Guide to Religion and Culture in Healthcare

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2 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

3 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

4 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

5 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

6 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

7 TABLE OF CONTENTS BACKGROUND... 1 INTRODUCTION Adventist, Seventh Day Amish (Anabaptists) Baptist Buddhism Church of Christ, Scientist Episcopalian Hinduism Islam (Muslim) Jehovah s Witnesses Judaism Lutheran Mennonite (Anabaptists) Methodist, United Mormons/ Church of Jesus Christ of Latter day Saints Pentecostal / Assemblies of God Presbyterian Roman Catholic Sikhism Unitarian CULTURES African American American Indian/Native American Arab American Asian: Chinese American Asian: Japanese American Asian: Korean American Asian: Vietnamese American Brazilian East Indian European American Filipino Gypsy (Roma) Haitian Hispanic Colombians Hispanic Cuban Hispanic Dominican Hispanic Mexican Hispanic Puerto Rican Jamaican/ West Indian REFERENCES BIBLIOGRAPHY v

8 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 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

9 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 prior to the information. Suggestions to healthcare professionals and staff have a mark and are in BOLD print. 2

10 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

11 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

12 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 1p Sabbath is set apart for worship, fellowship and deeds of mercy; secular activities are avoided 1p Members value bible promises, family, good works, nature, cleanliness, 6p122, 127, 254 fresh air, sunshine, water, exercise and rest, and peaceful music 257, ;7p60 Note: Holy days for Christian religions may be found on the FH Diversity and Inclusion website at No alcohol, tobacco or caffeine beverages; encourage vegetarian diet and 5p3; 7p avoidance of high fat foods 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 Chaplain, Pastor or other Christians pray with/for patient 9p157 Prayer for sick is very important in extending God s healing power 6p 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 6p No restrictions on blood products 5p2 5

13 Pain Management DNR END OF LIFE 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 Christians have a responsibility to care for those who are suffering and provide relief 4p1 May be comforted by Scriptures and healing prayers 2p396 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 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 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 Up to individual, family; no religious recommendations 2p395 If fetus has serious genetic defect, may consider abortion 11p292 No special rites; may wish to have pastor pray for the dying baby 11p293 No rites of faith practiced at birth 10p404 Baptism is requested when child is old enough to embrace faith 1p Baptism is by immersion 10p404 No special traditions 5p3 6

14 Family/Father involvement Contraception Child/Teen Environment of Care 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 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 aurora.realin@flhosp.org for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at Copyright 2009 Florida Hospital. All Rights Reserved. 7

15 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 Christian group whose belief system stresses lifestyle and peace; Amish Diet and Nutrition Communication Healing Environment 12p7 8, 16, 46 and Old Order Mennonites are missionaries by example Church is composed of adults who freely commit to disciplined lifestyle 12p7 8, 16, 46 Amish beliefs include Bible teachings Separation between church and state 12p7 8, 16, 46 Peaceful living 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 12p58; 2p174 restrictions in diet Not usually concerned about diet or weight loss; follow tradition for food preparation without additives; diet is high in fats and carbohydrates 14p 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 10p 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 Use direct and straightforward questions and explanations; education should include the family, as appropriate; obtain 8

16 Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation appropriate permission per HIPAA Many Amish do not have telephones or vehicles 14p 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 16p1; 2p174 recipient; otherwise, accept transplantation Accept if required by law 2p177 Autopsy Death Process 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 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 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 Prenatal care may be minimal, late in gestation or not at all, especially with subsequent pregnancies 14p 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

17 Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Newborn 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 Typically begin solid foods at six weeks when mother returns to routine duties; may increase likelihood of allergies 14p123 Adoption Adoption is supported 17p8Chp 1 Post partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care 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 14p Discussion of sex is prohibited in most Amish families 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 aurora.realin@flhosp.org for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at Copyright 2009 Florida Hospital. All Rights Reserved. 10

18 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 Bible provides guidance for life; Jesus Christ is Lord Individual freedom to communicate directly with God 19p49, 54 Salvation through faith and the Holy Spirit 19p49, 54 Ordinances: Baptism and Communion 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 No alcohol 3p161 Scripture reading, music, televised worship services 2p326 May be comforted with healing prayers 2p326 Transfusions are acceptable 2p325 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 In Vitro: various opinions in different Baptist groups; generally discouraged, but is individual decision 2p325 Abortion not acceptable 2p325 11

19 Birth Process (Labor/Cesarean Section/Vaginal Birth) Breastfeeding Circumcision Generally practiced, not a religious mandate 2p325 Genetic Conditions Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony Baptism by immersion; no infant baptism 3p May present infant at church services where parents reaffirm their responsibility for raising the infant 3p Newborn Care Adoption Post partum Care Family/Father involvement Contraception PEDIATRICS Child/Teen Environment of Care 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 aurora.realin@flhosp.org for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at Copyright 2009 Florida Hospital. All Rights Reserved. 12

20 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 No God, but Buddha is honored as having set a model lifestyle 21p23 Diet and Nutrition Communication Healing Environment Blood Pain Management END OF LIFE DNR Advance Directives Organ Donation Autopsy Does not prescribe means to reach ultimate goal of Nirvana; belief in reincarnation; healing does not occur through faith alone 10p 363, Buddha provided four Noble Truths : Life includes suffering; Desire for sensual gratification leads to suffering; If one gives up worldly desires, can eliminate suffering and attain Nirvana; The path to Nirvana is eight fold 2p 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 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 10p 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 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

21 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 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 Staff should avoid jostling because spirit remains with body for some time after death See DNR 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 Genetic Conditions Condition may be considered karma 17p6Chp 3 Neonatal Illness Neonatal/ Infant End of Life Fetal/End of Life Baptism/Birth Ceremony No baptism 3p17 Newborn Care Adoption Post partum Care Family/Father involvement Contraception No restriction on birth control 9p153 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 14

22 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 aurora.realin@flhosp.org for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at Copyright 2009 Florida Hospital. All Rights Reserved. 15

23 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 20 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; 10p 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 19p Believe following the Word of the Bible will lead to eternal Life 19p Disease comes from mental state which can be remedied by practicing Christian discipleship and following what Jesus taught 19p 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 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

24 is in violation of their religious beliefs 28p210 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 Blood Usually do not accept transfusion 10p 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 May use prayer 2p339 Pray for recovery but do not seek heroics or extending life through medical treatments 10p 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 10p Up to individual or family 2p342 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 Decided by parent or individual 10p384 Baptism is not practiced 3p23 17

25 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 aurora.realin@flhosp.org for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at Copyright 2009 Florida Hospital. All Rights Reserved. 18

26 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: Triune based faith: one God in three, Father, Son and Holy Spirit Incarnation of Jesus, fully human and fully divine Members are part of entire Body of Christ which is all baptized individuals 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 No religious restrictions; some fast before receiving Lord s Supper 2p356 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

27 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 religious indications; individual decision 2p356 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 restrictions regarding birth control 2p356 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 aurora.realin@flhosp.org for possible inclusion in a future revision of this guide. Further information about the guide including the disclaimer in its entirety is available at Copyright 2009 Florida Hospital. All Rights Reserved. 20

28 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 Hindu is the belief system of the majority of East Indians 32p98 2p470 Worship practice varies depending on community Religion is a way of life 2p467 Basic Teachings: Soul is divine One Reality (Brahman); there is one God One God, but many manifestations ( Truth is one; sages call it by various names ) All religions lead to same end goal 2p 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 2p Four goals of life Dharma: duty to self and society Artha: need for material goods Kama: desire for pleasure of the senses, legitimately 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 21p Practice mutual tolerance and believe all ways to God are acceptable There is no single belief system: some believe in faith healing others believe health problems are from God as punishment believe in reincarnation which depends on one s moral behavior in this life 10p Note: Religious holy days for Hindu may be found on the FH Diversity and Inclusion website at 21

29 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 34p 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 Verbally greet patient s husband or oldest female present 34p , 494 before greeting female patient 34p , 494 Touching is not acceptable in public Unless married, eye contact between two people of opposite sex is seen 34p , 494 as disrespectful Daily bath is required; not acceptable to add cold water to hot in preparing for bath 10p Patient may refuse bath after meal 10p p , 494 Personal care is done with left hand 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 10p Family is very important; hierarchical system with father or oldest son at head; however decisions are result of vote by family members 10p Family member who is closest to patient is usually the primary spokesperson 2p474 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 33p 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

30 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 3p36 At death, the soul continues and will return in another body 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 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 Tying blessed thread around neck/wrist of dying patient Sprinkling holy water Basil leaf placed on tongue 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 Discuss withdrawal of heroics with nearest kin or authorized representative before removing 23