Spiritual, Cultural and Religious Health Care Revd Mia Hilborn Hospitaller, Head of Spiritual Health Care & Chaplaincy Team Leader May 2008
The current UK situation the British Muslim community has worst reported health, followed by the Sikh population. For both groups, as well as for Hindus, females were more likely to report ill health whereas for Christians and Jews there was only minimal gender difference. It should be borne in mind that this is not necessarily cause and effect, but more likely confounded with other variables such as housing, economic and social status. ( http://www.statistics.gov.uk) 2008.
Healthcare issues Religious views can impact: reproductive medicine, abortion, Contraception neonatal care old age (resources, artificial nutrition and hydration) terminally ill News giving/place of family brain death, organ donations and care for the corpse (Equality Impact Assessments for Healthcare, DH, 2008)
Diet, drugs Religious belief can also impact on the types of treatment and drugs used, for instance the prohibition of eating pork in Judaism and Islam means that porcine or alcohol based drugs would be forbidden in these communities. Similarly, the use of bovine based drugs or cattle derived cartilage transplants would have religious implications for Hindu communities and for some vegans and vegetarians.
Spiritual, Cultural, Religious Health Care Clinical considerations: Diet * Religious time of death Dignity * Newsgiving Assessment * Organ donation/pm Special items * Religious rituals Amputation * Spiritual distress Medication * Washing Family * Pictures/representative art Time/day * Who should be present pre & Funerals post death?
Contractual arrangements Consideration should also be given to making clear contractual arrangements with suppliers of food for hospitals, nursing homes etc. to make sure that food for people from different religions or beliefs meets all the religious requirements and is clearly labelled. Catering suppliers should be educated and informed of the requirements, for example for Halal, Kosher or vegetarian or vegan food. It makes sound business and ethical sense to source dietary requirements from suppliers within the religious or cultural groups under consideration (Equality Impact Assessments, DH 2008)
Religious affiliations of GSTFT patients and staff (March 2008 ) 80.0 70.0 60.0 Religious affiliation for both Patients and Staff (excluding not recorded/disclosed which for patients is 57.69% and staff 50.45%) 66.96% 73.39% Percentage 50.0 40.0 30.0 20.0 10.0 0.0 0.57% 1.04% 0.72% 2.79% 0.59% 0.77% 5.78% 4.04% 0.22% 0.6 3.28% 2.97% 21.89% 14.4 Buddhist Christian Hindu Jewish Muslim Religion Sikh Patients Other Staff None
Recorded Religion for Inpatients (excluding "Not Recorded" which equals 57.69%) 50.0 45.0 43.89% 40.0 35.0 30.0 Percentage 25.0 20.0 21.89% 18.52% 15.0 10.0 5.0 0.0 2.48% None Church of England Roman Catholic Other Buddhist 0.57% 0.96% 0.72% Other Free church Hindu 0.67% 0.91% 5.78% Church of Scotland Methodist Muslim Sikh Jewish 0.22% 0.11% 0.48% Orthodox Baptist 0.83% Christian Scientist Faith 0.24% 0.13% 0.5 0.24% Church of God Pentecostal Jehovah's witness Rastafarian 0.09% 0.13% 0.2 0.2 0.09% 0.09% American Catholic Christadelphan Nonconformist Presbyterian Church of Ireland 0.04% United Reform Church Mormon 0.04%
Results of the Patient Survey 2008 GSTFT Wallis Religion of respondents Buddhist 2% Hindu 3% Jewish Christian 7 Muslim 8% Sikh Other 2% No religion 8% Perfer not to say Blank 7%
Results of the Patient Survey 2008 GSTFT Wallis Ethnic Background Irish 3% Other w hite 7% Indian 5% Pakistani 2% Bangladeshi 2% White & Black African British 66% Chinese White & Asian Other asian Other Chinese Other M ixed White and Black caribbean Blank 3% Perfer not to say Caribbean African 5% Other Black 8%
Results of the staff Survey 2008 GSTFT Wallis Religion of respondents Christian 57% Blank 13% Buddhist 2% Perfer not to say 2% No religion 14% Other 2% Sikh 1% Muslim 7% Jewish 1% Hindu 1%
Results of the staff Survey 2008 GSTFT Wallis Ethnic Background British 53% Irish 3% Blank 5% Other w hite 11% Perfer not to say 3% Indian 4% Other Black 1% African 6% Caribbean 6% Other Mixed 2% White & Asian 1% White & Black African 1% White and Black caribbean Other Chinese 2% Chinese Pakistani Bangladeshi 1% Other asian 3%
GSTFT 2008 Wallis 40.0 Patient Religious affiliation (as recorded on admission) mapped against the religious affiliation of patients seen by the Chaplaincy Department 35.0 30.0 25.0 Percentage 20.0 15.0 10.0 5.0 0.0 American Catholic Ba'hia Baptist Buddist Christadelphan Christian Scientist Church of England Church of God Church of Ireland Church of Scotland Hindu Jain Patient records % Activity Based (including Staff) % Jehovah's witness Jewish Methodist Mormon Muslim Nonconformist Orthodox Other Free church Pentecostal Presbyterian Rastafarian Roman Catholic Sikh Religion/Faith United Reform Church Other None
From: 01/04/2007 To: 31/03/2008 Children's Services GSTFT White 53% Black or black British 31% Asian or Asian British 6% Mixed 3% Other Ethnic 7%
01/04/2007 to 31/03/2008 Children's Services GSTFT British 36% Irish 1% Other white 17% African 5% Caribbean 4% Other black 21% Pakistani 1% Indian 3% Bangladeshi 1% Other Asian 1% Chinese 1% Mixed 2% Other 6% 40 35 30 25 20 15 10 5 0 % British Irish Other white African Caribbean Other black Pakistani Indian Bangladesh i Other Asian Chinese
Children s Renal Unit ethnicity project 2004 Guy s Population need for renal replacement therapy in Thames regions:ethnic dimension Roderick PJ, Jones I, Raleigh VS, McGeown M, Mallick N BMJ. 1994 Oct 29; 309(6962): 1111-4
Hypotheses - ethnic minority children are over-represented in the paediatric ESRF population and particularly so in London are more likely to be dialysed are less likely to receive a LD graft are likely to wait longer for a cadaveric graft are less likely to receive a well matched kidney
Hypotheses - ethnic minority children are over-represented in the paediatric ESRF population and particularly so in London - yes, Asian children are more likely to be dialysed - yes, BAPN data are less likely to receive a LD graft - yes, BAPN data are likely to wait longer for a cadaveric graft - not answered
Hypotheses - ethnic minority children are less likely to receive a well matched kidney - not so, Guy s data tend to have less good outcomes - not answered are more likely to be non-compliant - not addressed require more resources (money) to care for them yes, dialysis, social worker time, translation services..
FICA F Faith Spiritual, Cultural, Religious Health Care Spiritual Assessment Tools: What gives meaning to life? I Importance/Influence How important is your faith/spirituality to you? C Community Are you part of a religious or cultural or spiritual community? A Address/Application How can the hospital address these issues? Palliative Care Perspectives, Pyschosocial and Spiritual Aspects of Care, James Hallenbach OUP 2003
Spiritual, Cultural, Religious Health Care Spiritual Assessment Tools: HOPE H Hope, sources of hope, strength, comfort, meaning, peace, love, connection O Organised, organised religion/culture, groups P Personal, spirituality, practice E Effects, on clinical care and EOL decisions Am Fam Physician 2001; 63:81-8,89
Spiritual, Cultural, Religious Health Care What can you do after assessment: Do nothing. May have no way of answering spiritual concerns. Listening may be only option Encourage individual s spirituality in health care, role of self-help Document spirituality into care plan, leave space eg saying prayers before surgery Modify treatment plan according to spiritual/religious/cultural needs