Navigating Cultural & Religious Beliefs in Nutrition Support

 Navigating Cultural & Religious Beliefs in Nutrition Support

By Baylee Rogee and Bridget Storm, MA, RD, LDN, CNSC

Importance of Understanding Cultural & Religion in Critical Care

Within critical care there is a diverse group of patients that all stem from different backgrounds. When providing individualized care to a patient, cultural and religious beliefs should be addressed in their medical nutrition therapy assessment and care plan. Everyone has different beliefs and values that drive their life and when it comes to medical care it is important to incorporate those beliefs. Patients may feel disrespected, have a sense of mistrust, or feel as if the provider brought bad luck upon the family if their providers don’t honor their beliefs.

Nutrition is not only what provides energy for the body; it has emotional ties as well. Food is a huge part of culture by bringing families together. In some cultures, it is a way to show love and care for someone as well as promote healing. When providing nutritional support, it can be challenging to navigate different cultures and religious beliefs around nutrition. Understanding different values and beliefs will allow the patient to feel safer and more respected.

Cultural Differences in Nutrition Support

Black Cultures

Black patients are family oriented and want their extended families and support networks involved in decision making. There is usually a spiritual emphasis among black patients and families. It is not uncommon for patients to opt for life-extending treatments, hoping for a miraculous intervention from a higher power. There tends to be more mistrust among black patients with the health-care system due to the past injustices in U.S. history and ongoing health inequities.

Latino Cultures

            Latino patients have larger families that are present in the care of the patient. Latino patients want their families and support networks to be included in the decision-making process. Traditional gender roles are typically maintained by men making decisions for female patients or women relying on the men to make decisions. Latinos also have an emphasis on spiritually, with Roman Catholicism being a more dominant faith in the culture.

Chinese, Japanese, and Korean Cultures

In many Asian cultures filial piety, the virtue of exhibiting love and respect for one’s parents, elders, and ancestors, is paramount. Decision making in Asian cultures is often handed off to the patients’ children. Elderly Asian patients may also have language barriers, relying on their children to bridge the language gap. Lack of effective communication due to language barriers can often lead to a distrust of providers.

While not a universal practice, some Asian patients have a cultural preference for traditional healing practices like Traditional Chinese Medicine (TCM). TCM incorporates deeply rooted traditions of using herbal remedies and holistic approaches to health that are embedded in practices like acupuncture and dietary modifications. These patients and families are often distrustful of Western medicine, which they feel is aimed at treating symptoms rather than taking a holistic approach to curing disease.

In the Chinese culture food is a seen as an essence of life and family love. Talking about death or end of life within the Chinese culture can be seen as taboo or bad luck. There is often a preference that serious diagnoses be discussed with the patient’s surrogate and not communicated with the patient, which presents an ethical dilemma for providers. Cultural preferences in this population can make it challenging to make feeding related decisions such as nutrition support.

South Asian and Indian Cultures

Parent-child relationship is important in the South Asian culture. Patients typically favor traditional medicine and healing methods because of their belief that diseases stem from spiritual or religious factors. This can prevent them from seeking medical care. Similar to northern Asian populations, South Asian and Indian patients may have language barriers hindering effective communication.

An additional barrier to nutrition support provision in some South Asian and Indian cultures is the preference of a vegetarian diet. In healthcare facilities with larger South Asian and Indian cultures, a vegetarian tube feeding formula should be included on the enteral formulary.

Arab Cultures

In the Arab culture, family is heavily involved the patient’s recovery because it is seen as a big contributor to one’s healing and visitation is encouraged. Patients may prefer to only hear “good” news and have all other serious diagnoses and care plans discussed with the family. Elders have a prestigious role in the family, and the eldest male in the family typically will make decisions.

American Indian Cultures

            In many American Indian cultures, talk of death and end of life decisions is considered taboo and thought to evoke negative spirits. Family in these cultures often expand to community members and large visitation gatherings are often sought.

Religious Differences in Nutrition Support

Christianity

Nutrition and hydration are necessities in some denominations like the Roman Catholic Church and Eastern Orthodox Church. This includes nutrition such as enteral nutrition and parenteral nutrition for patients who cannot consume food orally. It is forbidden in the Eastern Orthodox Church to withdraw or withhold nutrition support if there is a chance of recovery.

Judaism

Within the Orthodox Judaism hydration and nutrition are basic needs regardless of delivery. It is also forbidden to withhold nutrition and hydration unless it causes more suffering prior to death.

Islam

Nutrition Support should not be withheld from a patient. It is viewed as a crime if nutrition and hydration are withheld unless it is not beneficial to the patient by causing more harm then good.

Hinduism

In Hinduism good karma can be brought forth by fasting. This may cause some Hindus to reject nutrition support.

Buddhism

Nutrition support at the end of life is not mandatory, as it may negatively impact meditation and cause a non-peaceful death.

The Role of the RDN in End of Life Nutrition Support Decisions

Cultural competence is essential for the Critical Care RDN, as dietitians must respect and incorporate cultural, religious, and personal beliefs into care plans. This includes recognizing diverse practices surrounding food, fasting, and rituals related to death and dying, ensuring that nutrition interventions align with the values and dignity of the patient and their family. Dietitians can add valuable insight regarding appropriate use of nutrition support at the end of life, and should collaborate with Palliative Care and families in guiding nutritional goals of care.

References:

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