Care of the Pediatric Trauma Victim in the Field

Care of the Traumatically Injured Child in the ER or Trauma Center

Care of the Traumaically Injured Child in the ICU

Ethnic, Cultural, and Religious


Course Test


Attitudes affect the way the nurse approaches the child and his/her family.  Culture is composed of
an ingrained orientation to life and it serves as a frame of reference that individuals use to make
judgments and decisions.  As children are brought up in a specific culture, they learn what to eat, the
ideals they will adopt, the appropriate language to speak and the way they are expected to conduct themselves in specific roles.  Most children have assimilated their culture by five years of age. 
Individual resourcefulness, competition, aggressiveness and compliance are all part of cultural
norms.  The nurse will need to consider those factors in meeting the needs of the child and family. 
Ethnic influences affect many areas of family life such as structure, moral codes, how families express emotion and interactions with others.  Religious factors also affect the perceptions and attitudes of
the family and of the patient.  Religious differences influence the way families and individuals view
their destiny and the destiny of their family members.  This may influence decisions made as to the treatment of their loved one.

Table 3.1.  Religious beliefs that affect nursing care
Beliefs about birth and death Beliefs about diet and food practices Beliefs regarding medical care Comments
Birth: Opposed to infant baptism
Baptism in adulthood
Meat prohibited in some groups
No alcohol, coffee or tea
Some believe in divine healing and practice anointing with oil and use of prayer
May desire communion or baptism when ill
Believe in man’s choice and God’s sovereignty
Some oppose hypnosis as therapy
Sabbath: Saturday for many
Accept Bible literally
Birth: Opposed to infant baptism
Believers baptized by immersion as adults
Death: Counsel and prayer with clergy, family, patient
Some groups discourage coffee, tea and alcohol “Laying on of hands” (some)
May encounter some resistance to some therapies such as abortion
Believe God functions through physician
Some believe in predestination: may respond passively to care
Fundamentalist and conservative groups accept Bible as inspired word of God
Birth: No baptism
Death: Carefully prescribed procedure for washing and shrouding dead
Prohibit alcohol, pork and foods traditional among American blacks (e.g., corn bread, collard greens) Faith healing unacceptable
Always maintain personal habits of cleanliness
General adherence to Moslem tenets overlaid, in many instances, by antagonism to whites, especially Christians and Jews
Do not indulge in activities (such as sleeping) more than is necessary to health
Birth; No infant baptism
Infant presentation
Death: Last rite chanting often practiced at bedside soon after death
Priest should be contacted
No requirements or restrictions
Some sects are strictly vegetarian
Discourage use of alcohol and drugs
Illness believed to be a trail to aid development of soul; illness due to Karmic causes
May be reluctant to have surgery or certain treatment on holy days
Cleanliness believed to be of great importance
Family may request Buddhist priest for counseling
Optimistic outlook; teach ways to overcome fears, anxieties, apprehension
Birth: No baptism
Death: No last rites
No requirements or restriction Deny the existence of health crisis, see sickness and sin as errors of mind that can be altered by prayer
Oppose human intervention with drugs or other therapies; however, accept legally required immunizations
Many adhere to belief that disease is a human mental concept that can be dispelled by “spiritual truth” to extent that they refuse all medical treatment
Many desire services of practitioner or reader; will sometimes refuse even emergency treatment until they have consulted a reader
Unlikely to donate organs for transplant
Birth; No baptism at birth
Infant is “blessed by church official at first opportunity after birth (in church)”
Baptism by immersion at 8 years
Death: No special rites but may desire presence of church elders during any acute illness, when condition worsens, when undergoing risky or frightening tests or procedures when feeling sick enough to die or when dying
Prohibit tea, coffee, alcohol
Encourage sparing use of meats
Fasting for 24 hours on first Sunday each month (from after evening meal Saturday until evening meal Sunday)
Devout adherents believe in divine healing through anointment with oil and “laying on of hands” by church official (elders)
Medical therapy not prohibited
Married adults wear special undergarments
May request Sacrament on Sunday while in hospital
Financial support for sick available through well-funded welfare system
Discourage cremation
Discourage use of tobacco
Birth: Most believe in infant baptism by immersion 8 to 40 days after birth
Death: Last rites obligatory for impending death
Restrictions depend on specific sect. Anointment of the sick
No conflict with medical science
Discourage cremation
Birth: infant baptism mandatory; urgent if poor prognosis
Death: Last rites available but not mandatory
Abstain from meat on fast days
May fast on Wednesday, Friday, during lent, and before Christmas
Some fast for 6 hours before receiving Holy Communion
Some believe in spiritual healing
Rite for anointing sick available but not mandatory
Religious icons very important
Communion four times yearly: Christmas, Easter, June 30 and August 15, may be mandatory for some
Birth No baptism
Infant’s name recorded in official book
No requirements or restrictions
Most practice moderation
Avoid alcohol and illicit drugs
No special rites or restrictions Believe in plain speech and dress
Birth: Baptism considered important
Performed 40 days after birth
If not possible to baptize by sprinkling or immersion, church allows child baptism “in the air” moving the child in the form of a cross as appropriate words are said
Death: Last rites, administration of Sacrament of Holy Communion
Should be performed while dying person is still conscious
Church-prescribed fast periods – usually occur on Wednesday, Friday, and during Lent: consist of avoiding mead and (in some cases) dairy products
If health compromised, priest may be contacted to convince family to forego fasting
Each health crisis handled by ordained priest; deacon may also serve in some cases
Holy communion administered in hospital
Some may desire Sacrament of the Holy Unction performed by priest
Oppose euthanasia
Believe every reasonable effort should be made to preserve life until termination by God
Discourage autopsies that may cause dismemberment
Prefer burial to cremation
Birth: No ritual
Death: Special prescribed rites
Priest pours water into the mouth of dead child, ties a thread around neck or wrist to signify blessing (should not be removed)
Family washes body and is particular about who touches body
Many dietary restrictions
Beef and veal not eaten
Some strict vegetarians
Illness or injury believed to represent sins committed in previous life
Accept most modern medical practices
Cremation preferred
Birth: No baptism
Death: Patient must confess sins and beg forgiveness before death; family should be present
Family washes and prepares body, then turns it to face Mecca
Only relatives and friends may touch body
Prohibit all pork products and any meat that is not ritually slaughtered
Daylight fasting practiced during ninth month of Muhammadan year (Ramadan)
Strict Muslims do not use alcohol or mind-altering drugs
Faith healing not acceptable unless psychologic condition of patient is deteriorating; performed for morale
Ritual washing after prayer; prayer takes place five times daily (on rising, mid-day, afternoon, early evening and before bed); during prayer, face Mecca and kneel on prayer rug
Older Muslims often have a fatalistic view that may interfere with compliance to therapy
May oppose autopsy
Birth: No baptism
Death: No last rites
Eat nothing to which blood has been added: can eat animal flesh that has been drained Adherents are generally absolutely opposed to blood transfusions, including banking of own blood; individuals can sometimes be persuaded in emergencies
May be opposed to use of albumin; globulin, factor replacement (hemophilia vaccines)
Often possible to obtain a court order appointing a hospital official as temporary guardian to consent to child’s transfusion when parents refuse consent
Autopsy approved only as required by law
Birth: No baptism
Ritual circumcision of male infants on eighth day; performed by Mohel (ritual circumciser familiar with Jewish law and aseptic technique)
Reform Jews favor ritual circumcision, but not as a religious imperative
Death: Remains are ritually washed by members of the Ritual Burial Society
Burial should take place as soon as possible
Numerous dietary kosher laws exist that may be influenced by local practices and family and cultural tradition
Allowed only meat from animals that are vegetable eaters, are cloven hoofed, chew their cud and are ritually slaughtered; fish that have scales and fins
Prohibit any combination of meat and milk; milk products served first can be followed by meat in a few minutes, but milk may not be consumed for several hours after eating meat
Fasting for 24 hours is part of Yom Kippur observance
Matzo replaces leavened bread during Passover week
May resist surgical procedures during Sabbath, which extends from sundown Friday until sundown Saturday
Seriously ill and pregnant women are exempt from fasting
Illness is grounds for violating dietary laws (e.g., patient with congestive heart failure does not have to use kosher meats, which are high in sodium)
Oppose all forms of mutilation, including autopsy, body parts not donated or removed; amputated limbs, organs or surgically removed tissues should be made available to family for burial
Donation or transplantation of organs requires rabbinical consent
May oppose prolongation of life after irreversible brain damage
BIRTH: Baptize only living infants shortly after birth
Death: Last rites optional
No requirements or restrictions If grave prognosis, family may request anointing and blessing of sick or visit by church official Accept scientific developments
Birth: No baptism in infancy
Baptism during early or middle teens
No requirements or restrictions No illness rituals
Deep concern for dignity and self-determination of individual that would conflict with shock treatment or medical treatment affecting personality or will
Birth: No baptism at birth; performed on children or adults
Death: No ritual
No requirements or restrictions Communion may be requested before surgery or similar crisis Encourage donation of body or body parts to medical science
Birth: Baptism optional
Death: No last rites
No requirements or restrictions
Alcohol prohibited
Church official administers communion and laying on of hands
Adherents believe in divine healing but not exclusive of medical treatment
Cremation permitted
Birth: No baptism at birth
Baptism by complete immersion after age of accountability
Death: No last rites
Abstain from alcohol, eating blood, strangled animals or anything to which blood has been added
Some individuals may resist pork
No restriction regarding medical care
Deliverance from sickness is provided for in atonement; may pray for divine intervention in health matters and seek God in prayers for themselves and others when ill
Some insist illness is divine punishment; must consider it an intrusion of Satan
Practice glossolalia (speaking in tongues)
Birth: Infant baptism by sprinkling
Death: Last rites not a sacramental procedure; scripture reading and prayer
No requirements or restrictions Communion administered when appropriate and convenient
Blood transfusion accepted when advisable
Pastor or elder should be called for ill person
Believe science should be used for relief of suffering
Full forgiveness granted for any illness connected with a sin
Birth: Infant baptism mandatory; especially urgent in poor prognosis, when it may be performed by anyone
Death: rite for anointing of the sick is mandatory
Family or patient may request anointing if prognosis is grave
Fasting and abstaining from meat mandatory on Ash Wednesday and Good Friday; fasting optional during Lent; no meat of Fridays during lent as general rule
Children and most hospital patients exempt from fasting (eating only one full meal and no eating between meals)
Some older Catholics may adhere to older rule of no meat on Friday
Encourage anointing of sick, although this may be interpreted by older members of church as equivalent to the old terminology “extreme unction” or “last rites”; they may require careful explanation if reluctance associated with fear of imminent death
Traditional church teaching does not approve of contraceptives or abortion
Family may request that major amputated limbs be buried in consecrated ground
Transplant accepted as long as loss of organ does not deprive donor of life or functional integrity of body
Autopsy acceptable
Religious articles important
Birth: Baptism by priest only
Death: Traditionally after death arms are crossed, fingers set in a cross
No meat or dairy products on Wednesday, Friday and during Lent Cross necklace is important and should be removed only when necessary and replaced as soon as possible
Adherents believe in divine healing, but not exclusive of medical treatment
Opposed to autopsy, embalming or cremation
Birth: Some practice infant baptism; most consider it unnecessary
Death: No ritual
No requirements or restrictions Believe God helps those who help themselves
Some may prefer not to have clergy visit them in hospital
Cremation preferred to burial
Source: Carpenito, 1992, Conley 1990:  Koizer and Erb, 1987, Spector, 1985; personal communications.