NURS 505 Week 5 Cultural and Spiritual Assessment Paper Example

Seeing Language as Culture: Personal Cultural Awareness, the Deaf Community, the CLAS Standards, and the Spiritual History

Culture shapes how people understand illness, how they communicate with clinicians and what they expect from care, and nurses bring their own culture into every encounter. This paper reflects on my own cultural identity, examines the culture of the Deaf community, considers the nurse's role in applying the federal CLAS standards, and describes how to conduct a spiritual assessment.

Personal Cultural Identity and Awareness

I grew up in a working-class family in a small steel town in western Pennsylvania, the grandchild of Slovak and Irish immigrants. My family's culture valued hard work, self-reliance and loyalty to family, and it was deeply shaped by a Catholic parish that organized much of our social life. Illness was something you pushed through; going to the doctor was for emergencies, and questioning a physician was considered disrespectful. Faith was practical: prayers for the sick, casseroles for families in crisis, and a priest at every deathbed.

These values still shape my practice in ways I did not see until this course. My instinct to admire patients who "tough it out" can lead me to underestimate pain in patients who do not complain. My respect for authority made me slow to speak up when I disagreed with a physician early in my career. And my assumption that faith is expressed through a church community can make me miss the spirituality of patients whose faith looks different. Cultural awareness began for me not with learning about other cultures but with noticing that my own way of seeing illness was a culture, not simply the normal way. Recognizing these assumptions is the first step in what the literature calls cultural humility: lifelong self-reflection and a willingness to learn from each patient.

Two experiences challenged these assumptions. The first was caring for a patient from a Pentecostal congregation whose family filled the waiting room and prayed aloud at the bedside; my first reaction was that they were disrupting the unit, until the patient told me their presence was the reason the patient had agreed to surgery. The second was a Deaf patient on a medical unit to whom staff had been writing notes for two days; when an interpreter finally arrived, the patient asked questions about the diagnosis that no one had realized were unanswered. Both moments showed me that what I counted as normal care was shaped by my own culture, and that the patient's culture often holds the key to what care will work.

Another Culture: The Deaf Community

For many people who are Deaf, written with a capital D, Deafness is not primarily a medical condition but a cultural and linguistic identity. American Sign Language is a full language with its own grammar, distinct from English, and Deaf communities share a history, schools, social networks and values, including direct communication and pride in a visual way of life. Many Deaf adults learned English as a second language, so written English may not be easily understood, a fact clinicians often miss when they hand a Deaf patient a note or a pamphlet.

Research shows how this shapes health care. In a qualitative study of 25 Deaf ASL users, Paracha et al. (2023) found that experiences with medication centered on information seeking, comfort taking medicines, picking up prescriptions and communication with the pharmacy team, and that participants often perceived pharmacists as disrespectful; some did not understand the medications they were taking and relied on online resources, while technology helped them communicate. Access to interpreters is uneven. In interviews with 266 Deaf ASL users during the COVID-19 pandemic, Moreland et al. (2023) found that at follow-up only 32% of those with low self-rated ability to understand spoken language reported receiving interpretation at clinic visits, compared with 57% of those with higher ability, the reverse of what need would suggest. End-of-life care shows similar gaps: in interviews with 11 Deaf signers, Cerilli et al. (2023) described poor provider communication, inaccessible information and inadequate accommodations leading to distrust, with mean knowledge of advance care planning of 4.6 out of 15.

The Deaf community also values its own networks; Cerilli et al. (2023) found that participants learned about end-of-life care from family, friends and Deaf peers, which suggests that community-based, ASL-first education would reach Deaf patients better than written materials. For a nurse, respecting Deaf culture means asking each patient about preferred communication, providing qualified ASL interpreters rather than relying on lip-reading, notes or family members, and recognizing that a nod may mean "I see you" rather than "I understand."

The Nurse's Role in Applying the CLAS Standards

The national CLAS standards, released by the federal Office of Minority Health, number 15 organized under a principal standard, which calls for care that is effective, equitable, understandable and respectful and that responds to diverse cultural health beliefs, preferred languages, health literacy and other communication needs (U.S. Department of Health and Human Services, Office of Minority Health, 2013). Four standards on communication and language assistance apply most directly to Deaf patients: offering language assistance at no cost and in a timely manner, informing individuals of its availability, ensuring the competence of those who provide it while avoiding untrained individuals and minors as interpreters, and providing easy-to-understand print and multimedia materials and signage.

Each standard becomes a nursing action. Offering assistance means booking a certified ASL interpreter, on site or through a video service, whenever the conversation matters, not only for consent. Informing means asking at the first contact how the patient prefers to communicate and recording it prominently in the record. Ensuring competence means not asking a patient's hearing child to interpret a diagnosis. Accessible materials means seeking ASL video explanations of medications and procedures, the kind of technology the Paracha et al. (2023) participants found helpful. Nurses can also advocate at the organizational level for interpreter contracts that cover nights and weekends, since the Moreland et al. (2023) findings suggest that access breaks down most for those who need it most.

Conducting a Spiritual Assessment

Spirituality, the way a person seeks meaning, purpose and connection, influences how patients cope with illness and make decisions. It can be a source of strength, as when a patient draws courage from prayer before surgery, and occasionally a source of distress, as when an illness feels like punishment or abandonment. Nurses do not need to share a patient's beliefs to ask about them respectfully, and asking often opens conversations about fears that would otherwise stay hidden. Because spiritual concerns can change as illness progresses, the history is worth repeating at major turning points, such as a new diagnosis or a decision about life-sustaining treatment. Yet many clinicians feel unprepared to address it. In a 2024 cross-sectional study of 376 health professionals in two Ethiopian hospitals, Tarekegn et al. (2026) found that mean spiritual care competency was only moderate, and that a supportive hospital environment predicted greater competency, which suggests that institutions shape whether spiritual care happens.

The FICA tool offers a brief, structured spiritual history (Puchalski & Romer, 2000). F asks about faith and belief: "Do you consider yourself spiritual or religious?" or "What gives your life meaning?" I asks about importance: "How important is your faith in your life and in this illness?" C asks about community: "Are you part of a spiritual community that supports you?" A asks how the patient would like these matters addressed in care: "How would you like me to include this in your care?"

Applied to a Deaf patient, the spiritual history should be conducted through a qualified interpreter, and the nurse may learn that the patient's community is a Deaf congregation that signs its services. Faith practices may also need practical accommodation. In a qualitative study of hospitalized Muslim orthopedic patients in Malaysia, Sharifudin et al. (2026) described a gap between a hospital policy supporting daily prayer and patients' actual ability to pray when physical limitations made the required positions difficult, a reminder that respecting faith includes helping patients practice it, not only asking about it. For my own patients, the A question is the most important, because it lets each person decide how much of their faith belongs in their care.

Bringing the Four Topics Together: A Composite Encounter

Consider how the four parts of this paper would come together in a single visit. A Deaf adult who uses ASL arrives at a primary care clinic with a new diagnosis of type 2 diabetes. Cultural self-awareness reminds the nurse not to read the patient's quiet nodding as agreement, as the nurse's own background might suggest. Knowledge of Deaf culture leads the nurse to ask how the patient prefers to communicate and to arrange a qualified interpreter rather than relying on written English for complex teaching. The CLAS standards turn that respect into obligations: the interpreter is provided at no cost, the patient is told it is available for every visit, and teaching materials are offered in ASL video where possible. Finally, a brief spiritual history through the interpreter reveals that the patient attends a Deaf church whose members often share meals, which becomes a resource for diabetes education and support. Each step is small, but together they change the visit from one in which the patient is processed to one in which the patient is understood.

Conclusion

Cultural and spiritual assessment begins with self-awareness, continues through learning about cultures through research and relationship, is supported by national standards that turn respect into concrete actions, and includes a spiritual history that lets patients say what gives them strength. The Deaf community illustrates how language and culture are inseparable, and how meeting the CLAS standards can change a patient's experience from exclusion to partnership. As an advanced practice nurse, I will ask every patient how they prefer to communicate, use qualified interpreters, and include a brief spiritual history in my assessments. I will also keep examining my own assumptions, especially my admiration for patients who do not complain, because the patients who say least are often the ones whose culture, language or faith the health care system has least prepared to hear. That habit of self-examination is the part of this paper that will matter longest in practice.

References

Cerilli, C., Katz, G., Volandes, A. E., Davis, A. D., Paasche-Orlow, M. K., James, T. G., & McKee, M. M. (2023). "There is no communication": A qualitative examination of Deaf signers' experiences with advance care planning. Journal of Palliative Care, 38(3), 372-380. https://doi.org/10.1177/08258597231179763

Moreland, C. J., Rao, S. R., Jacobs, K., & Kushalnagar, P. (2023). Equitable access to telehealth and other services for deaf people during the COVID-19 pandemic. Health Equity, 7(1), 126-136. https://doi.org/10.1089/heq.2022.0115

Paracha, M., Wagner, E., Brumfield, O., Winninghoff, J., Wright, J., Rotoli, J., & Hauser, P. (2023). Medication-related experience of Deaf American Sign Language users. HLRP: Health Literacy Research and Practice, 7(4), e215-e224. https://doi.org/10.3928/24748307-20231116-01

Puchalski, C., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137. https://doi.org/10.1089/jpm.2000.3.129

Sharifudin, M. A., Yusop, Y. M., Taib, M. N. A., Omar, M. F., Ibrahim, A. H., & Yunus, A. M. (2026). Negotiating faith in a hospital bed: A qualitative exploration of barriers to prayer (Solah) among hospitalised Muslim orthopaedic patients in Malaysia. Belitung Nursing Journal, 12(4), 485-497. https://doi.org/10.33546/bnj.4619

Tarekegn, S. M., Gebeyaw, B., Wudu, M. A., Kassa, A. M., & Melese, H. A. (2026). Spiritual care competency among healthcare professionals working in East Amhara comprehensive specialized hospitals. SAGE Open Nursing, 12. https://doi.org/10.1177/23779608261471696

U.S. Department of Health and Human Services, Office of Minority Health. (2013). National standards for culturally and linguistically appropriate services in health and health care: A blueprint for advancing and sustaining CLAS policy and practice. https://thinkculturalhealth.hhs.gov/clas