Ethical, Cultural, and
Spiritual Considerations
DSN
Kevin Dobi, MS, APRN
Copyright © 2013 by Mosby, an imprint
of Elsevier Inc.
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Culturally competent care is delivered when nurses
value health or illness experiences through patient’s
eyes.
Nurses working together from diverse cultures may
practice in different ways.
For example: Native Indians emphasize spirituality in
their nursing practice:
 Touching someone has spiritual power.
 Honor is a characteristic that includes components of
appreciation and respect.
Copyright © 2013 by Mosby, an imprint
of Elsevier Inc.
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The United States has been called a “melting pot” because
many cultures and religions are represented.
About 20% of people in the United States speak a language
other than English at home.
On this continuum are people with varying cultural and
spiritual behaviors and beliefs.
Belief systems act as lenses through which people filter
everything.
Diversity can create challenges:
 When cultures and languages differ.
 When caring for individuals by not forcing compliance,
by working with beliefs and value systems.
Copyright © 2013 by Mosby, an imprint
of Elsevier Inc.
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You are not responsible for knowing health beliefs,
practices, and values of all groups.
You are responsible for asking about beliefs—this is
essential for individualized care.
There are many definitions of culture, and they all
overlap with ethnicity and religion.
You improve cultural awareness by asking about
unique beliefs, practices, and values.
Copyright © 2013 by Mosby, an imprint
of Elsevier Inc.
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Culture = All the socially transmitted behavioral
patterns, arts, beliefs, knowledge, values, morals,
customs, lifeways, and characteristics that influence a
worldview.
Ethnicity = Social group within a cultural and social
system that shares common cultural and social heritage
that includes:
 Language, history, lifestyle, religion, or all of these.
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Race is genetic in origin and includes physical
characteristics:
 Skin color, bone structure, eye color, and hair color.
All humans share a genetic code greater
than 99% identical.
Individuals from the same racial group are not
necessarily from the same culture.
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Religion refers to an organized system of beliefs, rituals,
and practices in which an individual participates.
Spirituality is a broader concept, which may include:
 Prayer
 Meditation
 Walking in the woods
 Listening to music
 Intentional appreciation of beauty
 Being present in the world with others
Spiritual and religious beliefs influence interpersonal
behaviors and expectations.
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of Elsevier Inc.
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There are national standards (14) to ensure equitable
and effective treatment (Source: USDHSS/OMH).
They are organized around three themes:
 Culturally competent care.
 Language access services.
 Organizational supports for cultural competence.
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of Elsevier Inc.
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Standard 1 directly affects nurses.
Healthcare organizations should ensure that patients
receive:
 Effective, understandable, and respectful care.
 Care provided in a manner compatible with cultural
health beliefs and practices and preferred language.
Furthermore, The Joint Commission requires that a
spiritual history be taken from every patient admitted
to hospital.
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of Elsevier Inc.
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Culturally competent nurses respect patient as unique
person by assessing the individual’s:
 Beliefs
 Values
 Preferences
 Needs
Be aware of your own biases.
Know questions to ask to learn about unique cultures
of your patients.
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of Elsevier Inc.
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Knowledge:
 Gain information about cultural differences and values.
Consideration:
 Use knowledge of languages, practices, and customs when
providing care.
Understanding:
 Thoughtful consideration of the importance of another’s
values and experiences.
Respect:
 Show appreciation and regard for cultural differences.
Tailoring:
 Adapting interactions based on cultural practices and
beliefs
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of Elsevier Inc.
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Recognize the uniqueness of each individual.
Cultural heritage equals “roots.”
 This helps explain activities and beliefs.
 Differences exist within cultures and groups.
Beliefs and attitudes in the United States have been
shaped by stereotypical images and misinformation.
Each patient deserves personalized assessment.
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of Elsevier Inc.
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Direct assessment of patient’s health beliefs and
practices that may reflect his or her cultural heritage.
Focused interview to provide information about
patient’s personal beliefs, values, and attitudes.
Observe behaviors during interview.
Ask one question at a time, allowing ample time for
response.
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of Elsevier Inc.
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Introductory questions:
 What cultural practices are important to you?
Primary language and method of communication:
 What language is spoken in your home?
Personal beliefs about health and illness:
 What are some of the practices you believe will improve
your health?
 Do you use alternative healing methods?
Beliefs about a current health problem:
 What are the most important results you hope to receive
from this treatment?
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of Elsevier Inc.
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Religious or spiritual influences:
 Do you have any spiritual needs or concerns related
to your health?
Roles in the family:
 Who makes decisions in your family?
Special dietary practices:
 Are there any special types of food that are
forbidden by your culture?
Note patient’s surroundings:
 Are there any religious symbols?
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Be sensitive.
Ask questions.
Gather specific information.
Do not stereotype.
Do not assume care for one individual of a culture is
appropriate for another individual of same or similar
culture.
Regardless of culture or race, each patient is unique—
take time to know each patient.
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of Elsevier Inc.
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Staff development educators are responsible for assisting
staff nurses in being adequately prepared to perform their
duties as they care for patients from many different
cultures and backgrounds. As the educator works with a
new nurse from the Philippines, the educator will include:
Training on American food choices.
Assistance with competency in skin lesions on dark skin.
C. Practice in assessing patients’ personal beliefs and
practices.
D. Information on immigration and privacy laws.
A.
B.
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of Elsevier Inc.
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Copyright © 2013 by Mosby, an imprint
of Elsevier Inc.
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