Nurse Culture Assessment

Running head CULTURAL ASSESSMENT pagan assessment June 14, 2008 Abstract In site to de sufferr nursing financial aid to contrastive wed manrys, nurses atomic number 18 judge to consider and tender cultur tot tout ensembleyy satisfactory wellness fretfulness to respective(a) psyches. paganly fitting manage is tailor-made to the particularised needs of each node, firearm incorporating the respective(prenominal)s article of faiths and value (Stanhope & Lancaster, 2006, p. 90). By existence heathenly competent, nurses be open to help cleanse health outcomes by using cultural knowledge and specific skills in selecting interventions that atomic number 18 specific to each knob (Stanhope & Lancaster).Therefore, nurses should perform a cultural legal opinion on e really lymph gland with whom they interact with (Stanhope & Lancaster, 2006, p. 90) to help understand thickenings perspectives of health and illness and discuss culturally subdue interventi ons. In this paper, the compose will demonstrate how nurses tidy sum utilize a cultural heritage assessment tool to help develop a cultural competent nursing assist forge, which can be referred to in Appendix A and B.By culturally assessing thickening, nurses will be satisfactory to identify the needs of culturally diverse separates and find out if whats definitive to the culture is really master(prenominal) to the person in terms of specific health needs. Introduction In order to deliver nursing administer to different cultures, nurses are expected to understand and provide culturally competent health care to diverse separates. admits must find out just or so peoples traditions, styluss of intent, and beliefs near health care so that the appropriate interventions can be broadcastned and implemented to produce culturally positive health outcomes (Stanhope & Lancaster, 2006).By being aware(predicate) of the invitees cultural beliefs and knowing closely other cult ures, nurses whitethorn be slight judgmental, to a gr devourer extent accepting of cultural differences, and less equally to engage in the behaviors that inhibit cultural competence (Stanhope & Lancaster, 2006, p. 84). Most importantly, nurses must listen to the thickenings perceptions of problems and fetch together to develop suggestions and recommendations for managing those problems.Therefore, cultural assessments tools confuse been substantial and are available to help assist nurses integrate callingal knowledge with the clients knowledge and be agrees to negotiate and promote culturally pertinent care for a specific client (Stanhope & Lancaster, 2006, p. 82). Part I Cultural Assessment of Client A cultural nursing assessment is acknowledge as a systematic way to identify the beliefs, value, meanings, and behaviors of people piece considering health history, invigoration experiences, and the social and physical milieus in which people live (Stanhope & Lancaster, 2 006, p. 5). For this reason, cultural assessments are an essential component in providing quality care to diverse individuals of different cultures. For this reason, the condition apply the cultural heritage assessment tool to help assess the ethnic culture of Mrs. P. Referring to Appendix A, the insinuate shows the interview questions and answers collected by the root per Mrs. P. Reassuring the confidentiality of the clients interview, utilization of the cultural heritage assessment tool enabled the beginning to gather, classify, and poll the culture of an American Hindu Indian. drawing History of Ethnic and/or Racial Origins The client evaluated by the seed was a 35 course of study old female named Mrs. P who lives in Poway, California. The immediate family composition consists of a wife and a save who just latterly got married. In regards to the clients cultural background, the ethnic culture that Mrs. P identified with was an American Hindu Indian. Born and raised in P oway, California, Mrs. Ps stick and the grandparents from the father and causes side were innate(p) in Punjab, India, while the mother was born in Utter Pradesh, India.Coming from India, the clients parents has lived in the United States for 14 years. Living in Poway since hence, Mrs. P grew up in a agrestic riding horse and lived with the parents and younger chum until recently moving out when the client got married. With Hindi as the clients autochthonal deli very, Mrs. P and the sidekick can only speak Hindi, compared to the mother and father who can both read and speak the native language. socioeconomic Considerations With occupation and rearing, the clients dad has a masters in business and excogitatet for Gateway com adorners.The clients mammary gland has a degree in psychology and is a kinspersonwife, and the younger brother has degree from UCSD for wariness science and economics and works at Boeing. As for Mrs. P, the client works as a instructor, having earne d a bachelors degree in business administration from the University of California, Riverside, and Mr. P works as a neuro-surgeon, with a bachelors degree in cellular and molecular biology and in ready reckoner engineering, and get the hang in computer engineering.Receiving no financial assistance, the client seemed satisfied in the menstruation socioeconomic class of upper middle class because in that location are no plans of changing billet. Currently owning a home with 4 bedrooms, 3 bathrooms, a living room, dining room, loft, and patio, the living arrangements for Mrs. P appear sufficient for a future family to live in. Value Orientation According to Mrs. P, gaze for elders, a inviolable education, good family background and fellowships, spiritual belief, and good ethics for society, are go over that are held highly in spite of appearance the familys culture.Education and a highly held position in a career are very important because these values determine an individ uals status in society. Examples involve doctors and engineers. Obviously, success is pertinent within the Indian culture. Indians are cognize for their hard work, vitality and dynamism. However, although looked as highly important, the familys overall word picture of these values do non define who a person is these values are appreciated. Growing up, Mrs. P canvased that every action requires sen metrent because all decision might have a negative impression on the family, and how society will react.Family repute is very important and in the Indian culture, individuals must be careful not to do anything to put down the family name. The Indian culture is very family-oriented, which is why family comes first. In health and in sickness, the family takes care of each other. Cultural Sanctions and Re uncompromisingions According to the client, there are no cultural sanction and restrictions that the client is aware of. For the or so part, Mrs. P means that since the parents wer e open-minded to the fact of living in the United States, a strict Indian culture was not experienced during childhood.The parents understood what kind of environment the children were in and did not expect Mrs. P and the brother to be dependent to an Indian invigorationstyle. Communication As far as communication is concerned, Mrs. P informed the reference that communication involves all subdivisions of the family, friends, and companionship. However, the Indian culture affects the way individuals communicate with family and friend by restricting certain topics when inappropriate. For example, foul language or inner topics may be considered unacceptable to discuss in front of parents.For the most part, Mrs. Ps family does get along well, which is evident by the clients close relationship with immediate and all-inclusive family members. With such open communication to some extent and having gr go with family relationships, Mrs. P maintains tinct with all members of the fam ily and takes the time to visit family every few weeks. Health-related Beliefs & Practices & viands Health-related beliefs and practices generally emphasize taking care of the health of all members in the family. According to Mrs.P, health-related beliefs and practices are related to nutrition. The only information that the client provided to the fountain was that Hindus perceive some foods as calorifacient and some are cool, and therefore, should only be eaten during certain seasons and not in combination. There are different perceptions of hot and chilly foods depending on the area of where individuals are from. From these perceptions, foods are thought to affect body functions. In the clients case, Hindus turn in to cook and eat traditional dishes that are perceived as healthy.From raima, cholay, and saag, these Indian dishes are usually made by the clients mother because Mrs. P does not usually make the traditional cultural dishes. As far as any specific dietetical rest rictions, feeding midpoint is not considered good, but some individuals within the culture still eat meat. With Mrs. P, the client strives on well-balanced meals and does not follow the ideas of hot and stone-cold foods. The only cultural diet that is followed is not alimentation meat. Cultural Aspects of affection Incidence In regards to aspects of disease, the clients culture customs and eliefs a lot ease up to the decision for medical care and choice of healthcare services. necromantic forces and excess in human needs are recognized to contribute to illness and disease, regardless of station in life. For example, the client gives that example of eating too many sweets will cause round worms and that too practically sexual employment can be associated with tuberculosis. Even to a greater extent so, if a disease is sexually related, the occurrence of such diseases is looked upon as disrespectful if unmarried. In addition, diarrhea can be caused by a variety of outlawed ea ting habits.As a result, cultural treatments that may be used include homeopathic medicine, herbal remedies, mixing religion and medicine, and observing the individual within a natural environment. In the clients case, a health problem that is watercoursely affecting the family is high blood pressure. spectral Affiliation According to Mrs. P, the clients ghostlike preference is Hinduism, which is the kindred religion for Mr. P and all members of the immediate family. Religious beliefs and practices include believe in reincarnation and in many gods, and now and again attending a temple.However, the client does not belong to a ghostlike institution nor is an lively member of any religious or ethnic organization. Yet, the client does practice the Hinduism when with the family. In the rootages opinion, the client expressed ideas for becoming more problematical with participating in religious or spiritual activities. As for the propinquity, there are diverse backgrounds of di fferent ethnic cultures and religions within the companionship. developmental Considerations The only achievements and tasks fulfilled by the clients family include having both children graduate from college and finding successful careers.With having such high values in education and career, the indite is not surprised that the parents consider graduation and a new job as very important achievements that a family member can accomplish. Even more, in the clients sake, getting married, scratch line a new job, and moving into a new home were life changing fulfillments that the client has longed to achieve. As far as failures and achievements, being Indian has affected the fulfillment of achievements and perspectives of failures by placing the pressure to always be on top of the game. Competition is what brings out the outgo in people and achieves the best results. Growing up, the client was always advance to excel. The expectations of families towards children were very high. Wit h Mrs. P, the client strived to be the best because expectations were high and from the authors point of view, the client has make very well to be at the point where the client is. Since the clients family first start, the only health and health-related events and experiences that Mrs. P has gone through is transaction with the removal of cataracts in clients fathers eyes.Fortunately for Mrs. P, there have been no immediate deaths or births have taken place since the client has been born. Since the clients the new union life, no health related events has occurred. Part II Self Assessment Health-related Attitudes regarding this Cultural Group From the authors self assessment about health-related attitudes regarding Indians, the author presumed that the most Indians are prone to respiratory infections such as tuberculosis and pneumonia, hypertension, nutritional deficits, and high risk behavior such as alcoholism and cigarette heater.To be perfectly honest, the main assumption tha t the author had in regards to this cultural groups is that individuals of the Indian culture prone to strive dietary restrictions, which excrete to a number of health problems. In addition, having had an Indian roommate, the author believed that individuals of this culture hold strong cultural beliefs and values because of the parents. Parents have a strong hold in the way Indian children think and behave. From family, friends, school, and fellowship relationships to sexual activities, education, and work, Indians are expected to be smart, careful, and successful in all aspects of life.In the authors opinion, such values and beliefs definitely puzzle out and contribute to the health-related attitudes held by author because American Indians physical, psychological, social, and spiritual dimensions of life can eventually affect the health of these individuals. Evaluation of Authors Values, Beliefs, & Practices In regards to the authors values, beliefs, and practices, much of what has been embedded into the value and belief system of the author, including lifestyle practices, has been due to family, friends, and personal experience.From respect, obedience, and honesty, to work, education, religion, rationality and practicality, and the quality of life and health, the author strives to maintain a positive outlook in life, believes that hard work and determination will lead to a successful career, marriage, and family upbringing, and appreciates life and all the fortunate blessings that are practically taken for granted like ambulation, breathing, and a healthy, loving family. Family, school, health, and religion are the most important values that the author holds.As a Catholic, the author believes that God has a plan for everything and whether life experiences are good or bad, God has a reason. Although the author does not religiously attend Church, prayer is a good deal performed at home and at school. With school, education is an important aspect to a succ essful career. In the authors opinion, knowledge is pertinent to success. Even more so, being aware of beneficial and risky lifestyle practices are necessary to maintain a healthy life. Such practices include exercise, a well-balanced diet, no smoking or drugs, and safe sexual practices.Obviously, values, beliefs, and practices may affect the physical, psychological, social, and spiritual dimensions in life. However, being only 25 years old, the author is aware that there is still so much more to learn about life. Therefore, the author remains open to new ideas and opportunities so that spare knowledge, mistakes, achievements, and failures will abide to add to the authors life experiences. How might Authors values, beliefs, & practices affect Delivery of Nursing Care to this Culture Group?The authors values, beliefs, and practices may affect the delivery of nursing care to this culture group with the inability to empathize and understand complaints and concerns about health which leads to wide of the mark assumptions about patient needs and creates assumptions that may impose ideas and interventions that may be unacceptable to the plan of care. Being unable to step outback(a) the authors box of values, beliefs, and practices may prevent the author from learning about another culture.As a result, the overall affect of delivering nursing care for this culture group is making incorrect assumptions about the needs of the clients and ontogeny a care plan that may serve no proceeds in improving the quality of life. Part III- Developing a invent of Care After culturally assessing Mrs. P, the author identified the clients readiness for growd religiosity. With a new marriage, a new house, and a new job, the client expresses concern that being away from the parents may lead to decreasing progressive lifestyle of practicing the beliefs and practices of the Indian culture.Even more so, the client acknowledges and expresses a desire to maintain the beliefs, value s, practices that the parents have taught. Being married to a husband who does not actively practice the Indian culture, along with dealing with the expected stressors of being a new wife, taking care of a new house, and starting a new job, Mrs. P. strongly believes that maintain the values and practices of the Indian culture may be an effective coping schema that Mrs. P is voluntary and prepare to do. Obviously, Mrs. P. recognizes the importance of the Indian culture and is ready to enhance what had been taught to cope with the new life changes.Referring to Appendix B, the authors goal for the client includes verbalizing the willingness to seek help to regain desired religious beliefs and practices and acknowledging the need to arm religious affiliations and become involved in spiritually based programs. These two goals seem appropriate for the client because if Mrs. P is willing to seek help with maintain the Indian culture and acknowledges the need for additional resources t o participate in religious activities the client can enhance religiosity within the newly accepted life transitions.Therefore, the interventions that the author has planned include determining the spiritual state/motivation for larnth by ascertaining religious beliefs of family of origin and climate in which client grew up, discussing clients spiritual commitment, beliefs and values, assisting the client to integrate values and beliefs to achieve a sense of wholeness and optimal balance in daily living by exploring connection of desire to strengthen belief patterns and customs of daily life, and encouraging confederation in religious activities, worship/religious services, denotation religious materials, etc and provide referral to community sources.In the authors opinion, the overall plan of care has been adapted to the specific ethnic or cultural beliefs of Mrs. P because the plan addresses the cultural needs of the client. The interventions are client-centered and do not for ce any assumptions or beliefs of the author or of any other culture. The client has crack of the care given. Even more so, communication, education, and religion being incorporated into the plan of care which were what the client expressed as the values and beliefs that are recognized as important. Hence, keeping what is important to the client.Conclusion To review, nurses must be able to provide culturally competent care to diverse individuals of different cultures. culturally competent care can be accomplished by utilizing cultural assessment tools to better understand clients and other cultures in the community. Assessing the culture of an individual is an essential component in providing quality nursing care. In order to provide culturally diverse care, nurses need to take the time to learn about each client who the client is, what the client feels and, most importantly, what the client needs.By doing so, nurses will be able to tailor a plan of care that implements intervention s that are best appropriate to a clients specific need, delivering quality nursing care, eespecial(a)ly when of a different culture. References Doenges, M. , Moorhouse, M. , & Murr, A. (2006). Nurses pocket guide Diagnoses, prioritized interventions, and rationales (10th ed. ). Philadelphia, PA F. A. Davis. Stanhope, M. & Lancaster, J. (2006). Foundations of nursing in the community (2nd ed). St Louis, MO Mosby, Inc. Appendices Appendix A Cultural Assessment of Client I.Brief History of Ethnic and/or racial origins of the cultural group with which the client identifies Q1. What ethnic culture do you identify with? A1. American Indian. Q2. Can you account a brief history of your ethnic culture? A2. Okay. Q3. Where were your parents born? Where did they grow up? A3. India Punjab (dad) mom U. P (Utter Pradesh) Q4. Where were your grandparents born? A4. India Q5. Mothers parents? A5. Punjab India Q6. draws parents? A6. Punjab India Q7. How many siblings do you have? A7. 1 younger brother. He is 28 years old.I am 35 years old. Q8. What setting did you grow up in? urban or rural? A8. Ive lived in Poway, California, all my life. I love it here. My area looks more rural than urban. There is a lot of open land and green grass. Were near the mountains so we are pretty far from the city life. Q9. What is your native language? A9. Hindi Q10. Do you speak this language? A10. Yes, everyone in my family can. Q11. Do you read your native language? A11. no. just my parents. Q12. Was your original family name changed? A12. No. Well, I just recently got married, so I carry my husbands name now.Q13. How old were you when you came to the US? (if applicable? ) A13. I was born in U. S. A. My parents, on the other hand, came about 14 years ago. Q14. Who lived with you growth up? A14. Parents and brother II. Values Orientation Q1. What does your culture value? A1. prize for elders, good education, good family background and connections, and good ethics for the society. Religi on is alike important. Our culture strives on hard work, vitality, and dynamism. Q2. Compared to western culture, how do you value achievement, materialism, ducation, work, equality, fellow feeling of the environment, rationality and practicality, orderliness, and the quality of life and health? (in terms from your culture, if different? ) A2. I value all these things, especially education and high status in career is important. The type of careers you do are likewise very important and sets your status in society (doctors and engineers looked upon highly). Growing up, I learned the reputation was highly looked upon so whatever I did, I had to think onwards I act. Q3. How does your family value these things? A3.My family believes these are also all important, but they do not see these things as items that define a person, but they do appreciate these things. For the most part, upholding the family name and image in society is an important aspect in our culture because family com es first. My family is very family-oriented and respect is expected within our immediate and extended relationships. III. Cultural Sanctions and Restrictions Q1. Any cultural sanctions and restrictions? A1. None that I am aware of. If there were, I certainly was not informed. I guess because my parents do not carry the Indian culture as strict as other families.They try to be very open-minded to living in the United States and understanding the kind of environment that me and my brother live in. IV. Communication Q1. How does your family communicate with each other? A1. We talk to everyone, openly and respectfully. We talk to family, friends, and the people of the community. Q2. How does culture affect the way you communicate to family and with friends? A2. authoritative things might not be accepted to be talked about in front of parents such as foul language or sexual topics. Q3. Does your family get along? A3. DefinitelyFamily is very important, unless something is inappropriate or unacceptable, then that causes problems. further for the most part, being close to family is an essential aspect of our culture. Q4. cause you or do you maintain contact with Q4a. Aunts, uncles, cousins? Brothers and sisters? Parents? A4a. Yes, especially since I move out of the house. I try to remain in close contact with everyone. Q5. Did most of your aunts, uncles and cousins live near your home? A5. Yes Q6. How often did you visit family members who lived outside of your home? A6. Every few weeks V. Health-related beliefs and practicesQ1. Does your culture believe in traditional health beliefs or practices? A1. Much of what we believe in is related to nutrition. What we eat affects the way we function. For example, some foods are hot and some are cold, and therefore, should only be eaten during certain seasons and not in combination. Depending on what region individuals are from, different families have a different perspective of hot and cold foods. Hindus love to cook and everyone has their own perception of healthy foods, so individuals usually cook dishes that they believe are nutritional to how one may function.Q2. Do you follow any traditional health beliefs or practices? A2. No, not really. I eat whatever my mom used to cook for me. But now that I moved out, I cook whatever I have in the fridge. I dont really believe in the hot and cold stuff. Q3. Do you do anything to keep healthy or prevent illness? A3. Just eat right and workout. I try to eat well-balanced meals and exercise. VI. Nutrition Q1. Do you prepare foods special to your ethnic background? If yes, describe. A1. I dont make them since I dont know how, but my mom makes many different dishes and I enjoy eating them. rajma, cholay, saag) Q2. are there specific dietary restrictions in your culture? A2. Eating meat is not considered good in our culture, but people still eat it. I, on the other hand, have kept that dietary restriction so I dont eat meat. VII. Socioeconomic considerations Q1. What is your familys occupation and education? A1. Well, my dad has masters in business and he works with Gateway computers. Mom is a housewife brother works at Boeing and got a degree from UCSD for management science and economics. Q2. Do you receive financial assistance? A2. No Q3. atomic number 18 there any plans of changing jobs to earn a little more income? A3. Well, I just recently got hired as a teacher and I have no plans for changing my career any time soon. Honestly, my husband makes money that is definitely sufficient for our income, and I am very fortunate to find a successful man. Q4. Do you own or rent a house? A4. Eventually, we plan to own the new house we just moved into. Q5. How are living arrangements? A5. We currently own a home with 4 bedrooms, 3 bathrooms, a living room, dining room, loft, and patio. I love it here. Were the only ones living in the house right since we just moved in.So there is a lot of concealing and a lot of space. We are ready to start a family. XIII. Organizations providing cultural sustain Q1. Are there any organizations that provide cultural support for you or your family? A1. No, but Im very interested in finding out every since I got married. XIV. Educational background Q1. draw and quarter your educational background? And your husband? A1. I have a BS in Business Administration and my husband has a bachelors degree in cellular and molecular biology and in computer engineering, and masters in computer engineering. Q2.Describe your parents educational background? A2. Dad masters in business, mom has degree in psychology XV. Religious affiliation Q1. What is your religious preference? A1. Hinduism Q2. Describe your religious background, beliefs, and practices. Does your family attend Church? A2. Believe in reincarnation and many gods, occasionally attend a temple. For the most part, since Ive moved out and my husband is not that religious, I tend to practice Hinduism at home and when Im with my family. My p arents strive on religion and since Ive moved out, I feel like I am not as active as I used to be.Q3. Is your boyfriend/ lady friend the comparable religion as you, if any? A3. Yes, husband is same religion, but he doesnt really practice any religious or spiritual activities. Q4. Is your girlfriend/boyfriend the same ethnic background as you? A4. Yes, he is also an American Indian Q5. Do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself? A5. No, diverse backgrounds in our apartment complex Q6. Do you belong to a religious institution? A6. No, but I think it would be great if I was. Q7. Would you describe yourself as an active member?A7. No. But again, I think being newly married I think that being religious and spiritual may be a good thing. Its hard to find the time to participate in religious or spiritual activities, but being a new wife with a new home and job, I think it would be good for me. Q8. How often do you attend your religious institution? A8. Very rarely anymore. I used to with my parents. Q9. Do you practice your religion in your home? A9. Yes Q10. Are your friends from the same religious background as you? A10. No Q11. Are your friends from the same ethnic background as you?A11. No XVI. Cultural aspects of disease relative incidence Q1. What does your culture believe in when it comes to aspects of disease? A1. Disease and illness is often thought be caused by our cultures customs and beliefs. From phantasmal forces to having excess human needs, individuals can be affected regardless of education and status in life. Some examples I can give you is eating too many candies can lead to ringworm, excessive sexual activity can cause tuberculosis, and diarrhea can be caused by not eating a well-balanced diet. Q2. Any cultural treatments? A2.Some like homeopathic medicines, herbal remedies, others like to mix religion with medicine and incur the patient with the natural environment. Q3. How does y our culture view the occurrence of diseases? A3. If its a sexual disease it can be looked upon as disrespectful if you are unmarried. Q4. Are there any health problems that could affect your family now? A4. towering blood pressure XVII. Biocultural variations Q1. Are you any other culture in any event Indian? A1. No. Full American Indian. XVIII. Developmental considerations Q1. Describe family achievements and tasks fulfillment since your familys start? A1.My parents best achievement, as they always tell me, was having me and my brother. former(a) than that, my family has not had significant achievements. With a stable career and a good neighborhood, my parents have had a good life without changing their line of profession or participating in life-changing events. However, me and my brother graduated from college and have institute successful careers. Even more so, I just recently got married and my parents are very proud of me to have found such a good man at the right time. Q2. How has your culture or ethnic identify affected fulfillment of achievements or failures?A2. Growing up, my parents always encouraged me to excel. The expectations of each member were high. From work to school to even household chores, my parents expected the best out of me. In our culture it is expected to always be at the top of your game. This makes you want to always strive for the best and procure for the stars. Q4. From your familys first start, what health and health-related events and experiences have happened? A4. Well, since I got married, there havent been any significant health-related experiences to note. Yet, during my family first start, my dad recently had his cataracts taken out.Other than that, I have been blessed with a healthy family for the most part. Appendix B Plan of Care Interventions Rationales A. Nurse will determine spiritual state/motivation for growth by A. Early religious training deeply affects children and is carried on ascertaining religious be liefs of family of origin and climate in whichinto adulthood. Any conflict may familys beliefs and clients current client grew up. learning may need to be addressed. B. Discuss clients spiritual commitment, beliefs and values. B. Enables examination of these issues and helps client learn more about self and what he or she desires. C. Nurse will assist client to integrate values and beliefs to achieve C.Becoming aware of how these issues affect the individuals daily life a sense of wholeness and optimal balance in daily living by exploring can enhance ability to incorporate them into everything he or she does. connection of desire to strengthen belief patterns and customs of daily life. D.Nurse will enhance optimum wellness by encouraging participating in D. Encouragement allows individual to pursue what he or she wants and religious activities, worship/religious services, reading religious referrals allow clients to become aware of what options are available. mate rials, etc and provide referral to community sources. Nursing DiagnosisReadiness of Enhanced Religiosity related to life changes secondary to getting married, a new house, and a new job AEB by clients desire to strengthen religious belief patterns and customs that had provided comfort in the past, request for assistance to increase friendship in religious beliefs through prayer, and requests for referrals to religious affiliation. Goal 2 diligent will acknowledge need to strengthen religious affiliations and become involved in spiritually based programs of own choice Goal 1 Patient will verbalize willingness to seek help to regain desired religious beliefs and practices Interventions