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Family and Cultural Care of the Critically Ill Patient 171

informants regarding the religious needs of the patient. enable a person’s spiritual or religious needs to be deter-
Having said this, some patients have adopted religions mined. The critical care nurse needs to ascertain whether
separate from their family of origin, and in these circum- the patient and family have any spiritual or religious
stances family cannot be relied upon as informants, and beliefs and practices to be observed during their time in
in some situations there may be a conflict between the the critical care setting. 1,132 Once the spiritual or religious
religious values and practices of the patient and those of beliefs and practices have been determined, the critical
the family. Religious beliefs and practices, like cultural care nurse can facilitate opportunities for the patient and/
beliefs and practices, will vary between orthodox or tra- or family to carry out their beliefs and practices, and will
ditional and contemporary interpretations. importantly avoid any insensitive actions. 132 In this way
the critical care nurse can be sensitive to, and recognise,
Patients generally fall into three groups with regard to any spiritual distress evident in the patient and family
their religious practices. 132 There are those who: members.
1. practise their religious beliefs regularly A person’s spirituality, whether informed by religion or
2. practise their religious beliefs on an irregular basis, some other basis, manifests in a variety of relationships
often in times of need and stress with self, others, nature and ‘divine’ beings. It is the
3. have no religious interests. essence of who a person is, or who groups of people are.
While assessing spiritual or religious needs is one aspect,
All patients should have access to religious support where presence and being with, empathetic listening, reality ori-
they indicate a need. Therefore, it is beneficial for critical entation of the family, and enabling visiting and contact
care nurses to have knowledge of how to access the rel- are all important nursing activities that can support the
evant religious resources if needed. The focus of the criti- spiritual and religious needs of patients and their fami-
cal care setting often involves going to extreme lengths to lies. When families are confronted with the possibility
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keep patients alive, which may well be in direct opposi- of death, the documentation of a death plan that outlines
tion to some religious beliefs. Religious beliefs can either the preferred care during the process of dying and death
facilitate or disrupt the process of living or dying. 130,131 is recommended. 132 Death plans are about empower-
There are a number of principles critical care nurses ment, and differ from advance directives, which outline
should underpin their practice with when nursing patients what is not wanted (e.g. cardiopulmonary resuscitation).
with specific religious needs (see Table 8.5).
Through formal discussion with the patient and/or
In addition to these principles, contact and communica- family, religious and end-of-life needs can be determined
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tion with the critical care nurse is important, and can and a management plan developed for implementation.

TABLE 8.5 Principles for recognising religious needs
Principles Areas for consideration
Diversity exists between and within the various religions. Determine values and beliefs related to health, illness, dying, death, and any
specific requirements for undertaking everyday nursing cares and
procedures.
Spirituality is an essential part of care planning and the Spiritual and religious needs should be documented in the care plan to
delivery of quality care. ensure continuity and quality of care.
Interpersonal skills and therapeutic use of self is essential Approaching the patient with a genuine, non-judgemental attitude.
to engaging and being present with the patient and Avoid imposing own religious or spiritual beliefs on the patient and family.
family.
Being knowledgeable about a patient’s religious values Consult family, if they share same religion, and/or consult appropriate
about life, health, illness, death and dying enables the representative of the patient’s religion. Areas to explore should include the
critical care nurse to be respectful and accommodates following to determine:
in their care. ● religious values regarding life, health, illness, dying, and death
● nature of the ideal environment
● processes surrounding dying, if appropriate to the patient
● beliefs regarding nutrition and hydration
● use of touch
● gender-specific care
● family presence, involvement and support
● care after death.
Philosophies and policies should be cognisant of the Policies should be cognisant of cultural and religious diversity, and include
cultural and religious diversity within the critical care management of the following:
patient population. ● visiting
● modesty
● gender-specific care
● communication
● language and the use of interpreters.