Introduction

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]

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]

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:

• Encouraging family to participate in healthcare decision making.
• Incorporating culture-specific values into health promotion
• Providing cultural awareness training
• Providing an environment that allows traditional healers
• Providing interpreter services
• Recruiting minority staff

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.

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]

Issues of Concern

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 

• Abandonment of all prejudice: race, religion, gender, or community
• Education for all children
• Abolition of extreme wealth and poverty
• Individual responsibility to search for the truth 
• The oneness of God, the unity of humanity, and the essential harmony of religion
• Religion is a divine revelation that is continuous and progressive. 
• Religion and science exist in harmony.
• Sexual equality is a spiritual and moral standard.
• Humanity's oneness and the wholeness of human relationships
• Unity among diverse groups is possible
• God is in every force in the universe.
• One God has a single plan within the teachings of the major world religions.
• The promise of world peace

Death 

• An individual’s reality is spiritual, not physical. 
• The body is the throne of the soul, worthy to be treated with honor and respect even when dead. 
• The soul is eternal and progresses to the next stage of existence, closer to God. 
• Organs may be donated
• The body should be buried, not cremated, preferably without embalming unless required by law. 
• The body must not be transported more than one hour’s journey from the place of death. 
• For children over 15 years old, the Prayer for the Dead is recited at the burial. 

Diet

• Patients over age 15 and in good health abstain from food and drink from sunrise to sunset during the month of Ala (meaning Loftiness) from March 2 through 20.
• Eating is for health. 
• Abstain from drugs when health is good, but may take them when necessary, including narcotic pain medicines, if prescribed by a clinician. 
• Blood transfusion is acceptable.
• Consumption of alcohol and mind-altering drugs is forbidden.

Holy Tenets

• Daily prayer and reading of sacred writings. 
• Seven Holy Day festivals per year during which one does not go to school or work. 
• Work performed in the spirit of service is the highest form of worship. 

Pregnancy 

• Circumcision of males is a family decision.
• Do not believe in abortion.
• No requirements; rarely use birth control.
• Sexual intercourse only between husband and wife.

Rituals 

• Daily private prayer and annual fast lasting throughout the day from sunrise to sunset during the month of Ala from March 2 through March 20. 

Symbols and Rites

• The nine-pointed star is the symbol of the faith.
• Local, national, and international representatives perform special religious rituals. 
• Prayers for private worship. 

Clinical Issues

• Avoid sterilization procedures unless needed for the preservation of the mother.
• Believe prayer assists in healing; allow uninterrupted time for prayer.
• Believe a balanced and nutritious diet helps prevent disease.
• Blood transfusion acceptable.
• Will most likely avoid birth control.

Buddhism 

Buddhism encompasses a variety of beliefs, spiritual practices, and traditions based on original teachings attributed to the Siddhartha Gautama, the Buddha.

Beliefs 

• Buddhists follow the path to enlightenment by developing his or her wisdom, morals, and meditation.
• Personal insight replaces belief in God with the study of the laws of cause and effect, karma. 
• Spiritual enlightenment through conscious living and meditation. 
• Rebirth is based upon the actions of a person, and insight and the extinguishing of desire bring freedom.
• Three major Buddhist traditions: Mahayana, Theravada, and Tibetan.
• 5 Lay Vows: no intentional killing, no stealing, no lying, no sexual misconduct, and no intoxicants.

Death 

• Avoid mind-altering medication while dying. 
• Buddhist representatives should be notified in advance to see that the appropriate person presides over the care. 
• Chanting and prayers. 
• Rebirth in the next life and avoid lower lifeforms of rebirth. 
• The state of mind at death influences rebirth, so they want to be calm and peaceful. 
• Unexpected death may require special rituals. 

Diet 

• Usually vegetarian
• Avoid alcohol, coffee, and tobacco. 

Health 

• Do not believe in healing through faith. 
• Healing and recovery are by awakening to the wisdom of Buddha. 
• Health is holistic; mental cures are important. 
• Illness is a result of karma or the law of cause and effect, an inevitable consequence of actions in a prior life or this life. 
• Medications are acceptable if they do not affect the state of mind. 
• No restrictions on autopsy, blood or blood products, organ donation, or procedures. 

Holy Tenets 

• Celebrations are common to all Buddhists.
• Daily chanting or meditation according to the form of Buddhism. 

Pregnancy 

• Artificial insemination and birth control are acceptable. 
• Buddhists do not condone taking a life. 

Rituals 

• Ceremony around baby blessings, marriage, and death. 
• Monthly atonement ceremony on the full moon.

Symbols and Rites

• Lotus flower, human life; Bodhi tree, victory over suffering; Dharma wheel, Eternal Knot, wisdom, and respect for others; Two Golden Fish, hope, and courage. 
• Flower and fruit offerings.
• Incense burning and candle lighting.
• Lay vows for men and women. 
• No institutional hierarchical structure. 
• Ordained men and women. 
• Statues of Buddha, prayer beads, and chant boxes. 

Clinical Issues

• Acceptable to use blood products.
• Avoid mind-altering drugs.

Christian Science

Mary Baker Eddy developed Christian Science, teaching that sickness can be healed by prayer alone, as Jesus healed.

Beliefs

• A Bible-based Christian religion, the Christian Science church was founded to “commemorate the word and works of our master Jesus Christ which should reinstate primitive Christianity and its lost element of healing”  (Church Manual, p. 17).
• Following the example of Christ Jesus, Christian Scientists rely on consecrated prayer to God, the eternal good, and rooted in a faith lifted to spiritual perception, as a practical and reliable method to care for all human needs, including their health.

Death

• There is no church policy on burial, but the body is best prepared for burial by one of the same sex. An autopsy may be sought in cases of sudden decease.
• There is no church policy on euthanasia, but Christian Scientists revere life and strive to overcome and heal suicidal tendencies.
• There is no church policy on organ donations, blood donations, or transfusions.

Diet 

•  Avoid tobacco and food or drink which contains alcohol and sometimes caffeine.

Health

• The church does not dictate individual health care choices.
• Christian Scientists generally choose spiritual means for preventing and healing disease.
• Christian Science practitioners offer spiritual healing support. They would not interfere in matters of specific medical treatment. Christian Science nurses provide practical non-medical care when only spiritual treatment is relied upon.
• If brought to a medical provider involuntarily, adherents may wish to choose to rely solely on spiritual means for healing. But they are free to decide.
• Once subject to medical care, they would not normally second-guess medical expertise.
• They may prefer minimal intervention where it is an option.

Holy Tenets

• Science and Health with Key to the Scriptures, by church founder Mary Baker Eddy, is the definitive statement of Christian Science teachings. This book includes six religious tenets or key points of Christian Science, summarized in 1894 by a Chicago journalist in the Daily Inter-Ocean: “The ‘confession of faith’ [of Christian Science] includes the declaration that the Scriptures are the guide to eternal Life; that there is a Supreme Being, and His Son, and the Holy Ghost, and that man is made in His image. It affirms the atonement; it recognizes Jesus as the teacher and guide to salvation; the forgiveness of sin by God, and affirms the power of Truth over error, and the need of living faith at the moment to realize the possibilities of the divine Life.”  The final Tenet, not represented in this summary, takes the form of a sacred Christian commitment: “And we solemnly promise to watch, and pray for that Mind to be in us which was also in Christ Jesus; to do unto others as we would have them do unto us; and to be merciful, just, and pure.” (SH p. 497)

Rituals

• Church services are simple and Bible-centered. 
• Patients might appreciate access to online resources such as church services, weekly topical Bible lessons, or church periodicals. 
• Members typically pray and study the Bible and other religious teachings daily.
• No traditional ritual sacraments, though there is a simple communion service and a special Thanksgiving Day service.
• Christmas and Easter have deep spiritual meaning to Christian Scientists. Most Christian Scientists celebrate a traditional Christmas holiday. 

Symbols

• The Bible is central to Christian Science. It is interpreted in the Christian Science textbook, Science, and Health, the authoritative guide for adherents.

•  Lay readers conduct church services. There is no clergy.

 Clinical Significance

• Christian Scientists and their children have often availed themselves of religious belief accommodations for vaccination, but the choice is individual, and members are encouraged to comply with applicable public health laws (including vaccination and quarantines where required). They are taught not to fear vaccines.

• Usually do not seek immediate medical care.

• They may prefer no, or minimal, medical intervention and drugs
• during pregnancy, labor, and birth – and they may request a midwife. Abortions are likely not favored. But church policy does not dictate any of this, nor does it cover birth control.

• Medical professionals will want to be sensitive to members’ preference against too much description of the severity, dangerousness, and fixed reality of the disorders or traumas treated – including matters of mental health.

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 

• The building of temples where personal and sacred covenants can be entered into with the Lord. 
• Daily Prayer and reading of Scriptures. 
• Jesus Christ is the Firstborn of God. 
• Members are spiritual daughters and sons of a living Father in Heaven. 
• They tend to be family-oriented and have strong connections to their extended family, reflective of their belief that families are connected after death.
• Mormons have a strict rule of chastity, requiring abstention from sexual relations outside heterosexual marriage.
• Mortality on earth is a probationary period to test to see if members will obey the Lord’s commandments given through current and ancient prophets. 

Death 

• All individuals will be resurrected and attain a degree of glory in heaven for acts during their mortality. 
• Autopsy permitted. 
• Euthanasia is not allowed.
• Organ donation permitted. 
• Promote dignified death, if inevitable. 

Diet

• Alcohol, coffee, tea, and tobacco are discouraged. 
• Fasting is required once each month; ill people are not required to fast. 

Health 

• Blood and blood products acceptable. 
• Faith in Jesus Christ to heal with medical. 

Holy Tenets

• Follow basic Christian holidays. 

Pregnancy 

• Procreation is a central purpose of life. 
• Abortion is forbidden except in the case of rape or when the mother’s life is in danger. 
• Artificial insemination acceptable between husband and wife. 
• Birth control is a decision left to the couple; per the LDS Church, "the decision as to how many children to have and when to have them is extremely intimate and private and should be left between the couple and the Lord."

Rituals 

• Blessing and naming of children. 
• Family home evenings once a week. 
• Two elders are required for the blessing of the sick. 

Symbols and Rites

• Designated leaders for specific roles, including Bishops and Elders.
• King James Version of the New and Old Testaments the Bible, the Book of Mormon, and scriptures. 
• No formal clergy.

Clinical Significance

• May avoid drugs containing alcohol and caffeine.

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 

• A person’s communion with God is expressed in love; where there is no love, God is absent, and no spiritual life exists. 
• All are saved through Christ’s death and resurrection, are still being saved through participation in the church, and will be saved again in the future second coming of Christ.
• Christ is the Son of God, both fully divine and fully human, and the Holy Spirit enables humanity to apprehend God’s presence in the world.
• God reveals Himself in the Bible as living and present. It is considered to be the “Word of God,” though not considered inerrant or literal.
• The Nicene Creed is recited at every Divine Liturgy, which summarizes the beliefs of the Church.
• In the Orthodox view, the Trinity is three persons, one in essence and undivided. 
• The veneration of Mary is referred to as the Theotokos or God-bearer as she carried the New Covenant in the person of Christ. 
• Consecration invoked by a priest that bread and wine become the body and blood of Christ.

Death

• The departed soul is affected by intercessory prayers; redemption and reconciliation with God may be possible even after death.
• Holy Unction anointing with oil is administered to the sick by Orthodox clergy on the Wednesday of Holy Week between Palm Sunday and Easter.
• The church offers prayers for the dead on the 3rd, 9th, 40th and upon the one-year anniversary of the death. 
• When a person passes, the traditional saying is “Memory Eternal.”

Diet 

• Fast from meat, dairy, and oil for a 40-day period during Great (beginning seven weeks before Easter ) and Christmas (November 15 through December 24) Lent. After the Divine Liturgy, the fast is broken with a joyous community feast. 
• Fast from meat, dairy, and oil on Wednesdays and Fridays. 
• Fasting is flexible if pregnant and for those with health concerns.

Health

• Allow blood transfusions and blood products.
• God is the “Divine Physician,” the healer of our bodies and souls, which is facilitated through prayer and Church participation. 
• Traditional medical interventions are accepted.

Holy Tenets

• Divine Liturgy on Sundays and holy days; some hold Matins and Vespers services daily.
• May pray at home with icons and incense.
• Saints’ days are celebrated throughout the year.
• The structured liturgical cycle of twelve feast days, Pascha (Easter) is the “feast of feasts.”
• Sunday is the celebration of the Resurrection and the Triune God. 

Pregnancy

• Babies are baptized by immersion at two months of age.
• Once a child is baptized, the child may receive Holy Communion and is considered a member of the body of the Church.

Rituals

• The focus of the liturgy is the blessing and receipt of Holy Communion.
• Worship is liturgical and structured, with chanted hymnody, iconography, and incense. 

Symbols and Rites

• Composed of self-governing ecclesiastical bodies, each geographically and nationally distinct but theologically unified. A Synod of bishops guides each self-governing body.
• Icons are not worshipped but honored as “windows” into divine reality and aid prayer.
• Pray by making the sign of the cross.
• The Three-Bar Orthodox Cross Prayer with icons. 

Clinical Significance

• No significant clinical issues

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 

• An attitude of mutual tolerance and belief that all approaches to God are valid. 
• Duties to God, parents, society, and teachers. 
• Future lives are influenced by how one faces disability, illness, or death. 
• Goal to break free of an imperfect world and reunite with God. 
• Pain and suffering are seen as a result of prior actions (karma). 
• Reincarnation and karma. 

Death 

• The atmosphere around a dying person must be peaceful. 
• Autopsy and organ donation acceptable. 
• Children under age two are usually buried. 
• Cremation is common on the day of death, and the body is not left alone until cremated. 
• Euthanasia is forbidden. 
• Immediately after death, the family may wash the body, and the priest may pour water into the mouth. 
• No restriction on the prolongation of life. 
• Prefer to die at home. 
• Religious chanting before and after death by family, friends, and priests. 
• The Gita or scripture is recited to provide comfort. 
• The last thoughts are of God.

Diet

• Fasting is important on special holy days as wells as certain days for the lunar calendar and days of the week representing specific deities.
• The right hand is used for eating, and the left hand for toileting and hygiene. 
• Vegetarianism common, or may avoid beef and pork.

Health 

• Bathing after a meal may be considered the cause of dyspepsia.
• Blood and blood products acceptable.
• Father or husband is the primary spokesperson for the family and to whom questions should be directed, and women may not request special care. 
• Hot water can be added to cold, but cold water may not be added to hot. 
• Organ donation and receipt acceptable. 
• Personal hygiene important, and daily bathing required.
• Prayer for health is not favorable; stoicism is preferable.

Holy Issues 

• Must be barefoot during religious worship
• Must sit at a lower elevation than where the deity image has been placed.
• No formal hierarchical structure
• Not a church-based religion
• Praying, meditating, recitation, and scripture reading
• Several holy days
• Special respect for elders
• Specific ceremonies vary due to local customs.
• A supportive environment and privacy for rites
• Ten to eleven days after birth, the priest performs the naming ceremony.

Pregnancy 

• Against abortion unless the mother's life is in danger.
• Birth control and artificial insemination acceptable. 
• Circumcision is uncommon. 
• The exact time of birth is important. 
• May not want to name the newborn immediately.

Symbols and Rites

• Sacred writings and objects include candles, fresh flowers, incense, prayer beads, and sandalwood. 

Clinical Significance

• No clinical issues that inhibit healthcare.

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

• Complete submission to God
• Judgment day
• Life after death
• Muhammad God's messenger
• Required to pray 5 times a day
• Give 2.5% to a charitable cause once each year.
• Oneness of God, his angels, scriptures, and messengers
• Pilgrimage to Mecca is required at least once in their lifetime.
• Ramadan is a month-long fast of drink, food, and no sexual intercourse during daylight.
• Reward and punishment
• The Quran is the final revelation of humanity.
• One God, Allah

Death

• Autopsy only for legal or medical reasons
• Confession of sins and begging forgiveness may occur before death.
• Death in God’s plan
• Euthanasia prohibited
• Organ donation acceptable
• Prayer for the deceased led by a male within 72 hours after death; death certificate should be signed quickly to facilitate the process.

Diet

• Children, women who are pregnant, and those who are ill may be exempt from fasting.
• Eat food that is clean, good, pure, nourishing, pleasant, tasteful, and wholesome.
• Eat with the right hand, considered to be the clean hand.
• Food not invoked in God’s name may be prohibited.
• Use only vegetable oil.
• Pork, shellfish, and alcohol are prohibited.

Health 

• Custom prohibits handshakes or any contact between genders.
• Female patients may require a female physician.
• Most surgical procedures are permitted.
• No restrictions on amputations, biopsies, blood or blood products, medications, amputations.
• Providers are seen as helpers of God’s will.

Holy Issues

• Congregational Prayer: Fridays are the Holiest Day for Muslims, and they have a noon prayer.
• Days of observance occur throughout the Muslim lunar calendar.
• Eid-ul-Aha (Celebration of the Sacrifice of Abraham) is a three-day celebration beginning on the 10th day of the 12th month called Dhul Hijjah.
• Eid-ul-Fitr (Celebration of the Fast-Breaking) is held on the first day of the 9th of the lunar calendar.
• Prayer 5 times a day facing Mecca (dawn, midday, mid-afternoon, sunset, night)
• Ramadan is during the ninth month of the Islamic lunar calendar and lasts 29 or 30 days, depending on the year.
• Wash face, hands, and feet before prayer.

Pregnancy

• Abortion is prohibited except in cases of incest, rape, or when the mother's life is threatened.
• A fetus is considered a human being after 25-weeks of gestation.

Symbols

• Only symbols the Holy Quran
• Some women are required to wear a burqa, covering the head, face, and entire body, including hands and feet, or a hajib, a veil covering the head but leaving the face uncovered.

Clinical Significance

• Find the same-sex practitioner if not an acute emergency.

Shia Muslims

• Approximately 15% of Muslims are Shia. Iran and Iraq have a majority of Shia Muslims. 
• Shia means Party of Ali.
• Shia Muslims are a minority in the rest of the world. Shia Muslims pray three times a day; Sunni Muslims pray five times a day.
• Shia Muslims believe that when Muhammad died, it was his wish that Ali, his cousin, would be the new caliph. They believe that the leaders of Islam should be direct descendants of the Prophet Muhammad. 
• Shia Muslims ignore the elected Sunni leaders and instead follow their leaders, which are direct descendants of Muhammad called Imams. 

Sunni Muslims

• Most Muslims are Sunni.
• Sunni means the words and actions of the Prophet Muhammad. 
• Sunni Muslims believe that Muhammad's wish upon his death was that the next leader would be elected. 
• Sunni Muslims believe the leaders of Islam should continue to be elected.

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 

• The world will be restored to a state of paradise; beneficiaries of Christ will be resurrected with healthy physical bodies and inhabit the earth.
• Do not give gifts on holidays and do not recognize birthdays or national holidays.
• God is the Father, and Jesus Christ is his son.
• The Holy Spirit is God’s motivating force.
• Reject the doctrine of the Holy Trinity
• Do not salute the national flag or sing the national anthem and refuse military service.

Death 

• Autopsy acceptable if legally required 
• Body organ donation is a personal choice.
• Death is a state of unconsciousness.
• Euthanasia is forbidden

Diet 

• Avoid any food that contains blood.
• Meat products must be properly drained of blood.

Health

• Refuse blood transfusion and blood products
• Whether to prolong life or the right to die is an individual choice.

Holy Issues 

• An annual congregational celebration of the memorial of Christ’s sacrificial death changes annually
• Prayer and reading of scriptures
• Meetings are held three times a week in local Kingdom Halls with a focus on education.

Pregnancy 

• Abortion is forbidden
• Artificial insemination by donors is forbidden.
• Birth control is an individual choice.

Rituals 

• Adult baptism
• Shunning of those who fail to live by the group's standards and doctrines

Symbols 

• None

Clinical Significance

• Refuse all blood products

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 

• One all-powerful God who created the universe
• God communicated the commandments to Moses on Mount Sinai, and they are written in the Torah.
• Commandments, commitments, duties, and obligations have priority over individual pleasures and rights.
• Sanctity of life overrides religious obligations.
• Orthodox Jews: Strict interpretation of the Torah. The Torah is divine and unalterable. Following the code of Jewish Law
• Conservative Jews: Modern and traditional religious observances accepted.
• Reform Jews: Choose religious observances and freedom to interpret the Torah

Daily Practices 

• Orthodox: Pray three times daily, usually in the community
• Conservative: Daily prayers
• Reform: open to multi-faith and prayers at the bedside

Death 

• Autopsy and organ donation acceptable
• Belief in life after death
• Burial as soon as possible
• Cremation discouraged or prohibited. 
• The family may stay with the body until it is moved by the funeral director.
• Graveside services are typical.
• Persons approaching death are encouraged to connect with the community and pray to denominational beliefs.
• Prayers for the sick can be an important part of the faith; the common prayer is called Mi Cheberach.

Diet

• May request kosher-certified food

Health 

• Amputated limb buried in consecrated ground
• Blood and blood products acceptable
• May consult Rabbi regarding the decision for life-support and tube feeding.
• Sick exempt from fasting

Holy Issues 

• Asara B'tevet: Fast days of mourning
• Channukah: Eight-day festival of lights
• Passover: Weeklong Holiday of Freedom
• Shavuot: Holiday of revelation
• Purim: Preceded by Fast of Esther (no eating or drinking) holiday of the Book of Esther
• Rosh Hashanah: Jewish New Year.
• Sabbath and Holy Days maybe without electricity
• Yom Kippur: Fast (no eating or drinking), Day of Atonement

Pregnancy 

• Allow abortion to save the mother.
• May not allow birth control.

Rituals 

• Lighting candles before Holidays and Sabbath
• Synagogue attendance.

Symbols 

• Sabbath Candles

Clinical Significance

• Kosher food
• Require saving of amputated limbs

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 

• Community worship is important.
• Emphasis on the Holy Bible and Scriptures 
• Jesus of Nazareth is the son of God.
• Two Sacraments: Baptism and Communion.

Death

• Autopsy, organ donation acceptable
• Euthanasia is generally not acceptable.

Diet 

• No restrictions

Health 

• Blood, blood products are an individual choice.

Holy Issues 

• Daily prayer and Scripture reading
• Traditional holidays observances

Pregnancy 

• Baptism of infants practiced in some denominations
• Birth control and artificial insemination are individual choices. 

Rituals 

• Anointing, prayer, Eucharist, and other rituals
• Prayers for healing, individual prayer, and the Sacraments

Symbols 

• Bible 
• Cross 
• Most ordain both men and women while some only men.

Clinical Significance

• No clinical issues that inhibit healthcare

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 

• African civilization and culture are superior.
• Being as close to nature as possible
• Dream of returning to Africa
• Following the Old Testament
• Jah is the Messiah promised in the Bible.
• Love and respect for all living things
• One God, Jah, the former emperor of Ethiopia, incarnated
• Spiritual use of marijuana
• Believe in everlasting life; may not talk about terminal illness or impending death.

Diet

• Limited or no meat, pork, or shellfish
• May be vegan
• Avoid alcohol
• Caribbean food is popular with fruits and vegetables.
• May only want to eat natural foods.

Health 

• The body is seen as a church and may be hesitant to put anything unnatural into it.

Daily Practices 

• Buttons and pins with images of Haile Selassie or the Lion of Judah 
• Dreadlocks common
• May wear robes, headscarves, and knit hats.

Pregnancy

• Birth control individual choice but may not want non-natural drugs.

Rituals 

• Dancing, singing, and marijuana use
• Old Testament readings

Symbols 

• Local, national, and international representatives may perform special religious rituals.
• Marijuana is common during ceremonies and is seen as cleansing spiritually and is written about in the Bible.
• May avoid taking non-natural drugs. 
• Often use green, red, and yellow colors.
• Spiritual use of marijuana

Clinical Significance

• Maybe mistrusting of medications or drugs that contain alcohol.

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 

• Belief in Apostolic leaders that are male successors of the original apostles of Jesus
• Dedication to creeds
• Emphasis on sacraments including baptism, confession, confirmation, Eucharist, holy orders, penance, prayers for the ill, and marriage
• A strong tradition of liturgy

Death

• Autopsy and organ donation are acceptable
• Life after death
• Persons approaching death are encouraged to compare their suffering to that of Christ.
• Sacrament of the Anointing of the Sick very important for the seriously ill called the Last Rites

Diet 

• Avoid meat on Fridays, especially during Lent; may eat fish. 
• Fast and sacramental confession prior to receiving Eucharist
• No general dietary restrictions

Health 

• Blood and blood products are acceptable
• May request amputated limb be buried in consecrated ground.
• Sacrament of the Sick by a priest important

Holy Issues 

• Attendance at Mass is an obligation.
• Prayers at bedside, dinner table, and other times
• Holidays such as Christmas and Easter are celebrated as a season.
• May desire daily Eucharist or Mass attendance
• Use of sacramental candles, holy images, and rosary beads

Pregnancy 

• Abortion prohibited
• Artificial conception discouraged
• Baptism of infants is required if the prognosis is grave
• Natural birth control only

Rituals 

• Attending Mass on Sunday and Holy Days, optional daily
• Lighting candles
• Observing sacraments
• Praying the rosary beads to aid in prayers

Symbols 

• Cross with a corpus of Jesus
• Holy water
• Incense
• Jesus pictures and statue
• Leadership includes priests, deacons, nuns, and brothers who all have taken vows, Eucharistic ministers, and chaplains.
• The name of Jesus is important.
• The only priest can offer Sacraments.
• Rosary beads
• Saints, especially Mary, the mother of Jesus and saints associated with healing

Clinical Significance

• May request saving of amputated limbs

Scientology

Scientology’s beliefs and practices are based on rigorous research, and its doctrines are accorded an equivalent to scientific laws.

Beliefs

• Adherents are encouraged to validate the practices through their own experience.
• It aims to create a society without insanity, criminals, and war, where the world prospers, and honest beings can have rights, and where a man is free to rise to greater heights.

Death 

• Believe in rebirth

Diet

• No restriction on a diet

Health

• Rely on the advice and treatment of medical doctors.
• Scientologists do not take mind-altering psychotropic drugs.
• Use prescribed medical drugs when physically ill.

Holy Issues

• The human is an immortal, spiritual being that is resident in a physical body.

Pregnancy

• No mandate or a position on these subjects.
• Individual’s personal choice and parishioners are free to decide for themselves.

Rituals

• Congregations celebrate weddings, namings and mark the passing of their fellows with funeral rites.
• Each Sunday, public worship service is open to both members and non-members of the Church.
• Services comprise a recitation of the Creed of Scientology, sermons, congregational auditing, and prayer. 

Symbols

• The Scientology symbol is an "S," curving through two triangles.

Clinical Significance

• A Scientologist with a physical condition will usually seek and obtain examination and treatment by a qualified medical professional.

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 

• Bible is interpreted literally. 
• The body is the temple of God and must be kept healthy. 
• Duty to warn others to prepare for the second coming of Christ. 

Death 

• Autopsy and organ donation acceptable. 
• Death is a state of unconsciousness with a return to consciousness with the Second Advent or coming of Christ. 
• Euthanasia is not practiced. 

Diet 

• Consuming alcohol, coffee, and tea is a matter of individual choice, although most refrain. 
• May practice fasting
• Vegetarian diet

Health 

• Emphasize rehabilitation and therapeutic diets. 
• Healing is accomplished through medical intervention and divine healing. 
• Many avoid narcotics or stimulants. 
• No restrictions on blood or blood products. 
• No restrictions on surgical procedures. 
• Physicians and chaplains are inseparable. 
• Holy Issues 
• Daily Prayer
• Saturday is the Sabbath.

Pregnancy 

• Abortion is discouraged. 
• Birth control is acceptable. 
• No infant baptism.

Rituals

• An ill person anointed with oil; elders and Pastors and elders may pray. 

Symbols 

• Pastors and elders may be male or female.

Clinical Significance

• May require a special restricted diet.

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 

• All people are equal. 
• God is eternal, formless, and unobserved.
• God is the supreme Guru, guide, and teacher.
• The ideal life is charity, work, and worship.
• Reincarnation is a cycle of rebirth. 
• Salvation is achieved through disciplined meditation and union with God. 
• Salvation is liberation from the cycle of rebirth. 
• There is a tension between God’s sovereignty and human free will. 

Death 

• The body is bathed, dressed, and then cremated. 
• The floor is washed and covered with white sheets; shoes are not worn room. 

Diet 

• No restrictions

Health 

• May not cut the hair on any part of their body.

Holy Issues 

• Meet as a congregation for prayer service on six holidays
• Morning and night private worship
• Following the 10 Sikh gurus and the Holy Scriptures

Pregnancy 

• A member of the family gives a drop of honey to the newborn to give the child his character later in life.
• There are no rituals connected with the birth of a child.

Symbols 

• Guru Granth Sahib is a collection of religious writing.
• A turban is worn as a symbol of personal sovereignty and symbolizes responsibility to others.
• Symbolic objects include a cloth around the chest, an iron bracelet, and a wooden comb.
• Khanda reflects fundamental concepts of the faith.

Clinical Significance

• Hair removal may be an issue for surgery.

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 

• "Aumakua" are family guardians and are respected. 
• A basic sense of community
• Inter-connectedness of all-natural things

Death 

• Body treated with respect.
• Burial is a family decision.
• Funerals are not attended by pregnant women.

Diet

• After a prayer ceremony, foods consumed provided by the family. 
• Fasting is a regular practice.
• No dietary restrictions
• Specific foods used to depend on the ceremony.

Health 

• Bad health results from not living in harmony with nature. 
• Healthcare is interconnected with cultural and religious beliefs. 
• Health is the connection between the body, mind, and spirit. 
• An individual is responsible for becoming healthy. 
• Medications acceptable for pain as long as they do not affect the state of mind.
• Prayers, fasting, and silence promote healing.

Holy Issues 

• Closely related to the moon and seasonal changes
• Daily prayers
• Observance occurs throughout the lunar calendar.

Pregnancy

• Avoid wearing Lei or garlands in a full circle as this is believed to ward off unfortunate circumstances.
• Massaged to avoid early labor
• A newborn name may be delayed because the mother relies on dreams, signs, and visions to obtain a name.

Rituals

• Ceremonies are done to connect to elements and self for value and respect. 
• Chanting for ceremonies. 
• Menstruating females are observers during ceremonies and have a separate responsibility.
• Performed with the intent of seeing, obtaining, or understanding a vision of clarity related to one’s self and others.

Symbols 

• Cleansing before the ceremony may start days to weeks prior and may include fasting and physical cleanse. 
• Offerings are called ho’okupu, which is valued from the time it is gathered to the time it is given.
• Respect for male and female elders. 
• Respect of caretakers and protectors of images. 
• Silence is golden, and observation is key. 
• There are no written scriptures or writings; everything is handed down by stories. 
• Traditional ceremonial wear is expected. 

Clinical Significance

• No clinical issues that inhibit healthcare.

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

• A basic sense of community
• Fundamental inter-connectedness of all-natural things - life, land, and Mother Earth
• Passed down by storytelling
• Use “God” and “Creator” interchangeably.
• Daily Practices 
• Prayers often include sacred objects.

Death 

• After death, some tribes will not touch clothes or belongings. 
• The body is often prepared for burial by family or tribe. 
• Varies from tribe to tribe

Diet

• No special diet

Health 

• Health care practices are related to cultural and religious and beliefs. 
• Ill health occurs from failure to live in harmony with nature, social, and supernatural environments. 

Holy Issues 

• Related to the moon and seasons

Pregnancy 

• No special issues

Rituals 

• Prayer accompanied by the burning of cedar, sage, sweetgrass, or tobacco. 
• Seeing and understanding a vision of clarity for oneself.

Symbols 

• A woman should not come near-sacred objects during menstrual periods.
• Include elder, medicine person, or spiritual leader in assisting in healing.
• A medicine bag is a leather pouch worn around the neck that should not be touched. 
• No written scriptures
• No one other than the elder should not touch religious articles.

Clinical Significance

• No clinical issues that inhibit healthcare.

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 

• All creation is considered divine and contains the power of the divine.
• Ewe asks for help and change. 
• Ewe rule the world and decide the fate of everything. 
• One God, Bondye, and other spiritual beings, called Ewe. 

Health

• Medicines such as herbal remedies and objects in religious rituals may be used for healing. 

Rituals

• Animals are sacrificed to thank the spirits. 
• Ceremonies include animal sacrifice, drums, and dancing. 
• Ceremonies may be held in secret. 

Clinical Significance

• Maybe mistrusting of modern medicine.

Wicca

Wicca is a neo-pagan, earth-centered belief.

Beliefs 

• Concern for ecological issues
• Consecrated items should not be removed or handled by anyone but the wearer. 
• Multiple gods and goddesses
• No action occurs without significant repercussions throughout the world, eventually affecting the original actor (Law of Nature).
• Pre-Christian civilization worship practices
• The principal deity is Mother Nature.

Death 

• No restrictions on autopsy

Diet

• Variable

Health 

• May want to contact coven to request a healing rite.

Holy Issues

• Individual study daily
• Worship is called a circle or ritual.

Pregnancy 

• The ritual blessing of pregnancy is held every trimester. 
• Ritual of blessing and naming children

Rituals

• The full moon is a time of great magical energy.
• Rituals are a large part of the faith.

Symbols 

• A consecrated pendant in the form of a pentacle or pentagram is often worn, which should only be removed by the individual. 
• The five-pointed star inside a circle
• Priests and priestesses perform rituals.
• Sacred objects include candles, chalice, herbs, images of gods or goddesses, incense, juice, oil, and wand, wine.
• Weekly classes and worship
• Written codes of conduct

Clinical Significance

• Maybe mistrusting of modern medicine.

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:

• Apologize for cultural mistakes
• Ask the patient and family how you can help make their experience more comfortable.
• Avoid being judgmental
• Avoid making assumptions and be patient.
• Avoid employees serving as interpreters for other employees.
• Be aware of the uniqueness of their religion and their special needs.
• Be respectful
• Observe body and facial language
• Recognize how values, behaviors, and beliefs may affect others
• Train staff about cultural competence
• Use medically competent and fluent interpreters with training in cultural competence.

Enhancing Healthcare Team Outcomes

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.