The diversity of religion within our world's population brings challenges for health care providers and systems to deliver culturally competent medical care. Cultural competence is the ability of health providers and organizations to deliver health care services that meet the cultural, social, and religious needs of patients and their families. Culturally competent care can improve patient quality and care outcomes. Strategies to move health professionals and systems towards these goals include providing cultural competence training and developing policies and procedures that decrease barriers to providing culturally competent patient care. This activity highlights the importance of cultural competence in clinical medicine and its consequences. Objectives:
The diversity of religions around the world creates challenges for health care providers and systems to provide culturally competent medical care. Cultural competence is the ability of health providers and organizations to deliver health care services that meet the cultural, social, and religious needs of patients and their families. Culturally competent care can improve patient quality and care outcomes. Strategies to move health professionals and systems towards these goals include providing cultural competence training and developing policies and procedures that decrease barriers to providing culturally competent patient care.[1][2][3][4] Consequences of Cultural Competence Deficiencies If providers and health care systems are not working together to provide culturally competent care, patients may have untoward health consequences, receive poor quality care, and be dissatisfied with the care they receive. The quality of patient-health professional interactions is decreased. Lower-quality patient-health professional interactions are associated with decreased satisfaction in the healthcare provider. In fact, African Americans, Asian Americans, Latinos, and Muslims report that the quality of their care was diminished because of their ethnicity or race.[5][6][7][8] Why should providers and systems be culturally and spiritually sensitive? The Joint Commission (TJC) requires hospitals to be accountable for maintaining patient rights, including accommodation for cultural, religious, and spiritual values. Healthcare professionals and systems must care for patients as whole persons; this includes the body, mind, and spirit. It is important for healthcare to include the cultural and spiritual needs of the patient. Healthcare professionals should be empowered with the knowledge and skills to respond to the needs of patients and their families at an intensely stressful time. Institutions that seek or maintain TJC accreditation need to demonstrate expertise in cultural and religious competence. Health systems and healthcare providers are developing strategies and techniques to respond to the religious and spiritual needs of patients and families for a number of reasons. One reason is that, in addition to TJC, state and federal guidelines encourage institutional responsiveness to population diversity. These strategies are essential to meeting the federal government's Healthy People goal of eliminating ethnic and racial health disparities.[9][10][11][12] Culturally Competent Medical Care Patient's beliefs, behaviors, and values are shaped by factors such as ethnicity, gender, language, mental ability, nationality, occupation, race, religion, sexual orientation, and socioeconomic status. Cultural competence is the provider and systems able to understand and integrate cultural intelligence into the delivery of healthcare. The goal of providing culturally competent health care services is to provide consistent quality of care to every patient, regardless of their cultural, ethnic, racial, or religious background. Strategies for improving cultural competence in individuals and systems include:
When individuals and systems are able to provide a positive environment of cultural competence that meets the religious and spiritual needs of those who are cared for, the outcome for patients improves, and the healthcare system as a whole becomes a more positive environment. Religion and Healthcare Why are religion and spirituality important in healthcare? Religion and spirituality are important factors in the majority of patients seeking care. Unfortunately, health providers may not take religious beliefs into account when they are dealing with difficult medical decisions for patients and their families. In the history of man, religious leaders and health providers were often the same. Only within recent times has medicine taken on a scientific approach that has resulted in a separation between medicine and religion. The challenge for health professionals is in understanding that patients often turn to their religious and spiritual beliefs when making medical decisions. Religion and spirituality can impact decisions regarding diet, medicines based on animal products, modesty, and the preferred gender of their health providers. Some religions have strict prayer times that may interfere with medical treatment. Healthcare providers should be respectful of a patient’s religious and spiritual needs. Many patient’s anxieties are reduced when they turn to their faith during healthcare challenges. Because many patients turn to their beliefs when difficult healthcare decisions are made, it is vital for healthcare professionals to recognize and accommodate the patient's religious and spiritual needs. Health professionals should provide an opportunity for patients to discuss their religious and spiritual beliefs and tailor their evaluation and treatment to meet their specific needs.[13][14][15] Religion and spirituality play an important role in the medical decisions of many patients. The following is an alphabetical list of the religious and spiritual groups most commonly encountered in a healthcare environment and a summary of their views. Knowledge of these beliefs can affect patient-provider communication, resulting in more culturally sensitive care and improved quality of treatment and outcomes.[16][17][18][19] Baha'i Baha'i teaches the essential worth of all religions and the equality and unity of all people. Beliefs
Death
Diet
Holy Tenets
Pregnancy
Rituals
Symbols and Rites
Clinical Issues
Buddhism Buddhism encompasses a variety of beliefs, spiritual practices, and traditions based on original teachings attributed to the Siddhartha Gautama, the Buddha. Beliefs
Death
Diet
Health
Holy Tenets
Pregnancy
Rituals
Symbols and Rites
Clinical Issues
Christian Science Mary Baker Eddy developed Christian Science, teaching that sickness can be healed by prayer alone, as Jesus healed. Beliefs
Death
Diet
Health
Holy Tenets
Rituals
Symbols
Clinical Significance
Church of Jesus Christ of Latter-day Saints (Mormon) Mormons are a religious group of the Latter Day Saint movement of Restorationist Christianity, initiated by Joseph Smith. The Mormons followed Brigham Young to the Utah Territory. Mormons dedicate time and resources to serving in the church, and many young Mormons choose a full-time proselytizing mission. Beliefs
Death
Diet
Health
Holy Tenets
Pregnancy
Rituals
Symbols and Rites
Clinical Significance
Eastern Orthodox The Eastern Orthodox Church or Orthodox Church is the second-largest Christian Church, with over 250 million members. The Eastern Orthodox Church teaches the One, Holy, Catholic, and Apostolic Church was established by Jesus Christ. Beliefs
Death
Diet
Health
Holy Tenets
Pregnancy
Rituals
Symbols and Rites
Clinical Significance
Hinduism Hinduism is one of the world's oldest religions, with roots and customs dating back more than 4000 years. It is the third-largest religion, with nearly one billion followers worldwide. Beliefs
Death
Diet
Health
Holy Issues
Pregnancy
Symbols and Rites
Clinical Significance
Islam The followers of Islam are Muslims who believe in one God, Allah, and his prophet Abraham. They believe Adam, of the Bible's Old Testament, was the first prophet. Other prophets include Abraham, David, Jesus, Moses, and Noah. Beliefs
Death
Diet
Health
Holy Issues
Pregnancy
Symbols
Clinical Significance
Shia Muslims
Sunni Muslims
Jehovah’s Witness Jehovah's Witnesses believe that the destruction of the present world system is imminent. The establishment of God's kingdom over the earth is the solution for all problems faced by humanity. Beliefs
Death
Diet
Health
Holy Issues
Pregnancy
Rituals
Symbols Clinical Significance
Judaism Judaism is the expression of the covenant that God established with the Children of Israel. Judaism includes texts, practices, theological positions, and forms of organization. Beliefs
Daily Practices
Death
Diet
Health
Holy Issues
Pregnancy
Rituals
Symbols Clinical Significance
Protestant (Amish, Anglican, Baptist, Christian, Churches of Christ, Disciples of Christ, Episcopalian, Lutheran, Mennonites, Methodist, Presbyterian, and United Church of Christ) Protestantism originated with the Reformation, a movement against what followers believed to be errors in the Roman Catholic Church. They emphasize justification by faith alone rather than by good works and the highest authority of the Bible alone in faith and morals. Beliefs
Death
Diet Health
Holy Issues
Pregnancy
Rituals
Symbols
Clinical Significance
Rastafarian Movement Both a religious movement and a social movement developed in Jamaica. It lacks any centralized authority. Rastafari refer to their beliefs as "Rastalogy." It is a monotheistic belief in a single God—Jah—who partially resides within each. Beliefs
Diet
Health
Daily Practices
Pregnancy
Rituals
Symbols
Clinical Significance
Roman Catholicism The Catholic Church or Roman Catholic Church is the largest Christian church. The Catholic religion teaches that it is the One, Holy, Catholic, and Apostolic Church founded by Jesus Christ, its bishops are successors of Christ's apostles, and the Pope is the successor to Saint Peter to whom Jesus Christ conferred primacy. Beliefs
Death
Diet
Health
Holy Issues
Pregnancy
Rituals
Symbols
Clinical Significance
Scientology Scientology’s beliefs and practices are based on rigorous research, and its doctrines are accorded an equivalent to scientific laws. Beliefs
Death Diet Health
Holy Issues
Pregnancy
Rituals
Symbols
Clinical Significance
Seventh-day Adventist (Adventist, Advent Christian Church, Church of God) The Seventh-day Adventist Church is a Protestant Christian that observes Saturday, the seventh day of the week in Christian and Jewish calendars, as Sabbath. The religion also emphasizes the imminent Second Coming of Jesus Christ. The Seventh-day Adventist Church teachings correspond to common Protestant Christian teachings, such as the Trinity and the infallibility of Scripture. Unique teachings include the unconscious state of the dead and the doctrine of an investigative judgment. Religion emphasizes diet and health, its "holistic" understanding of the person, conservative principles, lifestyle, and promotion of religious liberty. Beliefs
Death
Diet
Health
Pregnancy
Rituals
Symbols
Clinical Significance
Sikhism Sikhism originated in the Punjab region of India. It is one of the newest of the major world religions. The fundamental belief is faith and meditation in the name of one creator, unity of all humankind, engaging in selfless service, striving for social justice, and honest conduct. Beliefs
Death
Diet Health
Holy Issues
Pregnancy
Symbols
Clinical Significance
Spirituality - Hawaiian Hawaiian spirituality teachings reflect the daily practices of oneness and self-greatness, known loosely as the "aloha spirit." The sense of connection to oneness includes all those who have departed from the physical world. In Hawaiian spirituality, there is no death, just “changing address” from human to spirit form. Beliefs
Death
Diet
Health
Holy Issues
Pregnancy
Rituals
Symbols
Clinical Significance
Spirituality – Native American Native American religious, spiritual practices can vary widely and are based on the differing histories of individual tribes. Theology may be animistic, monotheistic, henotheistic, polytheistic, or some combination thereof. Traditional beliefs are passed down in the form of oral histories. Beliefs
Death
Diet Health
Holy Issues
Pregnancy Rituals
Symbols
Clinical Significance
Voodoo The Voodoo religion is elaborate, steeped in secret languages, spirit-possessed dancing, and special diets that are usually eaten by the voodoo priests and priestesses. The ancestral dead are thought to walk among the living during dances. Touching the dancer during this spirit-possessed trance is considered dangerous enough to kill the offender. Beliefs
Health
Rituals
Clinical Significance
Wicca Wicca is a neo-pagan, earth-centered belief. Beliefs
Death
Diet Health
Holy Issues
Pregnancy
Rituals
Symbols
Clinical Significance
The care of patients requires meeting the needs of individuals and families' cultures and beliefs. Religion often provides spiritual guidance as well as an emphasis on maintaining health. Religious beliefs often affect patient attitudes and behavior. It is important for healthcare professionals to have an understanding of these issues so they can provide culturally appropriate care. It is important to remember that preservation of life overrides guidelines; in a life-threatening situation, there are usually no restrictions on medications or surgical interventions. When caring for a patient, it is important to understand why adherence or non-adherence to treatment may occur given their religious beliefs.[20][21][22] Enhancing cultural competency by providing patient-centered care is the means by which healthcare challenges are ameliorated. Efforts aimed to improve provider-level cultural enhanced care will go a long way to facilitate cross-cultural communication and respond to patient needs by tailoring healthcare. Understanding the values and reasons for special requests for healthcare will improve cultural competence and provide culturally sensitive health care that is good for the patient and their families. The culture and religion of an individual can greatly influence their perspectives about healthcare and healthcare providers. Healthcare providers need knowledge and understanding of these patients’ backgrounds and beliefs to provide culturally sensitive healthcare. Recommendations:
Healthcare organizations need to empower their clinical staff with a sense of awareness through education and training on the world's religions and their potential impact on patient care. Provider education makes possible a respectful dialog with their patients about their religion and the impact it has on evaluation and treatment. Religion and spirituality should be incorporated into the healthcare practitioner’s armamentarium of knowledge in communicating with patients. Listening to a patient’s beliefs along with how those beliefs are tied to the patient’s health can help build and positive relationship between the health practitioner and patient. Knowledge of religious and spiritual beliefs and practices can result in decreased medical errors, earlier patient release, and reliable communication between patient and healthcare provider that results in improved healthcare delivery. |