Cultural

Considerations
© USMLE Galaxy LLC

Why is this so important?

● Helps the nurse to identify ways the client’s culture impacts their health
● This allows nurses to take better care of their clients!
● Always remain accepting and respectful
● Humans are diverse!
○ No two of us are the same…
○ Just because two clients have the same religion doesn’t mean they will follow the exact same
practices!
○ Moral of the story - always ask!

Morgan’s bedside practice:

“Is there anything about your background or culture that would help me take
better care of you?”

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What does culture impact?
● The meaning of a mental health illness
● The way the client tells the health care provider about their symptoms
● How the client copes with stress
● If they want to seek treatment for certain disorders
● Which treatments they will accept
● Family & interpersonal dynamics
○ Who makes the decisions about treatment
○ Who they want at the hospital
○ Who they want to know about their care
○ How close they are comfortable with the nurse being
● Communication
○ Eye contact
○ Verbal/non-verbal

Orthodox Jewish
● Some client’s follow a kosher diet
● Kosher
○ No shellfish
○ No pork
○ Do not combine meats and dairy products in the same meal
● Client will need wrapped plastic utensils and they will unwrap the utensils
and prepare their own meal

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NCLEX Question
Which of the following meals would you offer to your client who practices
Orthodox Judaism?

A. Chicken parmesan and spaghetti

B. Chile con carne topped with queso fresco
C. A club sandwich with low sodium ham and cheese
D. A cottage cheese salad with fresh fruit

Answer: D
D is correct. This is the only meal choice that does not combine meat and dairy
products in the same meal. Clients practicing orthodox judaism typically will not
consume meat and dairy in the same meal.

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Islam
● Muslim faith
● Halal
○ No alcohol
○ Meat slaughtered religiously - no pork
● Ramadan
○ Fast during daylight hours
● Women will typically require a female provider for their care
● Prayer
○ 5 times a day
● May interpret illness as the will of Allah or a test of faith
○ May prefer alternative therapies
● End of life care and death
○ May want to prepare the body by washing and wrapping in white cloth
○ Post Mortem examinations discouraged

Jehovah’s Witness
● May refuse blood products
○ Blood transfusions

■ Whole blood

■ Packed red blood cells

■ Plasma

■ Platelets

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Seventh-Day Adventist church
● No alcohol
● No caffeine
● Lacto-ovo vegetarians
○ Eggs and dairy products okay
○ No meat
● No pork

Hinduism
● Hindus practice ayurvedic medicine, which encompasses all aspects of life,
including diet, sleep, elimination, and hygiene
● Prefer a shower - not a bathtub
● Most Hindus are lacto-vegetarians
○ No eggs
○ Dairy - okay!
○ Most will not eat meat - especially beef
● Fasting usually means eating only pure foods, such as fruit or yogurt, but is
not expected of the sick

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NCLEX Question
Which of the following special considerations should the nurse make when caring for a Hindu client
based on her religion?

Select all that apply.

A. Provide all vegetarian meals

B. Handle the client's temple garments with care
C. Be sure the bathroom is equipped with a shower and not just a tub
D. Be aware that the client will likely refuse blood transfusions
E. Arrange for female nursing staff to provide care for the client as much as possible
F. Be aware that the client will likely refuse pain medication

Answers: C and E
Choices C and E are correct. Hindus prefer to wash in free-flowing water (e.g. a shower instead of a bathtub). If a
shower is not available, provide a jug of water for the person to use in the tub. Hindus practice ayurvedic medicine, which
encompasses all aspects of life, including diet, sleep, elimination, and hygiene. Most Hindus are lactovegetarians. Most
will not eat beef and avoid bovine-derived medications because they believe in the reincarnation of certain gods. Fasting
usually means eating only “pure” foods, such as fruit or yogurt, but it is not expected of the sick. Hindu women are modest
and usually prefer to be treated by female medical staff (Choice E).

Choice A is incorrect. Although some Hindus will eat eggs and even chicken, most are lactovegetarians, consuming milk
but no eggs.

Choice B is incorrect. Hindus may wear a “sacred thread” or religious jewelry around their body or wrist. Mormons, not
Hindus, wear “temple garments”.

Choice D is incorrect. Jehovah's Witnesses—not Hindus—refuse to accept blood transfusions or blood products, which
they view as morally wrong.

Choice F is incorrect. Christian Scientists—not Hindus—would be likely to refuse pain medication.

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Asian Americans
● May value the ability to remain stoic while in pain
● Are typically family oriented and involve their extended family in care
● May prefer a greater physical distance from the nurse or provider
● Prolonged eye contact sometimes viewed as rude

Latino Americans
● View of illness
○ Signs of weakness
○ Punishment
● Extended family typically involved in all decision making
● Multiple generations may wish to be at the hospital with the client

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NCLEX Question
You are caring for a client in the step-down unit who tells you that they are an
active member of the Seventh-Day Adventist church. When their breakfast tray
comes up, you see the following items. Knowing the religious dietary
preferences of these clients, which item does the nurse remove from the
breakfast tray? Select all that apply

A. Coffee
B. Bacon
C. Scrambled eggs
D. Pancakes

Answers: A and B
The correct answers are A and B. Members of the Seventh-Day Adventist church are not permitted to
consume alcohol or caffeinated beverages. Due to this dietary preference the nurse should remove the
coffee from the client’s breakfast tray. These individuals are usually Lacto-ovo vegetarians, and for
those who do consume meat pork is avoided. Because of this, the nurse should remove the bacon from
the breakfast tray.

C is incorrect. Scrambled eggs would be allowed for Lacto-ovo vegetarians.

D is incorrect. Pancakes would not violate any of these dietary restrictions.

NCSBN client need:

Topic: Psychosocial Integrity Subtopic: Religious and Spiritual Influences on Health
Reference:
Silvestri, L.; Saunders Comprehensive Review for the NCLEX-RN Examination, ed 6, St. Louis, 2014, Elsevier, p. 97

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Using interpreters
● Do not use a family member
● Certified medical interpreter
● Speak to the client- not to the interpreter
● Ask one question at a time

“If it isn’t culturally and linguistically appropriate, it isn’t

healthcare”

-Marjory Bancroft, Director of Cross-Cultural Communications

End of life care

● Chinese
○ Often do not discuss death and end of life - seen as hopelessness
○ May wish to use alternative therapies or herbal remedies
● Muslim
○ Help facilitate times of prayer
○ May request to be facing Mecca
● Different cultures have specific views about the end of life

● Important to remember that every person is unique

● Do not make any assumptions
● Ask the client and their family members about their wishes to provide the
best care

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NCLEX Question
The Nurse is assisting a client of the orthodox Jewish faith while serving lunch. A
kosher meal has been delivered to the client. What is the next appropriate action
to perform with this client?

A. Substitute plastic utensils with metal utensils

B. Unwrapping the eating utensils for the client
C. Carefully transferring the food from a styrofoam tray to a ceramic plate
D. Allowing the client to unwrap the utensils and prepare his own meal

Answer: D
D is correct. The client practicing Orthodox Judaism will likely need wrapped
plastic utensils and they will unwrap the utensils and prepare their own meal.

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NCLEX Question:
The primary objective in identifying similarities and differences among cultural
beliefs of a client is to

A. Communicate with their family

B. Make sure the proper diet is ordered
C. Perform a spiritual consult
D. Avoid making assumptions

Answer: D
D is Correct Making assumptions or generalizations about a client’s spiritual needs based on ethnic or
religious affiliation is almost sure to be an oversimplification. The nurse should be able to identify
similarities and differences among the cultural beliefs of the clients. Just because a client belongs to a
certain culture or ethnicity, it is incorrect to generalize their spiritual needs.

Choices A, B, and C are incorrect. Ordering a specific diet as per the client's specific cultural or religious
preference is certainly warranted. However, generalizations cannot be made here either, and knowing
the client's specific preference will help the nurse cater to the client's dietary or spiritual needs.
Communicating with the family and performing a spiritual consult should also be done at the client's
request. While identification of cultural similarities and differences among the clients can help guide
these processes, these are not the primary objectives. The primary objective is to avoid making
assumptions.

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