Crosscultural Issues And Spirituality

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Meeting patient's needs in a multicultural society is challenging, but important. The patient's culture influences the perception of illness and its treatment options. Virtually all cultures provide explanatory models that attempt to account for infirmities and sufferings in the life of a human being. Religion and spirituality are among the most important cultural factors that give meaning and purpose to one's existence (12).

The three monotheistic religions (Judaism, Christianity, and Islam) believe in the same God, the God of Abraham, hence the common designation as the "Abrahamic" religions. However, observance of traditional beliefs and practices varies within each of these religions, and each of these three religious groups typically has denominations or subgroups.

In Judaism, religion and culture are intertwined. Judaism is based on the worship of the God of Abraham, with the Jewish law based on the Old Testament of the Bible (written law) and the Talmud (oral law). Judaism is integral to the life of religiously observant Jews, and even secular Jewish patients often welcome the wisdom of their tradition when considering treatment options. Very traditional or religious Jews may have concerns about modesty in the health care setting, and many appreciate care by nurses or physicians of the same sex (13). Illness is interpreted in the context of their religious perspective, and religion is used as a source of meaning and hope in times of illness (14).

The Christian believes in the God of Abraham, but also believes that God has three distinct beings (God the Father, Jesus the Christ, and the Holy Spirit), based on the Old and New Testaments of the Bible. Christians believe that every person has been made in the image of God, but has been tainted by the sin of Adam. Jesus' death on the cross provides atonement for the sinful nature of those who place their faith in Jesus. It is this faith in Jesus that transforms them into Christians (forgiven sinners) (15). Illness can be perceived as punishment from God (for sin), refinement (strengthening through trials), or the inexplicable will of God (14).

Islam worships God as Allah and reveres the prophet Muhammad. The Muslim framework of values is linked to the Qu'ran and the tradition of the prophet Muhammad. To the Muslim, God is the ultimate healer. Islam teaches that the patient must be treated with respect and compassion, and that the physical, mental, and spiritual dimensions of the illness must be taken into account. Many Muslims invoke the name of God in daily conversation, pray five times a day facing Mecca, and wash prior to prayer. They believe that their actions are accountable and subject to ultimate judgment (16).

Hindus and Sikhs, although their cultural and religious traditions have differences, share a belief in rebirth, a concept of karma, an emphasis on purity, and a view of the person that affirms family, culture, environment, and the spiritual dimension (17).

There is great diversity of religious belief and practice among African Americans. Some are Catholics, the number of Muslims is growing, but the majority are evangelical Christians. Thus, religion plays a major role in the lives of most African Americans, who rely on the comfort, hope, and meaning it provides (18).

Traditional Chinese medicine views the body and spirit as an integrated whole. This perspective is influenced primarily by Confucianism, but also by Taoism and Buddhism. Illness is believed to be a result of an imbalance of a vital energy force called \I\qi\R\ and yin and yang (19). Mankind and nature are considered interdependent; harmony of this nature-human relationship is vital to health (20).

In the Native American population, healing, spirituality, and culture are closely intertwined. Intuition and spiritual awareness are a healer's most essential diagnostic tools. Therapeutic methods include prayer, ceremonies, music, herbalism, and massage. Participation of family and friends is a large component of these healing interventions (21). Native American healing is based on wholeness, balance, harmony, and meaning (22).

As health care providers, it is important to appreciate the uniqueness of each patient. To be most effective, the various spiritual or religious and cultural issues of the individual patient must be understood.

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