CULTURAL AND SPIRITUAL ASSIGNMENT 1
Cultural and Spiritual Assignment
Candi M. Flanagan
Liberty University
NURS 505 Advanced Health/ Physical Assessment
Dr. Giese
September 21, 2025
Introduction
Nursing care that focuses on and includes cultural and spiritual diversity improves
patient satisfaction, adherence, and outcomes (Christy et al., 2021). The United States is
becoming more diverse, we as nurses must only assess medical needs but also cultural needs.
This includes language preference, spiritual and cultural norms that shape how patients
understand and respond to illness. As nurses it is our responsibility to provide advocacy and
care in a time of need while maintaining their cultural beliefs. In a Christian viewpoint, all
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humans are created in the mage of God (Genesis 1:27, NIV), making all patients equally
valuable. When someone chooses to ignore someone’s cultural beliefs it can affect their whole
outlook on seeking healthcare in the future. The population of Mexican Americans is relevantly
high where I live so I have decided to focus on their culture for this paper.
Mexican Americans are vastly different when it comes to making decisions and medically
decisions are high on that list. Over the past several years Mexican Americans have become one
of the larger ethnic groups in my area so learning more about their beliefs and customs allows
me to enhance the quality of care. This paper will reflect on my own cultural identity, focused
cultural linguistic assessment for Mexican American patients, and ending with the nurse’s role in
apply CLAS and current Joint Commission expectations for spiritual assessment.
My Cultural Identity and Awareness
Our personal awareness of cultural influences is important when it comes to
learning about ourselves and our cultural identity. I grew up in a small rural community in
northwest Alabama. I was raised in a blended family. My parents divorced when I was four years
old and they both remarried. I have one full sister and then blessed with three stepbrothers. My
sets of my parents were very hard-working blue collared Americans. I had a good childhood
with a large close-knit family. It was always great spending time with both sides, I had the
typical every other weekend visitation with my dad, stepmother and two stepbrothers. My
parents coparented well, and my sister and I came and went to our parents more than every
other weekend if we wanted. I unfortunately ended up losing both of my parents before the age
of thirty. I lost my dad at twenty-two to suicide and then my mother to medical conditions at
twenty-eight.
My parents taught and instilled in me core values such as responsibility, hard
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work, resilience, and independence that I am immensely proud of. Neither one of my parents
graduated from high school and started the workforce early but, they made sure that I did.
Family was particularly important, and we gathered regularly to maintain that close-knit
relationship. My value for hard work comes from not really having much growing up and
watching my parents work extremely hard to provide. We always got what we needed but not
always what we wanted and that was ok. It showed me that hard work and resilience will always
pay off.
I was raised in a Southern Baptist religion; I was not allowed to wear anything but
dresses to church and was raised that you did not wear anything other than that. Today that is
not the norm. This includes a high valuation of family, church, community, scripture (2 Timothy
3:16-17), and regular worship. Inside this spiritual framework of my beliefs, I was raised that
when some were ill or someone in the community was suffering to reach out, help and just
comforting them and loved ones. This is something that has instill the “want” to be a nurse and
help as a nurse, these values influence my communication style, my assumptions about spiritual
resources and my comfort with discussing religion.
Cultural and Linguistic Assessment
Mexican American culture is an ethnic group with cultural practices, language needs,
and spiritual traditions that differ from my own. Literature highlight’s themes relevant to clinical
care such as reliance on both biomedical and tradition healing practices, strong family
orientation (familismo), variable English proficiency language services, and centrality of religion
to help with decision making (Christy et al., 2021, Ortiz & Smeltzer, 2024). Mexican Americans
often emphasize familismo and collective decision-making over individual autonomy (Ortiz &
Smeltzer, 2024). Elders in the family may serve key roles in health decisions. Gender roles follow
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traditional patterns sometimes which affect communication about reproduction and endof-life
decisions (Ortiz & Smeltzer, 2024).
In a Christian perspective, honoring family and elders is consistent with the scripture
(“Honor thy father and thy mother,” Exodus 20:12). We should never assume who our patient
wants to be involved in the decisions and always ask and respect their choices.
Language and Communication
Mexican American usually prefer and primarily speak Spanish, especially the older adults
and recent immigrants (Lopez et al., 2024). Language barrier is something we must learn to
work around, and modern technology has evolved a lot over the years. Professional interpreters
are preferred which improves comprehension, satisfaction, and adherence. Using family
members puts things at risk such as miscommunication or loss of patient privacy (Christy et al.,
2021). We have hotlines to call and mobile computers for facetime calls which drastically
improves the quality of care. Determining a preferred language and literacy is crucial in
healthcare.
Health Beliefs, Traditional Practices, and Medical Variety
In this culture medical variety is common; patients may use traditional healers, home
remedies, herbs, and biomedical care (Ortiz & Smeltzer, 2024). Beliefs about illness causation
may include hot and cold balance, spiritual causation, and fatalism (Ortiz & Smeltzer, 2024).
Medical professionals should be respectful about these beliefs and ask questions to better
understand the patient and treat the patient.
Diet and Food Practices
The staples of the traditional diet include beans, rice, tortillas, cooked meats, fresh
vegetables and widely used spices. Social and religious festivals, like Cinco de Mayo and patron
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saints’ day, involve special foods and family meals (Ortiz & Smeltzer, 2024). Due to the
traditional diet, chronic diseases such as diabetes and hypertension are more common. Dietary
changes must be culturally adapted to offer familiar type meals and modifications instead of
imposing unfamiliar diets (Christy et al., 2021). Christian teaching regarding body stewardship
supports healthful eating (1 Corinthians 10:31, NIV).
Rituals, Death, and End-of-Life Choices
Mexican American patients practice Catholic rituals and folk- religious practice into
illness and death (Ortiz & Smeltzer, 2024). Family presence is highly valued and spiritual leaders
and ministry are asked for. Caring for dying patients includes comfort, presence, prayer, and
pastoral support though Christ (Matthew 25:36, NIV).
Spiritual Assessment and the Nurse’s Role
A spiritual assessment is particularly important. Two different tools to help with
assessing a patient spiritually are through using the acronyms HOPE and FICA.
•HOPE: H = sources of Hope; O = Organized religion; P = Personal spirituality/practices; E
= Effects on medical care and end-of-life decisions. This would allow structured
conversation. (Broom et al., 2025).
•FICA: F = Faith or beliefs; I = Importance of spirituality; C = Community; A =
Addressing spiritual needs. Useful for clarity and documentation. (StatPearls, 2023).
A nurse should always build a good rapport with patients, so they feel more comfortable
and vulnerable. This will help when doing an assessment. While doing an assessment a nurse
should initiate a spiritual assessment upon admission or after a clinical status change using
validated tools such as FICA or HOPE. One should open with nonjudgemental questions to help
identify needs and preferences. Nurses should also observe nonverbal cues, including religious
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items, references to family and church involvement, and prayer. Respecting a patient’s beliefs
without imposing personal views is important by helping to facilitate access. The nurse should
ensure that chaplain/clergy is offered, and the patient’s preferences are honored. Finally, nurses
must document all the findings in the electronic health record in compliance with Joint
Commission standards to ensure coordinated and comprehensive care (The Joint Commission,
2022).
National CLAS Standards in Nursing Practice
There are 15 National CLAS Standards that provide the framework for services that are
culturally and linguistically appropriate and a complete listing is provided in Appendix A. These
address language assistance, governance, workforce, communication, data collection, and
continuous quality improvement (Office of Minority Health, n.d).
To implement the CLAS for Mexican America patients, a nurse must include several key
actions into their assessment. In Standard 1, nurses should provide care to a patients’ cultural
health beliefs and language by learning their preferences and adding them to the care plan.
While being consistent with Standard 5, professional translators and language assistance
services should be provided to Spanish speaking patients to ensure complete comprehension of
care.
Standards 3 and 7, staff should receive training on Mexican American culture norms, beliefs,
and relationship communication to build a good rapport and build trust. Under Standard 13,
collaboration with community health and churches can contribute with relevant health
education programs. Finally with Standards 11 and 12, nurses and organizations should collect
and record accurate data on preferred language and ethnicity to monitor disparities which
promote health outcomes (Office of Minority Health, n.d.). Please refer to Appendix A for a
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complete comprehensive overview of the National Standards for Culturally and Linguistically
Appropriate
Services.
Comparing Self Identity and Mitigating Bias
Even though my Southern Baptist shares a deep religious outlook and strong family
values with many Mexican American patients, differences and variations in spiritual differences
and variation are noted as well. My role as the health care provider is to use my structured
assessment and avoid assumptions. Nurses must learn about the patient specifically and
advocate for them culturally and spiritually. This is imperative to love one another (John 13:34-
35), which implies respectful awareness for others and their own culture.
Conclusion
It is appropriate to deliver culturally and linguistically for Mexican American patients in a
structured approach. We must assess family roles, language preference, traditional health
practices, spiritual needs, and dietary restrictions. Using a spiritual assessment tool is important
while applying CLAS Standards and Joint Commission guidelines. Biblical Christian principles
support centering care on compassion, dignity, and holistic well-being. Medical servants are
positioned to bridge the cultural gap through empathic communication, culturally adapted
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education, use of interpreters and coordination of spiritual resources. When we utilize these
strategies it reduces the disparities, honors patient dignity, and improves adherences.
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References
Broom, A., et al. (2025). Evaluation of the HOPE spiritual assessment model: A scoping review of
international interest, applications, and studies over 20 years. BMC Palliative Care,
24, Article 53. https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-025-
01809-z
Christy, S. M., Cousin, L. A., Sutton, S. K., Chavarria, E. A., Abdulla, R., Gutierrez, L., Sanchez, J.,
Lopez, D., Gwede, C. K., & Meade, C. D. (2021). Characterizing health literacy among
Spanish language–preferring Latinos ages 50–75. Nursing Research,
70(5), 344–353. https://doi.org/10.1097/NNR.0000000000000519
Lopez, N., et al. (2024). Language concordance and interpreter use for Spanish-preferring
patients in primary care: Provider practices and patient experiences. Journal of General
Internal Medicine, 39(4), 620–629. https://link.springer.com/article/10.1007/s11606-
023-
07999
Nguyen, N. V., Guillen Lozoya, A. H., Caruso, M. A., Capetillo Porraz, M. G. D., PachecoSpann, L.
M., Allyse, M. A., & Barwise, A. K. (2024). Through the eyes of Spanishspeaking patients,
caregivers, and community leaders: A qualitative study on the inpatient hospital
experience. International Journal for Equity in Health, 23, Article 164.
https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-024-02246-9?utm
Office of Minority Health, U.S. Department of Health and Human Services. (n.d.). National
CLAS Standards. https://thinkculturalhealth.hhs.gov/clas/standards?utm
Ortiz, C. E., & Smeltzer, S. C. (2024). Utilization of traditional healing practices from Mexico by
U.S. women of Mexican origin: A systematic review. Explore (NY), 20(5), 102997.
https://doi.org/10.1016/j.explore.2024.04.001
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The Holy Bible, New International Version. (2011). Zondervan. (Original work published 1978)
The Joint Commission. (2022). Evaluating a patient’s spiritual needs (Standards FAQ).
https://www.jointcommission.org/en/knowledge-library/support-center/
standards interpretation/standards-faqs/000001669
StatPearls. (2023). Spiritual assessment. In StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK599554/
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Appendix A
National Standards for Culturally and Linguistically Appropriate Services (CLAS)
Principal Standard
1. Provide effective, understandable, and respectful quality care and services that respond
to cultural health beliefs and practices, languages, health literacy, and other
communication needs.
Governance, Leadership and Workforce
2. Advance and sustain organizational governance and leadership that promotes CLAS
through policy, practices, and allocated resources.
3. Recruit, promote, equip, and support a governance, leadership, and workforce that
respond to the digital, cultural and language needs of the population.
4. Educate and train governance, leadership, and workforce regularly on CLAS practices
and resources.
Communication and Language Assistance
5. Offer language assistance to individuals who have limited English proficiency and/or
other communication needs, at no cost to them, to facilitate timely access to all health
care and services.
6. Inform all individuals, in writing and orally, of the availability of language assistance
services in English and other languages that serve their linguistic needs.
7. Ensure the competence of individuals providing language assistance through training
and certification, when available, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided and discouraged.
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8. Provide easy-to-understand digital and print materials and signage in the languages
commonly used by the populations in the service area.
Engagement, Continuous Improvement, and Accountability
9. Establish culturally and linguistically appropriate goals, policies, and management
accountability, and infuse them throughout the organization’s planning and operations.
10. Conduct ongoing assessments of the organization’s integration of CLAS-related activities
and measures into quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate
the impact of CLAS on health outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results
to plan and implement services that respond to the cultural and linguistic needs of
populations in the service area.
13. Partner with the community to design, implement, and evaluate cultural and
linguistically appropriate practices and impact.
14. Create culturally and linguistically appropriate processes to identify, prevent, and resolve
conflicts, complaints, or grievances.
15. Communicate the organization’s progress in implementing and sustaining CLAS to all
stakeholders, constituents, and the general publi
