1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 8 Spiritual and Cultural Perspectives

2. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Spirituality is “ A unifying force of a person; the essence of being that permeates all of life and is manifested in one’s being, knowing, and doing; the interconnectedness with self, others, nature, and God/Life Force/Absolute/Transcendent”. (Dossey & Guzzeta, 2000, p. 7).

3. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Culture is The values, beliefs, norms, and practices of a particular group that are learned and shared and that guide thinking, decisions, and actions in a patterned way. (Leininger, 1991)

4. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Cultural Values Healing practices Cultural competence

5. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Spirituality Cornerstone of nursing practice Broader concept than religion A personal quest for meaning and purpose in life Harmonious interconnectedness Core of health and healing

6. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 A Holistic Model of Spirituality (Canda and Furman, 1999) Spirituality as the Center of the Person  Spiritual Aspect  Biological Aspect  Sociological Aspect  Psychological Aspect Spirituality as wholeness of the person in relation with all

7. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Religion is “An organized system of beliefs shared by a group of people and the practices, including worship, related to that system” (Burkhardt & Jacobson, 2000, p.92). Religion is a matter of choice

8. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Health as a state of wholeness Relationship between spirituality and health

9. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Spiritual Health Indicators Life meaning and purpose Sense of connectedness Sense of joy, peace, inner strength

10. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Spiritual Distress is “A disturbance in the belief or value system that provides strength, hope, and meaning in life”. (North American Nursing Diagnosis Association, 1999, p. 852)

11. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Spiritual Distress may be experienced when there is Loss or confusion related to the purpose of life Loss of connectedness Conflicts related to beliefs, values, and spiritual practices

12. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Signs of Spiritual Distress Fear Doubt Depression Despair

13. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Spiritual Assessment Comprehensive assessment of the client’s spiritual belief system Aspects  Meaning and purpose  Inner strengths  Interconnections

14. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Healing Practices for Restoring Wholeness Role of food and its rituals in sustaining health Communication with a God-force Positive affirmations Avoidance of negative thinking or judgments Being in right relationship with self and others

15. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Spiritual Self-care Reflection Taking time for oneself Taking time for what is important to you Nourish one’s own spirit

16. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Nursing Interventions for Restoring Wholeness Therapeutic communication skills  Attentive listening  Focused presence  Sharing

17. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 The Need for Cultural Understanding and Sensitivity Traditionally described using the “melting pot” metaphor Racially diverse population Population trends Cultural diversity

18. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Cultural Competence in Community Health Nursing Three levels of relationship development  Conceptual  Behavioral  Cultural Cultural compatibility hypothesis Universalistic argument

19. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Cultural Sensitivity Cultural competence Stereotyping

20. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Four Levels of Cultural Competence Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence

21. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Culturally Diverse Care Utilizing different nursing approaches to provide culturally appropriate care to a heterogeneous client population

22. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Transcultural Nursing “A learned humanistic and scientific area of formal study and practice which is focused upon differences and similarities among cultures with respect to human care, health (or well-being), and illness based upon the people’s cultural values, beliefs, and practices” (Leininger, 1991, p. 55)

23. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Leininger’s Sunrise Model Components of Culture Health Needs Folk Health System Professional Health System Nursing End result = Culturally Congruent Nursing Care

24. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Giger and Davidhizar Model (1999) Six cultural phenomena  Communication  Space  Time  Environmental control  Biologic variations  Social organization

25. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Cultural Beliefs and Values of the Nurse Cultural competence Personal values clarification

26. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Values of U.S. Culture (Leininger, 1978) Independence Equality Efficiency Individuality Justice Privacy

27. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Values of U.S. Culture (Leininger, 1978) (cont.) Materialism Competition Freedom of speech Enterprise Action Worship

28. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Family Folk Health Practices Pregnancy, birth, and postpartum period Infants and small children Children

29. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Family Folk Health Practices (cont.) All ages  Nutrition  Herbal remedies  Traditional practitioners  Treatments

30. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Religion: Bridging Culture and Spirituality Primal Religions of the World  Honor the spoken word  Honor the sacred place  Foundational beliefs

31. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Historical Religions of the World Founded in concrete events Sacred texts Cumulative traditions

32. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Hinduism Oldest religion Purpose of life = attainment of enlightenment Health practices

33. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Buddhism Four noble truths Deny existence of a personal Creator – God Emphasize personal responsibility Right living Healthy lifestyle Nonviolence

34. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Judaism Only one God Humans are to love, praise and serve God Family as basic unit of society Sabbath Regulations regarding permitted and forbidden foods Regulations regarding caring for the sick and dying

35. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Christianity Belief in one God Holy trinity – the Father, the Son, the Holy Spirit Bible source of inspiration Use of prayer to support those who are ill

36. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Islam Does not believe in God Believes in Allah Koran Rituals of faith

37. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Religion as a Vehicle for Expressing Spirituality Nursing role  Acknowledge, honor, respect patient’s religious views  Work with patient to meet spiritual needs

38. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 8 Caring and Cultural Diversity Universal desire for caring Caring is expressed differently among cultures Caring is the antidote to human suffering