Religion and nursing practice Adherence to the particular set of beliefs, values, and practices that constitute their religion may be of great importance to patients and their families. It is therefore essential that nurses should acquire at least a basic knowledge of the most common religions in order to deliver holistic care that meets their patients' needs. Religious beliefs may have implications for diet, dress, and medication, as well as procedures followed at birth and death. The sections below are outlines of the most commonly encountered religions. They focus on elements likely to have relevance to nursing practice and are by no means exhaustive, being intended only as a guide to enable appropriate care to be given. Nurses are urged to check the details of their patients' religious practices and not to make assumptions.

Roman Catholics

recognize the pope, based in the Vatican City State within Rome, as the successor to St Peter, whom Christ appointed as the first head of his church. Like other Christians, they regard certain rituals - the sacraments - as having special significance, being visible signs of inner grace. Catholics accept seven sacraments: baptism, confirmation, reconciliation (confession and penance), the Eucharist (or Holy Communion; receiving consecrated bread and wine), marriage, holy orders (joining the priesthood), and anointing the sick (formerly known as extreme unction or the last rites). Catholics are encouraged to attend an act of worship - Mass - at least once a week, during which participants may receive the Eucharist having made confession; they are under an obligation to do this once a year (during the Easter season). Catholics are usually expected to fast before receiving Holy Communion, but this may be waived for those who are ill. There is no objection to taking any kind of medicine before Communion. Catholics may take great comfort from the support of a priest and often wish to make confession or be anointed before an operation. Fridays are traditionally regarded as ‘fasting’ days, on which no meat is eaten; Catholics who follow the practice may eat a vegetarian or fish diet on that day. Fasting is also practised during the season of Lent. The faith endorses organ donation. The Church believes that using artificial methods of contraception is “intrinsically evil”, regardless of the consequences: Catholics are permitted to use only natural methods of birth control. Abortion is regarded as a moral evil whatever the reasons for it. Holding that human life begins at fertilization, Catholics are opposed to experimentation on human embryos and reject IVF treatment for couples who cannot conceive naturally. The Church considers it morally acceptable to refuse extraordinary and aggressive medical means to preserve life. It sees the refusal of such treatment not as euthanasia (which the Church regards as morally wrong) but as a proper acceptance of the human condition in the face of death.

Protestants

are of the Christian faith; they include, among others, members of the Church of England and the other churches of the Anglican Communion, Baptists, Presbyterians, and Methodists. Their beliefs and practices vary quite widely. The only generally accepted sacraments are baptism and Holy Communion: patients may wish to take Communion in a similar way to Roman Catholics. Access to a chaplain is important and some patients may wish to fast on Fridays or during Lent. Although most Protestants are opposed in principle to abortion, many accept that there are some situations in which it is indicated, as when the health of the mother would be severely compromised by continuing the pregnancy, when rape has led to the pregnancy, and when overwhelming disability has been diagnosed in the fetus. They generally regard suicide as morally wrong and do not support euthanasia.

Quakers

- also known as the Religious Society of Friends - believe that there is something of God in everybody and that each human being is of unique worth. Most Quakers regard themselves as Christians; others see themselves as agnostic or prefer to avoid such labels altogether. They do not accept the sacraments, have no formal creeds or ceremonies, and refuse to take oaths. There is no clergy as Quakers feel that all believers can minister to one another; Quaker services may include readings and periods of silence. Quakers are divided as to whether animal experimentation should be allowed for medical research; they regard abortion as a matter of individual conscience.

Jehovah's Witnesses

are members of a Christian-based religious movement with an evangelistic approach. They refuse blood transfusions, including autologous transfusions in which a person's own blood is stored for later use in a medical procedure. As a result of this approach, children and young people under the age of 16 years who require a blood transfusion may need protection (under the legal system). Jehovah's Witnesses refuse military service and are discouraged from voting in elections. Abortion is regarded as murder, and IVF treatment is unacceptable as it involves the destruction of some embryos. Smoking, drinking alcohol, chewing betel nut, and taking other drugs for pleasure are not acceptable. Adherents are not strictly vegetarian but will only eat meat occasionally. They believe that God's intervention at the end of the world is imminent and may become upset at the prospect of dying before this event.

Christian Scientists

do not rely on conventional medicine but hold that illness and injury can be healed through prayer. The Church respects the work of the medical profession and does not forbid the use of medicine by its members, but many Christian Scientists prefer to rely on prayer. Those who choose to undergo medical treatment for a specific problem normally give up Christian Science treatment for theperiod of treatment. This is because one treatment approaches healing from a material and the other from a spiritual perspective, and the approaches areconsidered to be incompatible. Christian Scientists accept the use of material aids, such as lenses for vision correction, splints for broken bones, and dental services.

Mormons

are members of a sect - the Church of Jesus Christ of the Latter-Day Saints - who follow a nontraditional pattern of Christianity. They have no clergy and reject infant baptism. Mormons prefer to bury their dead rather than cremate them. They oppose abortion, the consumption of tobacco, alcohol, tea, coffee, and the use of illicit drugs and are primarily vegetarian. They fast each month (on the first Sunday) by going without food and drink for two consecutive meals. Some Mormons wear a sacred undergarment, which is only removed for hygiene and medical treatments and must be treated with great respect.

Islam

, whose followers are called Muslims, hold that there is one God - Allah - whose prophet is Mohammed. The most important Muslim practices are the Five Pillars of Islam, which are incumbent on all Muslims. They are: • shahadah - reciting the Muslim profession of faith• salat - reciting ritual prayers five times each day, facing towards Mecca• zakat - paying alms to help the poor and the needy• sawm - fasting during the month of Ramadan• hajj - a pilgrimage to Mecca that must be made at least once in a Muslim's lifetimeA copy of the Qur'an (Koran) should be available for Muslim patients. They may use a mat to pray and will need to know the direction of east so that they can pray towards Mecca.

Certain foods are prohibited, including pork and its by-products, blood, and the flesh of animals that have died without being ritually slaughtered and fully bled. Although Muslims fast during other times of the year, Ramadan is the only time when fasting during daylight hours is obligatory for every able-bodied adult Muslim. The rules for fasting and praying may be relaxed for ill people, the elderly, pregnant or breastfeeding women, and those with certain medical conditions, such as diabetes. Insulin treatment for diabetics who wish to fast may need to be adjusted during Ramadan. Forbidden food and medicines are termed haraam; acceptable foods and medicines are described as halal. There may be issues of compliance if patients find that they have been prescribed life-saving but haraam medications (these may contain pork products, such as gelatine). Alcohol is forbidden.

Circumcision is not compulsory in Islam but it is an important ritual aimed at improving cleanliness. It is therefore strongly encouraged. Suicide and euthanasia are explicitly forbidden. Muslims regard abortion as wrong and forbidden but may allow it if continuing the pregnancy would put the mother's life in real danger.

Niqab refers to the piece of cloth that is worn by Muslim women to cover the face; women who wear it usually also cover their hands. Some Muslim women wear fullbody garments that only expose their eyes; some cover every part of the body except their face and hands. Some believe that only their hair and/or their cleavage should be covered, while others do not observe any special dress rules. Many Muslims consider that it is not permitted to touch an adult person of the opposite sex other than one's spouse. This means that some Muslim women may refuse to be examined by a male member of the medical staff, especially if no other females are present.

Muslims treat the dead body with gentleness and respect. The body is cleaned, scented, and covered with a clean cloth for burial, which should be performed - by Muslims - as soon as possible after death. Cremation is forbidden. Wherever possible, burial should take place within 24 hours of death.

Judaism

holds that there is one God, who appointed the Jews to be his chosen people in order to set an example of holiness and ethical behaviour to the world. Orthodox Jews require strictly kosher food, i.e. food prepared according to Jewish dietary laws. Some hospitals provide both a regular kosher and a strictly kosher diet. It must be served in the original container, unopened if possible, so that the patient cansee the hecksher (seal of reliability). Pork and shellfish are forbidden, as is any food that has come into contact with prohibited food or the utensils used to cook or serve prohibited food. All meat must be killed in the approved way (shechita), and meat and milk must not be consumed at the same meal (meat must not be served in a cream sauce or milky drinks served after a meat meal). If Jewish patients are fasting, food needs to be available before sunrise and after sunset. The pork restriction may have implications for diabetes management: nonporcine insulin will be required. Orthodox Jewish men always wear a skullcap (a kippah or yarmulke). Every week religious Jews observe the Sabbath (or Shabbat), which lasts from sunset on Friday to sunset on Saturday, and keep its laws and customs. Male patients will need to pray. Orthodox patients are forbidden to use or touch electrical appliances (such as light switches) or to carry anything during Shabbat. When dealing with patients of the opposite sex, avoid touching or other contact unless medically necessary. Women prefer to keep their bodies and limbs completely covered.

Circumcision for male babies shortly after birth is a religious and cultural practice that is considered to be fundamental to Judaism. However, not all Jews regard circumcision as an absolute requirement. All forms of contraception are permitted in Judaism in appropriate circumstances. Jewish law does not forbid abortion but does not permit it on demand; because the mother's life takes precedence over the life of the fetus, abortion may be performed to save the life of the mother. Jewish law forbids suicide and active euthanasia. Although organ donation is allowed in order to save lives, Orthodox Jews do not permit it.

Dying patients should not be left alone and their relatives may wish to stay. After death, the body should be touched as little as possible: it is traditionally regarded as sacred and should not be damaged in any way. Orthodox Jews do not permit post mortems unless required by law. Relatives may wish to keep vigil over the body. If death happens during the Sabbath, the body should be left and burial should take place within 24 hours if possible.

Hinduism

is a religious tradition that originated in the Indian subcontinent. It is a diverse and ancient religion in which a variety of deities are worshipped in temples and the home. Of central importance is the belief in reincarnation, resulting in a profound respect for all forms of life. Most Hindus are vegetarians (those who do eat meat abstain from beef and pork) and many avoid dairy products. Onions and garlic are avoided by many Hindus, as is alcohol. Fasts take place at various prescribed times. The cow is considered to be sacred, which may have implications in the treatment of diabetics (nonbovine/nonporcine insulin should be used). Hinduism is generally opposed to abortion except when it is necessary to save the mother's life. Cleanliness and modesty are features of the religion. Decisions about organ donation and transplantation are left to individuals to make, but there are many references in Hindu scriptures that support the concept.

Sikhs

believe that God is one, the ultimate and eternal guru who provides enlightenment and understanding for the disciple who sets his or her heart on finding him and serving him. Male Sikhs are distinguished by their adoption of the five ks:• kesh (uncut hair)• kangha (the comb that is used to keep hair clean)• kara (a metal bangle)• kaccha (knee-length underwear)• kirpan (a dagger)There are no strict dietary requirements but many Sikhs are vegetarians or avoid beef. Those who eat meat should not eat halal meat (meat killed according to Muslim law). Sikhs believe in reincarnation and therefore death may not be perceived as threatening or frightening. Their passing may be supported by readings from the holy texts and the attendance of family and friends. After death, religious symbols should not be removed from the body and the family should be asked about last offices.

Buddhism

is based on the teachings of Gautama Siddhartha (the Buddha) in the 6th century BC and focuses on personal spiritual development. Buddhists strive for a deep insight into the true nature of life and do not worship gods or adhere to a fixed set of doctrines. Traditional Buddhists reject abortion because it involves the deliberate destruction of a life; however, they may be willing to review this belief if abortion appears to be the lesser evil in the circumstances. In general, Buddhism prohibits the eating of all meat, because the killing of animals violates the First Moral Precept and because meat is considered an intoxicant to the body, which violates the Fifth Moral Precept. Alcohol is likewise avoided.

Rastafarians

accept Haile Selassie, the former emperor of Ethiopia, as the living God incarnate. Many adhere to the dietary prohibitions in the Old Testament and will not eat pork or shellfish. Others are vegans or strict vegetarians and avoid any foods containing artificial additives. Some Rastafarians also reject synthetic or extracted drugs, insisting on purely natural remedies.