Guide to Religion and Culture in Healthcare

Guide
to
Religion and Culture
in
Healthcare
Copyright 2009 Florida Hospital Prepared under the auspices of: Biomedical Ethics Committee Diversity and Inclusion Department Editors: Aurora Realin, BS, MBA Florida Hospital Diversity and Inclusion Marie Ruckstuhl, BSN, MBA, RN, CPHQ, CHCRM Florida Hospital Nursing PREFACE This document has been prepared for use by healthcare professionals and other staff members who interface with patients. An attempt has been made to present information related to religion and culture that may be helpful in fostering a positive relationship with patients in the interest of providing more effective whole person care. The information provided is rather basic and general. However, the reader should not interpret each item presented as strictly applying to each person falling within a specific category. Some information may apply to specific groups or is dependent on the patient’s age, generation and length of time exposed to Western Medicine. Therefore, this information is intended only as a starting point for establishing discussions with patients that will reveal, hopefully, details relating to their individual cultural practices and beliefs. The patient’s specific information may be significant in tailoring their care and removing possible barriers. By asking the patient about specific practices, the healthcare professionals will be better able to provide individualized spiritually and culturally appropriate care. i
DISCLAIMER AND LEGAL NOTICE This document is protected by copyright. All rights are reserved. No part of this Guide may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except as set forth in the remainder of this disclaimer and legal notice. Your use of this resource constitutes acceptance of the terms of this Disclaimer and Legal Notice. Upon acceptance of these terms, a limited license is granted to you, the user of this Guide, solely for the purpose of providing services, care, or treatment to the patients at Florida Hospital. This information is provided as educational and reference materials for the health care providers providing services or treatment to patients only. THIS GUIDE IS NOT INTENDED AS A SUBSTITUTE FOR DISCUSSIONS WITH YOUR PATIENTS CONCERNING THEIR HEALTH CARE NEEDS. Each individual is affected by his or her own life experiences and continues to change over time. Therefore, the application or use of this information in a particular situation remains the professional responsibility of the practitioner. No express or implied warranty or warranty of merchantability or fitness is implied or intended for the programming, publication, or development of this resource tool. The authors, editors, programmers, and copyright owner are not responsible for errors or omissions or for any consequences from application of the information contained in this book and make no warranty, express or implied, with respect to the currency, completeness, or accuracy of the contents of this Guide. Care has been taken to research and confirm the accuracy of the information contained in this manual and to describe a number of core practices, values, and ideals based on culture and religion. Even so, it has not been possible to describe every culture or religion, nor has it been possible to describe each and every difference or distinction within a particular culture or religious group. In addition, multiple religions may be practiced within the same specific culture. Conversely, multiple cultures may exist within a single religion. Finally, even within the same religion and culture, different people may have different perspectives and different beliefs. The promulgation of this Guide does not imply an endorsement by Florida Hospital nor by the editors of any one point of view, value or belief system, but rather the Guide provides a resource or compendium of information collected from the literature to help caregivers prepare to ask patients specifics about their spiritual and cultural practices. It is beyond the scope of this document to provide a detailed treatment of the subject matter. Information in this document is supported by references listed at the end. An extensive bibliography is also offered for those who wish to delve more deeply into the topics covered. In some cases, external links to primary or secondary source material have been provided for the convenience of the user. The authors, editors, programmers, and copyright holder have no interest in, responsibility for, or control over linked sites. They also make no promises or warranties of any kind, express or implied, including those of merchantability or fitness for a particular purpose, as to the ii
content of this site or those it links with. In no event will the authors, editors, programmers, or copyright holder, individually or collectively, be liable for any damages resulting from this web site’s use, even if they have been informed of the possibility of damages. iii
ACKNOWLEDGEMENTS We wish to thank the members of the Florida Hospital Biomedical Ethics and Perinatal Ethics Committees for their support, comments, and suggestions. It is also fitting to thank Karen Marcarelli, Vice President, Patient Care Services for Florida Hospital, and Louis R. Preston, Jr., Diversity Officer, Florida Hospital Diversity and Inclusion for their leadership on this project. We would also like to thank the Florida Hospital I‐Extend and Web team for their assistance in making this document available online. Thanks also to Ann McDonald with the Florida Hospital Medical Library and her staff in helping locate the many books and journal articles used in preparing this document. Aurora Realin, BS, MBA Florida Hospital Diversity and Inclusion Marie Ruckstuhl, BSN, MBA, RN, CPHQ, CHCRM Florida Hospital Nursing Department iv
TABLE OF CONTENTS BACKGROUND ..................................................................................................................................................... 1
INTRODUCTION ................................................................................................................................................... 1
1.0
Adventist, Seventh‐Day ....................................................................................................................... 5
2.0
Amish (Anabaptists) ............................................................................................................................ 8
3.0
Baptist ................................................................................................................................................ 11
4.0
Buddhism ........................................................................................................................................... 13
5.0
Church of Christ, Scientist ................................................................................................................. 16
6.0
Episcopalian ....................................................................................................................................... 19
7.0
Hinduism............................................................................................................................................. 21
8.0
Islam (Muslim) ................................................................................................................................... 25
9.0
Jehovah’s Witnesses ......................................................................................................................... 30
10.0
Judaism............................................................................................................................................... 33
11.0
Lutheran ............................................................................................................................................. 38
12.0
Mennonite (Anabaptists) .................................................................................................................. 40
13.0
Methodist, United ............................................................................................................................. 42
14.0
Mormons/ Church of Jesus Christ of Latter‐day Saints ................................................................... 44
15.0
Pentecostal / Assemblies of God ...................................................................................................... 47
16.0
Presbyterian ....................................................................................................................................... 49
17.0
Roman Catholic.................................................................................................................................. 51
18.0
Sikhism ............................................................................................................................................... 54
19.0
Unitarian............................................................................................................................................. 58
CULTURES .......................................................................................................................................................... 60
1.0
African‐American ............................................................................................................................... 61
2.0
American Indian/Native American .................................................................................................... 65
3.0
Arab American ................................................................................................................................... 70
4.0
Asian: Chinese American ................................................................................................................... 73
5.0
Asian: Japanese American................................................................................................................. 77
6.0
Asian: Korean American .................................................................................................................... 81
7.0
Asian: Vietnamese American............................................................................................................. 85
8.0
Brazilian .............................................................................................................................................. 89
9.0
East Indian.......................................................................................................................................... 94
10.0
European ‐ American ......................................................................................................................... 98
11.0
Filipino .............................................................................................................................................. 103
12.0
Gypsy (Roma)................................................................................................................................... 106
13.0
Haitian .............................................................................................................................................. 110
14.0
Hispanic Colombians........................................................................................................................ 113
15.0
Hispanic Cuban................................................................................................................................. 118
16.0
Hispanic Dominican ......................................................................................................................... 125
17.0
Hispanic Mexican ............................................................................................................................. 130
18.0
Hispanic Puerto Rican...................................................................................................................... 137
19.0
Jamaican/ West Indian..................................................................................................................... 142
REFERENCES .................................................................................................................................................... 146
BIBLIOGRAPHY ................................................................................................................................................ 150
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BACKGROUND In order to assist caregivers in providing trans‐cultural and spiritual patient care, the Florida Hospital Religion and Culture in Healthcare: Caregivers Guide was originally developed at Florida Hospital by the Nursing Department Patient Education Ad Hoc Committee and published internally in 1997. The first edition of the guide addressed basic topics within different religions and cultures including Beliefs, Birth, Baptism, Death, Diet, Health Crisis, and Healing Environment. In early 2008, an effort was made to update and expand that document. Topics such as Pregnancy, Pain Management, Advance Directives, DNR, Blood, Organ Donation, and Autopsy were added. During the approval process, it became clear that Florida Hospital should have a single hospital‐wide document instead of various departments preparing their own, in order to reduce duplication of effort and to provide a more comprehensive reference. Although the Nursing Department remains a key participant, sponsorship of the effort was transitioned to the Florida Hospital Biomedical Ethics Committee. Under its auspices, the Florida Hospital Nursing Department and the Florida Hospital Diversity and Inclusion Department have revised the format of the document for easier reading and included information from the Florida Hospital Diversity and Inclusion Department materials. INTRODUCTION Quality care in healthcare requires an awareness of the physical, psychological, social, spiritual and cultural needs of the patient. Awareness of religious and cultural backgrounds that differ from our own can facilitate care for many patients, especially during health crises. It is important to be aware of the religious and cultural needs of patients regarding healthcare in order to elicit cooperation and maximize the benefits of care. The caregiver, with knowledge of the perceptions and practices of patients that differ from ones own, will be better able to provide appropriate care. Offering opportunities for patients to reveal their personal beliefs and practices may provide insights into culturally sensitive ways to provide quality care that consider the patient as an individual rather than a member of a particular religion or culture. This is consistent with the mission of Florida Hospital and its culture of excellence. The mission of Florida Hospital is to extend the healing ministry of Christ by providing quality health care and service. Understanding of others and trans‐cultural care can help healthcare workers carry out that mission more effectively. The Culture of Excellence at Florida Hospital (as described in the Employee Handbook) creates a place of healing through understanding. Care is based on what needs and wants the patient expresses to the caregiver. It involves serving others as we would like to be served. The Culture of Excellence principles guide the caregiver behavior and actions and are seen in basic human relationships and skills. The principles follow the golden rule of caring for others as we would want to be cared for. Customer service for the Patient‐Employee experience is based on the expressed needs of our patients and what they most desire to receive from their caregivers. The principles guide our service behaviors and interactions with patients, guests and each other. 1
The five principles in the Culture of Excellence are: Simple: Always address patients, families and staff with a smile and tell them “Who you are, What you are doing and Why you care.” Doable: Always engage patients, families and staff by asking them “what is the most important thing I can do for you today/now?” Meaningful: Always end conversations with patients, families and staff by stating “It is my pleasure” Caring for others is a privilege beyond our tasks, jobs and responsibilities. Sustainable: Always give your full attention “one patient at a time, every time.” This is the key to consistency and quality in extending care. Transferable: Always come prepared to live “Trust, Belonging and Hope” every day and invite others to do the same. The more I live in the light of these principles, the more I experience the positive blessings of a mission‐based experience. A major goal of this document is to help improve the position of Florida Hospital in the realm of spiritual and cultural competence in providing healthcare. In striving to live the Culture of Excellence principles and provide a more personable patient care experience through attention to patient needs, Florida Hospital caregivers seek to extend the healing ministry of Christ to all religions and cultures. Current and predicted demographics indicate that the immigrant population in Florida is significant and growing. It is no longer unusual to encounter patients having different cultural and religious backgrounds quite different from our own. Thus, the importance of exploring religious and/or cultural concepts is very important in order to provide a personable patient care experience with individualized care. HOW TO USE THIS DOCUMENT The information provided in this document is basic and should not be strictly applied to everyone who claims to be of the same religion or culture. In order to obtain cultural or religion information to individualize care, it may be helpful to say “I understand that some (name religion or culture) may like to (name activity e.g., pray in a quiet space). Would this be helpful for you?” By eliciting the information from the patient, individualized care can be provided, thereby enhancing the patient’s experience and providing spiritually or culturally appropriate care. The document provides information in tabular form in order to facilitate its use as a quick reference. Selected religions and Christian denominations are listed alphabetically in the first section. Selected cultures are listed alphabetically in the second section of the document. These particular religions, denominations and cultures were selected based on the religions and cultures of the majority of patients who sought care at Florida Hospital. Subcategory information has a “¾” prior to the information. Suggestions to healthcare professionals and staff have a “9” mark and are in BOLD print. 2
COMMENTS Note: Western Medicine values patient autonomy. However patients in many cultures may be accustomed to family group decisions. In some cultures the patient information is shared with the family leader (e.g., a senior member of the family) or spokesperson before the information is disclosed to the patient. The Health Insurance Portability and Accountability Act (HIPAA) does not allow the caregiver to share patient health information with others unless the patient (or guardian) provides explicit permission to do so. Please be aware and obtain the appropriate patient permission if the patient would like to have information provided to designated individuals. 3
RELIGIONS and CHRISTIAN DENOMINATIONS This section provides information about how the religious background of a patient may affect the needs and expectations of that patient. 4
Guide to Religion and Culture in Healthcare Religion: 1.0 Adventist, Seventh‐Day Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood • Holy Scriptures are the word of God revealing his infallible will, written by men, who were moved by the Holy Spirit 1p5‐15 • Triune God: God the Father is a merciful, loving, forgiving God; God the Son became Man; and God the Holy Spirit guided those who wrote the Bible and helps believers 1p17‐68 • Lord’s Supper is observed every three months, with grape juice; before Lord’s Supper is served, rite of foot‐washing rite is conducted which symbolizes “ service to others” 2p395 • Plan of salvation centers on Jesus Christ as Savior 1p17‐68 • Holistic care 4p2 • Promote prevention/ wellness; health is from God 5p1 • Saturday is 7th day or Sabbath, which is observed from sundown Friday until sundown Saturday 1p249‐264 • Sabbath is set apart for worship, fellowship and deeds of mercy; secular activities are avoided 1p249‐264 • Members value bible promises, family, good works, nature, cleanliness, fresh air, sunshine, water, exercise and rest, and peaceful music 6p122, 127, 254 ‐
257, 275 ‐ 276;7p60 • Note: Holy days for Christian religions may be found on the FH Diversity and Inclusion website at http:///www.fhdiversityandinclusion.org • No alcohol, tobacco or caffeine beverages; encourage vegetarian diet and avoidance of high fat foods 5p3; 7p127‐131 • Abstain from eating “unclean foods as identified in Scriptures – Leviticus 11, 1‐47” (i.e. pork, rabbit, carnivorous animals, shellfish, and fish without fins or scales) 8p290 • Meats are restricted to “kosher” meats as identified in Scriptures 2p395 • No information found at this time • Chaplain, Pastor or other Christians pray with/for patient 9p157 • Prayer for sick is very important in extending God’s healing power 6p222‐275 • Comfort may be provided by healing prayers with healthcare workers or by “reading Scriptures, listening to religious music, watching televised worship services” 2p396 • Baptism, the Lord’s Supper, or Anointing of the Sick may be requested 2p396 • Anointing may be done if patient or family requests 10p404 • Provide bright, clean, cheerful environment; express kindness, encouragement and sympathy 6p222‐275 • No restrictions on blood products 5p2 5
• Christians have a responsibility to care for those who are suffering and provide relief 4p1 • May be comforted by Scriptures and healing prayers 2p396 Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care • Follow all medical procedures and/or treatments that sustain life, however, believe individual does not have to accept treatments that only extend dying process 4p2‐3 • Up to individual; no church teachings against use 2p395 • Promote organ donation and transplantation 5p3 • Autopsy permitted 9p157 • Believe death is time of comfort until second coming of Jesus; resurrection of body will occur at the second coming 2p396 • No last rites at death; dead are asleep until Christ returns 5p3 • Family may wish to view body of deceased before removal from hospital room 2p396 • Up to individual; does not go against church teachings 2p395 • No information found at this time • No faith prescriptives for prenatal care 11p291 • For vegetarian mother, may need information on additional nutritional needs during pregnancy and supplements 11p291 • In Vitro acceptable 2p395 • Human life is God‐given; in general, abortion is not permitted, but may “be considered” in special cases such as rape, incest, “severe congenital defects” or if life of mother is in danger 5p1‐2 • No specific rituals or traditions for birth 11p291 • No information found at this time • Up to individual, family; no religious recommendations 2p395 • If fetus has serious genetic defect, may consider abortion 11p292 • No information found at this time • No special rites; may wish to have pastor pray for the dying baby 11p293 • No information found at this time •
•
•
•
No rites of faith practiced at birth 10p404 Baptism is requested when child is old enough to embrace faith 1p188‐189 Baptism is by immersion 10p404 No information found at this time • No information found at this time • No special traditions 6
Family/Father involvement Contraception Child/Teen Environment of Care • No information found at this time • Birth control is up to individual; use of measures to prevent conception is generally accepted 5p1‐2 • Barrier methods are acceptable; abortions are not acceptable method 11p292 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 2.0 Amish (Anabaptists) Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment • Christian group whose belief system stresses lifestyle and peace; Amish and Old Order Mennonites are “missionaries by example” 12p7‐8, 16, 46 • Church is composed of adults who freely commit to disciplined lifestyle 12p7‐8, 16, 46
• Amish beliefs include ¾ Bible teachings ¾ Separation between church and state ¾ Peaceful living 12p7‐8, 16, 46 • As a reflection of belief that they are God’s servants, frequently speech is slow and soft to express “humility and meekness” 13p52 • Religious meetings are in members’ houses 14p121 • Lifestyle includes daily prayer, Bible reading; worship on Saturday or Sunday 10p172 • Many live on farms where plenty of food is available; have no restrictions in diet 12p58; 2p174 • Not usually concerned about diet or weight loss; follow tradition for food preparation without additives; diet is high in “fats and carbohydrates” 14p124‐125 • Do not show physical signs of affection; touch is limited 2p176 • It is important to respect personal space while providing kindness and support 2p176 • Accept modern medicine to improve health but understand that good health and healing are God’s gift 12p62‐65 • Believe when one eats well and appearance is good as well as is able to work, that person has good health 15p39 • Families care for their elderly who are well‐respected and valued 14p121 • Many will use home remedies, including folk and alternative medicines before seeking professional healthcare; may not be aware of disease etiology, disease transmission and immunizations 14p123 • Extended family and community members may visit to show interest and caring for patient 10p169‐172 • Amish women usually wear a hair covering at all times; this should not be removed unless necessary 2p175 • Do not carry medical insurance nor accept any kind of financial help from government; Church will assist, if unable to pay bills 13p56 • Schooling usually through elementary years; assessment of knowledge level of patient is important with regards to healthcare 14p122 9 Use direct and straightforward questions and explanations; education should include the family, as appropriate; obtain 8
Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions appropriate permission per HIPAA • Many Amish do not have telephones or vehicles 14p120‐123 9 Education for the patient’s family may include what to do in case of an emergency where there will be a delay in getting to medical help • Acceptable to receive and to donate blood 2p174 • Generally do not verbalize or express pain or emotion; children are generally very quiet in presence of unfamiliar person or place; may deny pain in presence of healthcare worker, although pain is severe 14p120 • Believe suffering allows one to become closer to God 2p175 • Focus on quality of life; seldom consider heroics to extend life 14p123 • Do not normally have advance directives 2p174 • May not agree to transplantation if outcome is uncertain for the recipient; otherwise, accept transplantation 16p1; 2p174 • Accept if required by law 2p177 • Community will support and help individual deal with loss 12p66‐69 • Family is not emotional at death of patient since death is considered the first step into “eternal life with God” 14p123 • Prefer to die at home 2p177 • In certain communities patient may request anointing prior to death; anointing signifies forgiveness of sins 2p177 • Accept hospital practices; no prescribed rite for preparation of body 2p177 • Individual decision; delaying death is not encouraged; fatalistic attitude that death is “God’s will” and consider the cost for extensive procedures and life prolonging treatments 2p175 • No information found at this time • Prenatal care may be minimal, late in gestation or not at all, especially with subsequent pregnancies 14p122‐124 • With uncomplicated first birth in hospital will probably have following pregnancies delivered at home 2p176 • In Vitro: generally do not practice 2p175 • Amish do not support abortion 2p174 • Believe that having children is woman’s highest goal; birth causes few changes in mother’s life 12p56 • Since one must be able to reason to freely choose church, children are considered a part of God’s kingdom until they reach the age of reason 12p16
• Some mothers will breastfeed, but will cease at around 6 weeks as mother returns to pre‐pregnancy lifestyle 14p123 • Up to individual, not a religious issue 2p175 • Many in a community are related by marriage; genetic issues may arise from intermarriages 15p36 • All infants, including those with serious birth anomalies, are integrated into the Amish lifestyle; each infant is a “gift from God” 14p123 9
Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • If newborn is ill, Amish consider it “God’s will” 2p176 • If newborn dies, Amish consider it “God’s will” 2p176 • Life is gift from God; if infant is disabled by condition, family will care for infant at home 17p9Chp 1 • See “Neonatal /Infant End of Life” • No information found at this time • Typically begin solid foods at six weeks when mother returns to routine duties; may increase likelihood of allergies 14p123 • Adoption is supported 17p8Chp 1 • Resumes normal role in a few days post birth 18p41 • Husband is usually at delivery of wife 2p175 • Traditionally do not support birth control 2p175 • Discussion of sex is prohibited in most Amish families 14p 122‐124 9 Evaluate the patient’s willingness to discuss sexual matters, if appropriate • Children are generally very quiet in presence of unfamiliar person or place; may deny pain in presence of healthcare worker, although pain is severe 14p120 • Parents usually stay with children when hospitalized 2p176 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 3.0 Baptist Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy • Christian; 27 denominations with each church independent but holding common beliefs ¾ Bible provides guidance for life; Jesus Christ is Lord ¾ Individual freedom to communicate directly with God ¾ Salvation through faith and the Holy Spirit 19p49, 54 • Ordinances: Baptism and Communion 19p49, 54 • All life including health and healing comes from God 2p325 • Believe in responsibility to share faith and do mission work 2p325 • Note: Religious holy days for Christian religions may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org • No alcohol 3p161 • No information found at this time • Scripture reading, music, televised worship services 2p326 • May be comforted with healing prayers 2p326 • Transfusions are acceptable 2p325 • No information found at this time • No information found at this time • No church position, but up to individual 2p325 • Transplant is acceptable if it will improve life of recipient 16p1 • Autopsy is permitted 20p494 • Belief in “life with God” after death 3p162 • May request Christian conversion; consult chaplain for assistance 2p326 • May request Lord’s Supper, prayer for dying, readings of Scripture texts 2p326
• Family may request to see body before removal from hospital room 2p326 • In futile cases, withholding or withdrawal does not go against teachings; up to individual 2p325 • No information found at this time • In Vitro: various opinions in different Baptist groups; generally discouraged, but is individual decision 2p325 • Abortion not acceptable 2p325 11
Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • No information found at this time • No information found at this time • Generally practiced, not a religious mandate 2p325 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • Baptism by immersion; no infant baptism 3p161‐162 • May present infant at church services where parents reaffirm their responsibility for raising the infant 3p161‐162 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • No information found at this time • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 4.0 Buddhism Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy • No God, but Buddha is honored as having set a model lifestyle 21p23 • Does not prescribe means to reach ultimate goal of Nirvana; belief in re‐
incarnation; healing does not occur through faith alone 10p 363, 376 ‐377 • Buddha provided four “Noble Truths”: ¾ Life includes suffering; ¾ Desire for sensual gratification leads to suffering; ¾ If one gives up worldly desires, can eliminate suffering and attain Nirvana; ¾ The path to Nirvana is “eight‐fold” 2p109‐110 • Believe that doing good deeds in this life will improve/raise the state that one is born into in the next life 3p11‐14 • May use prayer beads to help meditate 3p11‐14 • Promotes harmony; believe group benefit supersedes individual 9p244 • Note: Religious holy days for Buddhists may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org • Food taken in moderation; may avoid eating some foods together 22p153 • Prohibits alcohol; some branches of Buddhism may require diets with no meat 3p12‐15 • Generally, a healthy diet is recommended 3p12‐15 • Depending on the culture, touch may not be appropriate; wait to see if patient extends a hand 3p15 • May “chant out loud” 23p1 • Family and community support patient by visiting 9p153 • Illness is a result of action taken or events that occurred in this or previous life; may believe peace from Buddha's wisdom is factor in “healing and recovery process” 10p363‐377 • Transfusions acceptable 9p153 • Suffering is part of living 3p11 • May refuse pain medication due to concern about affect of medication on thoughts and clarity of mind 23p1 • If recovery is possible, all support is encouraged 9p153 • No information found at this time • No religious position regarding organ donation; up to individual 24p1 • Religious values of compassion and helping others supports concept of organ donation 25p25 • Acceptable 20p494 13
Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception • When patient is dying, allow patient undisturbed times for meditation to mentally prepare for death; Buddhist priest should be notified after patient’s death in order to pray with body 21p24 • Read scripture to help dying prepare for passage to next life 3p16 • Patient desires a clear mind, especially at end of life 23p1 • No death ceremony 3p16 • May have rites with “chanting at bedside soon after death” 26pB‐7 • Body is not moved before priest arrives 21p24 • In moving body 23p2 9
Staff should “avoid jostling” because spirit remains with body for some time after death • See “DNR” • No information found at this time • Woman who is expecting should not attend funerals; thought to be unlucky for fetus 26pB‐7 • Respect for life; patient’s health status and circumstances are considered in determination about abortion 10p377 • No information found at this time • No information found at this time • No information found at this time • Condition may be considered “karma” 17p6Chp 3 • No information found at this time • Parents may seek special rituals by local leaders of their faith to counteract the lack of preparation by the baby/child for death 26pB‐7 • No information found at this time • No baptism 3p17 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • No restriction on birth control 9p153 14
PEDIATRICS Child/Teen Environment of Care • In case of child’s death parents may seek special rituals by local leaders of their faith to counteract the lack of preparation by the child for death 26pB‐7
Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 5.0 Church of Christ, Scientist Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment • Believe each person is inseparable from God who created everything; everything reflects God’s goodness 2p338 • Belief based on Bible (King James) and text “Science and Health With Key to the Scriptures” by Mary Baker Eddy, founder of the Church of Christ 3p18‐
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• Doctrine: healing can be effected by prayers, therefore, they do not seek medical treatments; healing is natural result of becoming “closer to God” 3p18‐20; 10p381‐382 • Church has individuals with title of “Nurse” who have received training in the teachings of the church to provide non‐medical care; a “Practitioner “ is one who practices “Christian Science healing through prayer” 3p21 • Church teachings indicate that Golden Rule should be foundation of all actions; sin results when we “try to live apart from God” 3p18‐20 • Each individual has “a unique relationship with God” and a unique spirituality 2p339 • Described as “religious teaching and practice based on words and works of Christ Jesus” who is called the “Way‐Shower” 19p104‐106 • Believe following the Word of the Bible will lead to eternal Life 19p104‐106 • Disease comes from mental state which can be remedied by practicing Christian discipleship and following what Jesus taught 19p104‐106 • Church has individuals with title of “Nurse” who have received training in the teachings of the church to provide non‐medical care; a “Practitioner “ is one who practices “Christian Science healing through prayer” 3p21 • Church may have visiting home nurse service 10p384 • Worship with “music, singing, and prayer and readings” on Sunday; meet on Wednesdays for similar service and individuals share experiences in healing 2p339 • May avoid alcohol, tobacco, and drugs 3p22 • No information found at this time • Individual choice is very important to members; each determines what is best after prayer 2p339 • May use prayer to cure 2p339 • May request healthcare professional allow time for the patient to resolve health issue through his/her Christian Science faith 27p73 • Member who request medical treatment may ask to have drugs and therapy minimized 2p340 • Church may have visiting home nurse service 10p384 • Will avoid most testing and medical care which Christian Scientists “believe 16
Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement is in violation of their religious beliefs” 28p210 9
Ask patient what treatment they will accept • Believe that God can heal all conditions; however, may seek help from medical system for fractures 26pB‐10 • Usually do not accept transfusion 10p383‐385 • May use prayer 2p339 • Pray for recovery but do not seek heroics or extending life through medical treatments 10p383‐385 • Up to the individual 17p5Chp4 • There are no church restrictions on organ donation, up to individual 16p1 • Rely on spiritual healing, not physical; from that standpoint may not agree to transplant, donation or receiving organ 10p384‐385 • Up to individual or family 2p342 •
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Family prays for patient’s recovery until patient dies 10p384 There are no church “last rites” 2p342 No ceremony at death of patient; believe death is but a phase of life 29p205 Term “passed on” is used to indicate that this life has ended and that there is continuity for the deceased in another life 3p23 • Recommend that when the deceased church member is female, the body be attended by women 3p23 • Up to individual or family 2p341 • Believe that God can heal all conditions; do not generally take medications, agree to biopsies or exams; do not usually want to extend life 26pB‐10 • Prenatal care is up to individual 17p8Chp4 • In Vitro: no church position; up to individuals 2p3340 • Abortion is not consistent with beliefs 30p384 • May prefer home birth if possible 27p72 • No church rites at birth 2p341 • No information found at this time • Decided by parent or individual 10p384 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • Baptism is not practiced 3p23 • No information found at this time • No information found at this time • No information found at this time • No information found at this time 17
Contraception PEDIATRICS Child/Teen Environment of Care • Birth control decided by individual 10p384 • Oral contraceptives would be discouraged because they are drugs 17p8Chp4 • In some cases, parents have been taken to court to get authority to treat seriously ill minors 28p210 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 6.0 Episcopalian Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs • Bible (Old and New Testaments) provides all that is needed for salvation; it is the “ultimate standard of faith” 2p354 • People, guided by the Holy Spirit, wrote the Scriptures which members are to use for guidance while making moral decisions 31p121 • Believe: ¾ Triune based faith: one God in three, Father, Son and Holy Spirit ¾ Incarnation of Jesus, “fully human and fully divine” ¾ Members are part of entire Body of Christ which is all baptized individuals ¾ With Baptism the Holy Spirit resides in the Christian, allowing growth in Christ 2p354 • Two sacraments: Baptism and Lord’s Supper 2p354 • Communal worship, on Sundays and at other times 2p355 • Believe God is “ultimate source of all life, health and healing” 2p356 • Evangelism as well as mission work is important in many of the denominations 2p355 • “Daughter” of the Church of England 2p353 • Note: Religious holy days for Christian religions may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org • No religious restrictions; some fast before receiving Lord’s Supper 2p356 • No information found at this time • Comfort may be obtained from reading Scriptures or other religious material, “listening to religious music, watching worship services” or from healing prayers 2p357 • No restrictions 2p356 • Promote palliative care 17p14Chp6 • Acceptable to decline heroics in futile case 17p12Chp6 • Encourage advance directives 2p356 • Permitted, up to individual 2p358 • Individual decision 2p358 • Hospice care is acceptable 17p14Chp6 • Soul and spirit go to heaven at death; resurrection of body with reunion of “spirit, soul and body” will occur at second coming of Jesus” 2p357 • Baptism may be requested; sprinkling is acceptable 2p357 • May request Lord’s Supper 2p358 19
Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Family may request to see deceased before removal from hospital room 2p358
• Individual decision; no restrictions in medically futile cases 2p356 • Discussion about care in terminal case should include patient/surrogate 17p13Chp6
• No restrictions regarding in vitro fertilization 2p356 • Individual decision; acceptable to support mother’s health, mental and physical 2p356 • Not acceptable for birth control 2p356 • No information found at this time • No information found at this time • No religious indications; individual decision 2p356 • No information found at this time • Acceptable to decline heroics in a futile case 17p13Chp6 • See “Neonatal Illness” • See “Neonatal Illness” • Sacrament of Baptism by pouring water or immersion, conducted by priest 31p127
• Family may request baptism; consult chaplain or clergy 2p357 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • No restrictions regarding birth control 2p356 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 7.0 Hinduism Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs •
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Hindu is the belief system of the majority of East Indians 32p98 Worship practice varies depending on community 2p470 Religion “is a way of life” 2p467 Basic Teachings: ¾ Soul is divine ¾ One “Reality” (Brahman); there is one God ¾ One God, but many manifestations (“Truth is one; sages call it by various names”) ¾ All religions lead to same end goal 2p467‐468 Individual interprets teachings which he/she is to verify through own experience of life 2p469 “Creation, preservation and dissolution” are endless cycles as creation cannot occur from nothing 2p468 Karma: individual has accountability for thoughts, words and deeds; cause and effect gives individual incentive to act morally correct 2p468 Reincarnation: many cycles of life, striving for ultimate goal of raising consciousness to highest level 2p468‐469 Four goals of life ¾ Dharma: duty to self and society ¾ Artha: need for material goods ¾ Kama: desire for pleasure of the senses, legitimately ¾ Moksha: seeking the ultimate goal, “Liberation” in which one is freed from repeated life cycles 2p468 Rituals and prayers: call upon divine presence 2p468 Promote “ayurveda” (“Life Science”) which is positive attitude to health and maintaining the balance between “body humors;” imbalance in these causes illness 21p266‐268 Practice mutual tolerance and believe all ways to God are acceptable There is no single belief system: ¾ some believe in “faith” healing others ¾ believe health problems are from God as punishment ¾ believe in reincarnation which depends on one’s “moral behavior” in this life 10p388‐389 Note: Religious holy days for Hindu may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org 21
Diet and Nutrition Communication Healing Environment Blood • Religion fasting is common; ill are not obliged to fast; special permission may be obtained to eat fruits, vegetables, etc., for fasting individuals with health issues 2p471 • May be lactose intolerant 34p495‐496 • Consider a good digestive system essential to good health and place emphasis on diet 33p267 • Strict rules for food preparation 3p32 • Many eat no meat; those who eat meat usually eat no beef or pork 3p32 • During meals Hindus use only right hands to feed themselves 3p32 • At meal, will clean his/her mouth “with water before and after meals” 3p32
• Hindu greet with palms together and a bow of the head toward the person they are greeting to recognize person and the person’s soul 2p470 9 Verbally greet patient’s husband or oldest female present before greeting female patient 34p480‐481, 494 • Touching is not acceptable in public 34p480‐481, 494 • Unless married, eye contact between two people of opposite sex is seen as disrespectful 34p480‐481, 494 • Daily bath is required; not acceptable to add cold water to hot in preparing for bath 10p481‐492 • Patient may refuse bath after meal 10p481‐492 • Personal care is done with left hand 34p480‐481, 494 • After toileting, may wish to bathe with water 2p473 • Prayer and “ritual cleansing” of left hand is very important 21p21 • Hindu female may prefer female doctor 2p473 • Hindus of either gender prefer to wear clothing under hospital gowns; for procedures, clothing covers private areas 2p473 • Family may want to do hands‐on care for patient; extended family may remain at hospital when member is admitted 10p481‐492 • Family is very important; hierarchical system with father or oldest son at head; however decisions are result of vote by family members 10p481‐492 • Family member who is closest to patient is usually the primary spokesperson 2p474 9 Ask questions or discuss issues with spokesperson after obtaining appropriate permission from patient per HIPAA • Family may bring food from religious service for the patient; discuss any dietary restrictions with family 2p474 • Due to respect for professional may agree, but not comprehend 33p266‐268 • If patient determines that medication is affecting body functions, will try to change diet first to correct; if not successful, then may stop taking medications 33p269 • May request injections due to belief that illness can only be cured if treatment includes injections 33p269 • No restrictions on blood transfusion 32p99 • Blood is viewed as precious; may refuse to have lab drawn and provide for blood donations 33p267 22
Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal • Patient may accept some interventions for relief 32p99 • May be concerned about possible addiction and consequently refuse pain medication or reduce the dosage 35p37 • Patient may refuse pain medication that does not allow for a clear mind at the time of death 17p112Chp7 • Up to individual whether to prolong life through medical treatment, heroics 10p390 • Encourage Advance Directives be prepared 2p472 • Up to individual; some may believe this is a “gift of life” to others 2p476 • View varies as to receiving organ donation; may be acceptable if likely that there will be a good quality of life afterwards; for some, heart transplant is not acceptable due to the heart being “the seat of the soul” 2p476 • Autopsy is acceptable 32p99 • Desire health care professional to discuss “terminal illness” only with family, not patient 32p98 • At death, the soul continues and will return in “another body” 3p36 • Soul takes karma of deceased when it departs 2p473 • According to Scripture, the dying person obtains object of thinking at time of death; goal is to raise spiritual consciousness at time of death 2p473
• Prayers, chants for soul’s passing from this life to next; overt display of grief is acceptable in both male and female 34p491 • Small wishes of the dying patient for food should be fulfilled 2p475 • Family may desire to have holy water into patient’s mouth 2p475 9 Consult Hindu temple or chaplain, if appropriate • Family may desire to place a picture of a “Personal Deity” near the patient 2p475 • Family may ask Hindu Temple priest to provide spiritual support patient when dying; support is provided by chanting mantras, songs, and encouraging patient to visualize the image of God 2p475 • Other support practices include ¾ Tying blessed thread around neck/wrist of dying patient ¾ Sprinkling holy water ¾ Basil leaf placed on tongue ¾ Reminding dying that the real “Self” is immortal 2p475 • Deceased’s body is prepared by bathing and dressing, then covered with white fabric; an individual is with the body at all times until cremation 3p36
• Items such as thread around neck or wrist (signifying that Hindu priest blessed the patient) or red mark on forehead should remain 36p22 • Arrangements for deceased are made by oldest son 36p22 • Soul leaves the body at death 2p471 • Do not encourage prolonging death 2p473 9 Discuss withdrawal of heroics with nearest kin or authorized representative before removing 23
End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Death passage is part of cycle of life, balancing out birth passage into life; deceased enters into another life 26pB‐12 • Heroics to extend life are acceptable 26pB12 • Certain foods are avoided in belief that they may cause “miscarriage or fetal abnormalities” 10p103‐104 • Hindus may offer prayers to protect unborn and to petition for a male child 3p34 • In Vitro: Acceptable when donors are husband and wife 2p472 • Abortion may be permitted for medical reasons 2p472 • May prefer female doctor and nurse for delivery 2p474 • Mother may practice tradition of rest for 40 days after birth; child remains with mother except if there are medical reasons 2p474 • Usually during 10 days after birth, only midwife or MD touches mother and infant due to belief that they are impure 3p34 • Elders take part in care for neonate 33p266 • Hindu ritual of welcoming may be performed at birth; mantras said for long and happy life 2p471 • May not wish to breastfeed neonate until milk descends 33p266 • Circumcision is not a religious tradition; up to parents 2p471 • Accept “genetic therapy and genetic screening” 17p8Chp7 • No information found at this time • Parents may desire to bury deceased infant 26pB‐12 • Parents may desire to bury deceased fetus 26pB‐12 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • Husband may attend delivery in hospital although does not in birth that takes place in the home 2p474 • Birth control is permitted 10p389 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 8.0 Islam (Muslim) Note: The following information is general; depending on the patient’s geographical area, number of year’s family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs •
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37p1
Believe in one God, Allah Believe there will be a “day of judgment” for all 37p1 Individual communicates directly with Allah; no religious intermediary 38p3 Imam guides faithful in religious and spiritual matters 39p1 Faithful are called Muslims 37p1 Most follow Sunni (90% of world’s Muslims) or Shi’ite traditions 37p1 Qur’an was revealed to Mohammad, prophet 37p1 Fundamentals of faith in Qur’an include directions for daily life, marriage, economics, politics and worship 19p211‐212 There are five “Pillars of Faith” ¾ There is one God ¾ Pray five times a day ¾ Donate money to support poor ¾ Fast in Ramadan ¾ Make pilgrimage to Mecca, if possible 10p390 Prayer is very important, done after rite of cleansing; personal cleanliness associated with purity of spirit 21p23 May use prayer mats, rug or towel for prayer 10p49 Prayer rug and Qur’an should not be touched by anyone “ritually unclean” (e.g., with blood or urine on hand); nothing should be placed on top 40p2 May wear amulet (which should not be removed) with words from Qur’an in or on it 40p2 Talismans are often used for the ill; should not be removed unless necessary and only after discussion with patient or, in case of children, the parents 39p4 Other: ¾ Children are duty bound to take care of their parents 41p1152 ¾ Premarital sex prohibited; abstinence expected of male and female until marriage 8p969 Note: Religious holy days for Muslims may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org No pork, blood or alcohol 3p93 No shellfish 42p69 Prayers are usually said before eating 3p93 Practice “kosher diet” 9p197 Unless ill, fast daily during day in Ramadan (9th month in Muslim calendar); “abstain from food, drink, sexual intercourse, evil intentions and actions” 43p48
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Communication Healing Environment Blood Pain Management • Non‐nutritive medications are permitted except orally when fasting; nutritive solutions, (e.g., TPN) nullify fasting; if these are required, patient should not fast 8p968 • May refuse hospital food 9p197 • May use herbal remedies 9p156, 197 • Medications with alcohol as ingredient may be refused 44p452 • Muslim with Diabetes will not take pork insulin 9p156,197 • May consider condition of GI tract as a reflection of overall health ¾ Eating and elimination are very important • May consider NOT eating (NPO) as a prelude to becoming ill 45p41 • Culture may dictate no handshakes or contact between opposite sexes 43p48
• There is no touching during casual conversation by non‐family members from opposite gender (e.g., shaking hands); some avoid eye‐contact due to modesty 23p4 • Family and friends assist; there is no formal church assistance or prayer for sick 10p392 • Patient’s bed should be facing Mecca 44p252 • Purity of female is associated with family honor 45p41‐42 • “Extreme modesty” is necessary in treating the female patient 45p41‐42 • Female patient may wish to have notice on door “please knock” to warn them of someone planning to enter room 43p49 • Muslim clothing restrictions require a woman’s body to be completely covered, including the head; allow Muslim woman to wear own gown 43p49 • Left hand (used for washing self) is considered unclean 21p23 • Cleansing rites practiced for females after monthly period stops, postpartum and after toileting for all Muslims 45p41‐42; 46p2 • Daily pray 5 times at specific times facing Mecca, preceded by washing “face, hands, and feet”43p48 • Patient who cannot wash may use “dry cleansing (tayammum)” where “he strikes his hands on a clean surface, then brushes palms over his hands and face.” 47p2 • When Qur’an is read out loud, Muslims show respect by remaining silent, not eating or drinking; others should also be respectful during this time 3p887
• May require healthcare worker or provider to be same sex as patient 42p249 • Patient may request Imam who is “looked upon to facilitate interpretation of religious rulings at the level of individual patient;” patient’s autonomy is “exercised via a conscious transfer to the chosen religious adviser” 41p1152 • Muslim physicians or other Muslim providers on staff should be identified who will act as liaisons with Muslim patients 48p2 9 Establish relationship with local Imam or Muslin leader for religious support • Blood transfusion permitted 9p197 • Express pain verbally and with body language 32p200 • Pain may be considered a “test of faith” but Muslim faith dictates seeking relief from pain when necessary 49p38‐39 • May refuse medication to relieve pain if they believe pain is spiritually helpful 47p4 26
END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal • May agree to DNR after discussion of terminal situation 44p251‐253 • Believe discussing a terminal situation with the patient will cause death to occur earlier 50p318 • Faith dictates the ill obtain medical care; when treatment only prolongs dying, may refuse treatment 41p1152 • May allow cessation of life support that has been initiated if it is determined that patient would not have agreed to life support 41p1152 • Arab Muslim transplant is allowed if: ¾ It is only treatment that will resolve health issue ¾ Success is highly probable ¾ Donor or next of kin has given consent ¾ Donor’s death has been confirmed by Moslem doctors or living donor will be in no peril ¾ Full discussion has included the transplant surgery and consequences 51p521‐523
• Indian Muslim: culture does not permit transplant 51p521‐523 • Consider body to be holy; generally do not permit autopsy except where required by law 44p253 • Family remains with dying patient, share words from Qur’an 10p393; 21p23 • Islamic prayers should be recited as patient is dying 43p48 • “Brain death” is not seen as equivalent to death 44p251‐253 • Unless otherwise prescribed, healthcare worker may use gloves to remove lines and turn patient’s head to right shoulder, close eyes and mouth, straighten body 21p13 • At death, patient’s face should be turned toward Mecca (Saudi Arabia) 44p252
• Family may arrange for men to pray over patient who has died 42p250 • Family may grieve loudly at death, may shed tears; loud wailing, self flagellation, rending garments, complaining or cursing not promoted 35p111; 43p48
• Although brain death is recognized by some Islamic scholars, end of life rituals are done when the body has become cold and rigor mortis is evident 39p3
• Allow family to stay with patient and continue rituals until signs of death have become apparent 39p3 • After death, family member of like sex will prepare body in prescribed rites which include washing and rinsing of dead body 10p393; 21p23 • Believe discussing a terminal situation with the patient will cause death to occur earlier 50p318 • Duties include providing “food and hydration” to the dying unless those measures would hasten death 41p1152 • In futile care cases, withholding/ withdrawal of therapy is acceptable 2p490 • May allow withdrawal of life support (respirator); a minority of Islamic scholars (most Shi’ite) do not consider withholding and withdrawing equivalent 41p1152 • Shi’ite do not permit withdrawal of life support once initiated 41p1152 • In decisions about life support, usually the father or oldest son makes a 27
End of Life Discussion •
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PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life decision after consulting a Muslim scholar 52p3 When disease is judged to be terminal or there is no cure, the physician is to give a positive message to patient without lying 8p967 Believes life and death are determined by God, therefore medical providers should not say anything definite to patient “about future prognosis” 25p2 Recommend physician be compassionate, including the possibility of recovery “by the permission of God” thereby offering hope 8p967 Muslim family immigrants may expect physician to give negative news privately to the head of the family rather than the patient 8p967 Muslim who was raised in the U.S. may be more accepting of characteristic American disclosure in an open and frank manner 8p967 The concept of futility is not widely recognized; the physician may be seen as abandoning patient or exaggerating poor prognosis 39p5 Recommend the discussion be approached with help of Muslim cleric or Imam, or a Muslim physician 39p6 • Believe that blood associated with menstruation and birth makes woman “unclean” 45p41‐42 • Artificial insemination is acceptable between husband and wife 43p49 • In‐vitro and artificial insemination are permitted only in cases where husband’s sperm is used 53p15 • Abortion is generally not permitted 10p392 • Prohibited except in cases of great risk to mother’s life and when fetus is less than 130 days 43p967 • Husband is permitted at delivery; if husband is not present, female who is family or friend should be allowed 43p49 • Father or grandfather recites prayers in baby’s ears after birth 43p49 • After birth, the placenta should be offered to parents for burial in Muslim tradition 53p10 • Breastfeeding promoted; not mandatory, but sacred scripture recommends two years for breastfeeding 8p967 • May give baby honey or water instead of colostrum 25p3 • Lack of sunlight (due to dress and veil) may result in low Vitamin D levels in lactating mother, risking deficiency of Vitamin D in baby 25p3 • Practice male circumcision 10p392 • No information found at this time • During neonatal stay, Muslim mother may stop breastfeeding if there is lack of privacy 25p2 • Parents may not wish to see deceased baby as dead are not to be seen unless necessary; photos are not taken usually 54p318 • Do not permit locks of hair to be cut and saved as body is to be buried whole 54p318 • If newborn is expected to die shortly, father will need time to whisper into baby’s ear the call to prayer 54p318 • Infant body should be straightened; parent generally prepare body according to specific instructions 54p318 28
Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Fetus may be treated as any other tissue until day 130; after that time, fetus is considered a “full human being” 10p49 • Parents will want remains 2p491 • Traditional washing is done if baby was “at least 4 months and has formed features of child;” if not, body is wrapped and buried in traditional way without washing 2p491 • African Muslim: ceremony for naming newborn on 7th day; ritual circumcisions are performed after that 42p249 • May use Kohl (contains lead) on umbilicus after discharge from hospital to encourage drying of site 45p42 • Not acceptable to change surname or for child to lose connections with biological parents 53p20 • No information found at this time • Husband is permitted at delivery; if husband not attending, close female family or friend 43p49 • Birth control is permitted for married; method must prevent fertilization and not cause permanent damage to reproduction capabilities 8p969 • Both spouses must agree and sign consent forms for contraception 40p3 • Specific preparations are made that include washing body and wrapping it; done by parent of same sex unless patient is under 12 years 9 Ask father who should prepare body or if he would like healthcare professional to do it 54p318 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 9.0 Jehovah’s Witnesses Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation • One God who created all things, named Jehovah 2p260 • Believe ¾ in second coming of Christ, one God who is greater than Son sent by God 34p78 ¾ Lord’s Supper is most important; celebrated once a year 2p261 ¾ Scripture reading can lead to spiritual healing 10p394 ¾ human soul does not exist after death 3p48, 53 ¾ Bible is “New World Translation” in which God is named “Jehovah” 3p247
• No sacraments or holy days; members spend minimum of ten hours monthly “proselytizing” 10p393 • Communal worship on Sundays and other days is important 2p261 • Faith healing is prohibited 22p156 • May not eat foods which have blood added (i.e., sausages) 34p79 • May allow moderate use of alcohol; smoking and excesses of alcohol are forbidden 3p61 • No information found at this time • Believe God is “ultimate source of all life, health and healing” 2p262 • Elders, members of church may visit, pray for church member who is ill 9p156
• When needed, members seek medical care and accept most treatments available 2p262 • Blood, blood products are prohibited 9p156 • May accept certain volume expanders 34p77‐79 • May accept autologous transfusion that results from “closed circuit” system connected to patient’s circulatory system with no storage of blood 55p3‐4Chp3 • May accept some minor blood components, e.g., for hemophilia 55p1Chp7 • Believe that “source of soul” is in the individual’s blood 45p60 • May not accept medications made from blood products 43p44 • No church statement 17p9Chp9 • Heroics to extend life are up to individual; blood, blood products are prohibited 9p156 • Most members will have Advance Directives 2p263 • Individual decision; consider it important to keep body with spirit 10p394‐396 • May permit donation after blood removed from organ/tissue 22p26 30
Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception • Up to individual 2p265 • Believe that death is a period of total unconsciousness until resurrection occurs 2p264 • Church members may visit with family at time of death and for some time afterwards 3p48, 53 • No rites of faith for body of deceased 2p265 • Heroics that will prolong dying are not required 2p264 • Up to individual whether to accept treatments to extend life or not 26pB15 •
•
•
•
•
Artificial insemination by donor is prohibited 43p44 Destroying fertilized eggs is prohibited 2p263 Life begins at conception; abortion is considered taking human life 2p263 Abortion is unacceptable 55p3Chp3 No information found at this time • No information found at this time • Individual or family choice; not required by faith 2p263 • No church position; due to belief, church members will likely help take care of infant with anomaly and family 17p7Chp9 • See “Genetic Conditions” • No information found at this time • No information found at this time • No rites of faith at birth 2p264 • Baptism is requested when child is old enough to make decision to embrace faith 3p51 • Baptism is by immersion 55p7Chp3 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • Birth control is acceptable, except for sterilization 9p156 31
PEDIATRICS Child/Teen Environment of Care • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 10.0 Judaism Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition • Four main divisions: ¾ Orthodox: strictly follows traditional beliefs and practice ¾ Reform: individual makes informed decisions about religious observances, however must follow ethical teachings ¾ Conservative: accept Reform scholarship but maintain stricter observances of Jewish law ¾ Reconstructionist: autonomy generally supersedes tradition; changes should have consensus of members 2p515‐516 • Three essential components in Jewish teachings irrespective of division: ¾ There is one God; humans were created in image of God ¾ Torah: Holy book, includes teachings about God and moral duty ¾ Israel: included in daily prayers, recognized as Jewish state 2p515‐516 • Holy Days: Sabbath is celebrated from sundown Friday to sundown Saturday ¾ Other holy days include Rosh Hashanah (New Year), Yom Kippur (Day of Atonement), Chanukah (Festival of Lights) and Passover 10p396
• God’s laws are interpreted from Torah (the five books of Moses) and the Talmud ¾ Believe the Messiah is still to come ¾ Trained and ordained Rabbi leads the congregation 19p157‐160 • Value is placed on doing good during lifetime rather than focus on afterlife 34p532‐34 • Human body is God given and to be treated “with respect and sanctity” 2p517
• Faith requires that one take care of health, find best care and promote wellness 34p532‐34 • Death is not a punishment, but a part of living 2p519 • The yarmulke or skullcap, worn by men, indicates respect for God 3p63 • May not be willing to sign forms on Sabbath or holy days 11p205 • Note: Religious holy days for Jews may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org • Laws in Torah govern what can be eaten and food preparation 3p64 • No pork; may practice kosher diet 10p397 • Kosher laws are complicated and observance may differ among Jews 56p20
• Family may want to arrange for own food 56p21 • Do not serve milk and meat dishes at same meal 57p40 • Lactose intolerance common; many Jewish foods have high fat content 33
34p543‐546
Communication Healing Environment • Judge people by actions rather than words spoken 18p310 • Judaism includes a “commandment to visit the sick” 34p531‐534, 544 • Family and friends may visit and ask about patient’s condition 34p531‐534, 544 • May not verbalize condition that is “negative to destiny” (terminal disease or condition); do not want to give “credence to morbid diagnosis” 56p19 • Individuals in family are expected to assist member to avoid illness and promote health 34p531‐534, 544 • May be reluctant to accept professional help for mental health problems 34p531‐534, 544 Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process • If opposite sex patient is Orthodox, touch only while giving actual care 34p529
• Orthodox may request same gender caregiver 2p518 • Family and friends from Temple visit; Rabbi visiting sick may pray 10p398 • Male patient may want to use special prayer “shawl” and yarmulke 10p398 • Jewish “social services” are available 10p398 • Many are very knowledgeable about wellness issues; may observe results of medications or treatments and adjust timing, dose or omit depending on whether believes the medication or treatment is helping 34p535
• Blood transfusion is permitted 10p397‐398 • Usually verbalizes pain; may be hesitant to take pain medication due to concerns about addiction 34p534‐535 • Seeking relief for pain is seen as an obligation of faith 41p1150 • Patient has right to dignified death; if death is expected, artificial means to extend life are not necessary; however if already in place, not to be discontinued 10p397‐398 • Considered an important form for all Jews to address; the four main divisions of Judaism have options that patients may select according to that divisions interpretation of Jewish law 2p517 • Non‐Orthodox: may consider heroic measures that will only extend the “dying process” as not acceptable 50p319 • Transplant is acceptable and viewed as obligatory if it is to save a life 16p1 • View saving life as more important than keeping donor body intact; prefer direct donation 16p1 • Orthodox allows only if law requires or in cases where information obtained will benefit; all body parts must be buried with the body 34p538‐
539
• According to Torah, patient should be informed if he has serious illness; “controversy” exists as to whether a patient should be told of imminent death since some believe that the knowledge will advance death 34p538 • Patient may request rabbi be called to visit 2p519 • According to Jewish law the spirit leaves the body at death; family may not want to leave body alone 32p111 34
Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding • Provide quiet time when dying person recites “confessional;” if patient unable to recite confessional, may recite a “Shma” or those present may do it for patient 34p538 • Respect is shown by remaining in presence of dying person; after confirmation of death, “eyes and mouth should be closed” and patient covered 3p69 • Jewish community prepares body after death 32p111 • Orthodox: Deceased patient should not be touched by member of opposite sex 34p540 • Rabbi present at time of death; unacceptable for non‐Jew to handle body after death; family or member of Special Burial Society will handle body 21p24 • After death of patient, use gloves until Jewish member arrives to prepare body 21p24 • Determined on individual basis; may consult patient’s rabbi for consistency with patient’s religious beliefs 2p518 • Orthodox will choose heroics based on “pro‐life” position; however, it is acceptable to stop when heroics are merely extending “dying process” 50p319
• Orthodox: all steps are taken to save life 50p319 • Jewish law allows heroics if it likely that treatments will be effective; does not require if patient is gravely ill and treatment may not succeed 58p1151
• Birth of child of either gender is welcome 2p519 • Mother is charged by faith to get prenatal care and follow wellness practices 11p191 • Childbirth education is acceptable 11p191 • In vitro fertilization: object to selective abortion in cases where too many gametes or zygotes have been successfully implanted 2p518 • Orthodox: female may request a female physician; if physician is male, female attendant should be allowed 11p191 • Orthodox: may not agree to pelvic exams during latter part of pregnancy due to possibility of bleeding; after bleeding female must have mikvah ritual performed before contact with husband 11p191 • Generally abortion is acceptable only if mother is in danger 45p68 • Orthodox: within the period of 40 days after conception the fetus is considered “made of water” and abortions can be approved for fetal abnormalities 11p192 • Female family member may attend delivery and provide physical care and comfort 11p194 • Mother in labor may relieve pain through prayer, may accept “analgesics” 11p194 • Orthodox: large families with mothers who support breastfeeding and neonatal care; one who is having breastfeeding issues may avoid letting others know due embarrassment 11p194 9 Carefully assess in privacy mother’s technique and provide information as needed 35
Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement • Conservative and Reform: community less likely to have large families and follow breastfeeding; will be open to information about breastfeeding 11p194 • Ritual circumcision performed in front of family and group of ten adults, on eighth day 10p397; 3p67 • Within the period of 40 days after conception the fetus is considered “made of water” and abortions can be approved for fetal abnormalities 11p192 • Genetic conditions which may affect certain Jewish groups include: “Tay‐Sachs, Canavan disease, Gaucher disease, Bloom syndrome, dysautonomia, Fanconi Anemis, Niemann‐Pick disease and cystic fibrosis” 11p192 • No information found at this time • Baby would be buried as per Jewish burial rules and procedures 2p519 • Special rites and prayers are conducted in case of perinatal death 11p200 • Infant who was born live but dies is washed according to ritual and shrouded; family may have clergy perform this ceremony or, in case of the less conservative, may accept washing and shrouding by hospital nurse 54p316 • Death rite is different for baby from live birth versus stillborn 11p200 • Photos of living baby are acceptable; if less conservative parents, may be accepting of photo of deceased baby 54p316 • Until 5 months, fetus is not considered capable of sustaining life on own; therefore no death rites practiced 11p200 • Stillborn is treated with respect; family may have member remain with body 54p316 • Usually parents are the only ones to view the stillborn; orthodox may refuse to see baby or have pictures taken of deceased baby 54p316 • Male baby is named on 8th day at the ritual circumcision 11p197 • Routine newborn care except for on Sabbath when “cotton ball or paper tissue with light petroleum oil can be used to cleanse diaper area” 11p196
• No information found at this time • May request caregiver of same sex 11p194 • Family help care for new mother and baby 11p195 • Orthodox: may not want to be discharged on Sabbath; may ask for early discharge 11p194 9 Discharge planning and education should be started as soon as possible • Orthodox: during Sabbath there are certain taboos regarding bathing and pericare 11p195 9 Ask mother about taboos; caregiver should wear gloves after using liquid soap to wash own hands and for mother’s bath • Orthodox: until the new mother goes for prescribed ritual cleansing, man and wife do not touch other; husband may care for baby 11p195 • Conservative or Reform Jew: husband may attend wife and care for her during labor and delivery 11p193 • Orthodox Jew father may elect to be present at delivery but will not 36
Contraception PEDIATRICS Child/Teen Environment of Care touch wife due to traditional beliefs 34p529‐530 • Unless patient belongs to the Orthodox, birth control is acceptable 10p398 • Orthodox: contraception in male is considered contrary to “commandment to procreate;” however, female may use if indicated due to medical condition 11p198 • No information found Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 11.0 Lutheran Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care • Bible is God’s word, the foundation of faith and “standard” of practicing that faith 19p174‐178 • Worship focused on rituals at altar 19p174‐178 • Lutherans believe in the Father, Son and Holy Spirit 2p369 • Members are expected to worship as a community at least weekly 8p370 • Doctrine teaches salvation through faith 3p199‐200 • God administers grace through baptism and communion 19p174‐178 • Sacraments are essential to the healing ministry 59p151 • One is born with original sin; God’s grace is obtained through Baptism 2p373
• Life is God given 2p371 • Life is sacred; death is result of sin; hope of eternal life; resurrection of the body 2p373 • Note: Religious holy days for Christian religions may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org • Diet and fasting determined by individual; no specific restrictions in teachings 2p371 • No information found at this time • Pastors/ministers visit the ill, bring sacraments to them 59p160‐161 • May wish to receive Holy Communion while ill 2p373 • Acceptable, is individual decision 2p372 • Very important to relieve suffering; support palliative care even when there is a risk that the medication may hasten death 17p17Chp12 • Treatment is not required in futile cases 17p11Chp12 • Acceptable, is individual decision 2p372 • Individual decision, no church standing 16p1 • Autopsy is permitted 20p494 • Minister will give communion in sick room; dying person becomes aware that his/her struggle is shared through the Eucharist, in congregation or sick room, through intercessory prayer, pastoral and lay visitation 59p161‐162 • May request baptism 2p373 • Family may request to see body before removal from hospital room 2p374 • Body should be treated respectfully 2p374 38
Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Does not violate teachings but may wish to include Lutheran pastor in discussion 2p372 • No information found at this time • In‐Vitro does not violate teachings, individual decision, may wish Lutheran pastor input 2p372 • Church’s position is “pro‐life” 59p149 • No teachings violated with abortion, however may request pastor input 2p372 • Lutheran church Missouri Synod has a more conservation stand; abortion is not acceptable 17p10Chp12 • No information found at this time • No information found at this time • Circumcision is not a religious decision, determined by individual 2p372 • No church standing on “genetic screening and counseling” 17p12Chp12 • Usually support treatment of baby unless futile 17p11Chp12 • See “Neonatal Illness” • May seek Baptism at birth for stillborn if a “possibility of life exists”17p18Chp12 • Baptism is usually done by ordained minister; in emergency can be done by any Christian 2p371 • Baptize infants who are presented at church by parents; baptize by pouring water over head three times 19p200 • Parents may want baptism for seriously ill newborn 60p27 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • No information found at this time • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
39
Guide to Religion and Culture in Healthcare Religion: 12.0 Mennonite (Anabaptists) Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs • Christian group whose belief system stresses lifestyle and peace; Mennonites are more receptive to education and technology than Amish and have missions throughout the world 12p7‐8, 16, 46 • Church is composed of adults who freely commit to disciplined lifestyle 12p7‐8, 16, 46 Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process • Include “prayer and anointing with oil” as part of the healing practice 9p157
• Sacraments: Baptism and Holy Communion, neither of which is required for salvation 10p40 • Witness with their faith, words and actions; practice simplicity, look out for each other, live honesty, practice charity towards others and work at “peace‐building” 2p210 • Some are led by women ministers 12p56 • No food prohibited 10p400 • No information found at this time • Accept modern medicine to improve health but understand that good health and healing are God’s gift 12p62‐65 • Families care for their elderly who are well‐respected and valued 14p121 • Makes health care decision based on his/her beliefs; therefore decisions may vary from one person to another, based on individual’s background and “understanding of Bible” 10p401 • Acceptable to receive and to donate blood 2p212 • No information found at this time • Heroics are up to individual; when making decisions, may want to consult with other members of faith family as well as biological family 10p400‐401; 2p211
• No church position; member may have completed Advance Directives 2p211
• Generally permit organ donation 9p156‐157 • Permit autopsy 9p156‐157 • Death is the end of struggle, being gathered to God to await God’s final victory”; dying are comforted in hope to be with God 2p212 • May find comfort in reading Scripture, prayers or singing; “scriptural anointing (laying‐on‐of‐hands) are usually welcome” 2p213 40
Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • No religious rites at end of life; family of dying will desire to have family members there, private time to pray and share memories 2p214 • Accept hospital practice; no last rites 2p214 • Most would be willing to discuss “withholding/withdrawing treatment in futile situation” 2p212 • No information found at this time • In Vitro: no church statement; religion would support as long as procedures support human dignity 2p212 • May permit therapeutic abortion 9p156 • Hospital birth is usual 2p213 • No information found at this time • Up to individual, not a religious issue 2p212 • Support counseling where genetic disease possibility is an issue 2p213 • Life is gift from God; if infant is disabled by condition, family will care for baby at home when discharged 17p9Chp7 • No specific religious rite at birth 2p213 • Parents grieve in event of fetal death 2p213 • No religious rite at birth 2p213 • No information found at this time • Adoption is acceptable 17p8Chp1 • No information found at this time • No information found at this time • Permit birth control 9p156 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 13.0 Methodist, United Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion • Believe in Trinity, free will, sin, the need for repentance, scriptures as a means to salvation 19p198 • Observe two sacraments: Baptism and the Lord’s Supper 19p198 • There is latitude in interpretation of doctrines among the different groups of Methodist 19p198 • Membership is usually granted to those 13 years and over who profess the faith 19p198 • Believe in afterlife with God 31p286 • Life after death is assured through good works and faith 2p412 • Note: Religious holy days for Christian religions may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org • No specific recommendations regarding diet 2p410 • No information found at this time • May be comforted from Scripture reading, religious music; may request Holy Communion, in which case chaplain or local pastor should be consulted 2p412 • May be comforted by healing prayers which can be done by healthcare professionals 2p412 • Permitted 2p411 • Palliative care is acceptable 2p413 • No information found at this time • Promote Advance Directives 2p410 • Donation is encouraged 22p26 • Permitted 20p494 • Members seek comfort and dignity for dying patient 2p412 • Plans for funeral are made with minister who presides over service 3p206 • Family may pray with deceased 2p413 • No specific ceremonies for body 2p413 • No religious obligation to prolong life when treatments are futile 2p411 • No information found at this time 42
PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Within a marriage, when both husband and wife agree, in vitro fertilization is acceptable 2p411 • Believe in sanctity of life; however, believe that abortion may be justified in some conditions 2p410 • No information found at this time • No information found at this time • Up to individual family, no religious stand 2p411 • Support “genetic screening and counseling” 17p5Chp19 • Parents may want baptism for seriously ill newborn 60p27 • No church statements about end of life care for newborn with anomalies; provide respectful care 17p7Chp19 • See “Neonatal Illness” and “Neonatal/Infant End of Life” • Practice infant and adult baptism, usually by sprinkling 19p198 • Parents bring infant to church for baptism 3p206 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • Support birth control 17p3Chp19 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 14.0 Mormons/ Church of Jesus Christ of Latter‐day Saints Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment • Founded by Joseph Smith who in 1820 had a vision of God the Father and God the Son. Smith was told he would re‐establish the true church 19p165 • Book of Mormon and Bible are basis of beliefs; believe in “three persons in God (Father, Son and Holy Ghost), gift of tongues, visions, prophecy and healing” 19p165, 167 • Sacraments include “Baptism, Confirmation and Lord’s Supper;” ordinances include “blessing of babies, blessing of sick, consecration of oil used in blessing of sick” 10p386 • Believe in after life 10p388 • All will be resurrected and judgment of individuals will be based on their thoughts and actions 3p75‐77 • Sabbath is Sunday; after services at the chapel, may visit with others, stay at home, or do “acts of service” 2p245 • Conservative with emphasis on family life 19p165, 167 • Believe in anointing, prayer, laying of hands and in God’s power to heal 10p386
• Baptism is necessary to salvation; believe in baptism for dead with a living proxy for deceased 19p167 • Members enter temples, “houses of the Lord,” for marriage and for necessary ordinances (“baptism and eternal marriage”) for those who have died 2p245 • Healing by Elders may be done in addition to medical care 10p386 • Service to others is essential; support aid programs and encourage young adults to take temporary assignments of missionary work 3p75‐77 • Note: Religious holy days for Christian religions may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org • Promote keeping mind and body healthy, following Word of Wisdom regarding good diet 2p247 • Abstain from “tobacco, alcohol, coffee, tea and illegal drugs” 2p247 • 24 hour fasting once a month on specified day, but ill are not required to fast 10p386 • No information found at this time • May wear special “garment” of underclothing that indicates worthiness, is of special significance; patient may not wish to remove 10p386‐388 • Family, friends and church offer support; Mormon Relief Society helps members 10p386‐388 • Frequently use herbal remedies 10p386‐388 44
Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life • Transfusion permitted 10p387‐388 • No information found at this time • Church: no official stand; up to individual 2p247 • Heroic measures acceptable 10p387‐388 • If death is “inevitable,” members are not obligated to extend life through heroics 2p247 • No church standing; up to individual 2p247 • No religious position; decision on organ donation is up to individual who must decide with which choice they are most comfortable 16p1 • Permitted 20p494 • Promote dignified, peaceful death 3p77 • When mortal life ends, the spirit will continue; resurrection will occur in the future, with body and spirit reunited 2p248 • Reading scriptures or other religious matter may provide comfort 2p249 • No information found at this time • Determined by family 2p249 • Acceptable to allow natural death to occur when it is inevitable 2p248 • No information found at this time • Mother makes sure to appropriately take care of herself in order to do best for fetus; prenatal car is very important 11p249 • In Vitro through use of couple’s sperm and eggs is acceptable 11p250 • Abortion not permissible except in case of risk to mother’s life, pregnancy is from rape or incest, or the fetus has anomalies that from which it will not survive after birth 2p247 • Labor is considered natural; most will use hospital for delivery 11p250 • Mormon mother will keep temple garments on until delivery 11p250 • Father attends during labor and delivery, other family members may also be at delivery 11p250 • Prefer to breastfeed infant 11p251 • No religious stand; up to individual family 2p248 • Do not usually seek prenatal testing for abnormalities; usually do not seek abortion for abnormalities 11p249 • May accept treatment given through use of “genetic engineering” 17p12Chp11
• Information should be given to both parents together; decisions are made together and frequently are made with prayer 11p248 • May choose heroics for handicapped baby 17p11Chp11 • Parents may request a “priesthood blessing” which offers comfort; infant in intensive care may receive more than one blessing 11p249 9 Provide privacy for blessings • Life of preemie or sick baby has religious significance; believe that infant who lives is to has an important mission while infant who dies was “righteous spirit who did not need the experiences of mortality” and has 45
Fetal/End of Life Baptism/Birth Ceremony •
•
•
•
•
Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care •
gone back to God 11p252 For sick newborn, naming ceremony may take place soon after birth 11p254 Family considers stillbirth or miscarriage as tremendous loss; may wish to view fetus, may bury it near other relatives 11p252 Baptism by immersion > 8 years 10p386‐387 Special blessing is given to babies after birth by someone in priesthood; usually done in church building, but may be done in hospital or home 2p249 For sick newborn, naming ceremony may take place soon after birth 11p254
Father and family helps with care for newborn 11p254 • Unwed Mormons frequently offer baby to be adopted; the Mormon Family Services can help find home for baby 11p248 • Mother is expected to recuperate during post‐partum period; family and church provide much support with care for family 11p250 • Father attends labor and delivery 11p250 • Birth control not acceptable unless parent ill or there is possibility of inherited anomalies 10p387 • Therapeutic abortions are prohibited 11p251 • Believe that those who die before the “age of 8 years (age of accountability)” go straight back to God; if parent’s marriage was “sealed as an eternal family unit” parents and child will be together after death 11p252 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 46
Guide to Religion and Culture in Healthcare Religion: 15.0 Pentecostal / Assemblies of God Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs • Believe: ¾ divine healing is supported by Bible and pray for sick ¾ devil is cause of disease, God gives “life and health” ¾ speaking in tongues is evidence of Baptism in Holy Spirit ¾ believe in Christ’s second coming when he will reign for 1000 years 61p67‐73, 96‐98, 123
• Protestant; beliefs include Trinity 19p237‐238 • Members acknowledge Jesus is God, Scriptures are from God, gift of tongues and salvation are through Christ 19p237‐238 • Many churches have Methodist or Baptist background; most groups have the following two sacraments: Baptism and the Lord’s Supper 19p237‐
238
• Believe communion is healing sacrament and that one may “receive healing and strength for the body” as well as spiritual healing 61p52, 85 • May have services for healing 3p222‐223 • Worship on Sundays, at other times; evangelism is very important 2p317 • Practice prayer, meditation and Scripture reading 2p317 • Dynamic in prayer, may “speak in tongues” 23p5 • Church promotes mission work to help marginalized peoples, witnessing for the faith while serving 2p317 • After death of believer, “soul and spirit of deceased ascent to heaven and will be with Lord forever” 2p319 • No food prohibitions; fasting is recommended “for spiritual growth” 2p318 • No information found at this time • No information found at this time • No restrictions on blood 2p318 • Reading of Scriptures and healing prayers may give comfort to sick 2p320 • No church policy; encourage members to pray and consult with clergy before making decision 17p11Chp2 • Encourage members to have Advance Directives 2p318 • No church policy on organ donation; individual decision 22p26 • Individual decision 2p320 • May ask for clergy or chaplain to pray when patient is near death 2p320 • No information found at this time 47
Death – Body Care Withholding/Withdrawal • Family may request to view the body 2p320 End of Life Discussion PERINATAL CARE Prenatal Care • Encourage members to consult with clergy 17p11Chp2 Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Individual decision 2p319 • In Vitro acceptable in heterosexual couple after prayer; couple “make decisions in good conscience with guidance of Spirit of God” 2p318 • Abortion is prohibited; with risk of death to mother, abortion may be acceptable 2p318 • No information found at this time • No information found at this time • Up to individual, no church reason 2p318 • No information found at this time • No information found at this time • No information found at this time • Acceptable to have testing and treatment for fetus 17p7Chp2 • Dedication ceremonies take place in some churches and consist of parents presenting infant for minister to bless 3p223 • Sacrament of Baptism by immersion is found in most groups 62p237 • Do not baptize children 61p42‐45 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • No church stand on contraception within marriage 2p318 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
48
Guide to Religion and Culture in Healthcare Religion: 16.0 Presbyterian Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs • Relationship between God and man has no clerical intermediary but is a personal relationship with God 31p315 • Sacraments are Baptism and Communion 3p228‐229 • Baptism is not necessary for salvation 63p4Chp56 • Believe in divine healing through faith and prayer 61p95‐96 • Believe in triune God, Father, Son and Hold Sprit 2p386 • Members practice meditation, prayer and reading Scripture 2p387 • Communal worship is important, on Sundays 2p387 • Consider mission work important, working for social justice, stewardship of time, talent, resources and planet 2p387 • Note: Holy days for Christian religions may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org • No restrictions 2p388 • No information found at this time • Believe prayer for patient when member is ill; church should be notified so that members can pray for patient 63p1Chp60 • Patient may be comforted by Scripture readings and healing prayers 2p389
• Special trained laypersons (Stephen Ministers) from church support those who are ill, through prayer and helping in the home 2p389 • Members try to obtain the best medical care possible 2p388 • Up to individual 2p388 • No information found at this time • No information found at this time • Church supports Advance Directives 2p388 • Donation is encouraged; promote signing donor cards 22p26 • Permitted 20p494 • Patient or family may request baptism or Lord’s Supper 2p389 • At death, faithful will be with God 31p325 • Death is a natural part, soul goes to “heaven” at death, to be with God 2p389
• Family may request to see deceased before removal from hospital room 2p390
• Family may ask for prayers to be offered for the deceased which can be done by chaplain, church clergy, family, friends and healthcare 49
Death – Body Care •
Withholding/Withdrawal •
•
End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy •
Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care personnel 2p390 Body is to be handled with dignity and respect; no other specific care recommended 2p390 No religious position in futile cases; up to individuals 2p388 Patient has right to die with dignity and be provided with adequate pain management 2p388 No information found at this time • No opposition to In Vitro; up to individuals 2p388 • Up to individual, consulting with her physician and spiritual advisor 2p388 • Church is “pro‐life”, especially “pro‐quality‐life” 2p388 • No information found at this time • No information found at this time • No religious stand 2p388 • Church supports genetic counseling 17p7Chp14 • No information found at this time • No information found at this time • At death, fetus should be handled with respect; provide parents with comfort 2p389 • Parents may want baptism for a seriously ill newborn 60p27 • Baptism usually done by minister by pouring or sprinkling water on child’s head in front of church members who are asked to assist parents in raising child Christian 3p230 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • Contraception up to individual 2p388 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
50
Guide to Religion and Culture in Healthcare Religion: 17.0 Roman Catholic Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs •
•
•
•
•
•
•
•
•
Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR •
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•
•
Catholic faith and doctrines are founded on Christ and Bible 19p267‐271 Catholic worship is primarily with Mass and receiving Eucharist 2p237 Christ is present in host and wine of Eucharist 19p267‐271 Observe Sundays and seven special days as holy days where members worship at Mass 19p267‐271 Sins after baptism are forgiven through sacrament of reconciliation 19p267‐
271
Sacrament of sick is administered by “priest, deacon or lay minister” to patient who is ill 10p378‐381 God is the source of life, health and healing 2p238 Many groups in parishes visit ill members 10p378‐381 Note: Holy days for Christian religions may be found on the FH Diversity and Inclusion website at http://www.fhdiversityandinclusion.org Avoid excesses in food 10p378 Fast and abstinence Ash Wednesday, Fridays in Lent, and Good Friday 10p378
Fasting not required when ill 10p378 No information found at this time • Reading Scriptures or other devotions may provide comfort 2p239 • May receive comfort from healing prayers that can be offered by healthcare professionals 2p239 • May keep religious items such as rosary, medals or scapula on person or nearby 23p2 • Blood transfusion is acceptable 9p153 • May use prayer to seek relief from pain 10p317 • Support alleviation of “pain and suffering;” do not support pain relief methods that place patient in “state of unconsciousness, unless those methods are essential for relief” 17p21Chp15 • Heroic measures are not prescribed 41p1151 • Not duty bound to continue heroics if they will only extend dying process 41p1151 • Duty to preserve life; may reject life prolonging measures that do not offer reasonable benefit 5p381 51
Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption • No restrictions on Advance Directives 64p14 • Encourages patient to provide documents on healthcare wishes and update, as needed 2p238 • Surrogate should follow “Catholic moral principles and patient’s wishes” 64p14
• Transplant is acceptable, seen as sacrifice for brotherly love 16p1 • Donation of body is acceptable 10p379‐381 • Autopsy is permitted; body is to be treated with respect 20p494 • Pain management for dying is very important to maintain comfort and dignity 64p21‐23 • At death the soul leaves the body to enter into eternal life 2p239 • Family may request Baptism, Sacrament of Sick or other Sacraments 2p230‐
239; 23p2
• No information found at this time • No information found at this time • Withholding/ withdrawing heroics is acceptable when it is artificially extending life in a futile case 2p238 • As long as nutrition and hydration benefits are greater than the risks to the patient, providing them is acceptable in spite of withholding/ withdrawing heroics 2p238 • Not duty bound to continue heroics if they will only extend dying process 41p1151 • No information found at this time • No information found at this time • Abortion is prohibited 2p238 • No information found at this time • No information found at this time • Circumcision is determined by individual, not a religious requirement 2p238 • Church supports dignity of all humans including those of handicapped newborns; heroics or treatment would be determined by benefits weighed against burden to infant 17p16Chp15 • See “Genetic Conditions” • Parents may want baptism for seriously ill newborn 60p27 • See “Genetic Conditions” • Baptism is necessary 26pB‐8 • Baptism through pouring or immersion is required for infant and adult 19p270
• No information found at this time • No information found at this time 52
Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • No information found at this time • No information found at this time • Church prohibits birth control other than natural 19p273 • Abortion and sterilization are not acceptable 10p380 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Religion: 18.0 Sikhism Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication • Sikh is seen as a Hindu reformation; founder combined features of Hindu and Islam 65p56 • Founder was a Guru; nine Sikh gurus followed, each adding significantly to the development of Sikhism 2p571 • Believe in: ¾ One God ¾ Member relates to God directly, no intermediary ¾ Self directed worship ¾ Equality among all people ¾ Reincarnation many times before achieving oneness with God 65p56 • After Baptism, a Sikh wears the five religious symbols: the “five Ks” of dress: “Kesh (uncut hair), Kangha (wooden comb), Kara (iron wrist band), Kirpan (short sword), and Kach (short trousers/breeches)” 65p56; 2p574
• Some members “take Amrit” (like Confirmation), then follow the rules below: ¾ Go to “temple” every day ¾ Follow specific diet ¾ Have “special prayers” ¾ Practice the “five Ks” of dress 65p56 • Salvation is freedom from the birth‐rebirth cycle, achieving oneness with God 43p54 • Karma (deeds performed in each life) “determines how a soul is reborn during reincarnation” 66p496 • Believe all people and religions are equal 2p570 • Follow “rules of conduct which include living a life of honesty, truth, restraint, family oriented and piety” 2p575 • May consider illness as “will of God” but believe that they should seek treatment to return to healthy state 2p578 • Many are vegetarians; those that eat meat would not consume beef 65p56 • Most do not take tobacco, alcohol or foods that contain alcohol products 66p497; 67p561 • May refuse to eat food with which they are unfamiliar 68p41 9 Describe ingredients to patient; may help encourage eating • Touching person of opposite sex is not acceptable; most will fold hands and greet person verbally 2p576 9 Limit unnecessary touching and respect personal space of patient 2p577 • Oldest adult male traditionally is spokesperson 2p576 54
Healing Environment •
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•
•
•
•
•
•
9 Healthcare professional to obtain appropriate permission of patient per HIPAA Five K symbols should not be removed without permission and only after washing hands; removal of the turban or pants (which symbolize sexual morality) for a procedure may embarrass individual 65p56; 68p40 Sikh’s head hair is sanctified, should be covered 9 Do not cut hair or beard 65p57 If necessary to remove hair 9 Get patient and/or family permission first for either gender patient 2p577 Surgical patient may be willing to use paper cap during surgery 2p577 Removed turban should be treated respectfully, given to family 2p578 Book of prayers is to be touched only with washed hands 66p497 May have “holy water called Amrit” which is sugar and water for drinking; this water is special and should be handled with respect and not be thrown out 66p497 Most prefer to be treated by same gender 68p41 Prefer running water (shower) for bathing; hygiene is very important 66p497; 68p41 Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs • Water should be provided in area for toileting; if patient must use bedpan 9 Provide separate container with water 65p56 • Traditionally sons take care of parents 66p497 • Permitted 65p57 • No information found at this time • No restrictions on heroics 68p41 • Encouraged to complete directives 2p576 • Permitted 65p57 • Permitted, however some may refuse in belief that the deceased “suffered enough” 65p57; 66p498 • Comfort may be derived from “reciting passages of holy book or having someone else read 68p41 9 Provide privacy to patient • Some patients may wish to sip holy water, or have it sprinkled around patient 68p41 • Patient may show increased attachment to the 5 Ks 66p97 • Many family and friends will visit 68p41 • Most are stoic about death 66p498 • Immediate family may weep loudly to express grief at death 2p579 • Maintain the 5 Ks 66p498 • Sikh’s head hair is sanctified and should be kept covered 65p57 9 At death do not cut hair or beard 55
• Face should be “peaceful” and clean with “eyes and mouth closed” 65p57 • Family may want to wash the body then “a white cotton shroud” is placed on the body as well as maintaining the 5 Ks 66p498 • Body may be washed with fresh yogurt to eliminate bacteria 2p579 • Non‐Sikhs are allowed to care for the deceased, but should remember to leave the five Ks and not cut hair on head or face 68p41 • Touching deceased’s feet is respectful; family, friends and healthcare professionals may touch feet 2p579 • Do not encourage heroics in futile situation 2p576 Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) • Oldest adult male traditionally is spokesperson 2p576 9 Healthcare professional to obtain appropriate permission of patient per HIPAA to include spokesperson in discussions •
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•
•
•
•
•
•
Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception •
•
Encourage large families 68p41; 67p561 Ensoulment occurs at conception 67p561 In Vitro is permitted within a marriage 2p576 Traditionally prefer male children 67p561 May be iron deficient due to vegetarian diet 67p561 Not acceptable except in case where health of mother is in danger 68p41 Most consider egg and sperm donation unacceptable 68p41 Family may say prayers for neonate and mother; mother may meditate during labor; baptized mother will wear 5 Ks 67p561 Baptized mother may request to wear Kachha (breeches) on one leg during birth; shaving private area may be acceptable, if necessary 67p561 Traditionally new mother rests; may need encouragement to ambulate 67p561
May wish to place the Kara (bracelet) on infant’s right wrist 2p578 Encouraged as the best food for baby 67p562 • Not a part of faith; up to individuals 2p577 • No information found at this time • Traditionally, mother and child are together for the first 40 days 2p577 • No information found at this time • Body of stillborn or late miscarriage, as well as infant who died should be given to parents for funeral rites 65p57; 66p498 • Baptism occurs in temple, after reaching the age of responsibility 68p40 • A naming ceremony is on 40th day; the name Singh (lion) is added to son’s name and the name Kaur (princess) is added to daughter’s name 67p562
• No information found at this time • No information found at this time • No information found at this time • No information found at this time • Use of contraceptives is permitted within marriage 68p41; 67p561 56
PEDIATRICS Child/Teen Environment of Care • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 57
Guide to Religion and Culture in Healthcare Religion: 19.0 Unitarian Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy • Believe in ¾ worth and dignity of each person ¾ justice and equality 2p615 • Common values are stated in the Principles and Purposes, however members do not have to follow for membership 2p615 • No Holy Days; may have “religious” celebrations for birth, death 10p406 • “Lord’s Supper” is administered by some churches 10p406 • Faith healing is not accepted 10p406 • Church does not follow a creed 2p615 • Local congregations are “self‐governing;” a congregation may give certain powers to elected trustees 2p615 • Each congregation may differ in beliefs and worship, from formal church liturgy to group or lecture style 2p615 • Promote the goal “of world community with peace, liberty, and justice for all” 2p615 • Unitarian focus is on this life, not on afterlife 2p620 • All food types acceptable 9p15 • No information found at this time • Patient may want minister of congregation to be notified and to make visit 2p616‐20 9 Ask patient what would be helpful to him/her with regards to religious practices 2p616‐20 • Most want to be informed about treatment and be a partner in their health care 2p618 • Transfusion acceptable 10p407 • No information found at this time • Individual right and decision; support non‐heroics for terminal patient 10p407
• Church supports Advance Directives 2p618 • Permitted 22p157 • Individual decision; helping others fits in with “ethical living and justice‐
seeking” values 2p622 • Autopsy promoted; frequently donate body for medical education 10p407 58
Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Individual has right to “die with dignity” rather than try to delay death 10p407
• For comfort 9 Ask patient and family what religious readings or prayers would provide comfort to the patient 2p621 • Family may request time with the deceased “to say final goodbyes” 2p622 • No specific or special actions promoted 2p622 • Treat body “with respect and dignity” 2p622 • Quality of life and human dignity is important ; may not wish to prolong life when quality of life is unacceptable 2p619 • Most members hope for a “natural” death 2p619 • In Vitro is supported 2p619 • Most are “pro‐choice” and abortion is acceptable 2p618 • No information found at this time • No information found at this time • Permissible 10p407 • No information found at this time • No information found at this time • No information found at this time • When fetus dies, parents may request a “naming or blessing ceremony” 2p620
• May perform Baptism of infant as symbol of dedication 10p406 • No information found at this time • No information found at this time • No information found at this time • No information found at this time • Birth control acceptable 10p407 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 59
CULTURES This section provides information about how the cultural background of a patient may affect the healthcare needs and expectations of that patient. In a cultural group, individuals hold a “common set of characteristics not shared by others, typically including common ancestry, language and religion, a sense of historical continuity, and interactions with persons in the same group.” 69pxiii Culture is learned; it is acquired through life’s experience and passed on from one generation to the next. It encompasses beliefs about life and death, life values, and traditional activities including how to treat illnesses. 60
Guide to Religion and Culture in Healthcare Culture: 1.0 African‐American Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs •
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Diet and Nutrition •
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Communication •
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Healing Environment •
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Blood •
Many follow Protestant, Catholic or Islamic faiths 26p41 May believe in “life after death” 11p27 May practice “laying of hands” as believe some have healing powers 18p31 May practice folk medicine in addition to traditional beliefs in health, illness; may have close ties with church 34p178‐185 May believe that illness is a punishment from God, due to some dissonance in his/her life or “bad spirits” 34p178‐185, 18p32 Frequently use prayer to as a remedy for illness; believe that when illness occurs, one is not in accord with nature 18p32‐33 May consult healers who use herbs or roots (depending on region) 9p193‐
200
Female may wear copper or silver bracelet to protect herself 9p193‐200 9 If necessary to remove, ask patient for permission Family may include extended family 34p178‐185 Diet is usually “high fat and salt” with little fruit or vegetables 18p27 Consider green leafy vegetables important for health and “bowel function” 69p19 May be lactose intolerant 34p146 Value close personal space 34p171‐177 Nonverbal cues interpreted as interest may not mean the patient is listening or understanding; clarify terminology used by provider and by patient 34p171‐177 Depending on region, may use eye contact when talking, but not while listening; may look the other way 15p49 9 Verify that patient is listening Patient may see timing of medications/appointments as flexible 34p171‐177 Greet patient formally (e.g. with Mr./Mrs. and surname) 69p16 May be loud and animated in discussion and use body language 18p21 Family very supportive during crisis 34p175‐176 Many families are matriarchal where woman looked to for treatment decisions and promoting wellness: as seriousness of event increases, more in family are consulted for input, and decisions regarding treatment may be delayed 34p175‐176 May take pharmaceuticals “PRN” instead of routine as prescribed 18p32 Various internal and external preparations are used to treat illness and to maintain wellness 9p193‐200 May be willing to donate blood for family 26p40 9 Discuss blood donation with patient 61
• May believe pain is an indication of illness; take medication only if in pain 18p33
• Some avoid taking pain medication in concern about “addiction” 26p39 • May be willing to take medicine or “non‐pharmacological methods” for relief 69p19 • May not ask for pain medicine in the desire to be “perfect” patient.; may believe that pain is “God’s will ” 34p178‐179 Pain Management END OF LIFE • Believe only God knows length of life; God can heal so the focus is on getting well 70p245 • Value life; generally support heroic measures until the death of patient 50p 316
• May be concerned that DNR would result in poorer care 31P5 • May have concerns that planning would hasten death 71p5 • Family may make decisions for patient; unlikely patient will make Advance Directives 18p29 • May permit in case of close family 69p24 • Depending on religious beliefs, may believe body of deceased should be “whole” for afterlife 22p22 • Acceptable if necessary 69p26 DNR Advance Directives Organ Donation Autopsy Death Process • May believe that death is but a passage from this life with evil to another life; therefore, funeral may be a celebration of deceased’s life 9p193 • Family may want to be present when patient dies 69p25 • Patient may want to die in hospital 26p40 9 Provide information and offer options regarding beliefs about hospice, heroics and terminal care • Family’s method of coping at time of patient's death will vary according to "education and socioeconomic background of bereaved;” many will receive support from church members, friends and others outside of family” 10p368 • Usually leave body care to professionals 26p40 Death – Special Needs Death – Body Care Withholding/Withdrawal • May not support withdrawal 18p25 9 Ask patient if he/she is supportive • May wish condition be disclosed to spokesperson who will then reveal condition to patient; however, some believe condition is “between patient and God” 18p16 9 Healthcare professional to obtain appropriate permission per HIPAA End of Life Discussion PERINATAL CARE Prenatal Care • See pregnancy as a “natural condition,” usually celebrated 11p7 • Prenatal care varies depending on education of mother; preference for natural delivery 26p40 • At risk for small infant and infant mortality 72p350 • May have “cravings;” mother may believe this is due to fetus’ needs 18p28 • If mother is lactose intolerant, vitamin supplements and calcium should be considered 11p11 • May hold various beliefs and taboos related to activities that may harm 62
Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception fetus 18p28 9 Ask patient about specific beliefs or fears, if any • Not generally done; children are “gifts from God” 69p21 • Appreciative for pain relief, but may use non‐pharmacological methods like music, massage 11p13 • Prefer female caregiver, but It is more important that healthcare professional be capable and caring than be female 11p25 • During labor may be “loud and verbally expressive” 69p21 • Breastfeeding depends on education of mother; education about “benefits of breastfeeding” encourages most mothers to do so 26p40 • Acceptable 69p21 • May believe condition is “God’s will” or punishment for parents’ activities 18p31 • May refuse testing before birth due to belief that outcome is in God’s hands; may be concerned that amniocentesis will cause a miscarriage 11p19 • Mother may believe that her activities during pregnancy are cause for neonatal/fetal condition 18p28 • See “Neonatal Illness” • Mortality rates are higher than rest of US population; newborn frequently weighs less at birth 11p8 • Other factors that contribute to mortality rates include differences in “housing, exposure to environmental pollutants, low wages, inequities in employment, limited access to public facilities” and time between pregnancies 11p9 • Loss of baby is a catastrophic especially since new baby is a sign of hope; bereavement is “intense” 11p21 • Family may have “viewing” with internment for neonate; may have an elaborate funeral and family eats together afterwards 11p22 • See “Neonatal Illness” • Mother may or may not grieve when there is loss early in pregnancy 11p21 • Depending on the region, selecting the newborn’s name may be significant; there may be a “naming ceremony” 11p15 • Baby may be “swaddled” to protect the baby from “air” or to prevent respiratory illnesses 11p17 • May use band or coin on umbilicus to prevent “protrusion” 18p29 • No information found at this time • Traditionally mother will be supported to rest and avoid “cold air” 18p29 • Postpartum is time to clear out any “impurities;” may take traditional remedies like teas, castor oil, and douching (after menstruation begins) 11p14
• Father may or may not be present at birth 69p21 • In some groups, nuclear and extended family are at the birth 11p26 • Contraception is acceptable 69p21 • Specific methods used may be determined by knowledge level about methods, privacy when used, and desire to avoid discussions about sexuality 11p17 • If using contraception, the method most used is oral 11p26 63
PEDIATRICS Child/Teen Environment of Care • With death of child there may be an elaborate funeral and family eats together afterwards 11p22 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 64
Guide to Religion and Culture in Healthcare Culture: 2.0 American Indian/Native American Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs • Beliefs, magic, folklore, disease treatment and herbal medicine differ among Native American groups 9p216‐223 • Spiritual leader learns traditional knowledge with traditional teachings, rituals and ceremony through apprenticeship which continues throughout life 2p78 • Most groups believe in a higher power who has created all; individual communicates with this power (God) without intermediary 2p79 • All of God’s creation is interconnected and interrelated 2p79 • Believe all of life has a natural cycle, all of life is sacred and to be treated with respect; there are four aspects to beings and all four need to be addressed to provide the best health care: “physical, spiritual, emotional and mental” 2p82 • Indian priest often synonymous with medicine man/woman, the person who establishes etiology as well as remedy for illness 9p219‐221 • Among approximately 500 different tribes, each has own culture regarding treatment of illness 30p281‐283 • Traditional Indian medicine focuses on holistic, behaviors to achieve harmony (wellness) 30p281‐283 • Healing process moves individual from illness (negative) to harmony and health; thinking positive is important to the process 73p9‐13 • May seek medical doctor for specific conditions and traditional healers for others; may see traditional healer and western doctor for the same illness, but each is seen for a “different aspect” of the condition 11p258 • Good health results from having balance of “mind, body, heart/ emotion and spirit; since physicians usually pay more attention to the physical, folk healers help to bring the “other elements into balance” 11p258 • Very family oriented 10p346 • Care of elders accepted as part of life responsibility 30p284 • Navajo: culture blends religion and healing practices which are part of daily life 34p244 • Navajo: Blessingway ‐ healing rites to remove illness through various “stories, songs, rituals, prayers, symbols and sand paintings” 34p243‐247 • Family participate in ceremonies related to beginning and end of life and at time of illness 34p243‐247 • In case of amputation, patient / family may desire to bury the limb 45p49 65
Diet and Nutrition •
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Communication •
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Healing Environment •
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Blood Pain Management END OF LIFE DNR Advance Directives Usually follow tribal food practices 34p148, 251 Diet depends on food availability and cost of foods 34p148, 251 May be lactose intolerant 34p148, 251 Diet is primarily “carbohydrates and fats” 10p345‐346 For healthcare teaching, use term “nutrition (seen as positive) versus diet (seen as negative or deprivation)” 10p345‐346 Frequent use of silence and non‐verbal communication; consider it rude for person they don’t know to talk loudly to them, write notes during conversation or to interrupt 9p233‐234; 30p282 Physical space is very important; some Navajo patients may not adapt easily to hospital environment 34p15, 242 “Excessive eye contact” considered an insult 30p283 Hand shakes should be “lightly and quickly”; hard handshakes are considered ill manners 2p86 Patient may be careful in communication to avoid making anyone feel inferior or to lose credibility; value truth; silence may indicate thoughtful evaluation of the discussion 2p83 May use metaphors to describe condition and avoid speaking about self 2p83
May refer to relatives by “familial term” as a sign of respect, however the relationship may be traditional or spiritual rather than biological 2p84 May avoid discussions about illness or bodily functions 10p345 Family provides support during health crisis 10p346 Patient may desire native healer to address spiritual health 26p17 Patient may prefer to be treated by someone of same gender 2p86 If patient is wearing a medicine bag, 26p14 9 make every effort to have it remain in place 9 if necessary to remove medicine bag, give to family or place where patient can see it 9 replace as soon as possible May be unacceptable to cut patient’s hair 45p49 9 If necessary, discuss with family and ask how to dispose of shaved or cut hair Navajo: extended family as well as immediate family is very important; family provides support; expect extended family to be present 34p244‐245 Up to individual 2p86 • May believe that illness is atonement for a past or future infraction 9p218 • “Value of tolerance without complaint;” not likely to express pain, however might indicate not feeling well 2p86 9 Healthcare professional should offer pain medication if warranted • May not wish to discuss DNR if there is poor prognosis in belief that it may bring death forward 26p13‐19; 2p87 9 Explore with patient and family what their feelings are about discussing health directives or terminal condition • May be unwilling to sign informed consent or other documents 2p86 9 It is best to ask the patient or family what their wishes are 66
• Usually refuse organ donation 26p18 Organ Donation Autopsy Death Process • Usually refuse autopsy 26p18 •
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Death – Special Needs •
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Death – Body Care •
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Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) May avoid touching dying patient or discussion of death 26p17 Maintain positive outlook in patient’s presence 26p17 Overt signs of grief may be expressed once patient has died 26p17 Do not use name of deceased 2p88 9 Whenever possible healthcare workers should not say name of patient who has died; use relationship, (e.g. “your sister”) 9 Ask family what do with personal effects of deceased Navajo: family participate in ceremonies for birth, death, and illness 34p241‐
243
Do not move body until checking with family; family may wish to pray, conduct ritual before the body is moved 2p88 Refrain from touching body if possible since some believe that the spirit remains with the body for some time after death 2p88 Family may want to cut “a lock of hair from the deceased to be used as part of a year‐long “soul keeping” ceremony” 2p88 Up to individual; concept of “medically futile” is not a part of beliefs 2p86 • Prefer that this issue be discussed with family rather than patient 69p29 9 Healthcare professional to obtain appropriate permission per HIPAA • Family prefer to be told to provide time for all to get together 69p39 • Crow Tribe: Pregnancy is seen as a natural event and prenatal care is not seen as essential; may seek care later in pregnancy than typical US culture 11p260 • Crow: Does not get baby items ready for birth in case baby dies during pregnancy 11p260 • Great Basin Tribes: May not discuss pregnancy or get care in first three months due to belief this may affect pregnancy 11p263 • Great Basin Tribes: May follow traditional taboos on certain foods during pregnancy; may avoid certain activities in belief that those would cause bad thoughts and be bad for the fetus 11p263 • Other tribes: may be accepting of prenatal care 26p13‐16 • Customs may include not touching hair during pregnancy 26p13‐16 • In Vitro: Up to individual 2p86 • Abortion is not forbidden or supported; up to individual 2p85 • Crow: May use sweat baths each week during pregnancy, which is believed to make labor easier; find delivery in hospital acceptable 11p261 • Crow: Mother may have taken Peyote during labor 11p261 9 Inquire about any traditional remedies that may have been taken • Great Basin Tribes: Usually only females attend mother in labor and delivery 11p264 • May use herbs or meditation during labor 26p13‐16 • Birth is a “sacred and holy event” 2p87 • Some tribes practice religious rites at birth 2p87 67
Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care •
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Crow: breastfeeding is less popular now 11p263 Great Basin Tribes: support breastfeeding 11p265 Generally breastfeeding or bottle acceptable 26p16 Up to individual 2p86 • No information found at this time • No information found at this time • Great Basin Tribes: Funeral and ceremonies same as for adult or child; 1 year of mourning 8p267 • If newborn is not expected to survive, family may desire to have ritual that would have been done at home post discharge 26p16 • At “naming ceremony” baby becomes “full member of community;” if baby dies before “naming ceremony” (at one month or later) it is not a full part of the tribe and will have no funeral 70p246 • Great Basin Tribes: funeral and ceremonies same as for adult or child; 1 year of mourning 8p267 • Great Basin Tribes: naming ceremony done whenever family decides 11p265
• At “naming ceremony” baby becomes “full member of community;” if baby dies before “naming ceremony” (at one month or later) it is not a full part of the tribe and will have no funeral 70p246 • Crow: Umbilical cord will be saved when it dries up and falls off, placed in decorative wear to protect health of child 11p262 • Crow: will name baby at 4 days; grandmother teaches how to care for baby 11p262 • Great Basin Tribes: swaddle babies, usually for first month; save umbilical cord 11p265 • Great Basin Tribes: may not bathe baby for 1 month; may have a naming ceremony for the baby 11p265 • Newborn is highly valued among Indians 11p259 • Baby may have dark spots (“Mongolian”) on low back 69p35 • Parents and extended family provide care 69p35 • Navajo mother uses touch to promote mother/newborn bonding 34p241 • No information found at this time Family/Father involvement •
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Contraception •
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Crow: grandmother teaches new mother how to care for baby 11p262 Great Basin Tribes: Mother , new baby remain home for 30 days 11p264 Tribal customs vary from exercise to bed rest 69p35 Crow: Customarily do not attend labor or delivery; younger may remain for labor and rarely for delivery 11p261 Father’s involvement or role depends on tribal custom 26p13‐16 Crow: traditionally used breastfeeding for contraception; may be open to other methods 11p262 Great Basin Tribes: younger generation find oral contraceptives acceptable; implants or intrauterine devices are unacceptable 11p266 Female may not be willing to discuss with provider who is male 69p35 68
PEDIATRICS Child/Teen Environment of Care • Death practices are same as for adult; mourn for 1 year 11p267 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Culture: 3.0 Arab American Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs • Patriarchal society; family loyalty of greatest importance; do not want the patient to know seriousness of condition 73p30‐36 • Muslim Arab believes that mental illness is not possible if one is following faith tenets; mental illness is taboo 74p1311 • Do not mix hot and cold foods at same meal 69p47 • Depending on faith, may eat meats; eat well cooked meats, avoid rare meat and raw fish 69p47 • Silence may mean respect for healthcare professional or lack of understanding; may agree in order to be polite 69p44‐45 • Greeting: 69p43‐45 9 Greet patient formally by title and first name 9 Handshake acceptable; touch between same gender • Left hand is used for “hygiene while right hand is used for eating;” may be offensive to hand patient something with left hand 69p45 • Family provides assistance to patient; someone remains with patient 73p31
• Expect to rest when ill, view patient care as the responsibility of the healthcare worker and do not help with patient’s personal care 73p31; 69p46 • May be willing to participate more actively in therapy if understand the reason for the therapy 73p30‐36 • Wash after toileting with running water; provide pitcher for patient 69p46 • Transfusions are acceptable 18p69 Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives • Some use prayers and religious readings to cope with pain 75p39 • Believe that he/she has low threshold for pain; may believe that relief should occur immediately after treatment or medication given 73p30‐36 • Consider injections better for pain relief; IV fluids indicate serious condition 69p48 • Express pain to family non‐verbally with loud noises; may exhibit less signs of pain with non‐family 73p30‐36 • May avoid usual postoperative coughing and exercise to avoid pain 69p47 • Death accepted as natural occurrence, however believe in providing heroics to extend life 69p55 9 Offering DNR option to family may cause them to mistrust professionals 69p56 • See above “DNR” category 70
• Body should remain whole, therefore may not agree to organ donation 69p56
• Muslim may not agree; consider the body to be holy 44p253 Organ Donation Autopsy Death Process • Prefer to die in hospital where options to extend life are available 69p56 • Muslim patient: 9 Turn patients face toward Mecca (Saudi Arabia) 44p252 • Family may arrange for men to pray over patient who has died 42p250 • May need a separate room for family to grieve; grief is expressed overtly and “uncontrollably” 69p56 • After Muslim death, family member of like sex will prepare body in prescribed rites which include washing and rinsing of dead body 10p393; 21p23
• See above “DNR” category Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony • Prefer discussion of serious matters be done with family spokesperson; family protects patient from serious information 69p44 9 Healthcare professional to obtain appropriate permission per HIPAA • Mother is to rest and eat “well” during pregnancy; may not seek prenatal care because pregnancy is normal or because of the cost 69p49 • Do not prepare for birth in advance (“deal with it when it happens”) 69p49 • Based on religious influence, abortion is not widely practiced 69p51 • Muslim mother keeps hair covered and remains in dress during labor, as long as possible 76p55 • May express pain during labor/delivery with loud non‐verbal noises 73p30‐
36
• May use low vocalization so that “strangers” cannot hear them 75p39 • May withstand pain in belief that God will provide benefit for that endurance 75p38‐39 • May request that baby be cleaned before she breastfeeds, due to concern for mother’s purity 76p55 • Acceptable to breastfeed; may believe colostrum is not good for baby and wait until milk comes in 69p50 • Muslim requires circumcision 69p51 • See “Neonatal Illness” • May view birth defects as a “test of faith” 77p1311 • Discussion of problems with baby should be with both mother and father, always providing hope to couple for restoration of health of baby 69p50
• See “Neonatal Illness” • See “Neonatal Illness” • In Muslim family, father may “whisper call to prayer” in baby’s ear 69p50 71
Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Parents may place amulet on clothing to protect newborn from “evil eye” 69p46 • For Muslim it is not acceptable to change surname or for child to lose connections with biological parents/family 53p20 • Mother may expect complete bed rest after delivery; females in family take over mother’s duties at home 69p50 • Father not usually in attendance at birth 69p50 • Muslims may use contraception in pill format for “preconception” but do not use “morning‐after pill” 77p1310 • Acceptable within the married union 69p50 • May view birth defects as a “test of faith”; most will mainstream child into daily family life, possibly pretending there is not problem 77p1311 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Culture: 4.0 Asian: Chinese American Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication • Generally practice one of the following four: “Taoism, Buddhism, Islam or Christianity;” may follow Chinese medicine, herbalists and other alternative therapies prior to seeking Western medicine or use concurrently with the Western treatments 34p402‐406 • Family unit is greater than one person in it; elders are important and consulted when making decisions 34p402‐406 • Believe in Yin/Yang balance in all aspects of life; through balance can reach “optimal health” 11p64 • May believe disease develops when yin and yang are not in balance 9p247 • Treat whole patient; traditional medicine includes “cupping, acupuncture and herbal medicine” 32p46 • Wellness promoted; believe physical and spiritual harmony provide for good health 32p46 • May refuse to take medications when does not feel ill 32p46 • Generally diet is low fat, high sodium content; new mother may follow customary strict diet 32p48‐49 • Practitioner of Taoism, following the theory of balance, will eat and drink in moderation 3p122 • May follow Yin/Yang and eat only certain foods when ill (e.g., post op or after delivery may eat only Yang foods such as chicken, beef, fried foods) 34p410 • Generally meals include rice and noodles with little meat; vegetables are eaten with meat for balance 26p76 • Silence and nonverbal expression used in communication; patient tries to maintain harmony 34p398‐402 9 Avoid physical contact during conversation • Are not comfortable or accepting touch of those they do not know 32p47‐
48
9 When touching is necessary, explain to patient/family • Family honor and loyalty are important 34p398‐402 • Greetings: 26p75 9 Greet patient by Mr./Mrs. with last name to show respect • Maintain eye contact with elder, avoid with others 32p47‐48 • May respond to a question with nod or shake for answer 34p398‐402 9 Healthcare professional should clarify patient’s response, use appropriate eye contact, touch • Older Chinese may be illiterate; discuss and ask questions to determine patient’s understanding 26p74 73
• Family honor and loyalty are important 34p398‐402 • Greet patient by Mr/Mrs with last name to show respect 26p75 Healing Environment • Chinese are very modest and may not give out personal information 26p75 • When discussing serious condition, family may want to be part of discussion 26p75 9...Include oldest male or eldest son after obtaining appropriate permission of patient per HIPAA • May practice coin rubbing to “draw out” illness 42p36‐37 • Family may want to protect patient from knowing if prognosis is poor; family is seen as decision maker, rather than the patient 78p325‐326 • Family takes care of patient 34p402 • Provide female patient with female nurse 26p75 • May refuse surgery in belief that body must remain whole 9p253 • Word for “4” is associated with death; therefore, it has a negative connotation. Patient may not want to stay in a room with “4” or with “7” which reminds one that spirits come back 7 days after death 42p103‐107, 234
• May follow Feng Shui practice that includes placement of furniture to promote flow of “positive energy;” Feng Shui dictates that bed should preferably face south and be sideways to door 42p103‐107, 234 • Offensive to receive paper with name or lettering in red ink, for example, a prescription; this is due to the fact that at “death or anniversary of death,” the person’s name is documented in red 42p39 • Believe that blood is not replenished by body; therefore, may not be willing to donate or have blood test done 9p253 • May refuse pain medication or intervention the first time it is offered due to social custom of refusing something the first time it is offered 32p48
• May use acupuncture for pain 10p318 • May be pleasant and quiet, concealing emotion or pain 34p397; 26p77 9 Assess body language and non‐verbal for indications of pain Blood Pain Management END OF LIFE DNR • Quality of life is more important than duration; may not agree to life support measures 78p318, 325 • May refuse to discuss DNR as many believe discussion about death will “cast a death curse” and will hasten patient’s death 78p318, 325 • For young patient, may want heroics in spite of inevitability of death 78p325‐326
Advance Directives Organ Donation • No information found at this time Autopsy • Organ donation is permitted 32p48 • According to Confucian and traditional medicine: body integrity is important, therefore generally refuse organ donation; Taoist accepts organ donation 22p25 • Autopsy is permitted 32p48 • In belief that body integrity is important, may not permit autopsy 26p78 74
• If patient is terminal or dying, family usually calmly accepts death 10p368 Death Process • Family may take patient who is dying to hospital in belief that “dying at home will bring bad luck; some believe “ghosts” stay in house where someone died 26p78; 70p247 • For the Taoist, death is the balance for life and is not feared; believe that the “soul” is with the deceased until burial 3p124 • Oldest son arranges for funeral 32p48 • Family may bring in “special amulets and cloths from home to place on the body” 26p78 • Family may wish to wash the deceased 26p78 Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life • Quality of life is more important than prolonging it; family may request heroics be stopped if burden of costs is issue 50p319 • For young patient, may want heroics in spite of inevitability of death 78p325‐326
• No information found at this time • May see pregnancy as a “natural” state 11p68 • Asking questions related to sex are “taboo” and should be asked “tactfully and indirectly” 18p105 • May be concerned that Yin foods should be eliminated from diet as pregnancy is seen as Yin condition and Yang is needed for balance 26p77 • Many need vitamin, calcium, mineral and iron supplements during pregnancy as well as postpartum; may be lactose intolerant 11p70 9 Mother may benefit from nutrition consult and nutrition education 9 Mother may stop supplements without notifying physician if experiences unpleasant gastrointestinal effects • Abortion is acceptable 32p48 • May prefer normal delivery to Cesarean section 26p78 • Mother may want to remain clothed for labor and delivery; may follow custom of not bathing for 1‐4 weeks after birth 32p48; 35p98 • For a Cesarean section, mother may want to select “auspicious” time for delivery 42p234 • After delivery, the Taoist mother may make an offering in thanksgiving 3p123
• Promote breastfeeding; cow and goat milk unacceptable 9p249 • May chose bottle feeding if returning to work soon 11p72 • Acceptable 26p78 • No information found at this time • No information found at this time • For young patient, may want heroics in spite of inevitability of death 78p325‐326
• Do not have usual funeral rites for those who die under 18 years old; family will “minimize” any reference to death; do not discuss in public 75
11p77
Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement • May believe stillborn or aborted fetus is not part of family; no grieving takes place for lost fetus 11p68 • No information found at this time • Most babies have “Mongolian spots (dark bluish spots over the lower back and buttocks)” 18p105 • No information found at this time • May follow practice of wrapping up and keeping doors and windows closed to protect from draft (“wind”); believe that in postpartum condition mother’s “pores” are open 11p72 • May refuse bath since water is considered “cold” no matter what the temperature; eat only “hot” foods to maintain balance 11p73 9 Mother may avoid eating certain foods on tray; ask which foods she may eat • May follow practice of rest for a month to recuperate from birth; usually the maternal grandmother will care for new mother and baby 11p75 • Mother may be with infant only for breastfeeding during the first month of baby’s life 11p75 • May believe that the laboring mother must eat well to provide stamina for labor 11p71 9 Explain to mother that nausea and vomiting may occur at end of labor and a full stomach may be a problem • Fathers generally do not attend labor or delivery; couple who has been in the U.S. for some time may expect father to provide support for labor 32p48; 18p107 Contraception PEDIATRICS Child/Teen Environment of Care • Usually female family member will attend birth 26p77 • Contraception is acceptable and methods used are similar to U.S. culture 11p74
• Keep evil spirits from hurting the child by having child wear an amulet that has “an idol or Chinese character painted in red or black ink and written on a strip of yellow paper” 74p1037 9 Do not remove amulet unless necessary • For young patient, may want heroics in spite of inevitability of death 78p325‐326
• Do not have usual funeral rites for those who die under 18 years old; family will “minimize” any reference to death; do not discuss in public 11p77
Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 76
Guide to Religion and Culture in Healthcare Culture: 5.0 Asian: Japanese American Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs • Practice various religions, however cultural values originate from “Zen, Buddhist, Confucius and Shinto” teachings. Some believe imbalance causes illness and that treatment should be aimed at restoring balance 34p330‐332
• For a favorable outcome, may seek input of priests before making decisions; social rank and use of titles important expect healthcare professional to know what is best for patient 32p117 Diet and Nutrition Communication Healing Environment • Some may depend on the healthcare professional to make decisions for them rather than select from options presented 11p174 • Rice is a staple; diet is low fat but high in sodium (soy sauce) 34p335‐336 • Diet may include many fried foods and high caloric foods 11p168 • May avoid milk products due to lactose intolerance which is found frequently in culture 34p335‐336 • Eat uncooked fish 32p119 • Touch used with infants; less physical contact with adults 34p324‐325 • Acceptable to shake hands, other touch and eye contact is disrespectful 32p118‐119
• May agree for politeness, but not follow directions for care 34p324‐325 • Formal, reserved behavior with little physical contact between adults; healthcare provider should limit touch 34p324‐325 • Word for “4” is associated with death; therefore, it has a negative connotation. Patient may not want to stay in a room with “4” or with “7” which reminds one that spirits come back 7 days after death 42p107 • Respect physician, those in charge; patient may consult family for medical decisions 32p117‐118 • Culture values group decision and harmony as more important than individual choice 36p531‐538 • Bath is important but may be omitted when patient is sick; family gives “personal care”32p118‐119 • Patient/family may take assistance from family members but not outsiders or social service 34p328‐331 • Family ¾ is important; eldest son usually is responsible to care for parents ¾ some family members remain at bedside of elderly family member in hospital who is very ill ¾ is patriarchal; father makes family decisions 34p328‐331 9 Health care professional should approach patient before 77
procedures to ask whether patient wants physician to discuss results with patient or family and obtain appropriate permission from patient as per HIPAA • Transfusion acceptable 69p314 Blood Pain Management • Culture which often does not verbalize pain; healthcare professional may administer less than adequate pain medication due to this 10p308 • Patient may expect healthcare professional to pick up on non‐verbal cues as to pain 34p325‐326 • May refuse in belief that medicine will be addictive 26p183 END OF LIFE • May be willing to consider DNR if is accustomed to and familiar with Western Medicine practice 36p537 • Value physician’s input, may decide on basis of discussion with physician; may find it difficult to stop heroics once initiated 18p306 • Values group family decision making 36p537 • Culture dictates protection of elderly from knowledge of terminal situation; may be difficult to obtain Advance Directives 36p531‐538 • The more accustomed the patient is to Western life, the more likely the patient will be open to discussion of Advance Directives 36p531‐538 DNR Advance Directives Organ Donation • Generally do not agree to donation and transplant; believe that body should remain whole; the younger generations, more accustomed to Western life, are more likely to agree 22p22; 26p186 • Hindu, Buddhist: organ donation/ transplant up to individual; Shinto: generally refuse organ donation 22p24 • Believe that body should remain whole; the more accustomed to Western life, the more likely to agree to autopsy 26p186 • Shinto: autopsy permitted 20p496 Autopsy Death Process • No public expression of grief; may mask grief during discussion about death of someone close 32p118 Death – Special Needs • Family may want to stay with dying patient 26p186 • Shinto Japanese: Family remains with body until buried or cremated 3p104 • Body should be clean and dressed for viewing 69p315 Death – Body Care Withholding/Withdrawal • May be difficult to get agreement to stop heroics once initiated 18p306 • Those more accustomed to Western Medicine practice may accept withdrawal 36p537 • Hopes for a “peaceful death;” patient and family may not want to discuss terminal situation so that patient does not worry about it 18p302 • Prefer that prognosis be discussed with family, not patient 36p534 9 Healthcare professional to obtain appropriate permission from patient as per HIPAA End of Life Discussion PERINATAL CARE Prenatal Care • Mother seeks prenatal care 78p118 • Japanese are passive; may not ask for help but expect to provide help without being asked 11p166 • In Japan, use of ultrasound is frequent during pregnancy; may expect U.S. physician to order during most visits 11p166 • Taboos on certain foods believed to affect fetus 79p33 78
Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement • During pregnancy woman is to keep from getting “chilled” as this may harm the mother or fetus; wear socks to keep feet warm and may not use air conditioner 11p168 • Promote rest during pregnancy 79p32 • Traditionally, pregnancy is “woman’s fulfillment” and pregnant patient is “pampered” 18p301 • Abortion is acceptable 18p301 • May seek abortion if testing reveals abnormalities 11p167 • May wear amulet from Shinto shrine to provide for good birthing; usually worn around neck during pregnancy 11p169 • Endures labor without analgesic; believes that bearing pain makes better mother 79p33‐40 • May not show pain or ask for relief; expect healthcare professional to recognize the need for relief and provide a remedy 11p171 • No colostrum to newborn 32p118‐119 • Usually breastfeed 79p33‐40 • Traditionally babies are weighed pre and post breastfeeding; feedings are supplemented if determined that baby did not get enough milk 11p172 9 Mother’s education should include the importance of colostrum and how demand increases the quantity of milk produced • Acceptable, up to individual 26p183 • Family may believe that this is “punishment” for prior behavior in family 26p188
• Father is to be consulted before mother so that father can attend mother when illness is discussed with mother 26p185 • Parents may want “aggressive” treatment 18p304 • See “Neonatal Illness” • No funeral rites for stillborn or miscarriage 11p176 • Depends on spiritual beliefs, religion 18p303‐304 • Mother takes care of baby; father who has been exposed to U.S. practice may participate in child care 69p311 • Traditionally baby is “named on seventh day with ceremonial writing of name” 11p173 • No information found at this time • Post delivery rest; mother may refuse bath/shampoo for 7 days post delivery 32p118‐119 • Mother may plan to move in with grandparents who will care for her and baby for 2‐3 months 79p33; 69p310 • End of postpartum period celebrated on day 100 with ceremony 79p33, 40 • Father and maternal grandmother likely to attend delivery 26p184 • Father frequently takes passive role, does not coach mother 11p170 79
Contraception PEDIATRICS Child/Teen Environment of Care • Acceptable 18p301 • Usually use condom; IUDs and diaphragms are acceptable, but used less frequently 11p174 • Among younger generation, may consider abortion an acceptable method of birth control 69p311 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Culture: 6.0 Asian: Korean American Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment • May follow belief system of Tao, Confucius, Buddha, or Christianity; may practice a mix of traditional and Christian religion 34p561 • Promote wellness, care of own body 32p127‐128 • Use therapies including acupuncture and traditional treatments; herbs are frequently used 32p127‐128 • May believe that illness is because of actions that he/she had taken, bad luck or “imbalance of hot and cold” 26p200 • Family oriented society, family input on decision‐making but male makes final decision 80p12‐16 9 Healthcare professional to obtain appropriate permission from patient per HIPAA • Breakfast is the main meal of day; when first offered food or drink, social custom dictates refusal 32p129 • Rice and Chinese cabbage are staples; lactose intolerance seen frequently 34p567 • Touching is considered impolite unless person is good friend of same gender; family does hands on care of patient 32p128 • Respectful to avoid eye contact and physical touch with those outside of family or friends; family oriented; family is involved in giving care to hospitalized family member 34p559, 561‐562 • May seek Western medical care; respect physicians and nurses 32p127‐128 • May agree (or nod to imply agreement ) for the sake of harmony and saving face, but be noncompliant with instructions 28p80 • Word for “4” is associated with death and therefore has a negative connotation. Patient may not want to stay in a room with “4” or with “7” 42p107 • Offensive to receive paper with name or lettering in red ink, for example, a prescription; this is due to the fact that at death or death anniversary, the person’s name is documented in red 42p39 • “Coin rubbing” is practiced on children and older adults; red marks may look like abuse 80p3 Blood • Loss of blood takes away strength and allows “soul to leave the body” through loss; receiving blood, therefore, may provide entry for another’s spirits 45p34‐35 Pain Management • May be concerned about addictions; prefer pain medication by mouth or IV rather than IM 80p12‐16 • May not express pain 32p128 81
Assess for non‐verbal indications of pain 80p12‐16 END OF LIFE DNR • Believe in possibility of miracles thus maintain heroics until death 70p247 Advance Directives • Culture dictates protection of elderly from knowledge of terminal situation; it may be difficult to obtain Advance Directives 71p3 • Decision maker for family reviews documents for patient before patient can sign 80p3 Organ Donation • Generally do not agree to donation or transplant 22p22 • Based on Confucianism may refuse donation/ organ transplantation in belief that donor body must not be disfigured 62p148 • May be agreeable if cause of death unknown; most will refuse autopsy 26p198
Autopsy Death Process • Death is transition to another life; at death of patient family may be emotional and loud 32p129 • Family may wish to take elder back to home country before death 50p318 • May not consider “Brain death” as equivalent to death 62p147 • Family may wish to have time with deceased before removal from room 26p198 • Traditionally at death of Korean, name is written in red ink 11p216 • Family may wish to bathe body after death 80p12‐16 Death – Special Needs Death – Body Care Withholding/Withdrawal • Patriarchal culture where male determines life support decision; families may wish to return patient to native country before patient dies 50p318 • May consider removing life support as contrary to God’s will and disrespectful to elder 50p318 • Believe in possibility of miracles thus maintain heroics until death 70p247 • Among older Koreans, more patriarchal; in younger generations, more family involved in decisions, although male may make final determination 26p199 • May wish family leader to be informed first and that person will let patient know prognosis 26p194 9 Healthcare professional to obtain appropriate permission from patient per HIPAA End of Life Discussion PERINATAL CARE Prenatal Care • May not seek prenatal care until fifth month 11p213 • Typical Korean prenatal visits include but no physical exam; mother may not be aware of typical U.S. physical exam 11p214 9 Discuss exam to be done with sensitivity to modesty needs • Prefer provider of same sex 80p4 • Information about personal issues like breast exams and bowel habits would not be divulged until patient is comfortable with relationship with provider 80p4 • Certain foods are prohibited during pregnancy 10p103 • Many are lactose intolerant and consequently do not consume milk products 11p213 82
Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) • Family supports pregnant woman in maintaining a positive, calm attitude for a good pregnancy11p213 • Mother may believe infant at birth should be small; may wear binder and work very hard in belief that these will help her deliver a small baby 8p213 • Abortion is acceptable 11p216 • May not want medication in order to have a natural birth 11p214 • May want to “walk, squat or crawl” but is encouraged to withstand pain 11p214
• Rest is very important for mother after the birth 80p12‐16 • After birth, mother traditionally drinks special soup to encourage milk production 18p336 Breastfeeding • Breastfeeding promoted 32p129 • May use home remedies to promote milk 80p12‐16 • Some initiate breastfeeding at birth, others on third day; some Koreans accustomed to U.S. practices may give bottle feedings instead of breastfeeding 11p215 Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement • May refuse circumcision 10p 113‐116 • Conditions/Illness 26p197‐198 9 Discuss any problems with father before talking to mother due to fact that mother may believe that she caused problem 26p197‐198
• Prefer that condition be discussed with father and he will let the mother know 80p4 • See “Genetic Conditions” and “Neonatal Illness” • No rites practiced for stillborn birth; consider that baby as not having been born and may wish for hospital disposal 11p216 • No information found at this time • Infant remains in home for at least a month, is not taken out in public 11p215
• Baby is picked up when cries; may sleep with mother 11p215 • No information found at this time • Mother takes care of baby, rest is encouraged; family will help with other duties of mother 26p197 • Time of rest varies and may be from 7 days to 90 11p214 • Mother keeps warm and newborn is swaddled 11p214 • Certain foods are given to new mother (“seaweed soup and steamed rice) and anything consumed must be warm 11p214 • Father does not attend delivery 32p129 • Father may not actively participate in newborn’s care 11p215 Contraception • Generally practice withdrawal or douching as methods for contraception 11p216
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PEDIATRICS Child/Teen Environment of Care • Family may practice folk therapies that mark skin (e.g., moxibustion, cupping) 26p201 • Marks may appear to be abuse 26p201 9 Carefully question patient and family to ascertain whether these were made by folk therapies Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 84
Guide to Religion and Culture in Healthcare Culture: 7.0 Asian: Vietnamese American Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment • May follow belief system of Buddha, Confucius, or Tao or may practice a blend of the three 34p445‐458 • Therapies used include herbals, coin rubbing, and acupuncture 34p445‐458 • May believe illness is caused by imbalance of hot and cold 34p445‐458 • Consider respect and harmony as most important; eye contact is disrespectful when addressing someone of higher social standing or older 34p445‐458 • Believe that Western meds are stronger; may take reduced dosage due to this belief and smaller stature of Vietnamese 34p446‐459 9 Explain that dosage is based on patient’s weight • Believe that “perspiration removes body toxins;” may believe decrease of perspiration in US and stress is cause of illness 81p308 • May consider routine visit by chaplain means that patient is critical 34p446‐
449 9 It is important to explain visit beforehand • Traditionally low fat/sugar, high carbohydrate diet mainly of rice with leafy vegetables 34p458‐463 • Those more accustomed to U.S. lifestyle take in more calories and are sedentary leading to overweight 81p307 • Do not usually take drinks with ice 26p283 • May be lactose intolerant 34p458‐463 • Encourage prenatal salty diet with little fruit or vegetables 34p458‐463 • Unacceptable to touch patient’s head, unless necessary; may believe the soul resides in head, will lose soul if head is touched 80p16 9 Touch only when necessary; explain necessity to patient first; afterwards touch opposite side of head to keep soul from escaping • Palm up is offensive in communication 34p446 • Eye contact is disrespectful when addressing someone of higher social standing or older 34p445‐458 • May smile rather than express emotions, concerns or complaints 34p446‐459 • With people who are not family, usually desire more personal space 69p448
• Greeting: 26p193 9 Address patient formally with Mr. or Mrs. and last name • Believe that ill health is from not having yin‐yang in balance; imbalance may have various sources, including “spirit taking over body” 69p456 • Consider Western pharmaceuticals as “hot” affecting balance in body; 85
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END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process may lower dose when feel imbalance 81p308 Herbs or teas in traditional medicine are believed to “cool” the body and may be taken to balance “hot” Western medicines 81p309 May nod or indicate agreement to show respect and avoid conflict 69p448 9 Health care professional should discuss further with patient to verify and clarify understanding Usually do not offer medical information; accompanying family may provide information 69p448 Very modest; only touch between waist and knees when absolutely required for treatments, test, care 34p447 If plan of care or treatment for female patient includes examination of torso or pelvic area 34p446‐459 9 ..Carefully explain necessity and process; remain with patient during exam Family, including extended, support patient; family does hands‐on care for patient 32p244 Traditionally the husband/father makes decisions; wife may not agree but allow husband to decide to maintain peaceful relations 69p455 May believe that soul can leave body through invasive procedures, resulting in poor health or death 69p457 Does not count age from actual birth date; birthday is celebrated on New Year’s Day (Tet) 42p131 Loss of blood takes away strength and allows “soul to leave the body” through loss; receiving blood, therefore, may provide entry for another’s spirits 45p34‐35 May believe that loss of blood is permanent and results in weakness 34p459
Patient unlikely to express pain; the individual may consider pain is his/her fate 34p446‐454 9 Consider non‐verbal cues as to presence of pain May have concerns about addiction; may be “stoic” 26p283 • Usually avoid extending the dying process, but it may be difficult to get consent for DNR 69p459 • No information found at this time • Organ donation is not an accepted practice; Buddhist belief that removal of organs may result in lack of that part in next life 34p459 • Autopsy acceptable, but may be difficult to obtain unless family understands reason for autopsy 32p245; 69p459 • May want family to receive news of terminal state rather than telling patient so that patient is not worried 26p282 9 Healthcare professional to obtain permission of patient per HIPAA • In preparation for patient’s death, family/friends help dying patient remember the good he/she did in lifetime 32p245 • May prefer to die at home; one who dies away from home “becomes a wandering soul with no place to rest” 69p459 • Overt expression of emotions is considered a weakness, except for the widow at the burial of her spouse 34p446 86
• Family may request time with deceased before removal of body 26p286 Death – Special Needs Death – Body Care • Family helps prepare body of deceased and places coin in mouth as aid to spirit 10p369 • May consider delay in removing life support to a “more auspicious date” 35p109
• Family member may wish to consult with religious leader for advice before withdrawal of heroics 69p459 • Eldest male (husband or oldest son) is usually “spokesperson” for family and makes decision; female will likely defer to male in decisions to maintain harmony 26p286 9 Healthcare professional to obtain permission of patient per HIPAA Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care • Intimate touch allowed only in private; may not agree to pelvic exam 34p447
• During pregnancy, mother is to avoid “strenuous activity” and avoid “sexual activity”26p284 • Not acceptable; soul enters at conception 69p454 •
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Prefer to ambulate during labor 42p237 Deliver in “squatting” position 32p245 Attended by close female member of family 26p285 Following delivery: ¾ mother seeks to restore balance of hot/cold by intake of warm drinks ¾ showers are prohibited; provide “sponge” baths instead ¾ mother may appear to ignore newborn, as a measure to protect the newborn from the “evil eye” 42p117,237 • Promote breastfeeding but do not feed baby colostrum 35p105 • Usually do not perform circumcision 32p245 • May believe this is retribution for actions of family 69p457 • See “Neonatal Illness” • Prefer that the information be given to father who then decides who will disclose the information to mother; prefer physician presence when information is disclosed to mother 69p454 9 Healthcare professional to obtain permission of patient per HIPAA • See “Neonatal Illness” • No information at this time • No information at this time • Mother takes care of baby, but female relatives help for the first few months 69p453 • No information at this time • Mother will eat more “hot” foods to “replace and strengthen her blood” 69p453 87
Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Female family will keep father away from delivery but he should be accessible; father who is more accustomed to U.S. practice may take childbirth prep classes and attend to laboring mother 69p453 • Acceptable unless Catholic 69p454 • No information at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 88
Guide to Religion and Culture in Healthcare Culture: 8.0 Brazilian Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition • Most Brazilians are non‐practicing Roman Catholics; however there are other increasing religions such as Evangelical and Protestant 69p59 • Other religions include “Mormons, Jews, Muslims, Buddhists,” and Umbanda; the rationale for may religions is due to Brazil’s constitution that guarantees freedom or religion 69p59 • Roman “Catholics folk practices focus on saints, promises, and pilgrimages” 69p59 • “Syncretism” is frequently seen where individuals follow “beliefs and practices” from more than one religion 69p59 • Many believe in miraculous events which they consider the result of intercession of saints 69p59 • Many believe in “religious/spiritual healing;” ¾ May seek Catholic priests during emergencies ¾ Spiritits, practice laying on of hands, and folk healers give herbal remedies and offer “prayer and blessings” 69p59‐60 • Believe that sickness is caused by “fate” or God; may also believe ill because of environmental changes 26p52 • May believe that “suppression of strong negative emotions” results in “ataque” or “susto” and can be the source of mental problems 26p52 • Brazilians eat three meals a day with breakfast as the smallest meal; the main meal is at noon, with a lighter meal in the evening 26p47 ¾ Typical breakfast “consists of coffee with hot milk, French bread and butter” 69p64 ¾ Main meal “consists of rice, beans, meat and a vegetable or salad” ¾ Evening meal may be “similar to lunch or a light meal, e.g. soup, hot milk and coffee with bread or cake” 69p64 • To increase appetite, one should take vitamins 69p64 • Cooking food includes seasoning ; Brazilians usually do not add seasoning once food is served 69p64 • Beverages or water are taken without ice; may take soda with meals and “drink strong black coffee with sugar (cafezinho) after meals, also during mid‐morning and/or mid‐afternoon” 69p64 • May believe certain food combinations can lead to illness or make illness worse; for example, may avoid cold items when one has respiratory problems; combinations such as milk and specific fruits are believed to be potential causes of illness 69p64 • Catholic Brazilians often eat fish on Fridays, during Lent season 69p64 • In cases of “liver dysfunction” (mal do figado), bland diets and avoidance of fatty and spicy foods 69p64 89
Communication Healing Environment • Ill person are usually given herbal teas and soups such as “chicken soup and rice soup” 26p53 • Portuguese literacy; variations in level of literacy of the English literacy of the English language and most do not speak Spanish 26p45 • Physical greetings are with a hug except in “business situations;” then women may hug, but men usually do not do so 69p60 • Greetings: “Handshakes are appropriate when strangers are introduced or in formal situations for both greetings and goodbyes;” a kiss on each cheek is for a “family member, friend, or acquaintance” 69p60 • Brazilians may use the title “Doutor/Doutora” (doctor) when addressing someone of “higher status:” they are more likely to address their co‐
workers using “Senhor/Senora” in addition to their first name 69p61 • Speech volume is high and may talk over someone; interruptions are frequent and acceptable 69p61 • Brazilians are often detailed oriented when providing information but are courteous 69p61 • Brazilians consider it rude to say no to a health care professional 69p61 9 Health care professional should not assume the patient is in agreement • Written consent is not routine in Brazil; explanation in US consent forms of “possible complications and risks” may cause anxiety and worry for patients 69p62 • Questions: “Patients and family members may be reluctant to question medical professionals about treatment options or to request second opinion” 69p62 • Brazilians give direct eye contact when communicating; exception is lower class people avoiding direct eye contact with superior to show respect 69p62 • Brazilians do not observe personal space; if one moves to provide more space Brazilian may be offended 69p62 • Culture is highly tactile; touch is associated “with friendship and concern rather than intimacy” 69p62 • May not arrive on time when it comes to personal and social occasions but are usually prompt for business occasions 69p63; 18p88 9 May need to emphasize time constraints for appointments and importance of meeting assigned time parameters • Gestures are a normal part of conversations; however, the “American sign for OK (with thumb and forefinger)” is considered vulgar by Brazilians; to convey everything is good, use the “thumbs up” 26p45 • Brazilians value privacy in their home and family matters, but within the family little is considered private information 26p46 • Decision making role is often the duty of the parents or spouse 26p46 • Males are the head of household of traditional families 26p51 • Women may prefer/request for female caregivers due to modesty concerns 26p46 • Physical appearance is important for both sexes; hygiene is highly practiced (bathing, shampooing) 26p46 • Prefer to bathe prior to meal; may believe that post meal activity affects digestion process 26p47 90
Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process • Brazilians often use “periwash” after urinating or passing a bowel movement 26p47 • Patient values self‐care; if unable to do self‐care, may have family member to help 26p47 • May believe in spiritual clothing/amulets – “crucifix, rosaries, religious medallions, and figas (amulet in figure of clenched fist – used to ward of evil);” “colored ribbons tied around wrists or ankles as part of petition to Virgin Mary which are not removed” 26p47 • Women are primary caregivers of the family; others (family or caregivers) are expected to give attention and care to ill person 26p53 • Many Brazilians are hesitant to go through screening; they do not want the test to reveal illness /condition or deal with “bad news” 26p53 • Homosexuals are included in family activities but gender status may not be formally disclosed 26p51 • Blood transfusions and surgery are acceptable 69p70 • Both sexes have “low threshold for pain,” with males tolerating less than females 26p48 • Vocalization of pain may include “moaning, crying, or screaming” 26p48 • May use home remedies; some follow prescriptions and treatments ordered 69p65 • It is common for friends and family to share medications 69p64 • Many Brazilians often prefer intramuscular or intravenous medications; may relate infusions to how sick the patient is 26p48 • May use a variety of treatment such as “homeopathy, acupuncture, medicinal herbs, and spiritual healing” along with traditional medicines 26p53
• May postpone medical care in US if they think doctor will “only prescribe Tylenol;” may rely on medications obtained from Brazil where many antibiotics and other drugs are available without prescription 69p64, 70 • May not be open to DNR since family want to maintain hope for recovery 69p71 • No information found at this time • Organ donation not routine, however it is more acceptable among “the youngest, the higher educated,” and those belonging to families of higher economic status 88p33 • Autopsy not usually done 26p50 • Unforeseen death may be perceived as “fate or God’s will;” maintain religious beliefs “about life after death” 69p71 • Patient may prefer to stay at the hospital with acute illness, otherwise may prefer to stay at home 69p71 • May not desire hospice care due to belief that denying the patient “therapeutic measures” means giving up on possibility of recovery 69p71 • If death is certain 69p71 9 Advise family as soon as possible to allow time for family to say good‐by 9 Offer to call priest or chaplain religious leader or chaplain 91
• Family may desire prolonged visitation with deceased before body is removed to morgue 69p71 9 Healthcare professional may need to explain hospital and funeral services in US Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) Breastfeeding Circumcision • After death, family may kiss or touch deceased and choose clothing to dress deceased; no rituals are practiced; family may desire internment in Brazil 69p71 • Generally will want all efforts made to extend life or give palliative care 26p93
• Those Cubans who have recently immigrated or who are less accustomed to Western Medicine practice may want the information about serious or terminal illness shared first with the spouse, eldest child or spokesperson; those who have spent more time in U.S. and are accustomed to Western Medicine practices generally want to know about their condition 26p93 • Family may want to protect patient from knowledge about terminal status 69p61 9 Healthcare professional to obtain appropriate permission of patient as per HIPAA 9 Family members to be consulted, with appropriate patient permission, before patient is informed of terminal illness; ask family about how to inform patient about situation since they may want information given to patient “in an indirect manner” • Pregnancy is considered a special time; family tries to meet “desires or cravings (deseos)” of pregnant woman 26p49 • May ask for radiology test to determine baby’s sex 26p49 • Prenatal care is practice and desired, as is childbirth preparation classes; may not access if no insurance coverage for costs 69p65 • Discouraged from strenuous work and swimming during pregnancy; “taboos warn against sexual relations during pregnancy” 18p94 • Brazil law prohibits abortion with punishment for both the person undergoing the procedure and the one performing it 69p67 • Traditional remedies in the form of teas may be taken to bring on a late menstrual period, which may result in a “natural abortion” 18p94 • During labor mother may scream, has low threshold for pain 26p48‐49 • May choose Cesarean section for convenience, fear of problems with birth; may not accept normal birth after having had Cesarean 69p66 • Episiotomy is favored to “restore tight vaginal opening to afford male partner sexual pleasure” 69p66 • Many women prefer to feed with “powdered dry milk” with the assumption that this will help them regain their pre‐pregnancy shape sooner 18p94 • Males and females not typically circumcised 26p50 92
Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Genetic defects caused by “God’s will” or incidents during pregnancy; may also believe this is “associated with defective sperm sometimes associated with excessive alcohol use” 26p50 • Believe that exposure to fresh air may make infants/ children ill 26p52 • If child is sick, 69p66 9 Mother and father should be informed by the healthcare provider 9 If mother is single, she should be told with family members or friends present for support • Infant death is attended with little sadness as the infant is considered “pure and is regarded as an angel” 18p95 • Parents may want baptism for a seriously ill newborn 60p27 • No information found at this time • Catholics baptize infant after discharge from hospital 19p270 • Parents may want baptism for a seriously ill newborn 60p27 • In the first 40 days, newborn is kept inside home except for visits to doctor; when outside, baby is completely covered 26p49 • No information found at this time • New mother is expected to refrain from strenuous activity and remain at home for 40 days after delivery; she is expected to rest with family members providing help 69p66 • Father does not usually attend labor or delivery 26p49; 69p66 • Although the Catholic Church prohibits contraception except for the rhythm method and abstinence, most “married or partnered women” use other measures to prevent pregnancy 69p67 • Many request tubal ligation in conjunction with Cesarean‐section; tubal ligation in Brazil requires consent of the husband in “women older than 25 who have at least two living children;” consent of male in Brazil is not necessary for other methods used to prevent pregnancy 69p67 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 93
Guide to Religion and Culture in Healthcare Culture: 9.0 East Indian Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment • May follow Hindu, Sikh or Islam faiths 28p96 • May practice traditional or religious healing along with western medicine 69p147
• May believe that illness is an imbalance in body (body accumulates toxins) or may believe that illness is due to actions in previous lives 69p158 • May use hot/cold foods to balance hot/cold conditions (e.g. balance “hot” pregnancy with “cold” fruits and vegetables 28p98 • May be vegetarian 28p97 • Diet includes foods cooked in “oil and ghee (clarified butter)” 69p152 • May use hot/cold foods to balance hot/cold conditions (e.g. balance “hot” pregnancy with “cold” fruits and vegetables 28p98 • May observe fasting 28p97 • Many eat with right hand only; wash hands prior to and after meals 69p152 • Most speak softly; loud tone considered rude, or representative of anger in speaker 69p148 • May avoid discussion of condition or treatment; most, especially older people, do not discuss private matters about sex or sexual organs 69p148 • Eye contact with elderly or superior may be considered disrespectful; do not maintain eye contact with individuals who are strangers or of opposite sex 28p96 • Value personal space 69p149‐150 9 Healthcare professional should explain assessment or procedures that require close contact • Pointing with finger is an unacceptable gesture; offer food, medicine or other items with right hand only 69p150 • Greeting: 69p148 9 Address formally with title for respect • Usually a close family member stays with the patient and may wish to help with care 69p158 • May desire serious condition be discussed with spokesperson; spokesperson then discloses information to patient if deems it appropriate 69p149 • Male family (father, husband or oldest son) is spokesperson or maker of decisions 69p157; 28p96 • May want close family to attend discussion for consent; used to verbal agreement 69p149 9 Healthcare professional to obtain appropriate permission of patient per HIPAA 94
Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal • “Silence” may indicate agreement or wish not to oppose healthcare professionals recommendations; rely on health professionals to make decision that is best for the patient 69p148‐49 • Most follow washing protocol after elimination, using left hand for toileting 28p97; 69p151 9 Provide water container near toilet or bedpan and a way to wash hands after toileting • Body language expresses feelings; may not express feelings otherwise, depending on acculturation 69p150 • Patient rests and family members take over activities 69p159 • Depending on religion, may not cut hair 69p151 • Most prefer “daily shower;” however, someone who is ill may elect for a bath in bed 69p151 • Due to modesty, female may wish to wear own gown in hospital; do not consider hospital gown modest 69p150 • Do not support vaginal exams for pre marriage or virginal female 69p160 • May have concerns that blood loss makes the patient weaker; may be willing to receive blood from close family 69p159 • May use traditional remedies; narcotics are acceptable, but may prefer analgesic injections 69p153 • Hindu: up to individual 10p390 • Muslim: may agree to DNR after discussion of terminal situation 44p251‐253 • Muslim: May consent to stopping heroics if it is determined that patient would not have agreed 41p1152 • Sikh: No restrictions “on resuscitation attempts” 68p41 • Hindu: encourage Advance Directives be prepared 8p472 • Muslim: If treatment only prolongs dying, may refuse treatment 41p1152 • Sikh: Encouraged to complete directives 2p576 • May refuse due to faith 69p159 • Not acceptable unless necessary 69p161 • Attitude is reflection of faith 69p160 • Desire for healthcare professional to advise family first if patient terminal or death is near; they will decide when or if to tell patient 69p161 9 Healthcare professional to obtain appropriate permission of patient as per HIPAA Many family members may visit patient before death 69p161 May wish to die at home; family will do faith rites when patient dies 69p161 • Important to allow patient’s family at bedside at death; family may grieve openly 69p161 • May wish for priest or pastor, if Christian 69p161 • Family may want body washed and dressed; close family wash body if Hindu or Sikh 69p161 • Hindu: Do not encourage prolonging death 2p473 • Muslim: Duties include providing “food and hydration” to the dying unless those measures would hasten death 41p1152 • Sikh: Do not encourage heroics in futile situation 2p576 95
End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception • May desire serious condition be discussed with spokesperson; spokesperson then discloses information to patient if deems it appropriate 69p149 • Male family (father or oldest son) is spokesperson or maker of decisions; spokesperson may be husband or father 69p157; 28p96 • Avoids “pepper and papaya” during pregnancy due to belief that those will result in delivery prematurely; pregnancy is “hot” and cold foods are encouraged 69p154, 28p98 • Not generally supported; may be based on health of mother, religious or economic concerns 69p156 • May want to walk; may not want pain medication in belief that this will lengthen time to delivery 69p154 • Vocal expressions during labor are OK; may not want to know sex of baby until “placenta delivered” because female birth may stress mother and interfere with delivery of placenta (preference for boy child) 69p155 • Female family are in delivery room to provide support 69p155 • Supported and encouraged for a minimum of 6 months; may breast feed until baby is 2 or 3 years old 69p155 • Acceptable for males 69p157 • May believe that actions of mother before birth caused condition or that actions in former lifetime caused 69p159 • May refuse heroics if parents do not perceive child will be “normal” 82p469
• Usually any problems with baby should be addressed with mother first; if serious, father or mother‐in‐law notified first 69p156 9 Healthcare professional to obtain appropriate permission of patient per HIPAA • See “Neonatal Illness” • Muslim: fetus is considered “full human being” after 130 days 10p49 • Depends on faith 69p155 • Female relatives assist mother for 2‐6 months post delivery 69p155 • Daily baths for baby with gentle massage; keep baby warm and with mother 69p155 • Depends on faith; Muslim do not condone due to change in surname and need for child to keep connections with biological parents/ family 53p20 • Traditionally mother and baby will be at home for first 40 days; mother rests and is given certain foods and herbs to restore energy 69p155 • Depending on faith, may take bath weekly or may take special bath with traditional medicinal value daily for first 10 days 69p155 • Father does not usually attend delivery 69p155 • Depending on acculturation, may have little knowledge of conception and contraception, irrespective of educational level 28p98 • Acceptable to use birth control; oral and intrauterine devices most prevalent types used 69p156 96
PEDIATRICS Child/Teen Environment of Care • Family does not discuss puberty or sex 69p156 • May refuse heroics if parents do not perceive child will recover to previous state 82p469 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Culture: 10.0 European ‐ American Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication • Many practice a Judeo‐Christian faith; however, America supports religious freedom and there are many other faiths practiced 18p158 9 Ask patient if he/she would like to have chaplain or church leader visit • German: Many follow the Lutheran, Jewish or Catholic faiths 69p193 • Irish: Many are Protestant or Catholic 69p277 • Italian: Many are Catholic; older Catholic patients are especially influenced by faith 69p290 • Depending on faith practice, may have religious statues, or other religious symbols 18p158 9 Do not remove any religious items from patient or patient room unless necessary; ask for permission before removing • May believe that health comes from God 18p159 • Homosexuality may or may not be acceptable 18p154 9 Do not discuss with family patient’s sexual orientation for same gender • Usual foods eaten in the United States are high fat and low fiber 18p155 • Meal times usually depend on cultural practices, geographical area, and day of the week (e.g. Sunday main meal may be mid‐day while main meal during the week may be at night) 18p156 9 Ask patient about mealtimes and main meals; timing of medication may need to be adjusted according to when patient usually eats • German: three meals daily; foods typically high in fat and starches with light meal at night 69p197 • Irish: three meals daily; meals generally include bread, “meat, potatoes, and vegetables;” if Catholic, may abstain from meat Fridays during Lent and eat fish instead 69p281 • Italian: elders and less acculturated may still eat main meal at noon with a light meal late in day; may fast during religious holidays, especially during the Lenten season 69p294‐295 • Italian: diet traditionally has “complex carbohydrates, little meat and protein;” “staples are pasta, cheese, vegetables, bread, fruit and dessert” 69p295 • Depending on the geographical area, speech may be fast or slow 18p153 • Generally, European Americans conversations may be louder than many other groups 18p153 • Germans: voice is not loud; communication is “precise, explicit and direct” 69p195 98
Healing Environment Blood Pain Management END OF LIFE DNR • Irish: “ordinary conversation is controlled and relaxed; loud voice may be considered hostile” 69p279 • Italians: within the family, discussions may appear to be heated with more than one person talking at the same time 69p292 • Most maintain direct eye contact during discussion 18p153 • Those of same gender do not generally touch unless belong to same family or are good friends 18p153 • German: acceptable to touch when necessary for care; explain reason for touch in patient’s private areas before touching 69p196 • Irish: generally do not touch during conversation with family 69p280 • Italians: generally very tactile with family 69p293 9 Touch patient on arm or shoulder after getting patient’s permission • Handshakes are acceptable when being introduced or meeting 18p153 • Greetings: 9 Use patient’s title (e.g., Mr., Mrs.) and family name unless patient requests otherwise 18p153 • Usually willing to give own personal information 18p153 • Many use alternative therapies along with medical treatments 18p160 • May use “folk healers and magico‐religious healers” 18p160 9 Ask patient about any foods, traditional treatments, over the counter medications or other practices used to maintain health or treat illness • German: Persons helping in making decisions about healthcare depends on generation and religion; spokesperson role may be assumed by father or other 69p201 • Irish: May be male or female leader of family who makes healthcare decisions; in acculturated family, “adult child may be spokesperson” 69p295
• Italian: Due to respect for elders, making decisions about healthcare may include elders and those who are deemed important to family; “spokesperson may be the eldest male or family member who is educated” 69p298 • Most will accept or provide for blood donations 18p160 9 Ask patient to verify position on blood; Jehovah’s Witnesses, as a matter of faith, do not accept blood or blood products • Many believe that patients should receive comfort measures 18p160 9 Assess patient for pain; provide appropriate measures • Germans: May not report pain unless asked; accept most routes for medication 69p198 • Irish: May consider pain as a part of life and must be tolerated; may view person who admits pain as weak 69p282 • Italian: May not admit pain to family in order not to cause them distress or worry; may be afraid of pain and believe it is “unnatural” 69p295 9 Healthcare professionals should assess patient for pain and discuss benefits of pain medication on healing process • No information found at this time 99
Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion • May have advance directives or be willing to initiate one 18p159 • Most are accepting of transplantation or donating organs 18p160 9 Ask patient to verify patient’s position on transplantation • German: depending on religion, may be acceptable, especially when needed for legal or medical reasons 69p206 • Irish: acceptable “when it is necessary” 69p289 • Italian: body is “sacred;” autopsy may not be acceptable 69p302 • Many follow practice of having someone remain with dying 18p157 • Many are agreeable to hospice care 18p157 9 Explore patient’s understanding of hospice and expectations regarding heroics • German: Immediate family should be advised of impending death; depending on religion, may have certain prayers or rites for patient 69p205 • Irish and Italian: Family may want to be notified of “impending death” so that they can be present to support patient; when death is close, family may want priest to be called 69p288, 301 9 Healthcare professional to obtain appropriate permission per HIPAA • May be subdued in expressing grief 18p158 • German: Special needs may depend on patient’s faith 69p205 • Irish: Numbers of family present may require additional space and privacy; post preparation of body, family females may “keen, a wailing lamentation” and then wake, “a celebration of life,” begins 69p288 • Italian: May not seek support from the hospital staff but from family members and religious leader 69p301 • Rites for care of body: 9 Ask family if there are any special rites • German: care of body may depend on religious practice 69p205 • Irish: care of body is done with “respect and modesty” 69p288‐289 • Italian: Family who were not present at death may want to view body before it is removed from room; may prefer to have mortuary do body care and preparation 69p301 • No information found at this time • German: For terminal illness, healthcare professional should tell patient and family together 69p195 • Irish: If patient wishes to tell anyone, will usually disclose information to close family; usually stoic and may not wish to discuss illness or status 69p279
• Italians: Family may expect to be told of terminal illness before patient; once patient has been told, may not discuss further to avoid distressing patient 69p292 9 Healthcare professional to obtain appropriate permission per HIPAA 9 Ask if patient would like family member to attend discussions 100
PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony • Most mothers seek prenatal care and participate in activities such as healthy eating and resting 18p156 9 Ask patient if there are any ethnic beliefs or practices for prenatal care and incorporate any that are not harmful • May have cultural beliefs about not participating in certain activities during pregnancy (e.g., birthmarks caused by certain foods or actions) 18p157
• Abortion is “controversial” and acceptance may depend on the religion of the individual 18p156 • Cultural beliefs: 9 Ask patient if there are any ethnic beliefs or practices for birth and incorporate any that are not harmful 18p156 • German: Amish and German Baptist may prefer home birth; Cesarean section is prohibited for Amish and may result in “excommunication from community” 69p199 • Irish: May avoid any vocalization of pain during labor and delivery; very modest; will usually follow physician’s recommendation for vaginal or Cesarean section birth 69p283 • Italian: Most delivery vaginally; may be loud during labor pain and will accept medication to relieve pain 69p297 • Encouraged and acceptable to most mothers 18p156 • Mother may believe that she should only eat bland diet to “avoid upsetting baby” 18p157 • German: generally promote breastfeeding until age 1‐2 yrs and encourage mothers to eat and drink foods that will promote milk 69p199 • Irish: promote breastfeeding, however breastfeeding may be done for a short time 69p283 • Italian: breastfeeding may be practiced 69p297 • German: Usually do not practice 69p199 • Irish: Usually practice circumcision 69p284 • Italian: Practice is common is US 69p297 • May be attributed to an unfortunate event during pregnancy or God’s punishment for some activity of the parents 18p157 • German: May believe condition is hereditary; German Amish do not accept prenatal testing since they do not accept abortion 69p203 • Irish and Italian: May believe condition is God’s will 69p286; 69p299 • May be attributed to an unfortunate event during pregnancy or God’s punishment for some activity of the parents 18p157 • Irish: Issues should be discussed in privacy with mother and father of infant; parents may blame themselves 69p284 9 Use “neutral language” to discuss neonatal illness to try to avoid parents assuming blame for illness • See “Neonatal Illness” • See “Neonatal Illness • No information found at this time 101
Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • May have cultural beliefs about certain activities 18p157 • May believe that baby should have an “abdominal band” or “metal object over the umbilicus” to keep it flat 18p157 • German: Immediate family members, including father, may help care for baby 69p199 • Irish: Family may or may not help with baby 9 New parents with no family help may need information on baby care • Italian: Female family members help in care and give information to new mother 69p297 • No information found at this time • German: Grandmother may stay with new parents for extended time to help; “Amish and German Baptist communities” may help with support 69p199
• Irish: May have no help from extended family 69p283 • Italian: Mother’s female relatives may help for a few weeks 69p297 • Many fathers participate in childbirth classes with the mother and in the delivery room 18p156 9 Ask if father wants to participate • German: Father may or may not want to be present 69p199 • Irish: Usually mother prefers labor and delivery with few, if any, family present; depending on acculturation and generation may want father to participate in birth 69p283 • Italian: depending on acculturation and generation may want father to participate in birth 69p297 • Many accept most contraception methods; abortion is “controversial” 18p156 • German: depending on religion, may or may not practice contraception 69p200
• Irish: depending on religion, may or may not practice contraception 69p284 • Italian: contraception is up to couple69p297 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Culture: 11.0 Filipino Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment Blood Pain Management • Majority follow Roman Catholic faith. Some believe that illness is beyond their control 34p424‐428 • Therapies include home remedies; may use a combination of traditional remedies and professional 34p424 ‐428 • Promote wellness; consult health care professional for acute illness; mental illness carries a “stigma” 32p182 • Believe in "evil eye" 32p182 • Family is important vs. individual 32p182 • May believe illness is caused by imbalance or some misdeed of person 26p122
• Patient may believe condition/illness is preordained and is “will of God;” may be non‐compliant with medications or treatment 34p423‐427 • May follow “hot/cold” beliefs regarding properties of food 34p432‐434 • Ethnic food includes "rice, fish, and vegetables;” diet has high sodium content (for example, soy sauce)" 34p432‐434 • May be lactose intolerant 18p167 • May refuse food at first offering 42p68 • Eye contact is minimal 26p116 • Avoid offending others; concerned about “losing face” and may avoid verbalization of personal position or feelings particularly when in group 34p421
• Conversation 34p421 9 Conduct a social conversation before beginning serious discussions or interventions with the patient • Respect healthcare worker; whatever discussed is serious 32p182 • Patient may remain silent or give an affirmative answer rather than disagree 34p423‐427 9 Explore whether patient does not follow directions due to misunderstanding or due to belief that he/she cannot change course of illness • Son/daughter may stay with parent; may want to give hands‐on care 32p182
• Personal cleanliness is very important 18p173 • May be more concerned about blood donation causing “imbalance” than being recipient of transfusion 26p120‐123 • Frequently do not complain of pain 10p308 • Patient may endure pain in the belief that pain is the will of God 35p35 9 Ask patient if he/she has pain and offer medication 103
END OF LIFE • May refuse DNR; family decides 26p120‐123 DNR Advance Directives • May be unwilling to plan care due to taboo in “planning for one’s death” 18p172
• Organ donation may be refused 26p121 Organ Donation Autopsy Death Process • Autopsy may be refused unless necessary for medical reasons 26p121 • Patient may have attitude of acceptance to illness/death as God’s will; may be important to notify priest to visit patient prior to death 26p117‐120 • Family will want be at the bedside of dying patient and to pray for the soul immediately after death 18p172 • Overt bereavement displays may occur after patient dies 32p183 • Family members may want to “say goodbye” before the body is removed to the morgue 26p121 • Family members may want to prepare the body by washing 26p121 Death – Special Needs Death – Body Care Withholding/Withdrawal • Support heroics for religious reasons; may believe it is morally wrong to omit life sustaining measures 50p320 • Family may want to shield patient if prognosis is poor in the belief that it will burden patient and increase suffering 32p183 9 Healthcare professional to obtain appropriate permission per HIPAA End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ • Will seek care during pregnancy unless cost is an issue; family encourages rest and good food 26p119 • May avoid certain foods and vitamins in belief that foods will affect appearance of baby 18p170 • If physician is male, may be “embarrassed” with pelvic exam 67169 • Abortion is not acceptable 18p169 • Daily bath is important except immediately after birth; may or may not be traditional in following custom of refusing bath for 10 days after birth 32p183 • New mother may keep covered with blankets and clothing no matter the temperature; breastfeeding practiced 32p183 • Promote breastfeeding and drinking hot soups to encourage “milk production” 18p171 • Male circumcision is acceptable 26p120 • Birth of handicapped child may be seen as a gift from God to help family become better people, a curse, or a result of mother not taking care of herself while pregnant 18p175 • May believe that illness is from “evil eye” 18p174 • Any problems with infant should be discussed with father and family before discussion with mother; recommend that physician disclose issue to new mother afterwards 26p120 9 Healthcare professional to obtain appropriate permission per HIPAA • See “Neonatal Illness” 104
Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • See “Neonatal Illness” • No information found at this time • Babies frequently have dark spots (called “Mongolian spots”) on lower back or buttocks 34p427‐429 • May cover navel of baby to prevent “air from entering” baby’s body through cord and thereby causing illness 34p427‐429 • No information found at this time • Mother is with newborn round the clock but care is shared with family 26p120
• Personal cleanliness is important and mothers may take “sponge bath” more than once a day 26p120 • Father traditionally not present at birth 26p119 • Some may prefer female relative at birth 67170 • Practice rhythm method 67169 • See “Neonatal Illness” Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 105
Guide to Religion and Culture in Healthcare Culture: 12.0 Gypsy (Roma) Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment • Faith practice based on Catholic, Pentecostal belief systems; may use statues of saints 26p135‐136 • Believe illness is self inflicted; if return to “state of purity and conforming to correct social behavior” the illness will resolve 83p276‐280 • Respect for elders; elder has role in making decisions regarding patient treatment 83p276‐280 • Family and clan loyalty is the most important value 84p17 • Close knit culture which views others as impure; do not leave patient alone; many of clan will stay at same time with patient 85p17 • Believe in supernatural and may use herbs, charms, sing, curse or spit on floor” to ward off death; may take herbs, wear charms and red items to repel “evil spirits” 85p17 • Family members may request priest to visit patient; herbal medicines may be brought to the patient by gypsy spiritualist 26p136 • Primarily seek care in acute situations 86p260 • Believe good luck has been lost by those who become ill 83p276‐278 • Diet high in fat content and highly seasoned 86p261 • Culture has specific practices for food preparation 83p276‐278 • Believe eating certain foods will promote good health; believe health and luck go together 83p276‐278 • The heavier person is seen as healthy 83p276‐278 • Some adults may fast on Fridays 83p276‐278 • May bring in food in disposable containers to avoid items considered contaminated (used by non‐Gypsies) 83p277‐279 9 Staff may provide disposable food containers and utensils • No information at this time • View hospital as source of disease and isolation; hospitals are seen as “unclean” 83p276‐27 • May request pills by color, share with family 83p276‐278 • Gypsies generally do not follow preventive care measures and may be non‐compliant with follow‐up care, especially when it requires changes in lifestyle 86p260‐261; 26p126‐129 9 Explain need to take full course of medications; may be non‐
compliant once patient begins to feel better • Body secretions from top half of body are not thought to be unclean; Roma believe sputum to be curative 84p17 • Consider top half of body clean and must be separate from bottom half which is considered unclean 83p276‐278 106
•
•
•
•
•
Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs •
9...Providers and staff should wash hands before touching patient and between touching top half and bottom half of patient’s body; use separate bath soap / linens for each area Family members may request priest to visit patient; herbal medicines may be brought to the patient by gypsy spiritualist 26p136 Patient assessment and care should be done by same sex person as patient 26p128 Patient/ family distinguish between Gypsy illness and non‐Gypsy; patient will use gypsy cures or go to the “drabami” (Gypsy women who are knowledgeable about medicines) for Gypsy illness, use physicians cure other 83p277‐279 Patient may be unable to read or write; discuss information requiring signature, establish knowledge base of patient regarding disease 26p126‐129 9 Consider using videos, pictures or other education materials to instruct 9 Consider lifestyle when discussing post discharge care as patient may be migratory Custom of members of clan to support ill through physical presence 83p276‐78
9...To avoid multiple requests for information, request a contact who will share information with family; obtain appropriate permission from patient per HIPAA 9...May wish to consider placement of patient in bed which allows unrestricted visits to minimize disturbance to other patients or the giving of care; for example, provide room closest to unit entrance for gypsy patient No information found at this time • Expressive about pain; prefer “oral or IV” pain medication but no rectal meds 26p126‐132 • No information found at this time • No information found at this time • Generally do not donate organs; since gypsies believe that after death the soul “retraces its steps” for the first year, body must remain together 16p1 • Autopsy not generally acceptable 87p90 Large numbers of clan arrive at hospital and camp out when Gypsy dying; overt expressions of grief 83p280Some may believe that at death of “King” or “Queen” of gypsies, the soul of the deceased goes to the closest person present; others may ask to have dying patient moved outside or window opened to allow soul to be freed at death 35p111‐112 • Final words of dying are “very significant” and family will want to hear what the patient says; “feelings of person at moment of death indicate to relatives what will happen in the next year” 26p132 • May light a candle by window when death is near to “light the way” for the soul; family do not verbalize deceased’s name in concern that deceased may “haunt” them 84p18 107
Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception 9 Staff should avoid using deceased’s name when talking with family • No information found at this time • No information found at this time • Patient and family avoid discussion of matters pertaining to death 26p132 • No prenatal care due to non‐acceptance of vaginal exams 83p278 • Pregnancy and birth considered “impure;” patient may prefer to be in hospital for birth to keep home “clean” 84p18 • During birth family “tie and untie knots” in belief this keeps umbilical cord from tangling 84p18 • Newborn’s name is not verbalized; no photography; covered with father’s clothing to designate who is father 84p18 • Anything the mother touches after birth is thrown away since she is “unclean” 87p90 • No information found at this time • No information found at this time • Breastfeeding practiced 83p278 • Mother may eliminate some foods from her diet to avoid colic in baby 83p276‐278
• Male circumcision acceptable, but not usually done 26p131 • Usually accepting of conditions, take care of child at home 26p136 • No information found at this time • Death of infant is bad luck; parents may have grandparents or hospital authorities take care of burial 83p278 • No information found at this time • No information found at this time • New baby kept from visitors, cared for only by mother 83p278 • Traditionally clean baby’s navel and place ashes on it for protection 83p278 • If newborn fusses, becomes ill when visitor in, believe visitor gave baby evil eye 83p278 • No information found at this time • Very sensitive to and embarrassed with discussions/ examinations/ treatments of lower body and lower body excretions 26p126‐132 • Mothers are unclean for 9 days post birth and may not “cook or touch men” 26p131 • Father not present at delivery 26p131 • No information found at this time 108
PEDIATRICS Child/Teen Environment of Care • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Culture: 13.0 Haitian Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication Healing Environment • Majority follow Catholic or Protestant belief system ¾ Frequently take communion ¾ Believe prayer can bring about healing of body ¾ Follow sacraments but believe the Sacrament of the Sick indicates death near ¾ Many use traditional home remedies before seeking Western medical help 26p146‐151 • Believe in God and prayers 10p195‐197 • Matriarchal society with extended family 10p195‐197 • Follow folk medicine in addition to seeking physician’s care; frequently will use leaves (which are thought to have “mystical powers”) in clothing and on person 34p513 • Some believe in voodoo; an illness believed to “originate supernaturally or magically is treated with voodoo medicine;” may seek herbs to treat usual illness or “evil eye” 32p91 • Seek healthcare professional for acute illness 32p91 • May eat one meal per day 32p92‐93 • May not eat non‐ethnic food; preferences include rice and beans, plantains 26p144 • May follow “hot/cold theory” of balance to attain wellness 10p196 • Touch in giving patient care is supportive to patient 34p506‐509, 512 • Touch between friends in conversation is norm; may touch healthcare professional during discussion 18p211 • May speak loudly and very emotionally 18p210‐211 • Eye contact with superior is considered rude 18p211 • Supported by extended family 10p192‐199 • Family may wish to remain to do hands‐on care 32p92 • Often follow traditional remedies recommended by priests and healers; may not seek healthcare until condition is advanced due to immigration status, poverty and/or lack of education 34p504‐511 9 Consider using educational material in video, audio, diagrams and/or drawings; some may not be able to read • Based on personal experience or another Haitian’s experience, may try “home remedies” including Haitian medication, some of which are made with roots and/or leaves or some produced in Europe 26p147 • May agree by head movement, smile when do not comprehend instructions or discussion due to lack of education 18p211 • May practice routine purging 10p196 110
• Many believe that soul is associated with blood and are reluctant to give blood for testing 42p239 • Due to the importance of blood, many are fearful of transfusions and the serious connotation of needing blood; also may be concerned about transmission of HIV/AIDS 18p227 • Many have a “very low pain threshold” 18p219 • Expressive about pain, but may not localize it 26p145‐147 • Prefer parenteral route for pain medication 26p145‐147 Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process • No information found at this time • No information found at this time • Not promoted 26p150 • Believe body should “remain whole for burial” 18p227 • Not promoted but may accept if death was due to unnatural causes 26p150
• Relatives, friends want to be present when death is close; family grieves overtly after patient’s belongings removed from home 32p93 • Within 24 hours of death deceased is buried 32p93 Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care • If patient is dying, family would like member who is authorized to know; then, authorized person will then let patient know if deems it appropriate to do so 26p142‐150 • After death, family member gives last bath 26p142‐150 9 Ask family about participation in post mortem care • No information found at this time • No information found at this time • May not seek prenatal care 34p512‐517 • Place emphasis on certain foods the new mother is allowed to eat during pregnancy and post delivery 34p512‐517 Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions • Many not willing to discuss sexual matters with non‐Haitian 32p93 • Believe sexual intercourse is necessary to keep “birth canal lubricated for birth” 32p91 • Up to the individual; most unlikely to discuss abortion, considered a private matter 18p218 • Use midwife; during labor patient may “sing, pray, cry or moan to call voodoo protector” 34p512 • Deliver in “squatting or semi‐seated position” 32p91 • Prefer normal delivery; “fear” surgical delivery 18p219 • Generally do not request pain medication during labor 26p145 ‐147 • Practiced after milk arrives 42p239 • Do not promote male circumcision in belief that it will limit sexual satisfaction 26p148‐149 • No information found at this time 111
• No information found at this time Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn Care • No information found at this time • No information found at this time • No information found at this time • Believe meconium should be eliminated and may give traditional laxative to baby while waiting for breast milk; use of home remedy to rid infant of meconium may produce diarrhea and lead to dehydration 42p239 • When teaching pregnant or new mother 34p506‐509, 512 9 Use term “strong baby” which engages mother’s attention and interest more than “healthy” baby • No information found at this time Adoption Post‐partum Care • Mother may practice traditional bath in hot water with herbs for first 3 days postpartum 34p512 • Postpartum state requires certain “cold” foods to restore balance to body 10p196 • Father usually not at delivery 18p219 Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Traditional beliefs: God determines how many children a mother will bear; may not practice birth control 10p199 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 112
Guide to Religion and Culture in Healthcare Culture: 14.0 Hispanic Colombians Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication • The predominant religion is Catholic at greater than 90% 69p109 • Illness is caused by patient’s bad behavior, as a punishment or God’s will 26p89
• Mental illness is caused by an overwhelming situation; it disgraces family 26p89 • Feelings of happiness and good are associated with good health as well as being able to maintain usual “role in life” 26p90 • Extended family very influential; elder or oldest sister/brother acts as spokesperson 26p87 • Males are decision makers while females are caregivers to either sex patient 26p88 • Colombians are respectful of elders; family members are caregivers when elders are ill 26p88 • Admitting a patient to a facility for institutionalization is a last resort when there is no caregiver, but is regarded as desertion 26p88 • Homosexuality is not acceptable 26p87 • Most have three meals per day with lunch the largest; major meal in the US is usually at night 69p112‐113 ¾ Breakfast is “coffee or chocolate and bread; lunch usually includes soup” 69p113 ¾ Lunch and dinner “staples are rice and potatoes; vegetables are scarce in diet” 69p112 ¾ Fruit juice taken with meals, usually watered down 69p113 • May follow food beliefs influenced religion (e.g., Catholic will eat only fish rather than meat on Fridays during Lent season) 26p84 • Prefer stock from meat to chicken soup when ill 26p84 • If Colombians have a cold, fever or respiratory infection, they avoid cold or iced drinks; instead they “drink hot herbal tea (chamomile, mint, flaxseed, thyme or rosemary)” or a hot beverage consisting of “diluted unrefined sugar cane paste, possibly with lime (agua de panela)” 69p113 • During menstruation, women do not consume foods considered acidic 26p84
• Spanish is the “national language;” generally literacy level determined by socioeconomic class 69p109 • May be “very affectionate and friendly” 26p82 • Colombians use direct eye contact with family and friends; may avoid direct eye contact with elders, “authority figures” and healthcare professionals (e.g., doctors, nurses) 69p111 • May be emotional and loud; often hands are in motion while talking 69p111 113
Healing Environment 9 Health professional may provide comfort by holding patient’s hand or touching patient’s shoulder while relaying “bad news” • For greeting, use formal title, Mr., Mrs., Miss, followed by person’s last name 26p83 • Men shake hands with both sexes, women “clasp each other’s wrists,” or greet with cheek to cheek for family and friends 26p83 • Planning is usually for short term; may be flexible about time and late for appointments 26p83 9 Healthcare professional may emphasize need to be on time for appointments • Modest; will permit sharing private information if needed for care 26p83‐84 • In disclosing serious illness, family may ask the healthcare professional to deliver the information with them present or choose to tell patient themselves; may not wish to tell the patient how sick he/she is, especially if “the patient is a child or elderly parent” 69p111 9 Healthcare professional to obtain permission of patient per HIPAA 9 In the event of serious illness, consult with a close family member as to how to properly communicate news • Written consent is not routine in Colombia; healthcare professional may need to explain that “most procedures in U.S. require written and signed consent from patient” 69p111 9 Explain this process slowly, requesting input from patient often to verify understanding and provide time for patient’s questions 9 Patient may be “embarrassed” to ask questions, may need some prompting to ask • Room may contain images of the Virgin or crucifix; family may wish to surround image(s) with candles, if allowed; religious family members may pray or say rosary if patient is very ill 69p118‐119 • When Colombians cannot access medical care, may use a “traditional healer (curandero) who uses special herb mixtures, prayers, or massage” 69p109‐110 • Patients may not seek care until very sick and some seek Western medicine along with traditional methods; family members usually care for them 69p114 9 May need to explain need for patient to walk and to participate in self care as part of recovery process • Very modest, especially with caregiver of opposite sex 69p112 9 Healthcare professional should “offer gown, robe, and hospital pants to both women and men; take care not to expose patient’s body unnecessarily” 9 For toileting with bedpan or urinal, provide privacy • If healthcare professional is female, male patient may be distressed by examination or intervention needed in private areas 69p112 • Catholic Colombians often carry special clothing or amulets such as: “medallions (escapularios), rosary beads, and religious figures and pictures” 69p112 114
9 Do not remove these without cause; give to family • Transfusions are acceptable, if necessary 69p118 Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal • Women in pain may be more vocal and emotional than men; men are usually stoic 69p113 • Oral or IV medications are preferable to intramuscular or rectal 69p113 • May have concerns about addiction to pain medicine which results in not following directions for taking pain medication 69p113 • May apply “ice/heat to control pain, massage to control muscular pain” 69p113
• May have access to medications from Columbia which are sold over the counter 69p112 9 Ask patient if he/she is taking any medications not prescribed • No information found at this time • No information found at this time • May be acceptable 69p120 9 Healthcare professional to obtain appropriate permission per HIPAA early in admission 9 Ask spokesperson who may discuss autopsy and determine with family input • Permitted if necessary to identify cause of death 69p120 9 Healthcare professional to obtain appropriate permission per HIPAA early in admission 9 After patient dies, healthcare professional should ask family spokesperson before he/she leaves hospital • Patient may prefer to stay at the hospital in cases of acute illness, however in chronic or terminal cases may prefer to spend last days at home 69p119 • May accept hospice care if understand that this does not mean forsaking care for patient 69p119 • Catholics believe that “one should be at peace and without sin at time of death;” when patient is at the end of life 69p119 9 With appropriate HIPAA permission, healthcare professional should inform head of family (spokesperson), away from patient room so that the family can be advised • Patient or family may request “sacrament of sick” for patient 69p119 9 Offer to call priest when to visit patient for confession, communion, or to receive sacrament • Priest’s at bedside is very important if patient is gravely ill 69p109 9 Ask family if a priest should be called • May have religious items near patient 69p119 • All family members may want to view deceased before the body leaves the room 69p119 • Family may wish clean and dress the body; no special rituals 69p119‐120 • In Colombia internment is usually within 1 to 1 ½ days 69p119‐120 9 May need to inform family that internment in U.S. is generally at least 3 days after death • No information found at this time 115
End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption • Prefer that healthcare professional inform spokesperson about impending death, away from patient’s room 69p119 • Seek prenatal care if financially possible, unless recent immigrant from rural Colombia; when “childbirth” instruction is possible parents generally participate 69p114 • Mother is expected to rest, consume plenty of nourishing food, especially protein rich foods 69p114 • By law abortions are illegal; in Catholic faith it is considered “a sin” however abortions do occur and are more acceptable in “urban” families 69p116 • May deny pregnancy and use traditional “menstrual inducing techniques” early in pregnancy 89p25 • May take small amounts of liquids during labor, but do not take solids 69p114
• Relatives not usually present during labor and delivery; maternal grandmother may provide support26p86 • Anesthesia not customary but may be accepted 26p86 • Laboring mother may exhibit stoicism, passivity and/or become loud 26p86
• Cesarean section is more likely to be requested by those of upper class status; during periods of extreme pain mother may ask for Cesarean section 69p114‐115 • Usually breastfeed, especially those of “low to middle” socioeconomic levels 69p115 • Male circumcision acceptable, usually performed at birth; female circumcision unacceptable 69p115 • If problems are present with baby, discuss with father first, or close relative to ascertain best way to tell mother; physician should disclose news to mother 69p115 • Genetic defect may be attributed to parents’ actions 26p89 • Parents may want baptism for seriously ill newborn 60p27 • See “Genetic Conditions” and “Neonatal Illness” • No information found at this time • Catholics baptize, usually at church 19p70 • During the first 40 days, baby generally not taken out in public except for visits to doctor 26p86 • May give newborn “sugar water;” baby is shielded by “hats, mittens, and booties” from “drafts” which are believed harmful, irrespective of temperature 89p27 • Baby’s bracelets to ward off the evil eye are a common sight 89p27 • No information found at this time 116
Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Baby’s maternal grandmother and aunt may care for newborn and mother; newborn’s father may also participate 69p115 • May limit types of foods consumed and activities during the traditional “quarantine” period of 40 days postpartum 89p27 • May place “cotton in their ears to avoid air entering their system” 69p115 • Shower is customary on second day postpartum; female relative may provide perineal care 69p115 • Mother is provided a high protein diet, usually chicken, for first month 69p115
• Father from younger generation may be open to attending birth 69p114 • Acceptable for married couples; following Catholicism does not appear to affect decision to use/ not use contraception; generally use condoms, especially in younger couples 69p115 • May deny pregnancy and use traditional “menstrual inducing techniques” early in pregnancy 89p25 • Recent immigrants who are educated are more likely to practice rhythm method 90p78 • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Culture: 15.0 Hispanic Cuban Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition • Majority of population (85%) are Roman Catholic; rest follow African Cuban Santeria, Protestant or Jewish spiritual beliefs 18p123 • In order to promote a sense of well‐being and support, a visit from the patient’s local religious leader may help 18p123 • “Santeria” or “Regla de Ocha” is a blend of African tribal and Roman Catholic beliefs; “Santeria is viewed as a link to past and is used to cope with physical and emotional problems” 18p124 9 Offer privacy when patients and/or families want to conduct religious prayer or rites as long as sanitation and safety regulations are met • May be reluctant to accept treatment for illness or condition that cannot be “seen” or does not have symptoms 11p115 • May assume illness is result of nervousness, stress, or germs, evil spells or Vodoo 26p98‐99 • May worship specific saint; reciting rosary and praying is familiar practice 26p98
• May use amulets to protect from supernatural evil 32p57 9 To reduce anxiety, allow patient to continue wearing amulet, religious articles, if at all possible • In order to maintain good health, it is important to avoid bad news, extremes or stress 26p99 • Patient with a mental illness is a stigma; family may not admit to illness or accept treatment 26p99 • May suffer “anxiety and depression” from leaving Cuba, family, friends and having little contact from family remaining in Cuba 11p92 • Cubans primarily seek Western medicine when ill, however may also utilize spiritual healers as last resort 26p99 • Traditional Cuban diet may be high in fat, cholesterol, sugar, and fried foods; rice and beans are usually served, but very few vegetables 26p294; 32p57
• Traditional staples include “root crops like yucca, yams, malanga, and boniato” as well as “plantains and grains” 18p119 • Dishes are often cooked with “sofrito (olive oil, garlic, tomato sauce, vinegar, wine, lime juice) and spices;” frequently meat is marinated in citrus juice 18p119 9 Inquire about usual cooking and traditional food eaten; calorie‐ laden flavorings may be added • May be intolerant of milk products 18p119 • Routinely have “almuerzo,” the main meal, at noon and “comida as late 118
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as 10‐11 PM” 18p120; 26p94 9 Inquire about meal times to adjust medication doses appropriately Cubans consider being heavy as “positive, healthy, and sexually appealing” 18p120 9
Advise patients, if needed, about the health risks linked with obesity and partner with them in deciding an appropriate weight; include patients customary and favorite foods into diet planning Believe in consuming “fresh foods, soups and broths when ill,” but light meals 26p94 Beverages often consist of cold fluids; taboo to consume certain foods with certain drinks; “many foods used as home remedies” 26p94 Cubans primarily speak Spanish, often rapidly 26p92; 18p115 Many communicate in “Spanglish, a mixture of Spanish and English;” those with higher education are more likely to use English as choice of spoken language in the home 18p115 9 Those patients less familiar with English may need assistance with filling out required forms Cubans often use two surnames, “the mother and father’s family names;” at marriage a woman adds her husband’s surname 18p116 9 Clarify what is the patient’s legal name 9 It is important to greet patients formally, especially the elderly, with Senor (Mr.), Senora (Mrs.), or Senorita (Miss) unless patient desires a different address Prefer relationships that are non‐confrontational, “smooth” and show respect for others; value “intimate interpersonal relationships over impersonal” business relationships 18p115 Cubans are often late for appointments; focus is on current issues 18p115 9 Stress the importance and necessity of arriving on time for scheduled visits Support and care is provided by nuclear and extended family, including godparents 18p116 Cuban homes often include several generations; all are involved in decision making process 18p116‐117 9 Healthcare professional to obtain permission from patient per HIPAA 9 Inquire of patient who is the decision maker for family 9 For invasive procedures, obtain verbal consent from family as well as closest relative 9 Home care often provided by the extended family Touching and close contact is acceptable with family and friends; frequently use hand gestures when speaking 26p92 Anticipate direct eye contact; lack of eye contact indicates dishonesty or disrespect 26p92 Formal greeting for strangers; family greet with hug and kiss on cheek, handshake customary between men 26p92 Cubans articulate loudly, may seem unfriendly; commands or requests may appear demanding 26p92 Privacy is enormously imperative, only those permitted by patient or 119
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approved spokesperson are privy to personal health information; often patient or family will prefer information be withheld from patient 26p93 Believe that patient should not be given negative information; this would be additional burden for patient 42p238 Family may discuss health issues with eldest in family before agreeing to procedure or plan; if patient is terminal, family may expect healthcare professional to discuss it with patient’s spouse or oldest child 26p93 9 With appropriate HIPAA permission, allow family to determine whether or not to tell patient Family present at hospital round the clock, especially of gravely ill patient 26p97 Both sexes are “very modest;” prefer bathing daily 26p93‐94 May assume washing hair worsens illness and results in chills/drafts; nail care for women is essential 26p94 Toileting in bathroom is preferred over bedpan; “regularity is priority,” with pericare (soap and water) afterwards 26p94 Clothing or bed may have religious medallions attached to it 26p94 Patient may be totally passive in receiving care; self‐care not considered norm 26p94 May not be proactive in obtaining healthcare assistance; may request help only when critical 18p124‐125 Family often the chief source for health counsel; elder women supply conventional home remedies such as teas or mixtures to alleviate mild to moderate symptoms or cure usual illnesses 18p125 9 Provide teaching that includes extended family in order to increase likelihood patient will follow instructions; include teaching about “preventive measures and health promotion activities” since a Cuban’s definition of health means non‐
existence of pain Regard plump, rose‐colored cheeks as a sign of good health; thin seen as sign of poor health 26p99 Decision maker and family protector is generally the “most educated, respected, or eldest family member, usually male;” women are usually passive but supportive and provide care for family 26p97 Family oriented with love and respect for parents and elders; provide care for them at home 26p98; 11p86 Doctors are held in high esteem and patients usually will follow Doctor’s recommendation 26p97 Many use conventional “medicinal plants in the form of teas, potions, salves or poultices;” some share others” prescriptions 18p125 9 Inquire about traditional remedies used to ascertain which may be contraindicated or harmful to patient treatment; safe remedies should be continued if possible. 9 Determine what over the counter (OTC) or prescriptives the patient may be taking; may need to instruct patient on dangers of OTC or using medication prescribed for others Homosexuality is not acceptable; often do not disclose gender identity 26p97
Allows blood transfusions 18p128 120
Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal • Female appears to have higher tolerance to pain than male; Cubans do not want to be addicted to pain medication and stop as soon as possible 26p94‐95
• Culturally suitable to articulate feelings of pain; threshold for pain in male is usually lower than female 26p94 • Believe intramuscular medication has better effect 26p95 • Usually patient is passive and family females will provide care as well as manage symptoms 26p95 • To Cubans DNR means one has abandoned hope of recovery; this practice is not acceptable 26p93 • Generally will want all efforts made to extend life or give palliative care 11p91‐100
• No information found at this time • Usually do not practice organ donation 26p97 • Usually do not give permission for autopsy 26p97 • Family may desire to be with deceased patient overnight 32p57 • Support of the extended family at death is vital 18p122 • Loud crying occurs during grieving along with other physical expressions of sorrow 18p122 • At death of patient, men may be stoic, as death is often seen as a part of life 18p122 9 Stoicism does not imply lack of feelings for patient at end of life • Many family members and friends usually congregate around dying person 18p122‐123 • Catholic believe prayers said for the dying provide a “peaceful passage” from this life to the next; “rosary beads, crucifixes, or estampitas (little statues of saints)” are placed in the patient’s room 18p122‐123 • Death rites for those believers of Santeria may consist of “animal sacrifice, chants, ceremonial gestures” 18p123 • For adherents of Santeria, death rites may include animal sacrifice, chants, and ceremonial gestures” 18p123 9 Ask family if they would like you to call a local religious leader 9 Provide space for family members to congregate near the dying patient • May request lighted candles which are believed to illuminate the spirit’s way to the next life 18p123 9 Ascertain whether electric candles are permitted and acceptable to family • No specific rites or dress 26p97 • Believe in heroics and necessary treatments to prolong life or provide palliative care 26p93, 97 121
End of Life Discussion PERINATAL CARE Prenatal Care • Depending on acculturation, patient may wish to know of terminal condition 26p96 • Family may not wish to inform patient of impending death, family will stay near until death occurs 26p96 9 With prior patient permission per HIPAA, inform person directing patient care • Hospital death preferred, due to desire for hospital medical care 26p97 •
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Seek care during pregnancy unless cost is issue 26p95 Parents very receptive to attendance at childbirth classes 11p101 Women usually follow the provider’s directions, don’t question 11p111 Recent immigrant may have “calcium deficiency and be undernourished due to limited supplies of calcium, calcium‐rich foods, and protein” in Cuba; may have micronutrient deficiencies 11p87, 92 Cuban women have a high incidence of high blood pressure developing during pregnancy; malnutrition is seen frequently 11p112 Pregnancy is considered a normal event; both future grandmothers provide support and information during prenatal period as well as after the birth; immigrant may have limited or no support system 11p97 Grandmothers role is important in making decisions about pregnancy and baby, but more fathers are getting involved 11p101 Rest for mother is supported; no arduous activities 69p126 Keep loud noises and people with abnormalities away from pregnant women; may believe that these will affect the fetus 69p126 More accepted among recently arrived Cubans 69p127 • Woman’s mother may be present, husbands may or may not attend during labor process and delivery; desire to have medical doctor for delivery 26p96 • Laboring woman will have an inactive role generally; vocalizations of pain are loud 26p96 • Prefer to deliver in the hospital as believe that “infant and maternal mortality” is lower with hospital birth 11p105 • Traditionally breastfeeding is strongly encouraged; mother may elect to bottle feed when given formula choices in U.S. 11p107 • Breastfeeding is practiced 26p96 • Believe that breastfeeding is better than bottle, but breastfeeding may lead to breast “deformity” 18p122‐123 • Baby transitions to solid foods and bottle at an early age; bottle weaning often transpires at about 4 months due to the belief that “a fat child is a healthy child” 18p122‐123 • Male circumcision is not norm in Cuba; no female circumcision 26p96 • Problems with baby should be communicated with father and then maternal grandmother, but not directly with the mother 26p96 9 Healthcare professional to obtain permission of parent per HIPAA before divulging information to others 122
Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception • If baby needs neonatal intensive care unit, mother will usually be at baby’s crib and provide care 11p105 • Mother may believe that condition is “punishment” for her sins or that she saw a child with that condition during pregnancy; some will accept condition as part of God’s plan to make parents better 11p109 • Family will expect terminal infant to receive last rights 11p110 • Parents may want baptism for seriously ill newborn 60p27 • Death of baby affects extended family who support parents; may accept death with attitude that baby’s death was God’s will 11p110 • Usually parents will name stillborn 11p115 • Mother may believe that condition is “punishment for her sins” 11p109 • Majority are Roman Catholic whose practice includes baptism 34p221 • Cubans desire babies, children who are chubby 32p57 • Mother may expect to have baby with her from birth on, unless baby has medical condition; Cuban’s customarily have rooming‐in 11p114 • Traditionally will use binder over umbilicus to prevent it from sticking out and “keep the intestines from falling out” 11p106 9 If mother is using binder, remind her to keep it sufficiently loose for drying and use cotton to avoid infection • May believe blindness and deafness is caused by “cutting the infant’s hair or nails in first 3 months” 18p122 9 Obtain permission prior to cutting baby’s hair or nails • No information found at this time • Female family members will care for “mother, infant and housework” during the 40 days post birth designated for postpartum care; mother’s role is to breastfeed and care for the baby 11p106 • Avoid sexual relations during 40 days post birth; may wear girdle to help return to pre‐pregnancy condition 11p106 • Believe mother may contract infection during postpartum period if walks, is exposed to cold or does not cover feet 18p121 • Woman’s mother and sister usually care for new mother and infant for 41 days; typically do not leave home during this period 26p96 • Believe postpartum mother should not hear “bad news” or have stress as either may affect mother or baby negatively 26p96 • Traditionally father is not present; mother who is more aware of U.S. practice may be open to father’s involvement in birth 26p96 • Fathers attend labor/delivery, usually as observer rather than coach 11p101 • May be open to use of birth control unless religious 69p127 • Recent immigrant may be accustomed to oral contraceptives; condom use is not usual and males believe condoms interfere with sensation during intercourse 11p108 123
PEDIATRICS Child/Teen Environment of Care • No information found at this time Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 124
Guide to Religion and Culture in Healthcare Culture: 16.0 Hispanic Dominican Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition • High percentage of Catholics (95%); other gods and practices have also been introduced by African heritage 69p133 • Common practice to have small shrines around the house with saints and likeness of Virgin Mary; heritage combines the following spiritual aspects: ¾ “Christianity ¾ spiritism (espiritismo or promoting spiritual wellness through moral behavior) ¾ Santeria (merging Catholic saints and African gods) ¾ witches (brujos) ¾ healers (curanderos)” 69p133 • In spiritism, a medium acts as intermediary to receive information on how to make the petitioners’ soul pure through his/her moral behavior 69p133
• Santeria common practices “include worshipping African gods (orishas)” that are related to certain saints in Catholic faith 69p133 • May petition God for help with illness and offer religious activities in exchange for God’s assistance 69p133 • Dominicans believe in link between spiritual and illness 69p133 • Illness often seen as “punishment, a lesson to be learned or God’s will;” first step may be to pray for God’s healing 69p142‐143 • Mental illness as a stigma, a “punishment for moral” sins or the result of a “spell or curse;” care is provided by family at home and family usually agreeable to psychotherapy and psychotropic medications 69p143 • Gays and Lesbians most likely do not disclose their gender orientation; Dominicans do not recognize homosexuality or transsexuals 69p140 • Dominican’s most basic and “powerful social unit” is the nuclear and extended family 69p141 • Traditional meal pattern is three meals a day, with lunchtime as the largest meal 69p137 • A typical breakfast often consists of “white farmer’s cheese (queso blanco), eggs and salami, all fried” 69p137 • In place of bread, sometimes mashed green plantains are served; a typical dinner is “eggs, salami, plantains, and homemade soup” 69p137 • Staples are “beans, rice, meat and salad;” many favorite foods are fried 69p137 • Espresso is consumed at all meals; occasionally hot chocolate is also provided 69p137 • May use herbal teas to treat illness; may drink ethnic beverages that are 125
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fortified with vitamins 69p137 Families gather at meal, sharing news; it is considered rude to have the television or radio on at meal times69p137 May follow hot/cold balance of disease; “hot” medications or “hot” foods are taken for “cold” illnesses and cold foods are omitted for “cold” illness 69p137 During Holy Week or other religious holidays, may fast or refrain from eating meat products69p137 Castellano (Castilian) Spanish is the language spoken; may have learned English in Dominican school 69p134 Dominicans are polite and greet others with respect; address older women by Senora or Dona and last name, men by Senor or Don and last name 69p134 Greet all members in a group upon arrival with a “social kiss on each cheek;” handshake acceptable for newcomer of either sex 69p134 Tone of voice can be loud and emphatic 69p134 Prefer non confrontational conversation, although tend to be blunt; if they do not agree, they will indicate so 69p134 Recent arrival to U.S. or someone who is not sure regarding English pronunciation may use family member to interpret; patient usually prefers interpreter of same gender 69p134 Dominicans do not tell patient about terminal situation; want news to be given to family member who is closest relative; frequently family decides it is best not to disclose news to patient 69p134 9 Healthcare professional to obtain permission from patient per HIPAA Based on resources, education and status, families can react differently to serious illness; patient or family distribute patient information to family members in certain prescribed order 69p134 Dominicans anticipate health care professionals will be “sensitive and compassionate” 69p134 May be leery of signing consents unless trust the professional who explains it 69p135 9 Request consent after a trusting relationship has been made Typically reluctant to take part in research; concerned there will be no help if something goes wrong and concerned about being used as “guinea pigs” 69p135 Direct eye contact is used; generally less personal space is acceptable unless with person of opposite gender; do not want closeness to be misconstrued in sexual way 69p135 Extremely animate and emotional when speaking, using hands and body language; improper gestures similar to U.S. culture 69p135 May not share feelings with strangers although share with family and friends 69p135 Communicate “private information” with health care professional if pertinent to healthcare; however, sexual information is not usually shared 69p135 May “touch one another on the arms and shoulders; pinch on cheek is OK, especially with children” 69p135 9 Obtain permission to touch patient 126
Healing Environment Blood Pain Management END OF LIFE DNR • Dominicans have a flexible orientation to time; if involved with other interaction, may be late for appointment 69p135‐136 • Head of family in a traditional household is often dominant male, typically the family spokesperson 69p141 • Unacceptable for caregivers to be of opposite gender, especially for physical care 69p136 • Prefer daily baths; for skin care Dominicans often use many natural products, applied on skin until dry and then rinsed off 69p136 • Ill patients may refrain from bathing due to beliefs about balance in hot/cold theory; may believe getting cold increases “humoral imbalance” when have fever 69p136 • After toileting, Dominicans choose to wash (rather than use just toilet paper); also prefer perineal care 69p136 9 If bedpan or commode is require, ensure privacy to protect modesty • Dominican culture is “a mixture of Spanish, Taino, Indian and African slave influences that consist of protective and healing traditions;” persons who have made a religious promise often wear white clothing with colored sash 69p136 • Many embellish their attire with assorted “charms, amulets, and healing pouches;” a black onyx charm on a baby wards off evil eye; necklaces with pendants of saints are worn as well as placement of statues of saints at patient’s bedside69p136 • May affix bags of herbal mixtures to clothing for “protection and healing;” if necessary to remove special amulets or medals, patient/family usually agree 69p136 9 If protection/healing remedies must be removed, give the item(s) to a family member • Patients usually do self‐care; however, if unable, family members will do care 69p138 • Sick individuals are often inactive and permit family members to care for them 69p138 • Family members generally remain with patient 24 hours per day; at least one member remains with the patient, if possible 69p142 • Expectation is that all family members and close friends will visit; visitors offer comfort and are supportive to patient and family 69p142 • Blood transfusion is acceptable 69p143 • Improper for individuals to admit or seem weak; men especially do not express “pain or discomfort and are expected” to put up with it 69p137 • May not seek medical care until symptoms prevent normal function 69p137 • May refuse “narcotics” even after a discussion about the importance of narcotics to care; concerned about dependency 69p138 • Non‐prescription methods of pain management are OK 69p138 • May intermix traditional remedies such as herbs, ointments, and teas with Western Medicine 69p138 • Most allow others to do their care in acute or chronic illness 69p138 • No information found at this time 127
Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) Breastfeeding Circumcision Genetic Conditions • No information found at this time • Believe body should remain whole for burial; usually against organ donation 69p145 • In cases where a patient needs an organ, believe that someone in family will provide it, if he/she is able to do so 69p145 • Autopsy is unacceptable unless required 69p145 9 Healthcare professional should inquire with spouse, mother or whomever was closest to the deceased • In religious families, family may call clergy 69p144 • Family prefer to be advised of patient’s imminent death; may not tell patient 69p144 • Most family members come to the bedside if patient passes at hospital; customary to burn candles near the body of deceased 69p144 • Family comes together at the wake or funeral; most will travel to Dominican Republic if internment services will be held there 69p144 • Body of deceased is taken to funeral home for preparation 69p145 • No information found at this time • Prefer that information concerning imminent death be provided to immediate and extended families; usually do not tell patient 69p144 9 Healthcare professional to obtain appropriate permission per HIPAA • If financially feasible, will seek prenatal care early in pregnancy 69p138 • Abortion prohibited in Catholicism; however herbal remedies may be used secretly to cause abortion 69p140 • During labor mother remains active; delivers at hospital 69p137 • During labor woman is often very vocal and expressive; usually asks for pain medication, asks God or family for assistance 69p139 • If possible, both grandmothers of newborn are present and other females may support and coach 69p139 • Prefer a natural delivery; a Cesarean section is often seen by elder family members as weakness when mother is unable to give birth on own and will restrict mothers capacity to provide infant care 69p139 • Highly promoted for all infants; mothers who have become familiar to the American cultural practices may utilize a combination of breastfeeding and bottle‐feeding 69p139 • Not unusual for a toddler or preschooler to be on breast; weaning is done by child 69p139 • Generally make infants are not circumcised; female circumcision is not done 69p140 • May believe condition is punishment from God; will care for child at home 69p143 • “Husband, eldest person, mother and mother‐in‐law” tell new mother; problems are not shared with “outsiders” 69p139 9 Healthcare professional to obtain appropriate permission per HIPAA; should inform father/husband and elder family member first; head of family decides if it is acceptable to 128
Neonatal Illness Neonatal/Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care share information with extended family • If Catholic, may want baptism for seriously ill newborn 60p27 • See “Genetic Conditions” • See “Genetic Conditions” • No information found at this time • If practicing Catholic parents, Baptism is required, usually in church 19p270 • Mothers bond with newborn after delivery by “holding and cuddling;” during 40 days post birth, grandmother is caregiver for newborn 69p139 • If family is accustomed to U.S. practices, father may actively contribute to infant care 69p139 • May place a “black onyx charm in form of a hand” on newborn’s wrist to protect newborn from “evil eye” 69p136 • No information at this time • Grandmother helps family while mother recuperates and rests; mother’s care for infant is limited to breastfeeding 69p139 • Mother’s first meals postpartum usually include warm soup and stews as well as lots of fluids to regain “strength and well‐being” 69p139 • Elder females may discourage mother from baths or shampoos during the 40 days 69p139 • Postpartum, father is expected to continue to be loving and supportive, but sexual activity with new mother is prohibited 69p139 • During labor and delivery, male partner, although supportive, waits outside birthing area 69p139 • Postpartum, father is expected to continue to be loving and supportive, but sexual activity with new mother is prohibited 69p139 • Catholic church prohibits unnatural forms of birth control, only withdrawal or rhythm method allowed 69p140 • Men may refuse condoms; they believe condoms are restrictive 69p140 • May have special prayers and services for child or young person who dies; believe death of young or traumatic death indicates person was not prepared for death; special prayers will help “spirit go to heaven” 69p144 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved.
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Guide to Religion and Culture in Healthcare Culture: 17.0 Hispanic Mexican Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition • Majority of people are Roman Catholics but may also believe in some type of witchcraft 34p221 • Patriarchal society; elders and their opinions are respected; primarily seek care for illness 32p153‐154 • May believe in good health due to luck, a matter of keeping in balance or God given 22p280‐284 • Illness results from hot/cold not being balanced or the result of not doing right 22p280‐284 • May believe that illness can be expected in life and must be tolerated 92p19
• Prevent illness by “prayer, wearing medals or amulets,” herbs 22p280‐284 • May seek healers and traditional medicines before or while utilizing medical care 42p241 • Believe that when the “four body humors” are not balanced, illness occurs; cure comes from correcting the imbalance in these elements through addition or subtraction of “heat, cold, dryness, or wetness” 42p241, 246
9 If patient refuses food or medication, discuss what foods/medications he can take to restore balance • Many believe in maintaining health through hot/cold balance using hot foods for “cold” illness; “hot foods include chocolate, eggs, oil, red meat, chilies, and onions; cold foods include fresh vegetables, tropical fruits, dairy products and fish or chicken” 69p334 • Very social culture; family important, including extended family and godparents 34p213, 221‐222 • Family and priest pray for patient 34p213, 221‐222 • Homosexuality generally not accepted 69p337 • For many lighter meal usually consumed in evening with big meal eaten during lunch 69p334 9 Consider meal sizes and times when planning medication schedule • Staples include “beans, rice, and tortilla” 18p342 • High usage of salt and fat in diet 35p59 • Traditionally use lard in cooking; some now reduce fat intake 69p334; 18p343 9 Ascertain how food is prepared and promote healthier food preparation; recommend soups and stews with bones to increase calcium content since many cannot consume milk products • Breads and pastries are often used for snacks 69p334 130
Communication • Have a preference for cool drinks in summer, especially fruit juices 69p334 • Coffee is typically consumed for breakfast, on special occasions hot chocolate 69p334 • Some Roman Catholics do not eat meat during Lent 69p334 • English is often spoken by educated persons, however some Mexicans speak Chicano Spanish; recent immigrants use Spanish, but try to learn English 69p331 • There are 62 languages used in Mexico; many recent immigrants speak Spanish but are not literate in Spanish 69p331 • Many have only an elementary level education and cannot read or write in Spanish; however many can read and write in English 69p332 9 Inquire if patient can read and write in English and/or Spanish • May be suspicious of consent, especially written, if undocumented immigrant; fear they are “signing away their rights” and will be sent back to Mexico 69p332 9 Solicit assistance from Hispanic/Latino healthcare professional in obtaining consent • Will avoid eye contact with opposite gender and those considered in authority; extended direct eye contact can be misconstrued as a “challenge or intimidation;” gazing into another’s eyes indicates an “intimate relationship” 69p332‐334 9 Be warm and respectful in conversing with patient and look over patient’s shoulder • When addressing a professional or elder, conventional persons “prefer the formal “you” (usted) rather than the informal (tu) 69p331 9 Inquire how patient would like to be addressed • Handshake is appropriate for stranger; family and close friends greet with hug; many females greet each other with kiss to each cheek 69p331 • Patient and family may stand in respect when healthcare professional enters the room 69p331‐332 • Believe loudness to be impolite when addressing another; loudness may trigger disengagement and non‐compliance 69p332 9 Use non‐confrontational tone when giving commands or making requests • Friendly conversations between friends and family will be loud 69p332 • Intimate space may be up to 18 inches, depending on relationship; may maintain space of 9‐12 feet with strangers 69p333 • Women may use dramatic body language to express emotion; men are more stoic; however, some people may articulate less and maintain control over emotions 69p333 • It is unacceptable to openly disagree with physician; it may appear patient agrees when he/she does not 50p321 • Do not share family issues with non‐family; typically communicate information about condition with “spouse, children, and selected members of extended family” 69p333 • Touch “family and close friends” but it is not acceptable between others 69p333
9 Tell patient why touch is needed and obtain permission from patient before touching any area of patient’s body, especially private areas 131
Healing Environment Blood • May not be on time for appointments; time focus is usually on present time; future is up to God 69p333 9 Stress the necessity of arriving on time for scheduled appointments • May make social conversation first, before serious conversation with healthcare professional; may be polite and cautious, roundabout rather than frank; out of respect may agree with a provider’s recommendation or prescription 69p332 • Prefer to have interpreter who has “knowledge of regional differences in the Spanish language;” also someone who is same sex and near patient’s age 69p332 9 Do not use relatives as interpreters to prevent sharing personal health information with relative • Value modesty; uneasy revealing their bodies to someone of opposite sex 69p333 9 Prevent unnecessary exposure of patient; present a cover for his/her lower extremities 9 Provide patient privacy if bedpan or commode is used • When ill, patient makes every effort to remain clean; typical to bathe each day 69p333 • Amulets and special clothing differ broadly; some examples include “crucifixes, scapulars, and religious medals” 69p334 9 If amulet or special clothing needs to be removed, handle carefully and give to family • Patient is passive in self‐care at hospital; may expect hospital staff to assist or may wait for family members 69p334 • If patient perceives home care is a burden to family, may try to do self‐
care 69p334 • Women are the primary caregivers, however some may elect to be caregivers 69p334 • Family members remain near patient, some may sleep close to patient who is elder or child; limited visiting hours may appear to family as a way “to hide something from family” 69p339 • Touch, handshake, hugs are important in relationships; value physical presence 10p212 • Patient may not follow directions if patient believes he/she has no control over illness 10p222 • Elders and their opinions are respected 32p154 • Need to gain confidence of patient in order to help patient; confidence building begins with formally using patient’s correct surname and establishing rapport BEFORE discussing purpose of visit 42p247 • It is unacceptable to openly disagree with physician; therefore, it may appear that the patient agrees when he/she does not 50p321 9 Clarify patient’s understanding and wishes about his/her healthcare • Transfusions are acceptable; may be concerned about HIV 69p348 • Blood taken for testing may cause concern; may not believe that blood will be replenished by body and person will be weaker 11p229 132
Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process Death – Special Needs Death – Body Care Withholding/Withdrawal • May refuse pain intervention if believes pain is due to wrongdoing he/she did 32p154 • Pain is considered a sign of weakness, unlikely to express; but moaning is acceptable 32p154 • May not pay attention to pain since “lack of stamina” is not acceptable and patient should practice “self‐control” 92p19 9 Clarify patient’s behavior regarding pain; discuss pain relief options and what patient has used in past for relief • Prior to seeking medical care, patients may utilize folk remedies such as herbal that a relative suggests; due to economics or legal status may not seek medical care 69p335 • Also may seek healing by “visiting shrines or using spiritual healing or prayers” 69p335 • May not want DNR in belief that there is hope for patient to get better 50p321 • No information found at this time • If patient is practicing Catholic, transplant may not be acceptable; believe in body integrity at internment 26p213 • Autopsy acceptable 69p342 • Members are compelled to visit in hospital or nursing home; anticipate many visitors as death involves extended family 18p344 • Adult relatives, friends may wish to remain with dying, deceased 32p155 9 Locate a private place for family to gather with patient or nearby • Family may ask to have “lighted candles in room of dying patient” 18p344 9 If possible offer electric candles • Mexican Americans express grief overtly, may pray the rosary 34p221 • Patient may have religious items or rosary beads 69p341 9 Leave religious items close to patient • If patient is Roman Catholic 69p341 9 Offer to call priest for sacrament of sick; if cannot reach priest, call hospital chaplain • Priest may still administer sacrament if patient dies before priest arrives 69p341
9 If priest is on way, leave body in room until priest arrives • Families of other faiths as Protestants and Evangelicals may ask their minister or pastor to provide a service 69p341 9 Provide extra time for family members to say good‐bye to deceased • Family may ask to view body before it is removed from room; some may want to participate in body preparation 69p341 • Catholics say the rosary the night before burial and a solemn mass of resurrection is said before internment 69p341 • No information found at this time; see “DNR” above 133
End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) • If there is serious or terminal illness, inform patient and family together and as soon as possible 69p341 9 Healthcare professional to obtain permission per HIPAA 9 Ask patient who should be included in the discussion 9 Provide family private space to grieve • Some may prefer to die at home; may accept hospice, but varies according to acculturation, physical and financial support available to patient 69p341 • Mexican woman receives more attention during pregnancy than at any other time; it is a positive and natural condition 11p227, 228 • May refuse to seek prenatal care due to costs or doctor who is male 10p342 • Other reasons for not seeking prenatal care may include: no insurance, financial issues, transportation, language barrier, undocumented immigrant, attendance at job, lack of someone to take care of other children, necessity for pelvic exam 11p228, 229 9 Discuss the rationale and importance of the pelvic exam “before proceeding with history and physical examination” • Family and friends provide information and guide pregnant woman; prenatal care is usually sought for establishing due date or if there is a problem 11p228 • Childbirth classes are rarely attended in belief that birth is natural situation and does not require preparation 11p230 • May agree with providers directions but not follow them; follow advice better when provided by someone who speaks her language or is of the same culture 11p227 • May refuse to take prenatal vitamins which are considered “hot food” 32p155
• Believe that mother’s weight gain is not a problem; a healthy baby results if mother is “not thin or underweight” 11p230 • Avoid sexual relations towards end of pregnancy 11p230 • In order to prevent birth deformities “safety pins, metal keys, or other metal amulets are worn” 18p34 • More conservative do not accept abortion; level of acculturation and devotion to religious beliefs affect attitude towards abortion 69p337 • Even when there is a problem with fetus, Mexicans do not opt for abortion; believe that God can heal fetus 11p229 • In cases of incest or rape, abortion may be acceptable 69p336 • If healthcare professional is male, Mexican female may refuse care 34p212 • Favor natural delivery without medication; concern about effect of medication on mother and on baby 11p230 • Mother may want to eat during labor 11p230 • May perceive Cesarean section (C‐S) as extreme 69p336 9 If C‐S is needed clarify the rationale and results of undergoing C‐S • Mother may desire a chubby baby; sees size as an indication of health 34p209,221‐225
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Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care • Usually women favor breastfeeding; however, the advent of formula and advertising has led to less women breastfeeding 69p336 • May believe colostrum is bad for baby and want to bottle feed until milk comes in 35p104 • Generally do not circumcise male; female circumcision unacceptable 69p337
• Believe that condition may be God’s will, due to mother’s lack of care or a hex 69p340 • Usually open to counseling if recommended by provider, but may not want to undergo some testing; may have concerns that amniocentesis will lead to miscarriage 11p228 • Discuss baby illness/ condition as soon as possible with parents if mother and father at hospital setting 69p337 • New mothers consult with female family members regarding issues with baby; may search the internet for information or ask healthcare professional, if available 69p337 • If there are no other resources, some us traditional remedies 69p337 • If Catholic parents may want baptism for seriously ill newborn 60p27 • Believe that this is God’s will, not mother’s fault; accept death 11p235 • For fetal death, mother may wish to see and hold fetus; photos may be acceptable as well as a lock of hair as remembrance 11p235 • Baptism is practiced for those who are of Roman Catholic faith 34p209,221‐225 • May believe that blindness and deafness in newborns are associated with cutting the baby’s hair or nails in the first 3 months 18p345 9 Obtain permission before cutting an infant’s hair or nails • May follow practice of using “a key, coin or other metal object” on belly button to aid healing 18p345 9 Educate mother on how to prepare object to avoid infection • Family members may provide care for baby; grandmothers, aunts and close female relatives may baby‐sit 69p336 • Baby may not be bathed for few weeks to maintain balance in “hot and cold” theory 11p232 • Babies are not permitted to cry for extended periods in order to prevent umbilical hernia; may use a belt around baby’s abdomen 11p233 • Mother may wrap baby with many covers to protect from “bad air” and also others from looking at baby 11p234 • Touch is important; believe that admiring a child but NOT touching may induce “evil eye,” a folk illness 34p209, 221‐225 9 Touch infant or pediatric patient when assessing to avoid concern about “evil eye” • No information found at this time • Normally, women take 2‐3 months to recuperate (la cuarentena – 40 days) ; viewed as “special time” 69p336 • Post‐partum woman is susceptible to illnesses; new mother avoids “strenuous physical activity” while family provides care and does housework for her 11p232 • Generally family provide care for new mother and baby 69p336 135
Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Mother wears “an abdominal binder” to keep “air from entering the uterus” 18p345 • May avoid tub bath; personal hygiene is very important 11p232 • Mother may believe that “covering ears, head, shoulders, and feet can prevent blindness, mastitis, frigidity or sterility” 18p345 9 Identify which practices are harmless; respect the woman’s belief • Sexual relations do not usually occur during the 40 days of recovery 11p232 • Mother very modest; may not be comfortable with father in delivery room 11p231 • Husband may assume that his attendance at birth is not appropriate 32p154
• If the father is accustomed to U.S. practice, father may participate in delivery 69p336 • Males generally do not participate in caring for baby 11p232 • Birth control is acceptable; women may prefer pills or tubal ligation although tubal ligation may cause “psychological issues” (ability to have children is seen as a very important part of being woman) 69p337, 11p234 • Mexican female may not accept any method that requires touching her “genitals; ” may accept IUD 11p234 • Men may not agree to birth control, especially condoms; may consider contraception encourages women to have sexual relationships outside of marriage 69p337 • Although Metamizole (a non‐steroidal anti‐inflammatory) is banned in US, it may be purchased in ethnic stores or Mexico and used for fever and pain; it has been linked to agranulocytosis and death in children 91p1‐3 • Recent immigrants learn English in US schools; once learned, English becomes language of choice by most children 69p331 • Touch is important; believe that admiring a child but NOT touching may induce “evil eye,” a folk illness 34p209, 221‐225 9 Touch infant or pediatric patient when assessing to avoid concern about “evil eye” Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 136
Guide to Religion and Culture in Healthcare Culture: 18.0 Hispanic Puerto Rican Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs Diet and Nutrition Communication • Majority of population is Catholic (85%) 26p235 • May practice “Espiritismo, a blending of Indian, African, and Catholic beliefs that deals with communication and use of evil and good spirits” 26p235
• Puerto Ricans are extremely spiritual; heath care providers may be requested to communicate information with clergy or conventional healers 26p235 • Causes for illness may be one of numerous reasons, for example, “seen as hereditary, punishment, caused by immoral behavior, failure to care for health, result of evil or negative environmental forces” in the individual 26p235 • May believe in hot/cold system for good health; some seek folk healers 42p240 • Most seek care only when ill; do not use healthcare services for preventative care 18p391 • May use over the counter or traditional remedies for “mental health symptoms;” do not discuss mental status with others which may make it difficult to obtain information 18p391, 393 • Gay or Lesbian status is not discussed; most do not accept and consider this orientation a “stigma” 18p376 • Standard meal pattern is “three full meals a day” 26p227 • Typical breakfast meal includes hot cereal cooked with toppings; less commonly may consume “corn pancakes or fritters” 18p378 • Around noon lunch is served with dinner in early evening; traditional to have espresso at 10AM and 3PM 18p378 • Children are started on coffee at around 5 or 6 years 18p378 9 Inquire about conventional foods and their nutritional content to help families with dietary practices that combine their standard or preferred selections • Diet includes various root foods which are believed to provide important nutrients 26p228 • May find North American meals unappealing 26p228 • Normally favor iced drinks; hot drinks preferred when experiencing colds or respiratory illness 26p228 • Constipation and diarrhea are blamed on “harmful” food intake 26p228 • Use both Spanish and English in communication, although Spanish spoken mostly at home 26p223 9 Provide information at slow pace to increase likelihood of understanding of English language 137
Healing Environment • Education is highly valued there but many leave high school before graduation; few continue education to become professionals 26p223 • Interpersonal relationships are very important; very hospitable and caring 26p223 • Puerto Ricans offer homemade foods as an expression of thanks and appreciation; refusal of foods may be insulting 26p223 • Appropriate greeting for males involves a handshake; females tend to exchange embraces; close friends and family of both genders will generally exchange embrace 26p224 • Voice is pleasant sounding with Spanish accent; intonation often misunderstood as argumentative language 26p224 • Commonly augment conversation with body language by using “hand, leg, head, and body gestures;” emotions are also articulated through touch 18p372 • May nod “yes” and say “Aha!” during discussion but this does not signify patient understands 18p372 9 When obtaining consents, clarify understanding of information given 9 Allow time for patient to read and communication information to family 9 Ask if verbal consent from partner is needed before obtaining consent from female • May not consider appointment is at fixed time; may arrive later than prescribed time and overstay visit with lengthy discussions 69p393 • Develop “confianza” (trust) first so patient and family will be comfortable with discussions about health matters; most readily discuss health issues except for “sexuality” 18p372 • Formal greetings show esteem and consideration 18p373 9 Address individuals as Senora, Dona for females, and Don, Senor for males • Puerto Ricans want to be perceived as “likeable, appealing, and fun loving” 18p372 • Expect direct eye contact; some may not look into eyes as sign of respect for other person; single women, due to modesty, may refrain from direct eye contact with men 18p373 • Approachable in expressing their discomforts and physical issues with health care professionals 26p225 • Usually shampoo and shower every day except when ill; women do not shampoo during menstruation 26p226 • If cannot use toilet, patient may refrain from passing a bowel movement 26p226 • Prefer to do personal care on own or with little help from family member of same sex; in the home, family often offer support and care 26p226
• Various herbal teas (home remedies) are used to “treat illness and promote health” 26p228 9 Inquire about non‐conventional therapies during routine health assessments and include in care if seen as harmless • May favor bathing with “a basin of water instead of taking a shower after surgery” 18p391 138
Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Death Process • Family (nuclear and extended) regarded as very important; “all activities, decisions, social and cultural standards conceived around family” 26p233 • May seek advice from family and friends prior to seeking help from healthcare system 26p229‐230 • May consult adults before making decision as a “sign of respect;” in some families oldest son and daughter are authorized to make healthcare decisions 26p233 • Husband’s consent may be required in some women’s health matters, particularly with older women 26p234 • Men are expected to be decision makers for the family, whereas women are caregivers 26p233‐234 • May find comfort in “scripture readings, praise and prayer” 18p390 • During recovery, patient “assumes passive role” which may delay healing process 26p234 • May refuse blood (receiving/giving) due to concerns about HIV 18p394 9 Cautiously review patients attitude towards blood donation and transfusions 9 Clarify and correct misconceptions • As part of coping mechanism for pain, may be “very loud and outspoken” 26p228 • Favor oral or intravenous medications for managing pain 26p228 • Also use “herbal teas, heat, and prayer” to control pain 26p228 • May seek advice from family and friends prior to seeking help from healthcare system 26p229‐230 • No information found at this time • No information found at this time • Organ donation acceptable; seen as an “act of goodwill and a gift of life” 18p393
9 Calmly and carefully discuss organ donation 9 Provide clear and precise information 9 Priest or minister may assist in discussion • Autopsy may be unacceptable, a “violation of the body” 18p393 • Ill person usually has family member stay with them 24/7 26p231‐232 • May expect all close family be in attendance when patient dies as well as at funeral 26p232 • At death, spiritual leaders are anticipated to be with patient 26p2231‐232 • May prefer that family spokesperson be notified of impending death rather than patient, usually in a private area and with clergy present 26p231 9 Healthcare professional to obtain appropriate permission per HIPAA 9 Ask for clergy to be present when delivering terminal status news • Patient may desire closure with family before death so that spirit will be able to go into next life 10p367 9 Utilize an area without others in order to tell the family; “allow time for the family to view, touch and stay with the body before it is removed” 139
Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor /Cesarean Section/ Vaginal Birth) Breastfeeding • Family may want to “touch and kiss” deceased before body is moved to morgue 26p232 • Overt expressions of bereavement are common as some perceive lack of grief expression equates with lack of caring and respect for deceased 18p389
• No information found at this time • No information found at this time • Patient may not be told of terminal illness and seldom discussed within family; doing so allows family to be positive 26p226 9 Healthcare professional to obtain appropriate permission per HIPAA 9 Ask patient who will make healthcare decisions for the patient • Although many women receive prenatal care, may not begin until later than usual in U.S. culture 18p387 • Women may receive gifts and good wishes, rest and eat well; males cater to women during their pregnancy and are “tolerant, understanding and patient” 18p387 • View exercise as unsuitable 26p230 9 Emphasize importance of exercise during pregnancy • Women often “refrain from sexual relations after second trimester; men may view as time for extramarital sexual activity” 26p230 9 Discuss STDs and possible exposure to AIDS • Abortion seen as unconventional in the past; in past accepted only when pregnancy placed life of mother at risk; however, many women now find it acceptable 18p387 • If Catholic, abortion is prohibited 32p45, 52, 56 • Women in labor prefer to give birth at the hospital; important to maintain modesty; “assume active, demanding role” during labor 26p2230 • Most “prefer bed position for labor” 18p387 • Woman who undergoes a Cesarean section is seen as a “weak woman” therefore many do not want a Cesarean section 18p387 9 Include education about Cesarean section early in pregnancy and reasons why it is sometimes a necessary “invasive intervention during labor” • Most ask for pain medication 26p230 • Breastfeeding mothers are encouraged to drink “lots of fluids such as chicken soup and milk; punches (beverages consisting of milk or fresh juices mixed with raw egg yolk and sugar) are consumed if feeling weak or tired” 18p388 • Recommend against consumption of “hot foods such as chocolate, beans, lentils and coffee” because they are believed to cause stomach irritability, flatus and colic for mother and infant” 18p388 • May not understand the importance of breastfeeding as breastfeeding is thought of as a contributor to weight gain and unflattering changes to breast 18p388 9 Supply breastfeeding education; include maternal 140
Circumcision •
Genetic Conditions •
•
Neonatal Illness •
•
•
Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth ceremony Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care grandmothers and significant others who are influential for mother 9 Clarify beliefs as necessary Infant males often circumcised at birth; female circumcision not acceptable 26p231 Inform mother first if there are issues with the baby 26p231 Very stressful for family, frequently believe mother is at fault 26p236 9 Supply information about the causes of genetic defects to lessen guilt and stress for parents Inform mother first if there are issues with the baby 26p231 If Catholic parents may want baptism for seriously ill newborn 60p27 See “Neonatal Illness” • No information found at this time • Baptism is practiced by those who are of Roman Catholic faith 34p204; 34p221‐225
• New mother with help from father will care for baby; paternal grandmother of baby may provide assistance for several months 69p397 • No information found at this time • Traditionally “first meal after delivery is home made chicken soup” 26p231 • Women are encouraged to rest for the first 40 days after delivery; some may refrain from shampooing 26p231 • Father is usually supportive during labor/delivery, but does not take an active role; may or may not be present depending on acculturation and age 26p230 • Traditionally women do not use birth control methods such as “foams, creams, and diaphragms;” these are seen as immoral by Catholic Church; “only the rhythm method and sexual abstinence” are acceptable 18p387 • Male may refuse condom use in belief that it is less manly and reduces male satisfaction; female may think male perceives her as “dirty” if use condom 18p377 • May use “small black rabbit foot, or small black fist (azabache) “ to ward off evil; believe illness, misfortune or death may result if rabbit foot or azabache is removed 26p227 • May use “amulet” to watch over child’s health; also use “rosary and figures of saints” around the bed 26p227 9 Do not remove amulets or religious objects without permission Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 141
Guide to Religion and Culture in Healthcare Culture: 19.0 Jamaican/ West Indian Note: The following information is general; depending on the patient’s geographical area, number of years’ family has been present in the United States, generation and educational level, the patient may or may not believe or follow the information provided in the module. The healthcare professional is advised to explore specific patient religious and cultural needs relevant to healthcare. CARE OF THE PATIENT Beliefs • Religious beliefs are mostly Christian ¾ over 60 percent of the people belong to the Protestant churches ¾ over 34 percent belong to other religions, including spiritual cults and religions that are a combination of African cultural beliefs and Christianity 93p1 • Special healing rituals include honoring ancestors, memorials and giving thanks 94p7 • Most believe in life after death 11p148 • May seek help of traditional healers as well as modern medicine; promote wellness 32p115 • Matriarchal society; family unit may include three generations: grandmother, mother and children; may or may not have father as part of the unit 94p5, 32p116 • May view illness as caused by germs, natural occurrence, or a medical treatment that “failed;” other sources of illness include punishment for sin of parent or ancestor or evil spirits 11p142 • More accepting of physical illness than mental illness 11p142 Diet and Nutrition • Usually have big meal in middle of day; staples are carbohydrates (e.g., rice, yams, sweet potatoes), tropical fruits, cassava bread, with a small portion of protein (e.g., poultry, fish, beef, pork) 11p139 • Most meals include rice; during illness drink only warm beverages 26p295 • Traditionally, eat spiced food 95p1 • Traditionally teas are taken for many minor conditions with specific leaves to treat each condition 69p465‐467 • May be at high risk for “diabetes, heart disease and strokes” due to current tendency to eat diet of carbohydrates and foods “high in salt, sugar, and fat calories;” 11p139 • If Muslim, will not eat pork 69p465‐467 Communication • English is the official language of Jamaica, however the patient’s understanding and English use depends on level of education, social status and in what part of country the person lived; many may speak Creole 11p132 • Personal space should be observed 26p292 • Customarily do not use touch with those they do not know 26p292 • Avoids eye contact with those in authority; expects to be called by title and last name; may not understand or question healthcare providers 142
•
•
•
•
•
Healing Environment •
•
•
•
Blood Pain Management END OF LIFE about consents 26p293 9 Greet patient formally with Mr. or Mrs. and last name May appear “shy” and reluctant to discuss information with caregiver; due to respect for health caregiver, may agree to instructions without understanding 69p463‐465 Patient is unlikely to indicate he/she does not understand; will sign due to respect for provider 26p293 9 Discussion with patient on treatments or procedures should include drawings and simple words Women make most healthcare decisions and take care of children 11p136 May use traditional healing before Western medicine 94p7 Greetings: Formally meet stranger using Mr., Mrs., or Miss or a title that designates the person’s profession; shake hands and wish the person a “Good morning” 11p134 Greet family and friends with “simple nod or bow, handshake, hug or kiss” expressing respect for the individual 11p134 Autonomous, believe that it is essential to make own decisions and depend on selves; may not be compliant if he/she believes healthcare professional discounts Jamaican’s beliefs regarding healthcare 11p134 Family presence provides support when patient is told of serious or terminal illness 69p463 Blood transfusion is OK 26p302 • Usually try traditional remedies such as “herbal teas, ointments or balms,” before Western medicine; may only take pharmaceuticals until symptoms are gone; prefer oral medications 26p298 • Fear addiction to medications; may stop taking medicines as soon as pain or other symptoms are gone 26p296 DNR Advance Directives Organ Donation • No information found at this time Autopsy Death Process • Usually will refuse, unless required 26p299 Death – Special Needs Death – Body Care Withholding/Withdrawal End of Life Discussion • No information found at this time • May not agree to organ donations; believe keeping body whole is important. 22p22 • When death is near, family pray and “witness loved one’s passing” 26p299 • Death is accepted and natural for the very old; may believe death of younger person is due to having violated “cultural taboo,” or from “spirits or envy” 94p7 • Family may request to view body of deceased “as it was when individual died” 69p472 • No special rites or care given 26p299 • No information found at this time • If patient is “terminal, significant other(s) are to be told first” and they will decide when to tell patient 26p293 9 Healthcare professional to obtain appropriate permission from patient per HIPAA 143
PERINATAL CARE Prenatal Care Termination of Pregnancy Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony • Modest and private; do not generally discuss sexual matters or anatomy; prefer same sex caregiver 26p293‐294 • Traditionally, sexual experience starts at early age in both sexes; may have more than one partner 11p139‐141 • Usually seek prenatal care in second trimester; use traditional remedies even while pregnant; father does not usually go to childbirth classes 11p142
9 Very important to educate patient as to signs and symptoms for which she should go to medical doctor • Believe that mother’s actions have effect on child’s future 94p7 • May not be concerned about weight gain as believes that more weight indicates healthier baby 69p467‐468 • Follows diet carefully during pregnancy to make sure the baby will receive proper nourishment 26p297 • Traditional beliefs include specific instructions for certain foods and drinks (e.g., too much “milk, eggs, tomatoes and green vegetables” will produce a baby that is too large for a vaginal birth); believe cravings should be satisfied for a healthy pregnancy and delivery 11p143 9 Provide education about good diet during pregnancy including supplements • Due to separation from family, immigrant pregnant women may suffer stress routinely and mental illness 11p143 • No information found at this time • Encourage walking during labor; may be stoic with pain 26p298 • Prefer normal delivery 26p298 • Support system in labor may be very large; may want to have a large number of people at delivery 11p144 • Lactation practice is decreasing 32p116 • Breastfeeding may end at 6 weeks and solids like porridge initiated 11p145 • Temperature influences food given to baby; believe cold milk will give baby colic, and breast milk from mother who is hot is considered sour and not good for baby 11p146 • Not widely practiced 26p298 • Seen as “God’s will;” some believe condition is “punishment for parents’ sins” 26p302 • Mother may be blamed for baby’s condition 11p142 • Prefer to have news given to father or grandparents so that they can be present with mother when provider gives her the news 26p298 9 Healthcare professional to obtain appropriate permission from patient per HIPAA • See “Neonatal Illness” • No information found at this time • “Christening” occurs shortly after birth 94p6 144
Newborn Care Adoption Post‐partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care • Mother typically has baby with her most of the time 94p6 • May give baby with colic a folk medicine tonic with high alcohol content 42p18 • Believe that for good health babies and children need a cathartic and may give “laxative tonics;” during the purging, only liquids are taken 11p146
• No information found at this time • May ask for beverages that are hot (temperature) after birth 69p465‐467 • May not consume dairy products; traditionally eat “salty, spicy” foods in post‐partum period 11p151 • Father may not go to prenatal visits or take childbirth education 11p149 • Father does not usually attend birth 26p297 • Birth control permitted; men reluctant to use condom 69p467‐468 • May not be aware of contraception methods available in U.S. 11p147 • Believe that for good health children need a cathartic and may give “laxative tonics;” during the purging, only liquids are taken 11p146 Striving for a Culture of Excellence and continuous quality improvement, readers are invited to submit recommendations for improvements of the content of this Guide along with supporting documentation to Aurora Realin, Diversity Manager at [email protected] for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at www.fhdiversityandinclusion.org. Copyright © 2009 Florida Hospital. All Rights Reserved. 145
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