths are viewed as “good death” or “bad death” depending on the circumstances surrounding death. The quality of death plays a part in determining where the deceased’s spirit will reside.
Unexpected death, violent death and suicide may be viewed differently by various religious/spiritual groups.
Some religious groups believe that suicide is a “sin” which may carry consequences for the funeral as well as the afterlife.

21. Conditions of Death
The spiritual/religious traditions of an individual or group will likely influence the conditions and atmosphere that are desired at the time of death.
Specific objects of religious or spiritual significance that they rely on for healing or for safe passage into death.
In several religious traditions, it is undesirable for a dying person to be alone.
In Islam, the extended family and a prayer leader from the local Mosque are often present. The dying person’s bed is moved to face in the direction of Mecca and those present read the Qur’an and pray with the dying person.

22. Prolonging of Life
The concepts of prolongation of life versus the right to die are often influenced by an individual’s spiritual/religious beliefs.
In Islam, the right to die is not recognized and any attempt to shorten one’s life or terminate it is prohibited.
In Judaism and many Christian denominations, a balance is sought in end-of-life care so as to carry out all ordinary measures to prolong life, while maintaining the patient’s right to die with dignity.
While Jewish and most Christian traditions prohibit euthanasia, they often do allow the withholding of extraordinary treatment measures in the event that the health care provider sees that death is inevitable.
In Buddhism, if there is a way to extend life and possibly increase the chances of achieving enlightenment, then all possible strategies should be explored.
In the pharmacy practice setting, it is important that the desires of the patient and family members surrounding death are assessed and respected.

23. Spiritual Assessment, Role of the Pharmacist
A spiritual assessment addresses religious issues and spiritual factors that affect a patient’s sense of wholeness and allows the physician, pharmacist or other health care professional to openly acknowledge a patient’s faith system.
Recognizing the patient’s spiritual beliefs fosters a positive discussion and allows for better understanding of the patient, which could affect treatment decisions or patient education needs.
A spiritual assessment performed during an encounter with a patient in the pharmacy setting is a good way to incorporate spirituality into pharmacy practice.
Pharmacists who are not particularly religious can still perform spiritual assessments.
Pharmacists may also consider referring a patient to a pastoral counselor or chaplain for further spiritual assessment.

24. Reflection Questions
What religious practices will most affect your work as a pharmacist?
How will you help people whose religious beliefs contradict health care choices that you believe are in their best interest?
How does your own religious or spiritual background impact how you work with others?
What do you see as the role of spirituality and religion in the healing process?