The globalization of society is reflected in the multicultural nature of contemporary communities. While diversity is part of the fabric of the United States, the rapid shift of cultures and subcultures has resulted in increased personal interactions among people with varied traditions, both cultural and spiritual. People have differing, distinct faith traditions, which can be formal, such as a religious affiliation, or informal. There are rich differences in faith traditions, but a universal characteristic is that they help to define one's purpose for being and offer a source of hope, ethics and comfort, especially when in vulnerable situations.
The diversity in religions or faith beliefs is becoming more and more apparent in health care facilities. As the importance of patient-centered care is increasingly recognized, health care providers have been required to understand cultural dimensions so they can develop cultural "competency" or "sensitivity." However, the notion of "spiritual sensitivity" as a part of health care needs greater attention.
Nurses define their patients as persons whose essence is "mind/body/spirit" and seek to provide comprehensive health care to the whole person. When spiritual needs become apparent, an astute nurse will call a priest, minister, rabbi or the appropriate religious representative. This is good-quality care. Yet we are challenged to consider how spirituality can be integrated into routine health care. Religious beliefs, faith traditions and one's spirituality are viewed as personal in our society, yet attention to patients' spiritual needs has a role in health. Spiritual-care competence needs to be examined within the context of the personal interactions that occur in health care delivery.
Recently, NU's department of nursing partnered with the Network of Religious Communities of Western New York to offer a program entitled "An Interfaith Dialogue for Nurses." Representatives from area congregations discussed their varied religious beliefs with the nurses, sharing the basic tenants of their faith and their implications for health care. For example, a representative of the Sikh religion noted that, while both Islam and Christianity share a common belief in a single higher being, specific traditions of prayer, dietary practices and afterlife preparation differ between the two religions. He noted that the Sikh religion prohibits women from cutting their hair, so personal hygiene for a Sikh woman in a hospital would need to be planned with respect to this tradition.
A Muslim representative discussed the importance of personal prayer, said five times a day, and explained that prayers are acceptable only if the person's body, clothing and environment are clean. In a hospital setting, it would be important to plan care to accommodate for the prayer needs of the Muslim patient. Likewise, the prayer traditions of African American fundamentalist Christians, who believe in "laying on of hands" in prayer and in recovery as God's will, must be accommodated by providing time, place and privacy. Catholic patients also have prayer traditions and may seek to receive sacraments, which nurses can assist in facilitating.
A rabbi noted that members of the Jewish faith have specific dietary practices, and meeting these needs requires a team approach, with dietary personnel, nutritionists, physicians and nurses working together to provide appropriate meals. An atheist representing "humanistic" spirituality discussed the sources of hope and comfort in this tradition, which include the idea of living in the moment, with quality of life as a predominant value and without the belief in an afterlife or a greater spiritual entity.
These examples, as well as the conference itself, heightened nurses' awareness of the need to recognize diversity and respect differences in this very personal dimension so that they can effectively provide comprehensive patient-centered care.
Because of the rapid change in the make-up of our communities and the diversity of faith beliefs, "spiritual competence" is a challenge. The goal in health care may not be to acquire in-depth knowledge of all of the unique cultural, religious and spiritual traditions in a community. Rather, it may be to convey genuine interest, openness and respect for the diverse beliefs among people. This can entail engaging patients and their families in discussion of what is important to them with reference to their religious practices. The nurse who initiates a sharing dialogue will enable health care to be individualized to meet the multidimensional needs of patients and their families, inclusive of their spiritual health, in the "mind/body/spirit" paradigm.
Dr. Frances Crosby, '67
Dr. Connie Jozwiak Sheilds, '76