Adinkra Symbols

Handbook of Patients’ Spiritual
and Cultural Values

for Health Care Professionals
Updated March 2013
© HealthCare Chaplaincy 2013 1

Table of Contents
A Note 5
Introduction 6
Religions
Western Religions
Comparison of Jewish, Christian and Muslim Traditions 7
Christianity 8
Christian Science 8
Eastern Orthodox 9
Jehovah’s Witness 10
Mormonism 11
Protestantism 12
Roman Catholicism 13
Seventh-day Adventism 15
Islam (Muslim) 16
Sunni vs. Shiite
Judaism 19
Eastern Religions
Buddhism 22
Hinduism 23
Sikhism 25
Other Religions
Bahá'í 27

Hawaiian Spirituality 28
Native American 30
Rastafarian Movement 31
Santeria 32
Voodoo 32
Wicca 33
Cultures
Major American Cultures
African-American/ Black Culture 34
Hispanic-American Culture 35
Native American Culture 37
Native Hawaiian Culture 40
African Cultures
Ghanaian Culture 44
Kenyan Culture 46
South African Culture 48
Caribbean Cultures
Cuban Culture 50
Haitian Culture 52
Jamaican Culture 54
Middle Eastern/North African Cultures

Arab Culture 57
Egyptian Culture 59
Iranian Culture 61

Libyan Culture 63
East Indian Cultures 66
East Asian Cultures

Chinese Culture 69
Filipino Culture 71
Japanese Culture 74
Korean Culture 76
Vietnamese Culture 78
Indonesian Culture 80
Tibetan Culture 82
Euro-Asian Cultures
Gypsy / Roma Culture 84
Russian Culture 87

Notes for the Reader
1. This handbook is a guide that is meant to describe beliefs and practices generally found
within a particular cultural or religious group. As often as possible, we have verified the
content with people who self-identify with that particular group. That process is ongoing.
We have consulted, printed, and referred to online sources considered the most
authoritative in this content area. However, we understand, as should the reader, that
not everyone who identifies with a particular cultural or religious group will adhere to the
beliefs or values as presented.
2. This handbook is not complete – and it will likely never be. Thus, the reader will see that
much information is still missing because we have not found sources on a given topic
that we consider authoritative. We periodically post new versions of the handbook as we
accumulate new information. As this handbook is a work in progress, we welcome
feedback and contributions via email to the Rev. George Handzo, BCC at
[email protected]
3. These materials are authorized for use per the license agreement below:
― Cultural & Spiritual Sensitivity ─ A Learning Module for Health Care

Professionals and Dictionary of Patients' Spiritual & Cultural Values for Health
Care Professionals were developed by the Chaplaincy Care Leadership and
Practice Group of HealthCare Chaplaincy, New York, NY. (Revision and update
of earlier work by the Rev. Susan Wintz, BCC and the Rev. Earl Cooper, BCC)
―These materials are intended for educational and non-profit purposes which
are consistent with the mission and values of HealthCare Chaplaincy and the
Association of Professional Chaplains, and are for use only in their entirety
unless written permission is obtained from the developers and HealthCare
Chaplaincy.
4. When using these materials we request that this credit be included:
“This content is used with the permission of HealthCare Chaplaincy in New York, the
leading multifaith organization for the integration of spiritual care within health care and
palliative care through research, professional education and clinical practice. Learn more
at www.healthcarechaplaincy.org”

Introduction
Why do we need to be culturally and spiritually sensitive? The Joint Commission (JC) holds
hospitals accountable for addressing and maintaining patient rights. Founded in 1951, the Joint
Commission looks out to improve the healthcare providence of the general public. The Joint
Commission is the oldest standard-setting and accrediting body in health care. The commission
is headed and governed by a 32 member board. These rights include the accommodation of
cultural, religious, spiritual, and personal values as well as to religious and other spiritual
practices.
Health care professionals are entrusted to care for patients as whole persons - body, mind and
spirit. The health care approach is interdisciplinary and encompassing. It is important then, for
that approach to be culturally and spiritually sensitive. In addition, health care professionals
need to be empowered with the capacity, skills, and knowledge to respond to the unique needs
of each patient and their loved ones. Applicants seeking who seek accreditation by the
commission need to have high expertise in administrative affairs, clinical practice, cultural
competence, language access, pastoral access, patient advocacy, patient safety, patient-
provider communication, health care policy, research and risk management.
The Joint Commission’s Roadmap for Hospitals: Advancing Effective Communication, Cultural
Competence, and Patient- and Family-Centered Care promotes communication and cultural
competence. This monograph provides methods for hospitals to improve their efforts to ensure
that all patients are receiving the same high quality healthcare. The Roadmap for Hospitals
does not detail the process for how to become fully competent and patient/family centered.
However, the Joint Commission urges hospitals to adopt a combination of methods as a means
of setting a foundation for creating the process, policies and programs that best suit their
organization.
The Roadmap for Hospitals addresses topics like language access, cultural competency, health
literacy and communication barriers and mobility needs. The Roadmap for Hospitals is
structured so that the beginning chapters mirror the continuum of care including Chapter 1:
Admission, Chapter 2: Assessment, Chapter 3: Treatment, Chapter 4: End of Life Care, and
Chapter 5: Discharge and Transfer. Chapter 6 addresses Organization Readiness.
The Roadmap for Hospitals can be utilized in various ways to improve the quality and level of
patient and family centered care. It can be used to improve performance, train staff, help inform
policy and evaluate compliance with relevant laws, regulations and standards.
The Roadmap for Hospitals: Advancing Effective Communication, Cultural Competence, and
Patient- and Family-Centered Care can be found on the Joint Commission’s website at:
http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf

Religions
Western Religions
Comparison of Jewish, Christian and Muslim Traditions
*The three traditions are historically linked, yet with key differences in belief.
All believe in:

One God who is almighty, just and merciful.
Heaven and hell after death.
God’s call to Abraham in the land of Ur.
Similar codes of ethics.
Hebrew Scriptures (Christian Old Testament).
*Primary belief differences concern Jesus Christ.
Christians believe:
Jesus Christ is the messiah (savior) of humanity.
Jesus Christ is the holy son of God.
The Christian Scripture (New Testament) is a continuation of the Hebrew
Scripture (Old Testament).
Jews believe:
Jesus Christ is not the messiah.
The Hebrew Scripture (Christian Old Testament).
Muslims believe:
Jesus (called ‘Isa) was a prophet.
‘Isa did receive words from God (called Allah), but the Bible has corrupted
those words. Now the Qur’an is the only reliable book of Allah’s words
and ‘Isa’s teachings.
‘Isa didn’t die, he ascended to Allah.

Christianity
All believe in:
One God who is almighty, just, and merciful.
Jesus Christ who is the messiah and son of God.
Jesus’ death and resurrection.
Eternal life through faith in Jesus.
Following of the Bible, which includes the Old Testament and the New
Testament.
Following of Christ’s teachings in daily life. (In ways such as following the
10 Commandments, the New Covenant, the Bible).
Christian Science
* Also known as Church of Christ, Scientist
Beliefs Includes study of Metaphysics, which suggests the presence of spiritual
powers that operate on the mind and body.
Faith does not rest on blind belief; rather, understanding perfection of God’s
spiritual creation in the present.
All religions have value.
Daily Practices Prayer and sacraments.
Dying and Euthanasia contrary to teachings.
Death Most do not donate body or organs.
Disposal of body and burial is a family decision.
Facilitating Always clarify if and what medical and/or psychological techniques,
Practices practices, procedures, or medications patient and family wish to use.
Food No restrictions although some do not use food or drink which contains
stimulants such as caffeine or alcohol.
Health Illness believed to be the result of disharmony between mind and matter.
Believe that healing occurs when one draws closer to God and experiences
moral and spiritual change.
Not completely opposed to medical treatment but may be fearful of being
forced to accept unwanted treatments which violate individual personal
beliefs.
Holy days and None.
festivals
Pregnancy and Abortion incompatible with faith.
birth Birth control is an individual decision.
May desire midwife.

Rituals or No outward ceremonies or observances.
ceremonies
Spiritual Primary text is Science and Health with Key to the Scriptures.
instruments, No set apart leadership, but full-time healing ministers (practitioners)
structure and structure and practice spiritual healing, which is uniquely different from
symbols medical or psychological techniques.
Eastern Orthodox
Beliefs The community recites the Nicene Creed at every Divine Liturgy,
which summarizes the beliefs of the Church. The Orthodox view
the Trinity as‚ three persons, one in essence and undivided.‛ Christ
is understood to be the Son of God, both fully divine and fully
human, and the Holy Spirit enables humanity to apprehend God’s
presence in the world.
In the Bible, God has revealed Himself as living and present in his
people. It is considered the “Word of God” though not considered
inerrant or literal.
Veneration of Mary referred to as the Theotokos (God-bearer) in
that she carried the New Covenant in the person of Christ.
A person’s communion with God is expressed in love. Where there
is no love, God is absent and there is no spiritual life. All are
already saved (Christ’s death and resurrection), are still being
saved (through participation in the church), and will be saved in the
future (second coming of Christ).
Daily Practices Divine Liturgy attendance on Sundays and/or holy days; some
communities hold Matins and Vespers services daily.
Prayers at home with icons and/or incense.
Dying and Holy Unction (anointing with oil) is administered to the sick by
Death Orthodox clergy. It is administered to all Orthodox on the Wednesday
of Holy Week (the week between Palm Sunday and Easter).
The church offers special prayers for the dead on the third, ninth,
fortieth day and one year anniversary of the death. The traditional
saying after a person has passed away is “Memory Eternal”.
Belief that the departed soul can be affected by intercessory prayers;
redemption and reconciliation with God is possible after death.
Facilitating Christians pray in the presence of icons, making the sign of the cross.
Practices Icons are not worshipped but instead are venerated and honored as
“windows” into divine reality and as an aid to prayer.

Food Many Orthodox fast from meat, dairy and oil on Wednesdays and
Fridays. During Great Lent and Christmas Lent (Advent), a 40-day
period of fasting from meat, dairy and oil is observed. The fast is
broken with a joyous community feast after the Divine Liturgy. Fasting
is flexible for those with health concerns or those who are pregnant.
Health God is understood to be the “Divine Physician” and the‚ healer of our
souls and bodies, which is facilitated through prayer and participation
in the life of the Church. Traditional medical interventions are
generally accepted.
Holy Days and The Church observes a structured liturgical cycle of twelve feast
Festivals days; Pascha (Easter is considered the “feast of feasts”).
Every Sunday is dedicated to celebrating the Resurrection and the
Triune God.
Various saints’ days are celebrated throughout the year.
Pregnancy and Babies are baptized by immersion as early as 2 months of age; after
Birth baptism, they receive Holy Communion and are full members of the
body of the Church.
Rituals or Orthodox worship is structured and liturgical, with the use of chanted
Ceremonies hymnody, incense and iconography. Participants stand during most of
the liturgy. The focus of the liturgy is the blessing and receiving of
Holy Communion.
Spiritual The Three-Bar Orthodox Cross Prayer with icons.
instruments, 300 million members worldwide.
structure and Composed of numerous self-governing ecclesiastical bodies, each
symbols geographically and nationally distinct but theologically and
sacramentally unified. Each self-governing (autocephalous) body is
shepherded by a Synod of bishops.
Jehovah’s Witness
Beliefs No Holy Trinity. God is the Father, while Jesus Christ is His son, a
separate person. The Holy Spirit is God’s motivating force.
Do not participate in nationalistic ceremonies (e.g. saluting the flag),
and do not give gifts at holidays or celebrate traditional Christian
days.
Believe that after world is restored to state of paradise; beneficiaries
of Christ will be resurrected with healthy, perfected physical bodies,
and will inhabit earth.
Daily Practices Prayer and reading of Scriptures.
Dying and death Death is a state of total unconsciousness.
Euthanasia forbidden.
Autopsy acceptable if legally required.
Donation of body or organs is a personal choice.
Facilitating Be sensitive to strong religious beliefs opposing use of blood or
practices blood products.
Encourage patient or family to consult with congregational elders or
to contact the local JW Hospital Liaison Committee for assistance.
© HealthCare Chaplaincy 2013

10
Food Avoid food that contains blood.
Health Likely to be strongly opposed to blood transfusion.
Medications from blood products may not be acceptable.
Use of extraordinary means to prolong life or right to die is individual
choice.
Holy days and Meetings are held 3 times a week in local Kingdom Halls with focus
festivals on education.
Weekly meetings in homes.
Most important meeting of the year is a congregational celebration
of the memorial of Christ’s sacrificial death.
Pregnancy and Abortion and artificial insemination by a donor are forbidden.
birth Birth control is an individual choice.
No infant baptism.
Rituals or Adult baptism.
ceremonies No special rituals for sick or dying.
Spiritual None
instruments,
structure and
symbols
Mormon (Church of Jesus Christ of Latter-day Saints)

Beliefs Centered and focused on Jesus Christ as the Firstborn of God.
Members are literal spiritual sons and daughters of a living Father in
Heaven.
Mortality is a probationary period in which people are tested to see if
they will obey the Lord’s commandments given through ancient and
current prophets.
Building of temples where sacred and personal covenants can be
entered into with the Lord.
Daily Practices Prayer and reading of Scriptures.
Dying and Belief that all individuals will be resurrected, and will attain degree of
death glory in heaven for those qualified from acts during their mortality.
Euthanasia not practiced.
Promote peaceful and dignified death if inevitable.
Organ donation an individual choice.
Autopsy permitted.
Facilitating Allow for visits by church representatives; privacy for prayer or ritual.
practices
Food Coffee, tea, tobacco and alcohol are discouraged.
Fasting (no food or drink for 24 hours) required once each month - ill
people not required to fast.
Health Faith healing (faith in Jesus Christ and power of priesthood to heal)
and medical care/treatment used together.
No restrictions on blood, blood products or medications.
Holy days and Follow basic Christian holidays such as Christmas and Easter, as well
festivals as national holidays and church specific holidays.
11
Pregnancy and Belief that one of central purposes of life is procreation.
birth Birth control contrary to beliefs.
Abortion forbidden except when mother’s life in danger or rape.
Artificial insemination acceptable between husband and wife.
Rituals or Naming and blessing of children.
ceremonies Two elders required for ritual of blessing of the sick.
“Family Home Evenings” held once a week is important.
Spiritual King James Version of Old and New Testaments, the Book of Mormon
instruments, and other scriptures.
structure and No formal clergy but designated leaders for specific roles, including
symbols Bishops and Elders.
None.
Protestant
*Numerous Christian groups in the U.S.
*Mainline denominations include: Baptist, Christian (also Disciples of Christ, Churches

of Christ), Episcopalian (also Anglican), Lutheran, Mennonites (also Amish), United
Methodist, Presbyterian, Reformed, and United Church of Christ.
Beliefs Jesus of Nazareth is the son of God.

Emphasis on Scripture/Holy Bible as word of faith and life. Groups
vary widely in how literally they adhere to Scripture.
Traditionally two Sacraments- Baptism and Communion.
Community worship important.
Daily Practices Prayer, Scripture reading.
Dying and Death Organ donation, autopsy, burial or cremation usually individual
decisions.
Euthanasia beliefs vary from individual decision to religious
restrictions.
Body to be treated with respect.
Facilitating Ask patient and family what practices they support.
Practices Provide privacy as needed.
Food No restrictions.
Health In most denominations, decisions about blood, blood products,
vaccines, biopsies, amputations and transplants are an individual
choice.
Prayer, anointing, Eucharist or other rituals may be important.
Holy Days and Traditional Christian holidays and observances
Festivals

12
Pregnancy and In most denominations, decisions about genetic counseling, birth
Birth control, fertility tests, and artificial insemination are an individual
choice.
Some denominations may have restrictions.
Baptism of infants practiced in some denominations; others may
desire blessing or dedication ritual.
Rituals or Prayers for healing and comfort of the sick, commendation of the
Ceremonies dying, personal prayer, Sacraments.
Spiritual Bible
instruments, Cross
structure and Many mainline denominations ordain both men and women while
symbols some conservative denominations may have only male leadership.
Roman Catholicism
*Roman Catholicism is the largest group in the US. Because many Roman Catholics in
the US are immigrants, practice may be heavily culture and ethnicity dependent.
Beliefs Strong tradition of liturgy (ceremony).

Emphasis on practices (usually termed, sacraments), including:
baptism, Eucharist, prayers for the sick, holy orders, marriage,
confirmation and confession/penance.
Dedication to creeds (formulated statements of beliefs).
Belief in Apostolic succession in leadership, meaning leaders are
male successors of the original apostles of Jesus.
Daily Practices Prayers at table, bedside and other times.
May desire daily Eucharist or attendance at Mass.
Use of sacramentals or aids in the spiritual life, such as rosary
beads/prayer, holy images, candles, etc.
Dying and Death Belief in life after death.
Persons experiencing grave suffering and/or approaching death are
usually encouraged to compare their suffering to that of Christ’s.
Sacrament of the Anointing of the Sick very important for the
seriously ill, frail and elderly. Used to be called Last Rites.
Autopsy and Organ Donation acceptable.
Body to be treated with respect.
Wakes encouraged- usually in a funeral home the day before the
funeral.
Funeral Mass is the norm but can be replaced with a funeral version
of Liturgy of the Word.
Graveside service is also typical.
Facilitating Ask patient and family about preferred practices.
Practices Ask about rituals and needs such as Eucharist/Communion or
anointing.
Provide for privacy as needed.

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Food Traditional Catholics may fast and/or ask for sacramental
confession prior to receiving Eucharist and may wish to avoid meat
on Fridays, especially during season of Lent; offer to provide fish
instead.
No general dietary restrictions.
Health Blood and blood products acceptable.
May wish major amputated limb to be buried in consecrated ground.
Sacrament of the Sick (anointing by a priest) may be very important.
May believe suffering is part of one’s fate or punishment from God.
Holy days and Traditional Christian holidays as well as observance of special holy
festivals days when attendance at Mass is viewed as an obligation.
Holidays such as Christmas and Easter are celebrated as a season,
not only for one significant day.
Pregnancy and Natural means of birth control only.
Birth Abortion and sterilization prohibited.
Artificial means of conception are discouraged.
Baptism of infants may be required and urgent if prognosis is grave.
Rituals or Attending mass (worship) on Sunday and Holy Days, sometimes
Ceremonies daily.
Observing sacraments.
Praying the rosary (beads to aid in saying prayers).
Lighting candles.
Be aware of cultural differences in observance and practice,
especially in the large and growing number of Spanish speaking
communities.
Spiritual Rosary (prayer beads).
instruments, Holy water.
structure and Incense.
symbols Saints, especially Mary the mother of Jesus and saints associated
with healing.
Jesus pictures and statues; crucifix (cross with corpus of Jesus).
Name of Jesus is important.
Only (male) priest can offer Sacraments.
Leadership includes priest (Father), deacon (Mr. or Deacon), nuns
(Sister) and brothers (Brother), whom all have taken vows, as well
as Eucharistic ministers (lay-men and women who bring
Eucharist/communion); chaplains, both men and women, who are
specially trained and certified.
*Eastern Rite Catholics (different from Eastern Orthodox Christians) have similar but not
identical beliefs and practices.

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Seventh-day Adventist
* Also known as Adventist, Church of God, Advent Christian Church
Beliefs Bible is interpreted literally.
Believe it is a duty to warn others to prepare for second coming of
Christ.
Body considered temple of God and must be kept healthy.
Operate one of world’s largest religious health care systems.
Daily Practices Prayer
Dying and Death Euthanasia not practiced.
Autopsy, donation of body or organs acceptable.
Disposal of body and burial are individual decisions.
Death is held to be a state of unconsciousness with a return to
consciousness coming at the Second Advent- the second coming of
Christ.
Facilitating Ask patient and family about beliefs and preferences.
practices Provide privacy.
Food Vegetarian diet encouraged.
Consuming alcohol, tea, and coffee is a matter of individual choice
although many refrain.
May practice fasting.
Health Believe healing can be accomplished both through medical
intervention and divine healing.
Chaplains and physicians are inseparable.
Emphasize physical medicine, rehabilitation and therapeutic diets.
No restrictions on medications, blood or blood products or vaccines.
Some may not condone use of narcotics or stimulants.
No restrictions on surgical procedures.
Holy days and Saturday is the Sabbath, a day of worship and rest.
festivals
Pregnancy and Birth control is an individual choice.
birth Abortion is discouraged but the choice is left to the conscience of the
woman.
Opposed to infant baptism.
Rituals and Pastors and elders may pray and anoint ill person with oil.
Ceremonies
Spiritual In some groups, all pastors and elders are male. In other groups,
instruments, females do serve in these roles.
structure and
symbols

15
Islam (Muslim)
The religion is “Islam”. Those who practice this religion are “Muslim”.
The Five Shahadatain (Declaration of Faith) - To declare there is only one God,
Basic Allah, and that Muhammad is his messenger.
Principles of Salat (Prayer/ Worship) - Muslims must pray five times a day. The
Al- Qur’an is the final revelation to Humanity.
Islam/Beliefs Zakat (Charitable Contributions) - Requires that once a year a Muslim is
to give at the rate of 2.5% to a charitable cause.
Sawm (Fasting) - Participate in the month long fast of Ramadan, in
which they restrain from food, drink, and sex during daylight hours.
Hajj (Pilgrimage to Mecca) - If in good health and with enough money,
one must make the pilgrimage to Mecca once in their lifetime.
Beliefs One God, or Allah, is most important principle.
Complete submission to God.
Prophet Muhammad and Holy Qur’an.
A judgment day and life after death.
Commitment to fast during the holy month of Ramadan: abstaining from
food, drink, sexual intercourse and evil intentions and actions.
Commitment to attempt a pilgrimage to Mecca (in Saudi Arabia) at least
once in life.
Duty to give generously to poor people.
Belief in Oneness of God.
Belief in His Angels.
Belief in His Books (All the revealed Scriptures).
Belief in His Messengers (All of them).
Belief in Hereafter (Life after Death).
Belief in the Day of Judgment.
Belief in Reward and Punishment.
Daily May engage in prayer 5 times a day facing Mecca (dawn, mid-day, mid-
Practices afternoon, sunset, night); face, hands and feet are washed before
prayer. Do not interrupt or walk in front of patient when he/she is saying
prayers unless it is an emergency.
Days of observance occur throughout the Muslim lunar calendar.
Dying and Death is controlled by God’s plan.
Death Euthanasia or any attempt to shorten life prohibited.
Organ or body donation acceptable.
Autopsy permitted only for medical or legal reasons.
Confession of sins and begging forgiveness often occurs in presence of
family upon death.
Important to follow five steps of burial procedure which specifies
washing, dressing, and positioning of the body. First step is traditional
washing of the body by Muslim of same gender.
As moment of death approaches, Islamic Creed should be recited.
Grief expressed by shedding tears, but forbidden to wail, beat breast,
slap face, tear hair or garments, or complain or curse.

16
The Janazah Prayer (Prayer for the deceased) must be said in Arabic
and led by a male- an Imam is preferred. This process should take
place within 72 hours after death. Therefore, a death certificate
should be signed quickly to facilitate the process.
Facilitating Explore what practices are most important to patient/family.
practices Be aware that some customs prohibit handshakes or any contact
between genders.
Female patients may want a female physician.
Be aware of language barriers.
Food Tayyib: what is good, pure, clean, wholesome, nourishing, pleasant and
tasteful.
Halal: what is lawful and allowed for Muslims to eat.
Halal Diet: Pork, and some shellfish prohibited; alcohol is possibly
prohibited.
Only vegetable oil to be used.
Any food invoked by a name besides God’s may be prohibited.
Children, pregnant women, and those who are ill are exempt from
fasting laws, however may resist and need support from faith
group/leader.
May only eat with right hand, which is considered to be the clean hand.
Health No restrictions on blood or blood products, medications, amputations,
organ transplants, or biopsies.
Most surgical procedures permitted.
Doctors are seen as helpers of God’s will.
Abortion is prohibited except in cases of rape, incest and if the life of the
mother is threatened. A fetus is considered a human being after 25-
week gestation.
Holy Days Fasting during the month of Ramadan is included in the 5 pillars of Islam
and Festivals and is considered to be a spiritual obligation. Fasting happens from
sunrise to sunset. The ill and children are exempt from fasting, but they
may join anyway if safe to do so.
Jum’ah Prayer (Congregational Prayer) held every Friday, the Holiest
Day for Muslims and takes place at noon prayer. One may not work
during this time.
Islamic days are based on the lunar calendar. Muslims do not work on
two Holy days during the year; 1) Eid-ul-Fitr (Celebration of the Fast
Breaking)- this is held on the first day of the ninth month of the lunar
calendar. 2) Eid- ul- Aha (Celebration of the Sacrifice of Abraham) - a
three day celebration beginning on the 10th day of the twelfth month
called Dhul Hijjah.
These Holy days consist of prayer and a short sermon in congregation
followed by food, entertainment, feeding of the poor and visiting the sick
and shut-in.
Pregnancy At 25 weeks gestation the fetus is considered a living human being.
and birth Before and after that period there are no abortions, except if the
Mother's life is threaten. In any case it is the decision of the Mother

17
Rituals and There are many cultures in Islam that have their own particular rituals
Ceremonies and ceremonies such as facing the east before death, but there
are religious rituals and ceremonies that cross all cultural lines such as;
A Akika (New born ceremony) naming the child within 7 days of birth
with family and friends. Chapter 96 (Yasin) is read to the sick. The
declaration of Faith is said at the end-of-life by patient. Washing,
shrouding and Janazah Prayer (Funeral Service) and burial are done
with-in 72 hours of death.
Spiritual Muslims turn to the Kaaba (House Built to Worship One G-D) to pray 5
instruments, times a day, when the direction is known, although they can pray in any
structure and position or direction if dictated by circumstances. There are no symbols
symbols or signs that represent Islam except the Holy Qur'an.
Sunni Shia
Sunni roughly means “words and Shia roughly means‚ Party of Ali.
actions” or example of the Prophet Believe that when the prophet
Muhammad. Muhammad died, it was his wish that
Believe that when the prophet Ali, his cousin and son-in-law, would be
Muhammad died, it was his wish that the new caliph.
the next leader would be elected. Abu Believe that the caliphs (leaders) of
Bakr, Muhammad’s closest friend, was Islam should continue to be direct
elected. descendents of the Prophet
Believe the caliphs (leaders) of Islam Muhammad.
should continue to be elected (and they Shia Muslims choose to ignore the
are). elected Sunni leaders, and instead
85% of Muslims are Sunni. follow their own leaders, direct
descendents of Muhammad called
Imams.
15% of Muslims are Shia.
Iran and Iraq are the only countries that
have a majority of Shia Muslims. Shia
Muslims are the minority in the rest of
the Islamic world.
Can also be found in Pakistan,
Azerbaijan, Afghanistan, India and
Syria.
Some Shia Muslims pray only 3 times a
day; all Sunni Muslims pray 5 times a
day.

18
Judaism
All believe:
There is one all-powerful God who created the universe.
God communicated the commandments to Moses on Mount Sinai, they
are written in the Torah.
Commitments, obligations, duties, and commandments to religion have
priority over rights and individual pleasures.
Sanctity of life overrides nearly all religious obligations. Therefore, the
sick are exempt from normal fasting requirements.
Major Jewish Movements:

Orthodox
Conservative
Reform
Note- In describing a person’s religious affiliation, be aware that there are Orthodox Jews and
(Eastern) Orthodox Christians both often referred to as “Orthodox”. Likewise, someone who
labels themselves as “Reform” is Jewish. Someone who labels themselves as “Reformed” is
Christian.
Orthodox Jews believe in:
Strict and traditional interpretation of the Torah.
Strict and traditional interpretation of laws and commandments.
That the Torah is divine and unalterable.
Following of the code of Jewish Law.
Conservative Jews believe in:

Acceptance of traditional and modern religious observances.
Conservation of Jewish tradition, but also changing to fit modern times.
Reform Jews believe in:

Freedom to interpret the Torah and choose religious observances.
Beliefs Majority of Jews unaffiliated-Judaism can be seen as identity

and not faith system.
Orthodoxy is the most fundamental of the movements-
adhering to Written and Oral Laws.
Conservative sees revelation as divinely inspired and
contains a large tent between Orthodoxy and Reform.
Reform sees revelation as interpreted by the individual in a
dialogue between Jewish history and contemporary wisdom.
Other smaller movements generally fall on the more liberal
side although there is a branch loosely known as Ultra
Orthodox.

19
Daily Practices Orthodox- May pray three times daily-ideally in community.
Less open to non-liturgical prayer life.
Conservative-Daily prayers valued. Individual approaches
can vary.
Reform- prayers are valued- can be more open to multi-faith
and prayers at bedside.
Dying and Death Belief in life after death accepted by Orthodox and
Conservative; Reform acknowledges as part of tradition but
allows for individuals to form their own belief system.
Persons experiencing grave suffering and/or approaching
death are usually encouraged to connect with community (all
denominations) and pray appropriately to denominational
beliefs.
Prayers for sick can be an important part of faith in illness for
those who celebrate their Judaism in a religious fashion. The
most common prayer used in this context is called
micheberach.
Autopsy and Organ Donation acceptable to the Conservative
and Reform movements and smaller segments of Orthodoxy.
Always have families in touch with their rabbi.
Body to be treated with respect. Family may want to stay
with the body until it is removed by the funeral director.
Burial recommended as soon as possible.
Cremation either prohibited or discouraged.
Graveside and funeral home services are typical.
Facilitating Ask patient and family about preferred practices.
Practices Provide for privacy as needed.
Food Orthodox and many Conservative will need kosher-certified
food.
Health Blood and blood products acceptable.
May wish major amputated limb to be buried in consecrated
ground.
Consult Rabbi with issues of tube feeding and life support.
Holy days and Rosh Hashanah- Jewish New Year (Solemn).
festivals Yom Kippur-Fast (no eating or drinking); Day of Atonement.
Sukkot- Weeklong festival of Tabernacles.
Channukah- eight day festival of lights.
Purim-Preceded by Fast of Esther (no eating or drinking)
holiday of the Book of Esther.
Pesach/Passover- Week long Holiday of Freedom.
Shavuot/Pentecost- Holiday of revelation.
Asara B’tevet, Tzom Gedalia,Shiva Asar B’Tamuz and Tisha
B’Av- fast days (no eating or drinking) of mourning.
NOTE- be in touch with rabbi to facilitate religious celebration
in a healing environment- especially around fasting.
Sabbath and Holy Days can be days where electricity is not
used(Orthodox)- consult with Rabbinic authority
20
Pregnancy and Orthodox- Consult Rabbinic authority about birth control.
birth Other denominations are more liberal.
All denominations allow abortion to save the mother- consult
Rabbinic and other authorities.
Rituals or Synagogue/Temple attendance.
ceremonies Lighting candles before Sabbath and Holidays.
Be aware of cultural differences in observance and practice,
especially in the large and growing number of Spanish
speaking communities.
Spiritual Electric Sabbath Candles can be meaningful.
instruments,
structure and
symbols

21
Eastern Religions
Buddhism
*There are 3 major Buddhist traditions: Theravada, Mahayana, and Tibetan

Beliefs The main goal is to reach spiritual enlightenment through meditation
and conscious living.
Personal insight replaces belief in God with the complete study of the
laws of cause and effect (Karma).
Daily Practices May include meditation or chanting according to the form of
Buddhism the Buddhist follows.
Dying and Death All rituals at death are aimed at promoting human rebirth in the next
life, as well as preventing lower forms of rebirth taking place.
May wish prayers/chanting to take place.
Person’s state of mind at moment of death believed to influence
rebirth, so they will want to be calm and peaceful.
Person may not want medication while dying if it affects clarity of
mind.
Imperative that a Buddhist representative be notified well in advance
to see that appropriate person presides over the care of a dying
person.
Unexpected death or death of small child may necessitate special
rituals.
Traditionally, there is a 3-5 day period when the body is not disturbed
following death.
Facilitating Allow for quiet time to observe practices.
Practices Ensure calm and peaceful environment and comfort, especially for
dying person.
Food May be vegetarian, may avoid stimulants (coffee, alcohol, tobacco).
Health Illness is a result of karma (law of cause and effect), therefore an
inevitable consequence of actions in this or a previous life.
Health is holistic (connect between mind and body); mental cures are
important.
Healing and recovery promoted by awakening to wisdom of Buddha,
which is spiritual peace and freedom from anxiety.
Do not believe in healing through faith.
No restrictions on blood or blood products, surgical procedures,
organ donation, autopsy.
Medications acceptable if in great discomfort as long as they do not
affect state of mind.
Holy Days and While some celebrations are common to all Buddhists, many are
Festivals unique to particular schools.

22
Pregnancy and Artificial insemination, sterility testing and birth control acceptable.
birth Buddhists do not condone taking a life; circumstances of patient
determine whether abortion acceptable.
Pregnant women may avoid funerals to prevent bad luck for baby.
Rituals or There is a monthly atonement ceremony on the full moon. The major
ceremonies rituals are around baby blessings, lay and monk ordination, marriage
and death.
Spiritual Incense burning, flower and fruit offerings, altars/images/statues of
instruments, Buddha, social and ancestors, prayer beads, chant boxes.
social structure Ordained spiritual community involves full ordination for women and
and symbols men.
Lay vows for women and men.
No institutionally organized hierarchical structure.
Buddha image, lotus, swastika-looking symbol (which represents
peace).
Hinduism
*3rd largest religion in the world
*Large population in India, Nepal and Bangladesh
Beliefs A wide variety of beliefs held together by an attitude of mutual

tolerance and belief that all approaches to God are valid.
Humankind’s goal is to break free of this imperfect world and reunite
with God.
Reincarnation and karma (law of cause and effect).
One must perform his/her duties to God, parents, teachers and
society.
Daily practices Personal hygiene very important and bathing is required every day,
but bathing after meal may be viewed as harmful.
Hot water may be added to cold, but not the opposite.
Removal of shoes before entering a room.
Dying and Death The atmosphere around the dying person must be peaceful.
The last thoughts or words are of God; the Gita (scripture) is recited
to strengthen the person’s mind and provide comfort. Religious
chanting before and after death is continually offered by family,
friends and priest.
Prefer to die at home, as close to mother earth as possible (usually
on the ground).
Active euthanasia viewed as destructive.
No custom or restriction on prolongation of life.
Immediately after death priest may pour water into mouth of
deceased and family may wash the body.
Customary for body not to be left alone until cremated.
Autopsy and organ donation acceptable.
Cremation is common on day of death.
Fetus or children under age 2 may be buried; no rituals observed.
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Facilitating Provide supportive environment and privacy for rites.
practices Involve family members in plan of care and determine which
member will provide personal care.
Father/husband is primary spokesperson to whom questions should
be directed - women may not request special care.
Special respect for elders.
Food Usually vegetarian.
If not vegetarian, may avoid beef and pork.
According to dietary law, right hand is used for eating and left hand
for toileting and hygiene.
May fast on special holy days
Health Prayer for health considered low form of prayer; stoicism is
preferable.
Medications, blood and blood products, donation and receipt of
organs.
Holy Days and Several, which are observed at home; some take place in a temple.
Festivals Must be barefoot during religious worship or any kind of religious
celebration.
Must sit at a lower elevation than where the image of the deity has
been placed.
Pregnancy and Exact time of birth may be important to family.
Birth Circumcision is uncommon.
May not want to name the newborn immediately.
May be against abortion.
Birth control, artificial insemination and amniocentesis acceptable.
Rituals and On 10th or 11th day after birth, priest performs naming ceremony.
Ceremonies Specific ceremonies vary according to local customs.
Praying, meditating, scripture reading and recitation is common.
Spiritual Various sacred writings
instruments, Various objects for rituals- including sandalwood, incense, candle,
structure and symbols structure and or pictures, fresh flowers, prayer beads.
symbols Not a church-based religion; no hierarchical structure.
Religious practitioner is priest acceptable.
Pain and suffering seen as result of past actions (Karma).
Future lives influenced by how one faces illness, disability and/or
death.

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Sikhism
*Mostly from Pakistani and Indian region of Punjab
Beliefs God is formless, eternal, and unobserved.
God is the supreme Guru, revealed as guide and teacher
throughout the World.
Reincarnation as a cycle of rebirth.
Tension exists between God’s sovereignty and human free will.
Salvation is liberation from the cycle of rebirth. Salvation can be
achieved through disciplined meditation and spiritual union with
God.
Ideal life is one of work, worship and charity.
Equality of all people.
Daily Practices Private worship twice daily: Morning and night.
Following of the 10 Sikh gurus (enlightened leaders) and the Holy
Scriptures.
Dying and Death Body is bathed, dressed, and cremated.
Floor is washed and covered with white sheets; shoes taken
outside the room.
Facilitating Provide privacy.
practices Respect wearing of religious objects; do not remove without
permission.
Food Fasting not accepted as a religious practice, although can be
observed for medical reasons.
Health Adult members have made a vow never to cut the hair on any part
of their body.
Holy Days and Meet as a congregation for prayer service and common meal on six
Festivals primary holidays.
Pregnancy and Child is often named by opening the Guru Granth Sahib (book of
Birth collected religious writings) at random; the first letter of the first
verse on the left- hand page becomes the first initial of the child’s
name.
There are no particular rituals connected with the birth of a child in
the Sikh community. Some sections of the Sikhs recite the five
verses of the Morning Prayer, Japji Sahib into the ears of the
newborn child.
Gurthi: A respected, intelligent and favorite member of the family
gives a drop of honey to the new born child so as to give the child
his characters later in life. This is not a ritual and it mostly takes
place in the hospital itself.
Shushak: When a child is born into the Sikh fold, the maternal
grandparents gift him a package called Shushak, which consists of
clothes for the child and his family, a spoon, glass, and a bowl for
the child, money and gold ornaments for the child according to their
financial status.

25
Rituals and Sikh Baptisms (Amrit).
Ceremonies Naming Ceremonies.
Birth Ceremonies.
Spiritual Guru Granth Sahib, collection of religious writings, is the “Living
instruments, Word” and instruments, the “Living Guru” or teacher.
structure and A turban may be worn as a symbol of personal sovereignty and
symbols symbolizes responsibility to others.
Symbolic objects include wooden comb, cloth around chest, and
iron bracelet which must never be removed.
Local leadership consists of elected committee of 5 elders.
Khanda, which reflects certain fundamental concepts of the faith
(looks like two swords crossed with a circle overlapping).

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Other Religions
Bahá’í
Beliefs The oneness of God, the oneness of religion, and the oneness of
humanity.
All great religions are divine in origin and represent successive
stages of revelation throughout human history.
Unification of humanity and end of racial and religious prejudice.
Search for truth is an individual responsibility.
Harmony of religion and science.
Basic education for all children.
Abolition of extreme wealth and poverty.
Equality of the sexes.
Daily Practices Daily prayer and reading of Bahá’í sacred writings.
All work performed in the spirit of service is considered to be
worship.
Dying and Death An individual’s reality is spiritual, not physical.
The body is seen as the throne of the soul, worthy to be treated with
honor and respect even when dead.
After death, the soul continues to progress to the next stage of
existence closer to God.
Body should be buried, not cremated, preferably without embalming
unless required by law.
Body must not be transported more than one hour’s journey from the
place of death.
For persons over 15 years old, the Prayer for the Dead is recited at
burial.
Facilitating Provide privacy and supportive environment.
Practices
Food Bahá’í Fast March 2-20: Bahá’ís over the age of 15 who are in good
health abstain from food and drink from sunrise to sunset each day.
Health Consumption of alcohol or mind-altering drugs is forbidden except
when prescribed by a physician.
Holy Days and 7 Holy Day festivals per year in which one does not work or go to
Festivals school.
Other Holy Days also observed.
Pregnancy and No special requirements.
Birth
Rituals or Daily private prayer and annual fast lasting throughout day from
Ceremonies sunrise to sunset March 2-20.
Spiritual Bahá’í prayers for private worship.
instruments, Local, national and international representatives.
Social structure Authorized representatives perform special religious rituals.
and symbols 9 pointed star.

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Hawaiian Spirituality
(Content provided by: Kanoelani Davis, Cultural Health Navigator Manager, Molokai Community
Health Center)
No founder; tradition has evolved over centuries, passed down through genealogy and
storytelling.
Beliefs Fundamental inter-connectedness of all natural things; all forms of

life, with the land are of primary importance.
Basic sense of community or group.
‘Aumakua’ are regarded as family guardians and are respected.
Daily Practices Daily prayers.
Days of observance occur throughout the lunar calendar.
Dying and Death Body to be treated with respect.
Disposal of body and burial are individual decisions.
Facilitating Provide time, space, privacy & include the spiritual leader or elder.
Practices Do not pretend to be familiar with traditions and do not interfere with
them.
Involve family members in plan of care and determine which
member will provide personal care.
Special respect for elders.
Food No general dietary restrictions.
Fasting as a traditional practice
Depending on the ceremony specific foods are used. ‘Awa is used
more commonly.
After ceremony or prayer, foods consumed will likely be provided
by family.
Health May believe that all bad health results from not living in harmony
or being out of balance with nature, social relationships, and/or
supernatural environments.
Health is holistic (connection between mind, body, and spirit);
mental cures are important.
Health care practices intertwined with religious and cultural
beliefs.
Medications acceptable if in great discomfort as long as they do
not affect state of mind.
Belief in a long partnership with provider and self for the continuity
of their health. Each person is valued for their responsibilities to
becoming healthy.
Holy Days & Closely related to seasonal changes, the moon, provision of food
Festivals and other life essentials.
Pregnancy & Pregnant women may avoid funerals.
Birth Avoid wearing Lei or garlands in a full circle are practiced to avoid
unfortunate circumstances.
Certain foods may be avoided during pregnancy.
28
Belief that pregnant women should be massaged by specialized
practitioners to avoid early labor.
Names for newborn may take up to a month to be revealed to the
mother as many rely on dreams, signs, and visions to occur.
Rituals & Performed with intent of seeing, understanding, or obtaining a
Ceremony vision of clarity of oneself and individual issues in order to relate
to one’s self and others.
Ceremonies are done to connect to self and elements for value
and respect.
Prayers, fasting, and silence for healing.
Chanting for various rituals and ceremony.
Females that are menstruating are asked to be observers during
ceremony and have a separate responsibility from those who are
active in specific ceremonies. Depending on the district or
tradition, this may vary.
Sex, alcohol, nicotine, and drug consumption is avoided.
Spiritual There are no written scriptures or writings; everything is handed
instruments, down by generations, practices, traditions, & stories.
structures, and Offerings are generally called ho’okupu which is valued from the
symbols time it is gathered to the time it is given. It should not touch the
ground or by a female who is menstruating.
Females that are menstruating are asked to be observers during
ceremony and have a separate responsibility from those who are
active in specific ceremonies. Depending on the district or
tradition, this may vary.
Traditional ceremonial wear is to be expected
Cleansing prior to ceremony is done and may start days to weeks
prior to the actually ceremony and can include fasting and a
physical cleanse internally and externally.
Silence is golden and observation is key.
Respect for female and male elders.
Respect for the care takers and protectors of images and to
prostrate before them.

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Native American Spirituality
*No founder; tradition has evolved over centuries, passed down by storytelling.
*More than 2 million people in 300-500 different American Indian tribal groups, each with its own
culture and responses to specific situations.
Beliefs Creator - some tribes use “God” and “Creator” interchangeably.

Fundamental inter-connectedness of all natural things, all forms of
life, with the land, or Mother Earth, are of primary importance.
Basic sense of community or group/tribe.
Daily Practices Prayers, may include using sacred objects, usually private and
without strangers present.
Dying and Death Beliefs and practices vary widely from tribe to tribe.
Body is sometimes prepared for burial by family or tribe members.
After person dies, some tribes will not touch deceased person’s
clothes or belongings.
Facilitating Provide time, space, privacy and include tribal spiritual leader.
Practices Do not pretend to be familiar with traditions and do not interfere
with them.
Food After ceremony or prayer, foods consumed will likely be provided
by family.
Health Health care practices intertwined with religious and cultural beliefs.
May believe that Ill health results from not living in harmony or
being out of balance with nature and social and supernatural
environments.
Holy Days and Closely related to seasonal changes, the moon, provision of food
Festivals and other life essentials.
Pregnancy and Pregnant women included in religious ceremonies until delivery.
Birth
Rituals or Performed with intent of seeing, understanding, or obtaining a
Ceremonies vision of clarity of oneself and individual issues in order to relate to
oneself and others.
Prayer accompanied by burning of sacred plants, i.e. sweet grass,
sage, cedar or tobacco.
Spiritual No written scriptures; ceremonies and beliefs learned by word of
Instruments, social mouth and instruments experience.
structure and Sacred and should not be touched without permission, especially
symbols by a stranger.
Medicine bag: leather pouch usually worn around neck. Do not
open or question.
Religious articles carried by elders must not be touched by anyone
other than the elder; if inspection is required, an elder should be
invited to provide inspection services.
A woman should not come near sacred objects during
menstruation.
Respect for female and male elders.
Medicine Man or Woman will probably not have identification
defining member.
30
Include elder, medicine person, or spiritual leader as colleague to
assist in healing process.
A great variety of symbols which vary from one tribe to another.
Rastafarian Movement
*Started in the 1930’s in Jamaica
*About 10% of Jamaicans are Rastafarian
Beliefs One God, Jah, is the former emperor of Ethiopia (Haile Selaissie I)
incarnated. He is the messiah promised in the Bible.
Superiority of African civilization and culture.
Being all-natural and as close to nature as possible.
Love and respect for all living things.
The dream of returning to Africa (original home).
Following of the Old Testament.
Spiritual use of marijuana.
Daily Practices Often wear dreadlocks, either as a religious decision or a style
decision. However, not all Rastafarians have dreadlocks.
May not wash hair or body to be all natural.
Buttons and pins with images of Haile Selaissie or the Lion of Judah.
More conservative Rastafarians may wear robes and head scarves.
Knit hats.
Dying and Believe in everlasting life. As a result, they might be hesitant to
Death prepare for death or talk about terminal illness.
Since death is not real, they believe that Haile Selaissie I is still alive
Food Limited meat- no pork or shellfish (following of Old Testament

restrictions).
May avoid all meat.
May be vegan.
May avoid alcohol.
Caribbean food is popular, especially healthy fruits and vegetables.
May only want to eat natural foods, called “I-tal” foods in Jamaica.
Jamaican Patois, the Jamaican Creole, may be hard to understand

because of the patient’s accent and idioms. However, they can
usually understand English since the language is English-based.
Some Rastafarians speak Amharic, the original language of Ethiopia.
However, this is not common and most speak English or Jamaican-
English.
Health The body may be seen as a church. Therefore it is sacred and they
may be hesitant to put anything unnatural into it.

31
Rituals or May include discussion, singing, dancing, and marijuana use.
Ceremonies Readings of the Old Testament.
Spiritual Believe in the spiritual use of marijuana. Marijuana is common during
instruments, ceremonies or habitually. It is acceptable because it is considered to
social structure be natural.
and symbols Marijuana is seen as cleansing, spiritual, and written about in the
Bible.
May avoid taking any un-natural drugs.
Local, national and international representatives.
Authorized representatives perform special religious rituals.
Often red, yellow and green (colors of the Ethiopian flag).
Santeria
Beliefs Similar to Voodoo spirituality.
Mix of Catholic rituals and various African deities.
Healing May seek a Santeria priest for physical and mental healing who may
use herbal formulas, prayers, and ritual.
Ceremonies Mostly performed secretly at home because of Santeria’s stigma.
Can include spells, magic, and animal sacrifice.
Voodoo
*There are many variations of Voodoo…the following describes Voodoo Spirituality
found in the United States
Beliefs There is one God, Bondye, and many other spiritual beings, called
Iwa.
Iwa are the ruling force of the world, they decide the fate of
everything. They are asked for help and for change.
Ceremonies Include drums, dancing and animal sacrifice. Animals are sacrificed to
please and thank the spirits.
Because many Westerners are afraid of Voodoo culture, ceremonies
may be held in secret.
Demographics Originated in West Africa. It has spread to the Caribbean, the
Philippines, North and South America.
Healing Spiritual healing may include herbs, ritual, and faith healing.

32
Wicca
*Historically have met in small private groups called covens, which are autonomous
although many share common traditions.
Beliefs Polytheistic - many gods and goddesses.

Principal deity is the Earth/Mother Nature.
Concern for ecological issues.
Reconstructs the ancient worship practices of pre-Christian
civilizations such as the Greek, Norse, Celtic, Sumerian or
Egyptian.
Law of Nature: no action can occur without having significant
repercussions throughout the world, eventually returning to affect
the original actor.
Daily Practices Individual study.
Principal form of worship is usually called ritual or circle.
Dying and Death Beliefs and practices vary.
No restrictions on autopsy.
Facilitating Make time and space for rituals; provide privacy and quiet.
Practices Consecrated items must not be removed from patient or handled
by anyone but the wearer.
Food May not desire various foods due to beliefs; ask for preferences.
Health Patient may want to contact his or her coven to request a healing
rite.
Holy days and Various.
Festivals
Pregnancy and Rituals for blessings of pregnancy performed by women of
Birth community and are held every trimester of pregnancy.
Ritual of naming and blessing of children.
Rituals and Rituals are a large part of the Wiccan faith.
Ceremonies Full moon held to be a time of great magical energy, a good time
for putting a lot of effort into one’s spiritual life and work.
Spiritual Written works and codes of conduct.
Instruments, Consecrated pendant in the form of a pentacle/pentagram
social structure (interlaced five pointed star within a circle) is often worn; don’t
and symbols remove without asking.
Various sacred objects including a wand, chalice, wine or juice,
incense, candles, images of gods or goddesses, herbs, oil.
Weekly worship and classes.
Priests and priestesses perform special rituals.
Five-pointed star inside a circle.
A variety of symbols are used.

33
Cultures
Major American Cultures
African-American/Black Culture
Cultural and Family Structure
Important Historical Distrust of medical culture due to experimentation and abuse.
Issues Extremely diverse population; determine subgroup, such as
Caribbean or African immigrants/cultures.
Clothing or Amulets Religious items
Language English
Communication, May have regional dialects.
Nonverbal, and Refusal to sign forms could indicate literacy issues or distrust.
Greetings Address by title and last name.
Handshakes are appropriate for both men and women.
Maintain eye contact to show respect and assess/establish trust.
Silence may indicate lack of trust and/or arrogance.
Family structure Nuclear, extended and single parent households.
Often family friends are referred to with familiar pronouns, i.e.
Uncle, Aunt, etc.
Food May have religious restrictions against certain foods and drinks.
practices/beliefs
Spokesperson and Usually father or eldest male family member; however many
Decision-making Black homes are led by a strong matriarch, such as a
grandmother or single mother.
Determine who has final role within nuclear family as this can
vary widely from family to family.
Time orientation Life issues may take priority over keeping appointments.
Health, Illness and Death

Illness beliefs Varies from natural causes and exposure to cold air to God’s
punishment or work of devil or a spell/curse.
Consents Avoid using medical jargon.
Solicit feedback to assess understanding of the patient and/or
his or her family.
Invasive Procedures Historically skeptical, though with clear explanations, needed
surgery is accepted.
Pain Pain scales helpful.
May not wish medication due to fear of addiction.
Visitors May bring food and/or desserts.
May sleep at bedside.

34
Terminal Illness Patient and family may wish to include spiritual/religious leader.
Discussion
Dying Process May show open and public display of immense grief.
Attendance from family and relatives expected but
independence maintained.
Death-Special May have spiritual practices or rituals that can vary from Islam to
Needs Baptist Christianity.
Death-Body Care May want professionals to clean and prepare body.
Organ Donation May be hesitant due to lack of trust, faith issues, or fears;
however number of consents continues to increase.
Pregnancy, Birth, Postpartum

Prenatal Care Varies; may wait until after first trimester.
Labor Active participant.
Father’s role varies; may have only females present.
C-Section Accepted if indicated.
Postpartum and May refuse bath/shower or hair washing until bleeding stops.
Breastfeeding Breastfeeding benefits need to be explained
Genetic Defects May be viewed as God’s will.
and/or Sick Newborn Older females in family relied on for support.
Religious and Spiritual Practices

Religion Prayer, visits from spiritual leader and/or faith group members
depending upon spiritual tradition.
Spiritual Healing May incorporate faith and folk healing.
Hispanic-American Culture
Preferred Term: Hispanic or Latino

Important Historical Wide diversity due to area of historical or recent country of
Issues origin
Clothing or Amulets Religious items, such as rosaries, frequently kept on person or
on bed.
Language Spanish and American-English.
Communication, Differences in word usage depending on individual’s home and
Nonverbal, and region.
Greetings Oral English skills may exceed skill in reading and writing
English. May speak Spanish at home even if born in the US.
Same gender translation if possible.
Strongly influenced by respect.
Direct eye contact often avoided with someone perceived to
have more authority, i.e. doctors
Handshaking considered polite and usually welcomed.
Address individuals formally, especially elders; include children.
Silence may mean disagreement
35
Spokesperson and Usually head of household - father or oldest male.
Decision-making Important decisions may require consultation among entire
family.
Traditionally, father or oldest male holds ultimate authority.
Family structure Strong sense of loyalty, reciprocity, and solidarity among
members.
Mothers revered for cultural wisdom and life experience. Usually
families are matriarchal.
Food Some patients may adhere to hot/cold theory of foods.
practices/beliefs
Time orientation Traditionally present-oriented and punctual.

Illness beliefs Health is controlled by God and by fate.
Holistic understanding of emotional, spiritual, social and physical
factors; including connection between mind (emotions) and body
Illness seen as a crisis for the entire family.
Modesty very important.
Consents Requires clear explanation of situation and choices for
intervention.
Invasive Procedures Usually accepted if practitioner is trusted.
May ask for amputated limb so it can be buried in consecrated
ground.
Pain Patients tend not to complain of pain; assess by nonverbal
clues.
Visitors Stressful for individual to be separated from family group.
Large numbers of visitors, usually quiet and respectful.
Terminal Illness Family may want to protect patient from knowledge of
Discussion seriousness of illness due to concern that worry will worsen
health status.
Information usually handled by family spokesperson.
Traditionally women look after person with terminal illness at
home; may be resistance to placement in a nursing home or
other facility
Dying Process Family member at person’s side at all time
Strong religious faith may lead one to believe that a miracle may
still happen
Extended families obligated to attend to sick and dying and pay
respects.
Hospital environment may be seen as restrictive to family
needs, i.e. attendance of large number of family
Death-Special Prayers commonly practiced at bedside of dying patient.
Needs Family time with body before it is taken to morgue.
Death-Body Care Death a very important spiritual event.
Relative or member of extended family may help wash the body.
Organ Donation May have misinformation, i.e. not understanding that brain
death means death; ensure full understanding of facts.

36
Prenatal Care May believe unnecessary; assess for barriers such as finances,
transportation
May use folk medicine and have traditional beliefs, such as
mother avoiding evil eye, be frightened, or having cravings
unfulfilled; beliefs not always shared with practitioners.
Culture may prohibit pregnant women from caring for dying
person or attending funerals.
Medications, including iron and vitamins, may be seen as
potentially dangerous and avoided, even after delivery.
Labor Walking recommended to encourage quick birth.
Fears include unnecessary or dangerous medical interventions,
separation from family members and loss of privacy.
Laboring women seen as strong and participatory.
Female relatives may assist.
C-Section If needed for health of mother or baby
Postpartum and May resist getting out of bed for or taking showers for several
Breastfeeding days.
May cover back and wear a wide cloth band around abdomen.
Breastfeeding and bottle both acceptable
Genetic Defects Traditional family may feel that new mothers should be
and/ or Sick Baby sheltered from worry.
Baptism of infants may be especially urgent to Christian/Roman
Catholic families if prognosis is grave.
May be interpreted as will of God
Family may prefer to take care of disabled rather than long-
term care.

Religion Roman Catholic, Protestant, Jehovah’s Witness, Mormon (LDS)
Virgin of Guadalupe may be a powerful and popular cultural
religious image.
Daily prayer common.
Prayer and anointing of the sick may be important rituals.
Spiritual Healing May use traditional healers or healing remedies.
Native American Culture

Preferred Term: Tribal Name

Important Historical Native American culture is not comprised of only one
Issues tribe/nation but rather a collection of many.
Spiritual and healing methods vary between tribes
Clothing or Amulets Certain forms of dress indicate rank, specific kin and individual
role as a member of their respective society
Feathers, prayer ties, dreamcatchers and other items all have
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symbolic meaning regarding prayer and/or healing
Do not casually move, examine, or admire medicine bag or
other symbols.
If removal required, allow patient or family to handle it, keep it
close to person and replace as soon as possible.
Burning sage brings purification; spray sage acceptable in room
Language American-English, French, Spanish, Native American
Languages.
Communication, Do not interrupt speaker.
Nonverbal, and Long pauses are part of conversation.
Greetings Tone expresses urgency; when imperative command required,
be direct, emphatic, clear, and calm.
In making request, explain why it is needed; be personable and
polite.
Loudness associated with aggression
Respect communicated by avoiding eye contact.
Keep respectful distance.
Light touch handshake.
Spokesperson and Generally, individuals speak for themselves, family members may
Decision-making speak on behalf of person who is ill.
Give information and let family know providers need to know
family’s wishes for care/treatment; let spokesperson emerge from
family.
Spokesperson may not be decision maker.
Autonomy highly valued; do not assume spouse would make
important decision.
Includes responsibility to community, family and tribe.
Family structure May be either matriarchal or patriarchal.
Elders respected.
Children not encouraged finding help outside family.
Food Hospitality and respect may lead patient to sharing hospital food
practices/beliefs with visiting family and friends as well as consume food brought
by visitors.
Nutritional guidance should respect religious choices and
incorporate them; May believe that when food is blessed it is no
longer harmful.
Time orientation Emphasis on present moment may conflict with appointment
schedules.
Expect careful consideration in answering questions.
Rushing an elder is considered rude and very disrespectful.

Illness beliefs Mental illness a culturally specific concept; beliefs about cause
may include ghosts, breaking taboos, or loss of harmony
w/environment.
Sick role is to be quiet and stoic.
Home and folk remedies may be common.

38
Consents Talk about everyone’s role in procedure, family’s as well as
patients.
Allow time for consultation with family before consenting, if
possible.
May be unwilling to sign written consents based on political and
personal history of documents being misused or fear that worst
will happen.
Consent processes may lead families to believe they are not
being heard, or not considered competent.
Invasive Procedures May be skeptical of procedures but will allow treatment if
needed.
Likely to ask for amputated limb so it can be buried according to
customs
Pain Generally under-treated.
May complain in general terms or may complain to trusted
family member or visitor who will relay message to health care
worker.
Visitors Extended family may visit or hold rituals for critically ill person.
Terminal Illness Some cultures prefer not to openly discuss terminal status and
Discussion DNR orders discussion due to belief that negative thoughts may
hasten events and/or death
Dying Process Some tribes avoid contact with the dying.
If family wants to be present 24 hours a day, this may include
immediate and extended family and close friends; small children
also included.
Although outcome tacitly recognized, positive attitude
maintained and family may avoid discussing impending death.
Sadness and mourning done in private, away from patient.
May prefer to have body oriented toward a certain direction prior
to death.
Family may hug, touch, sing, and stay close to deceased.
Wailing, shrieking and other outward signs of grieving may
occur.
Death-Special Be prepared to support or inquire if family wants to bring in tribal
Needs healers to attend to spiritual health.
Death-Body Care Traditional practices include turning and/or flexing body,
sweetgrass smoke care or other purification, women may want
to prepare and dress body.
Family may choose to stay in room with deceased for a time,
then have individual visitation; other tribal traditions prohibit any
contact with deceased.
Ask if it is acceptable to prepare body in the room before
individual visits.
Organ Donation Be sure to distinguish fact from probability.
Indicate that consent or refusal is equally welcome.
Organ donation generally not desired however this is changing
depending on the tribal beliefs

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Prenatal Care Prenatal care expected, and exchange of ideas generally
appreciated.
Labor Practices may vary.
Mother or other female relative may be present.
Stoicism encouraged by laboring woman.
Father may be expected to practice certain rituals and be absent
following birth.
C-Section Acceptable if needed for health of mother or baby
Postpartum and Viewed as important for mother and baby to rest
Breastfeeding Umbilical cord has spiritual meaning; typically saved by family
for ritual
Breastfeeding and bottle both acceptable.
Genetic Defects Beliefs in cause vary with individual and tribal culture.
and/or Sick Baby If mother too ill or young to make decisions, family will be
involved.
If baby not expected to live, family may wish to conduct naming
or other rituals.

Religion Do not expect traditional religion to be openly discussed.
Spiritual Healing May be combined with Western medicine.
May include having no staff present and no interruption of ritual.
Do not casually admire, examine or move sacred items. If
necessary, ask family member to move them.
Native Hawaiian – American Culture

(Content provided by: Kanoelani Davis, Cultural Health Navigator Manager, Molokai Community
Health Center)
Preferred term: Hawaiian
Culture & Family Structure

Demographics 1.2 million Identified in the United States as Native Hawaiian &
Other Pacific Islander. *2010 US Census.
Symbols Clothing & Amulets: Cloth wrapped on one shoulder called kihei,
used for protection and/or status
The way it’s tied can signify authority, male/female, or significant
moment in life
Salt called pa’akai is used for purification and ti leaf lei or
garlands for protection
Language Hawaiian: ‘Olelo Makuahine
Pidgin/creole English
America-English
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Communication Do not interrupt speaker.
Long pauses are part of conversation
Speaks in kaona or hidden meanings
Sensitive to body language
May downplay or ignore symptoms because illness can be
shameful
Will not ask for help, will wait for it to be offered
Decision-making Important decisions may require consultation among entire
family
Includes responsibility to community and family
Females will usually fill out documentation & forms
Family Structure Maybe matriarchal or patriarchal
Elders known as kupuna are respected
Often family friends are referred to with familiar pronouns i.e.
Uncle, Aunt, etc.
Food practices/ Eating is important for recovery; offering food is associated with
beliefs nurturing
Beliefs caring for, accepting, and trusting.
Rice and/or poi are a main staple.
It is natural to bless the food prior to eating through inter-mixed
religions or cultural practice.
Greetings Address by Aunty, Uncle, or first name depending on

connection.
Hugs and a kiss on the cheek are acceptable.
Honi is a form where nose meets nose and forehead meets
forehead with an exchange of breath.
Aloha is used to say hello, goodbye, and can mean various
things.
It is traditional to bring something of value when entering one’s
home or space.
Non-verbal Listening is key, body language, strongly influenced by respect,
cautious in disclosure of thoughts to non-intimates, aware of
external judgment and concerned with respectability and good
appearance.
Prefers not to be helped, it’s a sign of weakness but welcomes
the offer.
Believes illness resulted from loss of mana or energy/force
which could happen through jealousy, hate, breaking kapu
(sacredness), or possession by evil spirits.
Spokesperson Mothers play a strong role in the family. They are the main
caretakers although they will usually consult with the male family
member to come up with a mutual decision.
Time orientation On time kept for official business and more spontaneous for
social and informal gatherings; emphasize importance of
appointment times.

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Health, Illness, and Death
Consents Avoid using medical jargon.
Assess understanding by asking clear questions.
May require clear explanation of situation and choices for
intervention. The female will take the role in filling and prepping
all paperwork, please allow time for family to come up with a
decision.
Death-body care Traditional practices include prayer.
Spending time with the body is highly respected, especially the
bones, as they are believed they carry great mana, divine
power.
May request not to cover face until body is fully removed from
presence.
Death-special needs Be sensitive to spiritual needs.

After the body is attended it is likely the family will be blessed
with salt water and lei or garlands may be present.
Dying process Attendance from family and relatives expected but
independence maintained.
Inform designated head of family of impending death.
May have food for comfort and family, may ‘celebrate’ life
instead of mourn in death.
Illness beliefs Health is a deeply rooted cultural concept.
Holistic understanding of emotional, spiritual, social and physical
factors.
Illness seen as a crisis for the entire family.
May participate in traditional cultural medicine, which includes
herbal remedies, fasting, and prayer.
May believe illnesses are caused by spirits which reside within
individuals and desire a healing ceremony according to cultural
traditions.
Family expected to care for patient.
Invasive procedures May be skeptical of procedures but will allow treatment if
needed.
Usually accepted if practitioner is trusted.
Organ donations Be sure to distinguish fact from probability.
Indicate that consent or refusal is equally welcome.
May have religious restrictions.
Pain Pain scales helpful.
May accept medication, however may also decline except for
severe pain.
May not complain, awareness of non-verbal cues are important.
Terminal Illness May prefer to have doctor disclose diagnosis to patient with
Discussion family present and prognosis to head of family and discussion of
who will determine whether to and when to tell patient.

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Visitors May bring food and/or desserts.
May sleep at bedside.
Welcomed and considered helpful in recovery.
Common for large number of family members to visit.

Breastfeeding Breastfeeding and bottle.
Breastfeeding is encouraged.
Beliefs that certain greens and foods should be avoided
believing they will give baby colic.
C-Section Not preferred.
Will if necessary.
Genetic Defects Same beliefs as illness.
Unconditional acceptance of loved ones
Family may prefer to take care of disabled rather than long-term
care.
Labor Walking or swimming recommended to encourage quick birth
Fears include unnecessary or dangerous medical interventions,
separation from family members & loss of privacy.
Laboring women seen as strong and participatory.
Father’s involved
Female family members supportive and present.
Postpartum Remnant of umbilical cord and/or placenta may have spiritual
value; family may request it.
Rest is important.
If baby hasn’t been named yet, parents will await for a family
member to have a dream to come up with the baby’s name.
Prenatal Care Culture may prohibit pregnant women from caring for dying
person or attending funerals.
May use traditional, natural medicines.
Prenatal care accepted & exchange of ideas generally
appreciated.
Sick Baby Traditional practice includes prayer.
If mother is too ill or young to make decisions, family will be
involved.
Important to reassure mother and family that no one is to blame
andnot to assume there is fault.
Religious & Spiritual Practices

Religion Prayer, visits from spiritual leader and/or faith group members
depending upon spiritual tradition.
Traditional religion may not be openly discussed.
Spiritual Healing May use traditional healers or healing remedies.
May be combined with western medicine.

43
African Cultures
Also see Middle Eastern/North African Cultures
Ghanaian Culture
*Located in Western Africa
* Accustomed to Western culture
Important Historical Traditional cultural values: human dignity, attitudes to nature

Issues and the environment, law and order, honesty and truthfulness,
unity and peace, self-reliance and dignity of labor, family
community and national solidarity.
Clothing or Amulets Kente cloth— usually worn for special ceremonies that may
include religious observance, birth of a child, or death.
Charms, amulets and talismans may be common.
Language English, Akan, Ewe, Ga, and Hausa
Communication, More indirect
Nonverbal, and Take care not to relay information in any way that would harm
Greetings their own and others’ or disrupt harmonious relationships
including giving someone bad news.
Proverbs, wise sayings, analogies may be used to convey
messages
Silence is a common means of communication. If someone is
uncomfortable with a question or does not think the asker will
appreciate response, they will say nothing.
It is considered neglectful to take part in extensive and informal
inquiring conversations.
May approach very close to others when speaking, and may
attempt to hold one’s hand.
Spokesperson and Spokesperson is male head of the family.
Decision-making Decision making is a family endeavor with male head of family
having final authority.
Family structure Greatly important, and includes immediate, extended, and

community.
Food Eating manners are typically formal.
practices/beliefs Soups are the primary component.
Time orientation May not observe specific time restrictions.

44
Illness beliefs Illness is generally believed to be a very personal and private
matter that is not openly discussed.
Based on science and medicine as well as beliefs in
supernatural
Strong ties to traditional African medicine—herbalism and
spiritual care can supplement conventional treatment of the
individual, including care from a shaman.
Illness comes from chance occurrences—from both social and
spiritual imbalances.
Illness can come from envy, seeking vengeance or someone
wishing the person ill.
Consents Typically male head of family
Invasive Procedures Agreeable when explanations are understood
Pain May describe their pain as spiritual or emotional pain
Visitors Family, included extended family, are important to have around
one when ill.
Terminal Illness In traditional culture, the conversation takes place with the family
Discussion rather than the patient; offensive to do otherwise.
Telling a person they are going to die is unacceptable in
traditional culture; family may give partial disclosure to patient.
Belief that time of death is in God’s hands; until then often cure
continues to be sought.
Families expect physician to be sad and apologetic when giving
bad news.
“Putting your house in order” is more familiar that advance
directive language.
Dying Process Important to hear the last words of the dying person
Depending on family’s religious and spiritual affiliation they may
want to pray at the bedside.
Often prefer to care for dying at home
Death-Special Death, suffering and diseases may be attributed to witchcraft; it
Needs will be important to identify if these are beliefs that are important.
Death-Body Care Many wish to send the body back to Ghana.
Belief among many Ghanaian-Americans is to root the individual
back in their ancestral homeland.
Women elders may want to wash the body.
Organ Donation Becoming more prevalent due to education.

Prenatal Care Cultural and religious beliefs may impact care women choose
to receive; often include aspects of both in medical care.
May believe pregnancy needs to be protected from evil eyes
and spirits to prevent miscarriage.
Labor Mother’s mother or another elder woman may often be in
attendance.
C-Section Varies with individual preference.

45
Postpartum and Culturally critical that the child is with the mother
Breastfeeding May want to dress newborn in waist beads for protection from
disease and evil spirits.
Breastfeeding is common practice
Genetic Defects A child suffering from a physical or psychological disorder may
and/or Sick Baby be viewed as a disgrace upon mother and her family.

Religion Christian, Islam, Hinduism and traditional African religions.
Religious beliefs are important both as source of support/coping
and in decision-making.
Spiritual Healing Families will seek out the support, guidance and advice of their
religious leaders and members of their religious community.
Use of charms, amulets and talismans may be common.
Kenyan Culture
Important Historical Great sense of national pride
Issues Numerous tribes
Clothing or Amulets Some women may wear a kanga, a large piece of cloth that can
be wrapped around the body as a skirt or shawl; head scarves
are also common.
Language English, Swahili, tribal languages

Communication, Not facially expressive
Nonverbal, and Deliver messages in a sensitive way rather than direct and
Greetings abruptly; uncomfortable with blunt statements.
Providers may need to and decipher what may really being said
by analogies, stories or metaphors.
Short and brief introductions
Elderly treated with great respect and deference
Spokesperson and Usually leading male is spokesperson and makes decisions
Decision-making
Family structure Patriarchal; women often treated as “second-class” in traditional
culture.
Traditionally polygamous (in Kenya)
Extended family
Food Tea with milk and sugar is a common drink

practices/beliefs Beverages usually not served with meal but consumed at
end; as considered impolite.
Time orientation Viewed as flexible

46
Illness beliefs Onset of sickness is caused by witchery imposed by someone
else.
Someone has violated a social norm.
May want to utilize traditional cures, which includes plants, bark,
etc and diviners who can expel evil spirits.
Consents Main male spokesperson/decision maker should be
consulted.
Invasive Procedures May be accepted
Pain
Visitors Family, both immediate and extended as well as community
members.
Terminal Illness To be held with male head of family
Discussion Life is to be preserved at all cost
Dying Process Often final words/rituals to be done with dying person
Prefer death at home with family providing support
Death-Special May believe body and persons’ possessions are ‘unclean’
Needs May express great concern that person have a “proper” burial in
order that they will have peace.
May want body to be removed from room feet first
Burial rites are very important
Death-Body Care
Organ Donation Acceptable, however cultural superstitions or religious beliefs
regarding need for body to be whole may lead to non-
consent.

Labor Traditionally only females present
C-Section Acceptable if needed
Postpartum and Family may request special food to give mom strength and
Breastfeeding help her in successful breastfeeding.
Genetic Defects Talk to father first
and/or Sick Baby May be believed to be caused by evil

Religion Predominately Christian, also Baha'i, Hinduism, Islam, and
traditional religions
Spiritual Healing May seek the guidance of their religious leader or members
of their religious community.

47
South African Culture
*South Africa is a country comprised of many different ethnicities with eleven official languages.

Important Historical Nelson Mandela and Steven Biko are seen as the leading icons
Issues for many black South Africans.
Clothing or Amulets Bright colored traditional African clothing represents different
regions
Amulets may be worn or tattooed for to bring a sense of the
sacred: protection, healing, or strength from ancestors
May be carried in a belt, on a chain, or connected to the body of
the person with leather or string. Ask before removal and treat
with respect.
Language Main languages are Xhosa, Zulu, English and Afrikaans.
Communication, Warm introductions upon first meeting are acceptable between
Nonverbal, and individuals.
Greetings Shake with right hand as left is assumed to be used for bodily
hygiene.
Respect communicated by Avoiding direct eye contact
Spokesperson and Usually the leading male
Decision-making
Family structure Extended family units
Friends of the family are usually referred to and regarded as
family—fictive kinship.
Strong sense of loyalty, reciprocity, and solidarity
Food Ritual slaughtering of cows, chickens, and goats is done in
practices/beliefs celebration of a birth or death.
Only food prepared in these rituals is to be used by the family
Time orientation May not be concerned with specific time deadlines
Concept of time in South African culture is seen as a “loose
concept”

Illness beliefs Onset of diseases or debilitating conditions may be attributed to
someone wishing the person ill, or to envy or vengeance.
Illness can be seen in “hot” or “cold” context.
A holistic relationship is recognized between the emotional,
spiritual and physical states of someone’s condition.
Consents Individual, immediate family members should be consulted for
consent.
Invasive Procedures May not be accepted
Pain Medication may be accepted, varies with the individual
Visitors Extended family—both blood and family friends—will most likely
be asked to visit

48
Terminal Illness Should take place with the individual and main spokesperson of
Discussion the family—husband, brother, uncle, son etc. A general
consensus should be reached.
Dying Process Death is feared, and any discussion or preparation for
approaching death is often strongly discouraged as there is a
belief that by talking about it, it will happen.
Senior member of family should be present for decision-making.
Death-Special May wish to hear dying person’s last words

Needs
Death-Body Care Traditional belief is that body - and family – are polluted until
after appropriate mourning rituals are completed
Organ Donation Acceptable, however cultural superstitions or religious beliefs
regarding need for body to be whole may lead to non-
consent.

Labor Older female in the family often present
C-Section May be accepted, depends on the individual
Postpartum and May want placenta for ritual
Breastfeeding Breastfeeding is common practice
Genetic Defects Everything should be done to take care of the sick infant
and/or Sick Baby

Religion Christian, Muslim, and Hindu
Spiritual Healing Families will seek out the support, guidance and advice of their
religious leaders and members of their religious community.

49
Caribbean Cultures
Cuban Culture
Important Historical Cuban revolution still has impact on daily life
Issues Afro-Cuban music and dance.
Clothing or Amulets Religious items, necklaces, herbs for healing
Language English, Spanish, and Haitian Creole.
Communication, Tend to speak loudly, may seem aggressive.
Nonverbal and Tend to make direct requests and statements, may seem
Greetings aggressive.
Lack of eye contact shows disrespect.
Handshakes and a light embrace are acceptable
Upon first meeting someone, a warm welcome between two
parties is acceptable
Once one has met an individual(s) of Cuban descent, a light
embrace is acceptable
May come across as less aware of personal-physical space.
This is acceptable within their circle of interaction
Spokesperson and Traditionally Cuban families are patriarchal. Major family
Decision-making, decisions are generally made by the leading male.
The female head of household typically takes on the role of
emotional provider and mediator across generations.
Depending on the family, male or female spokespeople may
have to be consulted
May see physician as a director rather than a partner.
Elders are often consulted first for decision-making.
Family structure In Cuba, families are becoming smaller.
Food Rice, beans, root vegetables, pork and meat make up the
practices/beliefs bulk of diet
Time orientation Usually present oriented

Illness beliefs According to traditional Cuban culture, mind, body and spirit are
connected.
Use of complementary mind-spirit, religious, and herbal
practices
Physical illness may be thought to be caused by mental stress
or supernatural forces.
The sick may be passive and dependent.
May decline shampooing of hair
Doctors and other healthcare providers are seen as having
authority and their decisions are respected.

50
Consents Consent is often given through family consultation and
consensus.
Important to clarify with patient whether he/she wants
information first and who within family can receive it to reduce
potential conflicts.
Invasive Procedures Acceptable
Pain Often incorporate mind-body modalities
Expressed openly, but may be stoic
Visitors The company of immediate and extended family members is
much sought after.
Family member may want to stay around the clock
Terminal Illness In Cuban health care, there is little discussion between

Discussion physicians and patient/families so this may be a new
experience.
Some expect that family spokesperson is informed before
patient with exception of HIV/AIDS diagnosis, which is to be
shared only with patient.
Involve immediate and extended members of the family
Dying Process DNR is usually unacceptable.
Belief that everything possible to keep patient alive should be
done.
Belief that DNR indicates giving up hope or abandonment.
Patient and family may have strong fears of death.
Death-Special Families may consult a senior male or female, or one who is
Needs most educated or influential in the community when deciding on
health care treatment and making end of life decisions.
Religious beliefs and practices are very important prior to and
after death. Family will likely want a religious leader present.
Grief may be expressed loudly
Death-Body Care Family member may want to stay with body until buried
Often buried quickly with funeral/ritual several days later
Organ Donation Acceptable to save a life

Prenatal Care Traditional women may be fearful of evil eye or having
someone they don’t know touch their belly or ask information
about pregnancy.
Do not discuss negative issues during pregnancy, including
potential deformities or risks.
Labor Natural delivery or other procedures suggested by healthcare
providers to help labor progress are acceptable.
Traditionally, only female relative present but this is changing
so father is present.
C-Section Generally accepted

51
Postpartum and Traditionally baby dressed in red to ward off evil eye.
Breastfeeding Traditionally mom and baby stay confined at home for a
month or more.
Breastfeeding common
Genetic Defects Talk to father first
and/or Sick Baby May be feared to have been caused by supernatural forces

Religion Roman Catholic, Protestant, or Santeria which is also often
practiced alongside Christianity
Spiritual Healing Those individuals who practice Santeria will seek spiritual
comfort as a way to ease physical pain
Many Cuban Americans seek out the support of their church
for spiritual guidance and advice.
Haitian Culture
Important Historical The expulsion of the French in 1804, making Haiti the first
Issues independently black-ruled nation in the world
Clothing or Amulets Religious medallions or other spiritual objects.
Language Haitian Creole, French, English.
Communication, Handshakes are acceptable

Nonverbal, and Informal introductions are acceptable upon first meeting
Greetings
Spokesperson and Females are seen as the decision makers for the family
Decision-making Women are usually thought of as the marketers of the family, so
they usually control their husband’s earnings.
Family structure Households typically are made up of nuclear family members
and adopted children or young relatives.
Elderly widows and widowers may live with their children and
grandchildren. The husband is thought of as the owner of the
house and must tend to the maintenance of it.
However, the house typically is associated with the woman, and
a woman is thought of as the manager of the property and the
decision maker regarding use of funds from wages
Food Staples in diet: rice, beans, sweet potatoes, manioc, yams, corn,
practices/beliefs rice, pigeon peas, cowpeas, bread, and coffee

Illness beliefs Haitians have tremendous faith in informal healing procedures
and commonly believe that HIV can be cured.

52
Consents Women often hold the authority to make and sign off on
decisions regarding their families
Invasive Procedures Accepted but frightening, particularly abdominal surgeries
Pain Vocal about pain although vague about source; may prefer
injections over oral medication
Visitors Includes both immediate and extended family members.
Terminal Illness Discussion should occur with immediate family present, and if
Discussion need be, extended family.
Dying Process Haitians prefer to die at home, though dying in a hospital is
acceptable.
When a person dies, the entire extended family is affected. The
oldest family member makes all the arrangements and notifies
the family.
Death-Special The moment of death is marked by ritual wailing among family
Needs members, friends, and neighbors.
Death-Body Care Family member may want to bathe body.
Autopsy acceptable; may be requested by family
Cremation usually preferred; may want mortuary to keep body
until all family members can gather
Organ Donation Organ donation typically not discussed or encouraged

Prenatal Care Not traditionally sought.
Labor Midwives may be preferred
C-Section Generally accepted
Postpartum and Traditionally common to have mother and child confined as
Breastfeeding considered to be susceptible and vulnerable to illness
Postpartum ritual frequently used includes special baths with
herbs and water to bathe in for the first three days and a tea
made to drink. The next three days she is encouraged to bathe
in herb fortified water that is warmed by the sun.
Breastfeeding is the norm
Some traditions believe that the breast is to be withheld from
newborns for the first twelve to forty-eight hours
Traditional liquid supplements usually introduced within first two
weeks of life, and food supplements often are begun thirty days
after birth.
Genetic Defects May believe defects are caused by an angry spirit or a spell cast
and/or Sick Baby by an enemy

Religion Roman Catholic (about 80%), Protestant (about 20%), Voodoo
(see Voodoo page).
Many people have rejected voodoo, becoming instead katolik
fran (“unmixed Catholics” who do not combine Catholicism with
service to the lwa) or levanjil, (Protestants).
Catholics and Protestants generally believe in the existence of
53
lwa, but consider them demons to be avoided rather than family
spirits to be served.
Spiritual Healing With the spread of Pentecostal evangelism, Christian faith
healing has spread rapidly.
Jamaican Culture
Important Historical Proud of independence from Britain in 1962
Issues
Clothing or Amulets Headwear varies from bandana wrapped in a special design to
straw hat decorated with flowers.
Language American-English (Official Language).
Jamaican-English.
Patois/Jamaican Creole - English-based, but may be hard to
understand due to a thick accent and African-based idioms.
However, Jamaican Americans almost always understand
American-English.
Jamaican accent may drop H’s and W’s and has a distinctive
rhythmic and melodic quality.
Communication, The most common greeting is the handshake with direct eye
Nonverbal, and contact, and a warm smile.
Greetings Use the appropriate salutation for the time of day: "good
morning", "good afternoon", or "good evening."
Once a friendship has been established, women may hug and
kiss on each cheek, starting with the right.
Men often pat each other's shoulder or arm during the greeting
process or while conversing.
Address people by their honorific title (Mr., Mrs., or Miss) and
their surname until a personal relationship has developed.
Always wait until invited before using someone's first name.
As your friendship deepens, you may be asked to call the
person by their nickname.
Spokesperson and Usually male
Decision-making
Family structure Women have primary responsibility of raising children and
supporting them, often alone or with help of extended family.
Domestic violence can be an issue
Marriage less common
Families contain a close-knit web of aunts, uncles, cousins and
grandparents.
Families provide economic and emotional support to its
members.
Food Depending on religious beliefs, may have dietary needs

practices/beliefs regarding foods that can or cannot be eaten
54
Illness beliefs Death is regarded as a natural transformation, and except in the
case of the very old, its cause is believed to be the violation of a
cultural norm, evil spirits, or envy.
Illness is thought to be imposed by evil supernatural forces or
cultural taboos. May tend to self-medicate and exhaust every
possible home remedy before seeking professional medical
assistance.
Once seeking professional medical attention, there is a sincere
belief in the physician or medical providers to cure the illness.
Consents Male may wish to do consents, however be aware that not all
marriages are legal
Ensure that children’s legal parents are identified as many
may move from relative to relative
Invasive Procedures Problems are initially dealt with holistically. However, if such
an invasive procedure is seen as the last resort, then it is
acceptable.
Pain May depend on the individual involved
Terminal Illness Should be done within the context of patient/family religious
Discussion beliefs
Visitors Family and extended family
Dying Process When a Jamaican individual dies, family at bedside to cry and
mourn.
Death-Special May have rituals based on superstitions regarding all in family
Needs including children, needing to say goodbye
Death-Body Care Body to be washed; family may have superstitions or rituals
regarding how this is to take place
Organ Donation Becoming more acceptable

Prenatal Care Not always sought
Labor May wish a midwife
Viewed as a religious/spiritual event and may want objects
present
C-Section Varies and depends on the individual mother
Postpartum and May wish to keep placenta for ritual
Breastfeeding An open Bible is often placed in a newborn's bed, to protect the
baby and ward off evil
A red string may be tied around a newborn's wrist, or in the hair
to chase ghosts away and ward off evil.
Breastfeeding common practice
Genetic Defects May be perceived as God’s will or result of evil spirit
and/or Sick Baby

55
Religion Christianity and Rastafarian
Spiritual Healing Important part of belief system and approach to medical
understanding and treatment

56
Middle Eastern/North African Cultures
Arab Culture
*Preferred Term: Identified by region

Important Historical Arab world is culturally rich, complex and diverse: It includes 22
issues countries
Clothing or Amulets Head scarves may be important or even essential for women.
May wear blue beads, religious scriptures, or other amulets as
necklaces
Amulets. Qur’an or Bible nearby.
Language Modern Standard Arabic (MSA) and many dialects related to
geographical location
Communication, May not speak English but not admit it.

Nonverbal, and Head nodding and smiles do not always mean comprehension.
Greetings Will tend to repeat same information several times if feel
misunderstood.
May downplay or ignore symptoms because illness can be
shameful.
May have flat affect to protect others from accessing their inner
feelings.
Respect elders and professionals and are reluctant to take up
their time.
Comfortable in touching within gender but not between
genders.
Traditional women may avoid eye contact with men.
Politeness means not disagreeing outwardly; may respond in
ways that they think others want them to respond.
Use title and first name.
Approach by shaking hands and acknowledge country of origin
and something personal about patient or family.
Smiling face helps; direct eye contact, even if avoided by
patient.
Spokesperson and If there is a grandmother, may defer to her counsel.
Decision-making Physicians expected to make decisions related to care of
patient.
Families make collective decisions
Family structure Includes nuclear and extended family.

Children are sacred (parents usually very strict); expected at
bedside.

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Food Eating is important for recovery; offering food is associated with
practices/beliefs nurturing, beliefs caring for, accepting and trusting.
Take time to share a cup of tea or a sweet offering, indicates
acceptance.
Follow hot/cold theory; i.e. hot soup helps recovery; do not give
ice with drinks.
If Muslim, have food restrictions (see spiritual beliefs).
Time orientation On time kept for official business and more spontaneous for
social and informal gatherings; emphasize importance of
appointment times.

Illness beliefs Health defined as gift from God; illness caused by evil eye, bad
luck, stress in family, germs, winds, drafts, imbalance in hot
and dry and cold and moist, and sudden fears.
Being overweight associated with health and strength.
Patient encouraged to be passive and pampered; not make
decisions.
Consents Written consents may be problematic because verbal consent
based on trust is a more acceptable mode of contracting.
Dislike listening to all possible complications before procedure.
Explain need for written consent, emphasize positive
consequences and humanize process.
Invasive Procedures Children may have morbid fear of injections and invasive
procedures; may want to negotiate having parents out of room
during procedures.
High acceptance of treatments and procedures expected to
cure; low acceptance of complications, viewed as negligence or
lack of expertise.
Pain Very expressive, especially in presence of family.
Pain feared and causes panic; better able to cope if source and
prognosis of pain is understood.
May have difficulty with numerical scale; use metaphors (fire,
knife, etc).
Visitors Social expectations high priority; entire families may visit
patient and family.
Terminal Illness Will find it difficult to decide on DNR; may lose trust in health
Discussion care providers discussion if this option is offered.
Dying Process Timing of death is seen as God’s will.
Traditionally do not openly anticipate or grieve before death.
Inform designated head of family of impending death or death.
Prepare private room for family members to meet and grieve.
May avoid discussing death.
Death-Special Needs Be sensitive to religion-specific needs and/or rituals.
Death-Body Care May have special rituals for washing body due to spiritual
beliefs.

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Organ Donation Acceptable to save a life

Prenatal Care May believe pregnancy is not an illness and prenatal care
unnecessary.
Encouraged to rest, do minimal work and eat well.
Little or no preparation for birth or baby; very present-oriented.
Labor Tend to be passive; i.e. tense muscles and wait for delivery.
Father not expected to participate.
Mother, sister or mother-in-law expected to be present and
supportive.
C-Section May be greatly feared.
Postpartum and Expect complete bed rest.
Breastfeeding May fear bathing or showering.
Very difficult time for first time mother without extended family;
needs more understanding, support and networking.
May believe colostrum is harmful to baby.
May not request assistance for fear of imposing on staff.
Genetic Defects Include mother, father, aunts or grandparents when discussing
and/or Sick Baby baby.
Often believed to be due to wrath of God, God’s will, test of
endurance.
Disclosure an issue; prefer to “hide” genetically defective family
member; tend to care for patient at home and shun
institutionalized care.
Genetic counseling may be refused as believed to defy God’s
will.

Religion Christian or Sunni/Shia Muslim
Spiritual Healing Western medicine respected and sought after.
Home and folk remedies may be used.
Egyptian Culture
Important Historical Emphasis placed on social and financial status

Issues Women do not have same legal rights as men in issues such
as marriage
Clothing or Amulets Modest clothing
Woman may cover up depending on the degree of their Islamic
observance
Amulets or religious verses may be worn as necklaces
Language Arabic
Communication, May present as stoic, self restrained, hesitant; typically quiet
Nonverbal, and and reserved
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Greetings May not ask about treatment plan
Half closed eyes do not express boredom
Men and women stand relatively far apart and generally do
not touch.
Rude to show the sole of one’s shoe
Handshakes are followed with a touch on the elbow
Spokesperson and Primarily leading male
Decision-making
Family structure Patriarchal
Nuclear families
Food Islamic practices—no blood, gelatin or other bodily products
practices/beliefs from the animal that is about to be eaten
Allowed foods are regarded as “halaal” and prohibited foods
are regarded as “haram”
Feasting and fasting days are celebrated according to the lunar
calendar
Time orientation Usually present-oriented although slower and unhurried

Illness beliefs Onset of illness is a part of God’s plan
Will avoid discussion about death
Euthanasia is forbidden
Consents Include close family members in the consent process

May feel uncomfortable giving written consent
Invasive Procedures Usually acceptable
Pain Prefer prescriptions of pain killers except possibly near death
when ability to recite the Islamic creed is desired.
Visitors Integral in the dying process for loved ones to visit the
individual
Terminal Illness Will tend to avoid the discussion
Discussion If Muslim, religious views are important, particularly around
issue of futile treatment which prevents person’s death
Dying Process Islamic creed should be recited before death if Muslim
Grief is not expressed other than through tears
Death-Special Needs Death is not prepared for with prior funeral arrangements; to do
so is disrespectful
Physician should inform elder of family first, even prior to
spouse, to show respect
Emotive in grief, including wailing and gasping
Death-Body Care Islamic protocols for body care: washing, dressing and specific
positioning of the body. Care provided by person of the same
sex.
Autopsies only if foul play is suspected as considered
disrespectful
Family will stay with body until transported from facility

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Organ Donation While may be acceptable by religious tradition, it is an issue
involving misinformation and high ethical debate

Prenatal Care Strong support and advice from family members
Do not always seek out care except for emergencies
Prefer female health care providers
Labor Typically women only are present
Modesty very important
C-Section Acceptable
Postpartum and Breastfeeding is common practice and encouraged for first two
Breastfeeding years
Genetic Defects May believe that everything should be done to take care of the
and/or Sick Baby sick infant

Religion Muslim, Christian
Spiritual Healing Families will seek out the support, guidance of their religious
leader and members of their religious community including in
the making of treatment decisions.
Iranian Culture
*Primarily Shiite Muslim, could be Jewish, Christian, Bahá’í, Sunni Muslim

Important Historical Multiethnic, multicultural society rich in cultural symbolism
Issues Uses solar calendar
Clothing or Amulets May try to keep body covered to avoid draft.
May wear gold charm on neck chain symbolizing Islam.
Language Farsi
Various dialects
Communication, Cautious in disclosure of thoughts to non-intimates.
Nonverbal, and Aware of external judgment and concerned with respectability
Greetings and good appearance.
Silence can have many meanings.
May prefer use of last name.
Handshakes, a slight bow, even standing when someone
enters the room are appropriate; greet elderly first.
Spokesperson and Father, eldest son, eldest daughter, or eldest male family
Decision-making member.
Patriarchal society.

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Family structure Family-oriented.
The concept of family is more private than in many other
cultures. Female relatives must be protected from outside
influences and are taken care of at all times. It is inappropriate
to ask questions about an Iranian's wife or other female
relatives.
Iranians take their responsibilities to their family quite seriously.
Families tend to be small, only 1 or 2 children, but the extended
family is quite close.
The individual’s social network and assistance in times of need
comes from the family.
Elderly relatives are kept at home, not placed in a nursing
home.
Loyalty to the family comes before other social relationship,
even business.
Nepotism is considered a good thing, since it implies that
employing people one knows and trusts is of primary
importance.
Food Diet centered on fresh fruits, greens and vegetables with meat
practices/beliefs as a condiment
Primary beverage black tea
Time orientation May have fatalistic beliefs which can hinder understanding and
compliance with present needs.

Illness beliefs Health a deeply rooted cultural concept.
Body viewed in relationship with environment, society, God,
nutrition, family, etc.
Patient generally assumes passive role.
Sense of hope always important.
Consents Explain procedure/treatment to family spokesperson.
Some families believe in protecting loved one from information.
Invasive Procedures Accepted.
Pain Expressed by facial grimaces, guarded body posture, moans.

More easily expressed by quality than numeric scale.
Visitors Welcomed and considered helpful in recovery.
Terminal Illness Talk with family spokesperson first.
Discussion Bad news may be kept from patient by family.
Dying Process Religious beliefs may require that environment be as peaceful
as possible so that dying person can complete spiritual
requirements
Death seen as beginning, not end, of spiritual life
Grief can be very emotional
Death-Special Needs Notify head of family or spokesperson first.

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Death-Body Care Family may wish to wash body according to religious
requirements
Organ Donation Accepted.

Prenatal Care Diet and rest encouraged as well as refraining from heavy
work.
Labor Walking encouraged.
Fathers involved.
Female family members supportive and present.
Postpartum and Showering common shortly after birth.
Breastfeeding Emphasis on rest, diet, hygiene and emotional care.
Breastfeeding preferred.
Genetic Defects Talk first to father of child.
and/or Sick Baby May be viewed in scientific terms or as God’s punishment.

Religion Shiite Muslim; Jewish, Christian, Bahá’í, Sunni Muslim,
Zoroastrianism, Baha’i
Silent prayers at bedside.
Spiritual Healing Viewed as a complementary method in addition to medical
treatment.
Libyan Culture

Important Historical Historically restrictions on human rights, including freedom of
Issues speech, press, assembly, association, and religion and gender
roles.
Clothing or Amulets Modest dress/traditional Islamic clothing
Language Arabic
Communication, May come across as reserved
Nonverbal, and Light hand shake
Greetings Smiling important
Eye contact okay, but intermittent rather than constant
Titles important; do not use first name unless invited to
Spokesperson and Leading male
Decision-making
Family structure Patriarchal
Domestic violence common
Nuclear and extended

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Food Islamic practices—no blood, gelatin or other bodily products
practices/beliefs from the animal that is about to be eaten.
Allowed foods are regarded as “halaal” and prohibited foods
are regarded as “haram.”
Feasting and fasting days are celebrated according to the lunar
calendar.
Time orientation Present oriented

Illness beliefs Onset of disease is part of God’s plan
Consents Be aware that medical care in Libya is limited; as a result may
need to provide a lot of education regarding consents and
treatment.
Should approach close family members and main
spokesperson.
May feel uncomfortable giving written consent
Invasive Procedures Usually accepted.

Pain Muslims may avoid pain medicine near death in order to be
able to recite the Islamic creed.
Visitors Family, nuclear and extended as well as religious community
Terminal Illness Will tend to avoid the discussion
Discussion Only God can determine time of death
requirements.
Death-Special Needs Tell leading male first, even before spouse.
Death-Body Care Islamic protocols for body care: washing, dressing and specific
sex.
Organ Donation Living donation accepted, however cadaver donation a new
concept and most decline

Prenatal Care Diet important; may need education if pregnancy falls during
religious fasting times that eating allowed
Labor Modesty important
May desire female medical team
May want a female relative present
Father’s presence personal choice
Postpartum and Father may want to whisper traditional prayer to baby shortly
Breastfeeding after birth.

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Genetic Defects Tell father first
and/or Sick Baby Typically viewed as God’s will

Religion Primarily Sunni Muslim, some Christian, Hindus, Baha’is, and
Buddhists
Spiritual Healing Viewed as a complementary method in addition to medical
treatment.

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East Indian Cultures
* Preferred Term: May be religious affiliation rather than nation of origin.
Important Historical Religion is central to life
Issues East Indians from various regions are primarily distinguished by
language.
Clothing or Amulets May include: sacred thread around the body, cloth around chest,
wooden comb, iron bracelet, scripture verses folded in cloth, etc.
Do not remove without permission of patient or family member.
Prayer beads called a mala hold great spiritual significance for
the patient.
A deity whose right hand is raised with their palm facing out is in
prayer.
Language English is common both oral and written; additionally at least 15
official languages and many dialects.
Communication, Loudness may be interpreted as disrespect, command,
Nonverbal, and emotional outburst and/or violence.
Greetings Touching not common; love and caring expressed through eyes
and facial expressions.
Direct eye contact may be considered sign of rudeness or
disrespect.
Silence usually indicates acceptance, approval and/or tolerance.
Greet with the right hand—handshaking or embracing—as the
left hand is seen to be impure.
Hindus and Sikhs press palm of hands together in front of chest
while also expressing verbal greeting.
Muslims take the palm of right hand to forehead and bow down
slightly while also expressing verbal greeting.
Shaking hands common among men but not women.
Elders addressed by titles.
Spokesperson and Male family member, usually eldest son, has decision-making
Decision-making power in family; however other family members are consulted.
Family structure Nuclear and extended family structures; most families are
multigenerational.
Gender roles are very distinct
Food May prefer metal utensils for cooking and eating.
practices/beliefs Food given much respect.
May use fingers of right hand to eat food and prefer to wash
hands before touching food.
May refrain from meat and fish and also fast daily or weekly.
Time orientation May not be extremely time conscious.
May not like to monitor every moment which may impact
treatment.

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Illness beliefs Strong belief that health and treatment involve integration of
physical, mental, and spiritual health.
May believe illness can result from past actions, not necessarily
in this life, and that illness washes away person’s sins.
May believe illness results from body imbalances.
Use of herbs and other complementary treatments are often
utilized.
Consents Approach for consent with close family members present for
moral support and consultation.
May feel uncomfortable giving written consent.
Explain procedure in simple terms.
May rely completely on health professionals to make decisions.
Invasive Procedures Receptive to blood transfusion and surgery; may prefer to
receive blood from individuals of own caste or religion.
Pain May accept medication, however may also decline except for
severe pain.
Visitors Close female family member may stay and participate in care.
May bring food for patient.
Terminal Illness May prefer to have doctor disclose diagnosis and prognosis to
Discussion family first, who will determine whether to and when to tell
patient.
Dying Process Unusual to inform dying person of impending death; family
members told first and decide whether to tell person.
Death-Special Spiritual needs should to be met including prayer and ritual.
Needs Grief expressed openly.
Death-Body Care May have rituals for body care, including washing.
Organ Donation Due to black marketing scandals in home country, poverty, and
misinformation, not usually accepted

Prenatal Care Pregnancy considered hot state and cool food encouraged.
Hot foods (such as such as meat, eggs, nuts, herbs
and spices) avoided as they may be believed to cause
miscarriage.
Baby considered to be prone to evil spirits, so mother typically
stays at home during pregnancy
Labor Female family member present;
Fathers may not be present at delivery but this is changing
Pain medications may not be accepted.
After birth, father or grandfather may wish to whisper traditional
prayers to baby.
Postpartum and Mother may want to keep warm.
Breastfeeding May not want to shower.
Breastfeeding strongly encouraged.
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Genetic Defects If serious, father or mother-in-law approached first.
and/or Sick Baby Doctor expected to reveal diagnosis.
May believe to be a result of actions in a past life.

Religion Primarily Hindu; also Muslim, Christian, Buddhist, or Sikh
Spiritual Healing While Western medicine accepted, spiritual healing may also be
important to incorporate.

68
East Asian Cultures
Chinese Culture

Important Historical Important national symbol is the dragon, which provides what is
Issues needed.
Respect for one’s parents and ancestors considered most
important virtue.
Clothing or Amulets Good luck articles (jade, rope around waist) may be worn to
ensure good health and good luck-avoid removing.
May want incense burned; will need to determine alternatives
Language Three major languages: Mandarin (official language), Wu, and
Cantonese; various dialects.
Communication, Elderly, especially women, may be unable to read or write.
Nonverbal, and Nodding politely does not mean understanding.
Greetings May maintain an impassive expression.
Eye contact avoided with authority figures as sign of respect.
Asking questions seen as disrespectful; silence may mean
respect.
Frowning while someone is speaking is interpreted as a sign of
disagreement.
Considered disrespectful to stare into another person's eyes; will
avoid eye contact to give themselves privacy.
Often shy, especially in unfamiliar environments.
Use of first name could be considered disrespectful.
Spokesperson and Patriarchal society; oldest male in household usually
Decision-making spokesperson and makes decisions.
Family structure Nuclear and extended families

Children highly valued.
Elders very respected and honored.
Belief it is a moral duty to take care of a sick family member.
Food Important in maintaining balance of hot and cold in body.
practices/beliefs
Time orientation Being on time not valued by traditional societies.

69
Illness beliefs Concept of “saving face” may make it difficult for patients to talk
about illness or symptoms.
Physical illness caused by imbalance of Yin and Yang (hot and
cold) in the body and environment.
Harmony of body, mind and spirit important.
Patient often takes passive role; family expected to care for
patient.
Medication may be taken only until symptoms disappear; if
symptoms are not obvious, or side effects noted medication may
not be accepted.
Medications may be shared among family or community
Consents Involve oldest male of family.

Assess understanding by asking clear questions.
Invasive Procedures May be fearful of having blood drawn believing it will weaken
body.
May avoid surgery wanting body to be kept intact.
Pain May not complain- be aware of non-verbal clues.
Visitors Common for large numbers of family members to visit.
Terminal Illness Family may prefer that patient not be told of terminal illness or
Discussion may prefer to tell patient themselves.
Patient may become fatalistic and not want to talk about it.
May have reluctance to utilize long term care because of family
belief it is their responsibility to care for person, however may be
open to hospice facility.
“Good death” typically means natural causes at elderly age;
otherwise may be seen as negative event.
Dying Process May believe dying at home brings bad luck.
May be concerned that person’s spirit may get lost.
Death-Special May desire that special amulets and cloths may be placed on
Needs body.
Death-Body Care Family may want to bathe body after death according to cultural
customs.
May not want autopsy due to concerns about body needing to
remain intact in afterlife.
Organ Donation Historical issues in China regarding donation may mean lack of
trust in process.
Religious concern may be how donation would affect ancestors
and impact on donor in afterlife.
Approach best done by highly respected authority, i.e. physician
or religious leader.

70
Prenatal Care May believe certain activities will affect baby during pregnancy.
Pregnancy considered a hot condition, so cold foods should be
consumed.
Labor Traditional belief is that crying out may attract evil spirits and
that silence protects baby.
Sometimes a necklace is tied around baby’s neck before cord is
cut.
Father usually does not play active role.
Female family members present.
C-Section Acceptable.
Postpartum and Placenta may be kept by family for cultural rituals.
Breastfeeding Postpartum is considered “cold” condition due to blood lost and
diet should consist of “hot” foods.
Mother’s rest considered essential with little activity
During first 30 days, mother’s pores believed to remain open
and cold air can enter body, so may be forbidden to
shower/bathe or be exposed to drafts.
Breastfeeding encouraged
Colostrum considered “dirty” and discarded
Genetic Defects Address head of household.

and/or Sick Baby Culturally there is a desire for a healthy child due to restrictions
on number of children.

Religion Confucianism, Taoism, Buddhism, Christian (both Catholic and
Protestant).
Spiritual Healing Spiritual is integrated into all aspects of life; may use herbs,
acupuncture, and acupressure along with Western Medicine.
Filipino Culture
Important Historical Doctor Jose Rizal is recognized as a national hero due to his
Issues non-violent contributions to the historical and social
transformations within the country.
Clothing or Amulets Western style of dress
Language
Pilipino or Tagalog is the national language, and English is
the second official language.

71
Communication, Allow times of silence during conversation
Nonverbal, and Sit rather than stand; brief and frequent eye contact
Greetings Head nodding doesn’t always mean agreement
Formal greeting—handshakes are welcomed
Spokesperson and Any older, leading man of the family seen as main decision
Decision-making makers for the family, however decisions and ideas are usually
relayed and discussed with the family beforehand.
Family structure The extended family such as grandparents, aunts, uncles, or
cousins may live in the same house and assume vital roles.
Group harmony and loyalty, respect for elders and authority,
and kinship that goes beyond strong biological connections.
Food May follow hot/cold beliefs
practices/beliefs Vegetables, fruit, and fish are main diet staples
Time orientation May seem to not be fixed on time

Illness beliefs Acceptance of western medicine as well as use of traditional folk
practices and/or spiritual roots of illness.
Rapid shifts from “hot” to “cold” lead to illness.
“Warm” environment is essential to maintain optimal health.
Cold drinks or cooling foods should be avoided in the morning.
An overheated body (as in childbirth or fever) is vulnerable; and
heated body or muscles can get “shocked” when cooled
suddenly.
A layer of fat (“being stout”) is preferred to maintain “warmth”
and protect vital energy.
Consents Discussion of risks or bad outcomes may provoke anxiety; it

may also suggest to the elder a lack of caring from service
provider.
Invasive Procedures Varies by individual and family members involved
Pain Pain is referenced in “hot” and “cold” terms
Visitors Family members, both nuclear and extended as well as
friends and members of cultural community
Terminal Illness Elders and family may avoid talking about advance directives or
Discussion dying as some believe this may bring the event to their door.
Use indirect approach when discussing terminal illness for the
first time
Continue to give further information in small doses and stages
Presence of spiritual/religious person helpful
May believe that if faith is strong enough, person will survive
Dying Process Spiritual needs very important
Pain control and comfort are high priorities. Grieving is less
private.
Women may be very expressive: swooning, sobbing, fainting
Filipino culture holds that the “longer the grief, the better.”
Death-Special It is considered very important for the dying to be blessed by a
Needs religious leader.
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Death-Body Care May be concern about autopsy being done, wanting body kept
intact
Organ Donation Formal donation program in Philippines is relatively new so
there may not be education or understanding

Prenatal Care Any jewelry, especially necklaces, are prohibited to be worn
during pregnancy as it is believed that this can cause the
umbilical cord can wrap around the baby’s neck
Drinking cold liquids is believed to help the baby become
large
Touching of the stomach is avoided
Labor Foot massages are given to relieve a woman’s pain

During labor, it is believed by some that the father should not
be present as it may be hard for him to understand the
process, time of delivery, etc. However, it is encouraged that
the expecting mother should have her family around
Most of the time the umbilical cord is kept, and not discarded.
This is believed to be the connection between mother and
child. It is kept in the mother’s wallet or otherwise safe.
Burial of the placenta is seen as a way to keep the baby
brave.
Postpartum and After birth of infant, a black pouch consisting of chopped garlic
Breastfeeding pinned to the infant is believed to ward off evil spirits
Mother is not allowed to leave the house for 30 days
Genetic Defects Consult father or other family support person who generally
and/or Sick Baby decides who will tell mother; usually best to have doctor present

Religion Roman-Catholic, Protestant, Muslim, Buddhist, Animist.
Spiritual Healing May incorporate prayers, massage, herbs; sometimes magnets,
crystals, and other mind/body techniques such as meditation,
healing touch.
Traditional healer or religious leader may be important.
May consider physical or emotional pain as a challenge to one’s
spirituality.

73
Japanese Culture

Important Historical Saving face is crucial and harmony is a key value
Issues
Clothing or Amulets May use prayer beads.
Language Japanese, American English.
Communication, Great emphasis on politeness
Nonverbal, and Pay great attention to non-verbal communication
Greeting May not ask
Typically quiet and polite, may be reserved and formal.
Tend not to disagree.
May have little direct eye contact; considered disrespectful
especially to elders; it is also a way of maintaining sense of
privacy.
Nodding doesn’t necessarily mean understanding or agreement.
Formal use of surname.

It is important to show respect.
The traditional form of greeting is the bow.
Spokesperson and Father; perhaps mother, eldest son, eldest daughter.
Decision-making Both men and women involved in process.
Family structure Family oriented; family as main unit rather than individual.
Hierarchical with father being head of household and main
authority.
Food Chopsticks.
practices/beliefs Rice with most meals.
Time orientation Promptness important.

Illness beliefs Illness is not usually discussed openly.
May believe chronic illnesses are due to karma/bad behavior in
this life or past life, or from actions of another family member.
Sick cared for primarily by women.
Patient assumes passive role.
Consents May be given by leading male in family after discussion with
family.
Invasive Procedures Generally accepted.
Pain May be stoic.
Visitors Family members, particularly spouse, may wish to stay by the
bed.
Entire family and close friends will visit.

74
Terminal Illness There may be initial hesitation in having discussion due to past
Discussion cultural influences that it is a negative thing to do so.
Conscious courtesy and respect will improve trust.
Brain death may be a difficult concept to understand.
May not be willing to use long term facility as family cares for
dying person; may be open to hospice facility.
Families may want to overrule a Living Will if is one is
completed.
DNR is difficult choice, decided by entire family.
Dying Process Family and patient may avoid discussing dying; however this is
dependent upon religious tradition.
Family may want religious items to be with patient throughout
dying process.
May have specific religious rituals that need to be completed.
Death-Special May want religious items accompany body to mortuary.
Needs
Death-Body Care Families may want to wash body. Dignity and preservation of
modesty for viewing.
Organ Donation May prefer body to be kept intact because of religious beliefs
concerning afterlife. Others may find it acceptable with their
religious beliefs.
Families may want to overrule patient’s choice to be a donor.

Prenatal Care Expected from early in pregnancy.
Encouraged to rest and not overdo.
Labor Modesty important.
May attempt to control vocal expressions of pain.
Father actively involved.
C-Section Acceptable if needed for health of mother or baby
Postpartum and New mother expected to rest and recuperate for several weeks.
Breastfeeding Personal hygiene important.
Breastfeeding accepted
Genetic Defects Best to consult with father before telling mother.
and/or Sick Baby Have father or other family members present for discussion with
mother.
May be interpreted as punishment for parents’ or family’s bad
behavior.

Religion Buddhist, Shinto, Christian.
Spiritual Healing Depends upon religious beliefs.

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Korean Culture

Important Historical End of Japanese rule after World War II.
Issues There are significant differences between North and South
Korea
Clothing or Amulets May wear religious symbols.

Amulets to bring good luck, protection, happiness, etc
Very modest dress.
Language Korean
English
Communication, Ability to speak English does not necessarily equate with
Nonverbal, and capability of reading and writing English.
Greetings Considered rude to direct sole of shoe or foot toward another
person.
Eye contact depends on comfort with and trust of others.
Personal space important.
Use title and surname.
Spokesperson and Husband, father, eldest son.

Decision-making Family-focused, although husband, father or eldest son may
have final say.
Family structure Nuclear, extended, and intergenerational
Food May prefer mostly vegetables and rice
practices/beliefs Important to balance “hot” (spicy, rich) and “cold” (leafy greens)
foods in diet.
Time orientation Punctuality important.
Fate commonly accepted; everything happens for a reason.

Illness beliefs Health seen as harmony or balance between soul and physical
being.
May be believed to have spiritual causes
Because of closeness of family and friends, may look to their
understanding of illness rather than physician’s
Passivity expected.
Accept western medicine however typically incorporated with
complementary practices including acupuncture, herbs, and
spiritual interventions.
Consents Allow time for patient to think and consult with family.
Invasive Procedures Acceptable although anxiety and fear may be high
Pain Varies from silence to stoicism
Family will be a good source of information on how patient
copes with pain.

76
Visitors Frequent
Family member may wish to stay with patient.
Terminal Illness May be preferred for family spokesperson to be informed first,
Discussion then family discussion will inform patient.
May prefer for patient to die at home
Prolonging life through artificial means generally unacceptable
due to religious beliefs.
Dying Process Imminence of death should be told to spokesperson, who will
relay information to family.
Religious rituals, including prayer, chanting, and objects may be
important.
Use of incense may be desired; seek alternatives.
Death-Special Mourning and crying by family part of tradition
Needs Being present during person’s last moments is important in
religious beliefs.
Death-Body Care Depending on religious beliefs, there may be desire for body to
remain untouched following death so that soul is able to leave
and prayers completed.
Organ Donation Traditional belief is that body must maintain its integrity by
remaining intact.

Prenatal Care Diet important; refrain from “hot” foods as pregnancy is
considered a “hot” condition.
Pregnancy is considered not only a physical state, but a spiritual
one as well.
May prefer same sex medical providers
Labor No ice chips
May be expected to be silent so that all energy goes into
delivery.
Father involved.
Postpartum and Rest is considered extremely important.
Breastfeeding Traditionally mother drinks a particular seaweed soup daily
Babies may be dressed in warm clothing
Traditionally newborn sleeps with mother
Breastfeeding acceptable, however education needed to
supplement family teaching.
Genetic Defects Tell father first.
and/or Sick Baby Parents may feel responsible, having done something wrong.
Important to reassure mother and family that no one is to blame.

Religion Buddhism, Confucianism, Christian (Protestant and Catholic),
Islam, Traditional Shamanism
Spiritual Healing Important aspect of holistic view of body, mind, and spirit

77
Vietnamese Culture

Important Historical Image of Ho Chi Minh.
Issues Impacted by Chinese culture
Clothing or Amulets Modest dress
Religious objects may be worn.
Language Vietnamese (with many dialects), educated may speak French
Communication, May not maintain eye contact however believes that a medical
Nonverbal, and person who does so is honest
Greetings Speaking up and direct honesty considered rude
Personal space more distant.
Silence in conversation typical
Maintain a soft voice; loudness and excessive hand gestures
cause discomfort
Traditionally handshakes take place only between same
genders
Spokesperson and Traditionally father or eldest son is spokesperson and holds
Decision-making ultimate authority although women have strong voice within
family structure
Family structure Very family oriented, Intergenerational and extended

Great respect for elderly and ancestors
Family unit is more important than individual
Food Rice, vegetables, small amounts of meat or fish
practices/beliefs
Time orientation Present oriented
Very punctual; being late is considered rude and disrespectful

Illness beliefs Illness can be caused by either or all: Body imbalance, spiritual
reasons, or biomedical means
Doctors are highly respected
May stop taking medication once symptoms are relieved or
readjust the dosage themselves
May use complementary and traditional methods including
acupuncture, massage, coining, cupping, pinching, herbs
Head may be considered sacred and feet profane; always touch
head first
Will need emphasized education regarding medication
schedules and keeping of appointments
Consents Explain procedures as precisely and simply as possible.
Head nodding does not mean understanding or approval.

78
Invasive Procedures May be feared, including blood draws, which is believed to make
illness worse
Surgery may be a very fearful option as it is believed to alter the
body’s balance
Pain May be stoic; it is considered impolite to accept pain medication
first time it is offered
Talk about intensity rather than numeric scale.
Visitors Female family member may stay at bedside.
Many family members and friends visit.
Terminal Illness Do not tell patient without consulting head of family.
Discussion DNR a sensitive issue and a decision made by entire family.
Important questions or issues are raised indirectly
Can be a lengthy process as family will want to consult on
details as a group.
Dying Process Inform head of family in private room.
Usually an emotional lengthy process for family involving many
rituals.
Extended family and community expected to come in shifts
May cry loudly and uncontrollably.
Death-Special May wish spiritual/religious ritual.
Needs Important to allow family extra time with body to complete
religious rituals
Death-Body Care Family member may stay with body until it is moved by mortuary
May object to autopsy due to religious beliefs that body must
remain intact.
Organ Donation May decline due to religious beliefs that body must remain intact

Prenatal Care Mothers must be kept warm and have special hygiene
measures, such as only using salt water to clean teeth.
Labor Woman is expected to be silent.
Personal hygiene important.
Father is present but may assume passive role.
Female family member may serve as labor coach.
C-Section Acceptable if required for health of mother or baby
Postpartum and Seen as critical time; mother expected to be with baby at all
Breastfeeding times.
May not shower or wash hair due to beliefs regarding hot/cold
influences; sponge bath acceptable and family may provide
herbal wash.
Breastfeeding common; mother will adhere to restricted diet that
avoids “cold” foods
Genetic Defects Consult father or other family support person who will decide
and/or Sick Baby who will tell mother; best to have doctor present.
Unconditional acceptance of loved ones, but believe genetic
defect in family is God’s punishment for wrong behavior.
79
Religion Primarily Buddhism, also Confucianism, Taoism, Christian
(Roman Catholic)
Spiritual Healing Very important according to religious tradition
Indonesian Culture

Important Historical Much diversity with each region having own language dialect,
Issues history, and customs.
Most people define themselves locally rather than nationally.
Clothing or Amulets Typically western clothing; women may wear darker colors
Modest dress
Traditional clothing (batik) worn for special occasions
Language Indonesian and many regional dialects
Communication, Usually quiet and reserved
Nonverbal, and May give a slight bow to open/close the discussion
Greetings If being introduced to an entire family, make sure to greet the
elder first to demonstrate respect.
Genders typically do not touch each other, i.e. handshakes
Names are considered sacred and should be treated with
respect. Using titles is important.
Concept of “saving face” is important so communication likely to
be indirect.
Pay attention to nonverbal language
May smile even when disagreeing; nod when not understanding
Avoid using a loud voice in discussions
Eye contact can be viewed as aggressive behavior.
Use eye contact intermittently
Spokesperson and Usually eldest male
Decision-making Group decisions important
Family structure Traditionally a patriarchal society
Interdependence among intergenerational and extended family
Food Religious requirements for fasting during certain times

practices/beliefs Religious requirements for diet
Time orientation Time tends to be viewed as flexible however others expected
to be punctual

80
Illness beliefs Accept western medicine however typically incorporated with
complementary practices including acupuncture, herbs, and
spiritual interventions
High respect for physicians
Modesty important
Consents Inform male spokesperson as well as patient
Invasive Procedures Usually accepted; may have high anxiety and fear
Pain Muslims may avoid pain medicine near death in order to be able
to recite the Islamic creed.
Visitors Family, nuclear and extended as well as religious community
Terminal Illness Find out from male spokesperson if family wishes patient to be
Discussion informed
May tend to avoid the discussion
Only God can determine time of death
requirements
Death-Special Tell leading male first, even before spouse.
Needs
Death-Body Care Islamic protocols for body care: Washing, dressing, and specific
sex.
Organ Donation Usually the consideration of organ donations are
unacceptable, but it depends on the family and/or individual
involved

Prenatal Care Traditional belief is that mother must overeat during
pregnancy; education needed regarding healthy choices
May prefer female care providers
Labor Modesty important
May prefer female care providers
May want to labor/deliver sitting up
May refuse pain medication
C-Section Acceptable if health of mother or baby is in danger
Postpartum and Father may want to recite religious prayers to a baby
Breastfeeding following delivery
May believe that one must engage in excessive heavy
exercise after birth to lose weight quickly
Genetic Defects Inform father first
and/or Sick Baby May be viewed as will of God

81
Religion
Primarily Muslim; also Christian (Protestant, Roman
Catholic) Hindu, Buddhist
Spiritual Healing Depends on what religion family associates themselves with

and what kind of spiritual healing they wish to seek out.
Tibetan Culture
Important Historical Strong Buddhist influence and foundation of culture
Issues Sacred art very important
Clothing or Amulets Conservative dress
Some western dress, but most wear traditional clothing
Malas (beads), rosaries
Ritual items: Buddha statues, etc
Language Tibetan
Communication, May appear reserved and stoic
Nonverbal, and Half-cast eyes, hands in a prayer position and a smile is the
Greetings customary Tibetan greeting
Spokesperson and Whomever is the leader of the family is usually the
Decision-making spokesperson for that family
Great degree of interdependence among family members
May want to consult religious leader first
Family structure Includes extended family, friends, religious community
Elders are treated with great respect
Food May be vegetarian

practices/beliefs May avoid stimulants
Time orientation

Illness beliefs May use Tibetan medicine which is a system of balancing the
relationship between the universal elements and the three
bodily energy systems.
Holistic view of body and mind; relaxing the mind to inner peace
has a direct impact on physical well-being.
Illness may be a result of karma
Consents Close and immediate family members may need to be

counseled and be asked to give consent.
Invasive Procedures May be accepted
Pain Medication is not usually accepted because it disturbs the
clarity of the mind
Visitors Extended family and religious community
82
Terminal Illness Discussion should take place well in advanced to alert close
Discussion person(s) related to the individual of concern so that they can
go about the right procedures for preparing end of life care.
Dying Process Dying seen as a natural part of life
Family may request time for chanting at the bedside, or for a
chant box to be kept with the patient during illness and dying
process
Death-Special Religious rituals important to maintain
Needs
Death-Body Care May have religious rituals for washing of the body
May want religious items to accompany body
Tradition calls for body to not be moved for 3 days so sensitivity
and respect need to be shown when explaining next steps
Organ Donation May be accepted; will not interfere with rituals regarding body
as believed to bring great merit as an act of compassion to
others

Prenatal Care Often use midwives
Gestation by week followed intently for spiritual practices
Labor Traditional rituals are often offered to help ease mother
through labor and birth, including use of blessed butter which
mother may eat during last stages of labor
Father is present
C-Section Allowable
Postpartum and Tradition for holy symbol to be painted on baby’s tongue with
Breastfeeding saffron powder and blessed butter placed on nose
Mother and baby rarely separated
Placenta to be kept to be buried
Genetic Defects Accepted as part of karma
and/or Sick Baby

Religion Tibetan Buddhism, which is the basis of the culture
Spiritual Healing May chant and pray as a way to seek psychological and
emotional refuge
Monthly atonement ceremony

83
Euro-Asian Cultures
Gypsy/ Roma Culture

Preferred Term: Gypsy or Roma
Important Historical There is a set of rules for Romani culture; however they are kept
Issues orally, not written down. While there are variations to Roma
culture, all follow the Romani Code.
Varied traditions, beliefs, and customs among groups
Clothing or Amulets Married women customarily cover their hair with a scarf that is
knotted at the neck.
Most wear an amulet around neck, especially children.
Several amulets, including nature, special symbols, or words
May carry a small cloth or leather pouch that is to be on or near
person at all times.
Allow amulet under pillow or at bedside table.
Never put amulet at foot of bed.
Man’s hat and woman’s scarf must also be kept at head and not
at foot of bed.
Language Usually English (may have a strong accent), however Romani
may be first language.
Communication, Normally very animated but in illness become very anxious.
Nonverbal, and Naturally very loud (shouting) and argumentative; doesn’t
Greetings always mean they are arguing.
Real anger does erupt, however is usually contained by family
members. Rarely violent. Best not to overreact.
Concern over illness shown by being gregarious and assertive.
First reaction often mistrustful; important to take time to
establish trust.
Respect older medical professionals more than younger.
Desire close personal contact with family members; very
anxious when alone; avoid close-contact with non-Gypsies.
Spokesperson and Eldest male
Decision-making Individuals make own decisions, but prefer to consult entire
family first, especially older relatives.
Parents speak for their children; however also listen to wishes of
child, often to detriment of child’s health.
Family structure Large extended families of at least 3 generations.
Fierce family loyalty.
Women generally keepers and communicators of medical and
spiritual knowledge; have very important role in time of illness.
Children indulged and allowed to express themselves freely.
Family cares for each other; rarely send ill/elderly to institution.
A family member will likely want to be present at all times
Large number of visitors expected.
Elder in authority usually willing to organize system when and

84
how many at a time may visit.
Provide a room/area where all can gather as preference is
outside and separate from non-Gypsies.
Food Food must be prepared in a way that is clean - wrapped in
practices/beliefs plastic, on paper plates or anything disposable, including plastic
utensils.
Food that falls on the floor cannot be eaten.
Diet is heavy, greasy, and high in salt and cholesterol.
May fast on Fridays.
Time orientation Usually present-oriented

Illness beliefs Tied to beliefs of good and bad luck, purity and impurity,
inclusion and exclusion.
The waist divides an adult’s body; the lower half is considered
impure; if lower body is touched, then hands must be washed to
be purified.
When bathing, the body must be washed with the water flowing
from the head down.
Washing and other taboos will often be relaxed for elders due to
respect.
Lack of spiritual and moral cleanliness results in disease and
bad luck; also attracts certain spirits or devil.
Sick person expects family to attend to needs and care for them.
Illness is a crisis for the whole family
Will recognize and accept western medicine; however may also
want to use traditional medicine.
Consents Illiteracy may be a sensitive issue.

Confirm understanding of medical terminology.
Invasive Procedures Usually fearful of any surgical procedure that requires general
anesthesia because of a belief that a person under general
anesthesia undergoes a "little death."
For the family to gather around the person coming out of
the anesthesia may be especially important.
Pain Sharing medications is common
May ask for a specific color of medication
Visitors Belief in importance of spiritual energy which is believed to be
lost when one spends too much time in the non-Romani world.
Will want to have family members present in order to renew this
energy.
Terminal Illness Initiate first with eldest leader
Discussion Dying person anxious to have all arrangements made

85
Dying Process First inform eldest in authority and ask for help with relatives.
May want chaplain present for purification of body as there is
usually an extensive ritual that is done.
Grief expressed by wailing and calling out to God over and over.
Women may beat breasts and tear out hair.
Death-Special May ask for religious object in room or favorite foods and
Needs personal article of dying person.
Moment of death and last words of patient highly significant;
relatives will want to be present and to hear them.
May want to have older female relative present.
May want window open to allow patient’s spirit to leave.
Death-Body Care Body after death may be source of spiritual danger for relatives
until it is embalmed; may likely leave quickly after death occurs
Generally decline autopsies
Organ Donation Usually not accepted due to fears and beliefs

Prenatal Care A woman is considered to be unclean during pregnancy
Labor Father usually present due to modesty at birth process.
Assistance from older women relatives expected.
C-section If necessary; eldest male of family may decide
Postpartum and Since baby is born from lower half of body, both are considered
Breastfeeding impure or unclean for length of time.
Older women relatives may be nearby to help with cooking and
other chores, but family members’ visiting kept to minimum for
fear of bringing in spirits that may harm baby.
Babies often swaddled tightly.
Babies believed to be vulnerable to Evil Eye. Giver of evil eye
must make a cross with spittle on baby’s forehead; if asked to
do so, best to comply. People with bushy or heavy eyebrows or
lots of body hair believed to often have Evil Eye.
Breastfeeding acceptable. Identify food traditions, such as belief
that drinking bill or whiskey will calm baby.
Genetic Defects May be viewed as due to an impurity suffered or “the spirit of
and/or Sick Baby death”
If baby dies, parents may avoid it at all costs and may leave
hospital suddenly
Baby’s body is traditionally buried in a secret place by
grandparents
Or to avoid bad luck family may leave the funeral and burial to
hospital authorities

86
Religion Traditional belief system related to spirits, saints, and other
spiritual supernatural beings is always incorporated into other
beliefs: Roman Catholic, Orthodox Christian, Muslim, and
Protestant.
Shrine in home - or even in hospital room - is common.
Spiritual Healing Spiritual leaders are usually older female relatives who may
bring in certain plants and medicines for patient.
May wish to see chaplain regularly for blessings.
Russian Culture
Important Historical Very proud of history and traditions, especially Orthodox
Issues religious history
Clothing or Amulets Some elderly women may prefer to wear warm clothing on top
of hospital or gowns to avoid cold.
May wear religious necklaces.
Language Russian
Communication, May use loud voice, even in pleasant conversations.
Nonverbal, and Direct eye-to-eye contact used.
Greetings Straightforward in conversation
May use metaphors to discuss important issues
Personal space is closer for friends/family.
Elders may be called “uncle” or “aunt” even if unrelated by
blood.
Handshake acceptable
Direct eye contact
Appropriate greeting for time of day
Spokesperson and Father, mother, eldest son or eldest daughter.

Decision-making
Family structure Nuclear family most common
Strong bonds to extended family especially in times of illness.
Strong view of distinct gender roles
Women are the nurturers and caregivers in illness
Great respect for elders.
Food Bread considered a staple; meat and fruit important
practices/beliefs May observe religious fasts
Time orientation Will try to be on time for appointments or early.

87
Illness beliefs Good health maintained by dressing warmly, avoiding stress,
regular bowel movements, nutrition.
Folk medicine may be utilized, i.e. herbs, spiritual healing,
leeches, homeopathy
May believe illness is will of God, testing of faith or punishment.
Believe doctor is ultimate authority; if possible have doctor
introduce other members of team, stressing their credentials
May tend to self-diagnose
Often reluctant to complete advance directives
Consents Explain procedures, tests, etc with patient and family together
and allow time for family discussion.
Invasive Procedures Usually acceptable, however may be fearful of blood

transfusions, IVs developing air in the line, unfamiliar
procedures or equipment
Pain May be stoic and not ask for medication.
Comfortable with numeric pain scale.
Visitors Family members and friends expected to visit to provide
support.
Terminal Illness Inform head of family first.
Discussion Family may be concerned about quality of care issues and
express them often
May not want DNR.
Family will likely remain cheerful with patient throughout illness
and dying process
Dying Process Ensuring patient comfort and lack of distress is a priority.
A family member will usually be at bedside at all times
Efforts are made by family not to openly grieve in front of patient
Family may view the giving of comfort medications as “giving
up”
May want religious items in room
Death-Special Likely to have religious/spiritual ritual requests and needs.
Needs Tradition is often to light a candle after death; discuss to
accommodate with battery operated candle
Death-Body Care Family members may want to wash body and/or put special
clothing on care deceased.
May wish coins on eyes and roll of cloth under chin
May not wish autopsy unless absolutely necessary.
Organ Donation May not consent due to cultural misinformation

Prenatal Care May not be utilized unless there is a problem.
Believe pregnant women should be protected from bad news.
Believe certain activities, such as lifting, heavy exercise or
skipping steps when going down stairs will result in harm to
baby.

88
Labor Women generally passive; follow commands of doctor/midwife.
Traditionally believe that drinking castor oil or have enema will
encourage an easier birth.
May not desire pain medication due to expectation to be stoic.
May wish lighting dim due to believe that it will harm baby’s
eyes.
C-Section Acceptable if health of mother or baby at risk
Postpartum and Traditional practice is 15 days of bed rest
Breastfeeding May wear pelvic binder
Breastfeeding very important, supported and encouraged within
culture.
Important for breastfeeding mother to be at peace.
Believe breasts must be kept warm.
Genetic Defects Tell mother first.
and/or Sick Baby May be viewed as testing or punishment from God

Religion Russian or Eastern Orthodox Christian, Jewish
Spiritual Healing Spiritual leaders may be important in healing process.

May use folk remedies.

89

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Handbook of Patients’ Spiritual

and Cultural Values

Updated March 2013

© HealthCare Chaplaincy 2013 1

© HealthCare Chaplaincy 2013 2

Native American Culture 37

Native Hawaiian Culture 40

South African Culture 48

Middle Eastern/North African Cultures

© HealthCare Chaplaincy 2013 3

East Indian Cultures 66

East Asian Cultures

© HealthCare Chaplaincy 2013 4

― Cultural & Spiritual Sensitivity ─ A Learning Module for Health Care

4. When using these materials we request that this credit be included:

© HealthCare Chaplaincy 2013 5

© HealthCare Chaplaincy 2013 6

All believe in:

*Primary belief differences concern Jesus Christ.

© HealthCare Chaplaincy 2013 7

© HealthCare Chaplaincy 2013 8

© HealthCare Chaplaincy 2013 9

© HealthCare Chaplaincy 2013

Mormon (Church of Jesus Christ of Latter-day Saints)

*Mainline denominations include: Baptist, Christian (also Disciples of Christ, Churches

Beliefs Jesus of Nazareth is the son of God.

© HealthCare Chaplaincy 2013

Beliefs Strong tradition of liturgy (ceremony).

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© HealthCare Chaplaincy 2013

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© HealthCare Chaplaincy 2013

Major Jewish Movements:

Conservative Jews believe in:

Reform Jews believe in:

Beliefs Majority of Jews unaffiliated-Judaism can be seen as identity

© HealthCare Chaplaincy 2013

© HealthCare Chaplaincy 2013

*There are 3 major Buddhist traditions: Theravada, Mahayana, and Tibetan

© HealthCare Chaplaincy 2013

*Large population in India, Nepal and Bangladesh

Beliefs A wide variety of beliefs held together by an attitude of mutual

© HealthCare Chaplaincy 2013

© HealthCare Chaplaincy 2013

© HealthCare Chaplaincy 2013

© HealthCare Chaplaincy 2013

Beliefs Fundamental inter-connectedness of all natural things; all forms of

© HealthCare Chaplaincy 2013

Beliefs Creator - some tribes use “God” and “Creator” interchangeably.

Food Limited meat- no pork or shellfish (following of Old Testament

Jamaican Patois, the Jamaican Creole, may be hard to understand

© HealthCare Chaplaincy 2013

© HealthCare Chaplaincy 2013

Beliefs Polytheistic - many gods and goddesses.

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Health, Illness and Death

© HealthCare Chaplaincy 2013

Pregnancy, Birth, Postpartum