NURSING PARADIGM: ENVIRONMENT

SPIRITUALITY
- Search for meaning and purpose in life, which seeks to understand life’s ultimate questions in relation to
the sacred
CHARACTERISTICS:
- Informal
- Non-organized
- Self-reflection
- Experience
- Subjective
SPIRITUAL ASSESSMENT
- Active and ongoing conversation that assesses the spiritual needs of the client
CHARACTERISTICS:
- Formal or Informal
- Respectful
- Non-biased
SPIRITUAL CARE
- Addressing the spiritual needs of the client as they unfold through spiritual assessment
CHARACTERISTICS:
- Individualistic
- Client-oriented
- Collaborative

RELIGION
- Rituals, practices, and experiences involving a search for the sacred (ex. God, Allah, etc.) that are shared
within a group.

MAJOR WORLD RELIGIONS AND COMMON HEALTH BELIEFS

Religion:
Buddhism
Overview:
part of human existence
Inward death of the self and senses leads to a state beyond suffering and existence
Illness:
meditation is used for cleansing and healing
Terminal illness may be an opportunity to reflect on life’s ultimate meaning and meaning of one’s
relationship with the world
Nursing Consideration (NC): medication should not interfere with consciousness
End of Life:
Life is an opportunity to cultivate understanding, compassion and joy for self and others
Death is associated with rebirth
NC: Serene surroundings are important to the dignity of dying
Nutrition:
Many are strict vegetarians
Some holy days fast from dawn to dusk but considerations for the frail and elderly
Religion:
Hinduism
Overview:
Primary purpose: Nirvana (oneness with God)
Illness:
Illness is the result of past and current life actions (Karma)
NC: Right hand is seen holy, thus, eating and interventions (ex. IV) should be done with the right hand to
promote clean healing.
End of Life:
Death marks a passage because the soul has no beginning or end
At death, the soul may be reborn as another person and one’s Karma is carried forward. It is important
for karma to leave this life with as little negativity as possible to insure a better life next birth.
NC: Holy water and basil leaves may be placed on the body; sacred threads may be tied around wrists
and neck. The deceased's arms should be straightened
Nutrition:
Many but not all are vegetarians
Many holy days include fasting

Religion:
Islam
Overview:
Mohammed – greatest of all prophets
Worship occurs in a mosque.
Prayers occur five times a day: dawn, sunrise, noon, afternoon, sunset and evening.
Prayers are done facing east toward the sacred place in Mecca and often occur on prayer rug with ritual
washing of hands face and feet prior to prayer.
Women are to be “modest” and are not to view men, other than their husbands, naked.
Illness:
Allah is in control of the beginning and end of life, and expressions of powerlessness are rare.
NC: to question or ask questions of health care providers is considered as a sign of mistrust so clients and
family are less likely to ask questions.
End of Life:
All outcomes, whether death or healing, are seen as predetermined by Allah.
NC: It is important for dying clients to face east and to die facing east. Prayer is offered but need not be
done by an Imam (religious leader.)
Nutrition:
Consumption of pork and alcohol is prohibited.
Other meats must meet ritual requirements and many use Kosher (Jewish ritual).
During Ramadan, neither food nor drink is taken between sunrise and sunset; frail and young children are
exempted
Religion:
Christianity
Overview:
Beliefs focus on the Holy Bible and view Jesus Christ as the Savior Prayers may be directed to one or all of
the Holy Trinity.
Beliefs usually culturally developed vary within denominations
Illness:
Most view illness as natural process for the body and even as a test of faith
Others may see illness as a curse brought by living outside the laws of God and, thus, retribution of
personal evil
End of Life:
Miracles through prayers
Western medicine is usually highly regarded Memorial services are common
Nutrition:
No special or universal beliefs are common. Regional and cultural beliefs may be present.

Religion:
Judaism
Overview:
Major Beliefs: Reform, Reconstructionist, Conservative and Orthodox.
Prayer shawls are common and are often passed between generations of family.
The clergy are known as Rabbi
Illness:
Restrictions related to work on holy days are remove to save a life
NC: tests, signatures and assessments for medical needs should be scheduled to avoid holy days
End of Life:
NC: Psalms and the last prayer of confession (vidui) are held at bedside. At death, arms are not crossed;
any clothing or bandages with client’s blood should be prepared for burial with the person. It is important
that the whole person be buried together.
Nutrition:
Orthodox or Kosher involves no mixing of meat with dairy; separate cooking and eating utensils are used
for food preparation and consumption. Kosher laws include special slaughter and food handling.
“Keeping Kosher” is an Orthodox practice and Kosher foodsare marked “K” onthe labels. Many holy days
include fasting period.

EFFECTS OF RELIGION TO HEALTH CARE

POSITIVE
- Promotion of health lifestyle:
- Avoidance of promiscuous sexual activity
- Shunning alcohol and tobacco use
- Dietary guidelines
NEGATIVE
- Failure to seek timely medical care and withholding “proper” medical care based on religious dogma:
- May lead to depression and anxiety over not meeting group expectations, and certain spiritual practices
or participation in complementary and alternative medical practices may delay needed medical care
(Koenig, McCullough, & Larson, 2001; Barett, Kurlan, & Johnson, 2001)
CHRISTIAN SCIENTISTS
- Frequently rely on prayer alone to heal illnesses, rarely seek mainstream medical care, and have higher
rates of mortality
JEHOVAH'S WITNESSES
- Refuse blood transfusions due to their belief that the body cannot be sustained by another’s blood and
accepting a transfusion will bar the recipient from eternal salvation
FAITH ASSEMBLY OF INDIANA
 - Has negative view on modern health care and have an especially high rate of infant mortality due to
limited prenatal care

FAMILY
- Basic unit of society
- Unity of interacting persons related by ties of marriage, birth or adoption, whose central purpose is to
create and maintain a common culture which promotes the physical, mental, emotional, and social
development of each of its members
- Two or more persons who are emotionally involved with each other and live in close geographical
proximity

MAJOR FUNCTIONS OF THE FAMILY

PHYSICAL FUNCTION
- Carried out by providing a safe, comfortable environment necessary to growth, development and
rest/recuperation.
ECONOMIC FUNCTION
- Provide financial aid for members, as well as meeting monetary needs of society
REPRODUCTIVE FUNCTION
- Met by the birth of Children
SOCIALIZATION FUNCTION
- Includes teaching, transmitting beliefs, values, attitudes and coping mechanisms; providing feedback
and guiding problem-solving.

FAMILY STRUCTURE
TRADITIONAL
Nuclear Family – consists of a father, mother and their children.
Extended Family – includes the relatives in addition to the nuclear family.
Single Parent – May be married, separated, divorced or widowed
Alternate: Cohabitating – It includes whose individuals who choose to live together for variety of reasons (ex.
relationships, financial needs, and changing values)
Although the single person is not living with others, he or she is a part of a family of origin, usually has a social
network with significant others (ex. young adult who has achieved independence; single adult living alone)

FAMILY STAGES
Beginning Family
Establishing a mutually satisfying marriage
Planning to have or not have children.

Child-bearing Family
Having and adjusting to infants
Supporting the needs of all three members
Renegotiating marital relationship

Family with Pre-School Children (3-6 years old)

Adjusting to costs of family life
Adapting to needs of preschool children to stimulate growth and development
Coping with parental loss of energy and privacy.

Family with School-Aged Children (7-11 years old)

Adjusting to the activity of growing children
Promoting joint decisions between children and parents
Encouraging and supporting children’s educational achievements

Family with Teenagers

Maintaining open communication among members.
Supporting ethical and moral values within the family
Balancing freedom with responsibility for teenagers
Releasing young adults with appropriate rituals and assistance
Strengthening marital relationship
Maintaining supportive home base

Post-Parental Family
Preparing for retirement
Maintaining ties with older and younger generations

Aging Family
Adjusting to retirement
Adjusting to loss of spouse
Closing family house