Page 119 - Cultural Competence in Health Education

A Spiritually Grounded and Culturally Responsive Approach 97

immigrant and refugee women ’ s organization, in whatever way it chose to use my

skills, and to find a kindred spirit in Libby Tisdell.
Histories of nursing and medical care from many cultures locate the beginnings of
this care in religious settings, so the spiritual element in health care practice cannot be
considered a new invention (Donahue, 1985). But spirituality often has an uncomfort-

able fit in the evidence - based and outcome - focused biomedicine of today. In medicine,
where curing disease is paramount, the interest in spirituality has focused on belief,
meditative practices, prayer as medicine, and faith and religion as related to health.

Sympathetic medical researchers argue for a broader definition, relating spirituality to
that which is pleasurable to the aesthetic senses (Rabin, 2003). Thus spirituality could
be related to activities that regulate production of stress hormones, establishing a clini-
cal relationship and connection with quality of life. A notable follower of this approach,
Herbert Bensen (2003) has spent a career studying the relaxation response among
followers of many faiths. He finds that practices in all faith traditions are equally effec-

tive at evoking this stress - reducing response; the words or techniques used do not mat-
ter. It is the coupling with a belief system that is necessary.
Other empirical support for spirituality as an aspect of health comes from extensive
research focusing on spirituality as religious coping (Harrison, Hays, Koenig, Eme - Akwari,
& Pargament, 2001). There is clearly evidence in this body of research emphasizing the
individual person ’ s traits and beliefs that a coherent belief system supports stress manage-
ment and coping with challenges. Much more controversial is the study of prayer. Pioneer-
ing efforts by Dossey (1993) to study prayer as a form of nonlocal healing have progressed
to randomized control trials of distant healing by strangers through prayer. Interpretations
of results vary widely depending on where they are published, and systematic reviews of
results remain equivocal (Roberts, Ahmed, & Hall, 2007). Research taking a more cultur-
ally grounded perspective on prayer identifies that Americans of diverse ethnicities iden-

tify prayer as both folk home remedy and spiritual practice. It is the most frequently
reported home remedy (Easom, 2006).
Somewhat differently, in clinical nursing practice, where the therapeutic relation-

ship is primary, spirituality is consistently defined as a unifying force and integrative
aspect in a person, the dimension that evokes feeling and provides meaning through a
transcendence and interconnectedness that manifests at many boundaries — relation to
self and to others, group relations, and relation to that which is transcendent or beyond,
above, or ultimate (Reed, 1992; Dossey & Guzzetta, 2000). Similarly, the nature of
hope is a recurrent theme in the palliative care literature, where spirituality is emerg-
ing as a concept largely devoid of religion (Sinclair, Pereira, & Raffin, 2006). Here,

where the needs for recurrent patient education are great, numerous studies show that
what works is a multifaceted, personally tailored approach, using various media and
activities and honoring the self (Bugge & Higginson, 2006), much like the model my
coauthor, Libby, has developed for teaching.

In looking to professional literature to help define my clinical practice, I found
validation in these resources. However, to avoid labeling and diagnosing spiritual
needs or problems, which could open the door to transgressing religious boundaries,

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