Culture Culture is learned. It is transmitted from one generation to the next through socialization.

It is learned through life experiences within ones own cultural group and as one experiences contact with another cultural groups. Culture is shared. Norms for behaviors, values and beliefs are shared by the cultural group to a group extent; it is the sharing of these through interaction and socialization that forms the cultural group. Culture is associated with adaption to the environment. As environmental circumstances change, the group changes to improve its ability to survive or to make maximal use of the environment in which it lives. Culture is, therefore, ever changing. Culture is universal. Cultures may vary but humans cannot exist without culture. The only humans without socially transmitted culture would be those known as feral children who are separated from all human contact (some raised by animals in the wild; rarely; children left in the wilderness who survives). If we have limited interaction with other cultural groups, our cultural world view is the limit of our experiences. The perception that ones world view is the only acceptable truth and that ones belief, values, and sanctioned behaviors are superior to all others is called ethnocentrism. Many people are aware of others cultures and the different beliefs, values, and accepted behaviors but do not recognize the great variation that can exist within any cultural group. When a person fails to recognize this variation, she tends to stereotype all members of the particular culture, expecting group members to hold the same beliefs and behave in the same way. Cultural competence in health assessment To be successful in completing a health assessment, the nurse must develop skill in the many areas of cultural competence. The variations in communication style and content, the different beliefs and behaviors that result from different world views, the effects of environment and genetics all affect behavioral, physical, and pharmacologic variation. Recognizing the possible influence of culture on

assessment skill and findings is essential for the nurse assessing any client not just the client who comes from a culture obviously different from the nurses own.

Spiritual and Belief system Spiritual and belief pattern reflect an individuals relationship with a higher power, or with something, such as an ideal, a human group, or humanity itself, that the person sees as being larger than self and that gives meaning to life. Spiritual patterns also include the outward demonstration of that relationship. This outward demonstration may be reflected in a religion, lifestyle, or relationships with others. An individuals moral code may also be included in spiritual and belief patterns. A moral code is the internalized values, virtues, and rules learned from significant others and developed by oneself in order to distinguish between right and wrong. It includes the rules people use to determine what they should or should not do. An individuals spiritual and belief patterns are significantly affected by culture and ethnic background. Spiritual assessment does not begin at the bedside. The nurses knowledge of the spiritual

temperament of the community and his or her own spiritually will lead the greater ease when discussing the clients spiritually. It would be far too great an undertaking to study or review all current religious dominations or faiths. However, a working knowledge of the majority faiths ideals, beliefs, and practices in the nurses community would provide a useful foundation for spiritual care. When conducting any type of review of the denominations or faith in a particular community, be aware that a clients spiritual dimension is subjective and may vary greatly between person, even persons of the same denomination or faith. However, a general knowledge of the faiths may give context to some issues that certain religious groups face and provide time to develop appropriate interventions to meet those needs. A discussion with a hospital chaplain or clergy regarding the views religious faiths in the nurses community would also provide a greater understanding about the particular faiths view of health and give the nurse a resource for future referral or collaboration.

Collaboration and referral with pastoral chaplains or clergy are extremely important when dealing with religious issues in a health care setting. Many hospitals have staff pastoral chaplains, and community resources of different faiths are usually available through social work professionals. While nurses can assess and support many clients spiritual needs, some situations are beyond the scope of nursing. Practice and require someone with more experience and knowledge about a particular faith. For example, a nurse from a protestant faith faced with a muslim client who has just been diagnosed with terminal cancer may not be able to speak to the clients end of life issues and many require referral to the appropriate professional. Spiritual assessment Spiritual assessment techniques Spiritually is multidimensional. It is also unique to each individual. These characteristics of spiritually can present difficulties in proper assessment. Many instruments to assess spiritually were derived within a particular faith background and may have little cross-cultural relevance. The most useful spiritual assessment techniques should have general introductory questions and not be specific to any religious denomination that would guide precise questions related to the clients specific spiritual needs. Religion Religion can affect the individuals health and lifestyle in all phases of the persons life. It may play a significant role during health and illness, influencing the course of action an individual chooses and the persons feeling about life and death. Religion is the organized set of beliefs pertaining to the cause and purpose of life and the universe held by a group of individuals. Group members practice common rituals and ceremonies. Religion may or may not include a belief is a higher being. Spiritually is often closely related to religion. Spiritually is an individuals concept of the purpose and meaning of life and includes ones individual belief about right and wrong. It influences the decisions made by the individual and is closely integrated with and often manifested in the individuals religious practices.

Religious rituals often mark milestones in life, such as birth, attainment of adulthood, marriage, and death. They also can govern daily activities such as eating and maintenance of nutritional status. Some religions prohibit certain foods. Hinduism prohibits all meats. Islam prohibits pork and alcohol. Mormons (Church of Jesus Christ of Latter Day Saints) and Seventh-Day Adventists prohibit alcohol, tobacco, and caffeine. Catholics and Mormons practice fasting. Orthodox Jews follow dietary laws based on the Talmud. Foods selected and prepared correctly are called kosherfrom the Hebrew word kashar, meaning right or fit. You need to assess the influence of the individuals religion on health and lifestyle because the client often uses religious beliefs to explain the cause of illness and to determine the course of action to ensure both mental and physical health. Religious belief can also affect individuals choice of healers, their perception of the severity of their health concern or illness, and the role, if any, that they can play in preventing illness and promoting a healthy lifestyle. For example, an individual who believes that a higher being controls all that happens may see prayer as the most important health-promoting activity. Sometimes, religious influences and beliefs can be in conflict with accepted medical practice. For example, Jehovahs Witnesses generally wont accept blood transfusions even when the condition is life threatening.