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. 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 second largest minority 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

7. Hispanic Americans The second largest population in the U.S. 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 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. Culture and Cultural Awareness English language proficiency 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

11. 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)

12. 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

13. 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

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

15. 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.

16. Spirituality and Religiosity Providing spiritually competent care –Spirituality related to a sense of well being in the elderly –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.

17. 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