This blog is the first of a weekly series we’ll be running during National Athletic Training Month to highlight different aspects athletic trainers should consider as they strive to provide “compassionate care for all.” The slogan for National Athletic Training Month 2018 comes directly from the first principle of the NATA Code of Ethics. It states, “Members shall practice with compassion, respecting the rights, welfare and dignity of others.” Principle 1.1 goes on to specify that NATA members “shall render quality patient care regardless of the patient’s race, religion, age, sex, ethnic or national origin, disability, health status, socioeconomic status, sexual orientation or gender identity.” In a nutshell, athletic trainers are proud to provide compassionate care FOR ALL.
ATs work closely with patients from all walks of life, so it is imperative to have a thorough understanding of how patient values such as gender, ethnicity, socioeconomic status, religion, etc. can affect the delivery of appropriate health care. The NATA Cultural Competence Work Group, a collaborative effort between members of the NATA Ethnic Diversity Advisory Committee, LGBTQ+ Committee and the NATA Executive Committee for Education along with members from the Professional Education Committee and Professional Development Committee, was established to look more closely at this topic and provide additional resources as culturally competent care continues to evolve. The workgroup collaborated together on this content series for the March 2018 NATA News and NATA Now that will examine religion, implicit bias, socioeconomic status and compassionate language.
By Dani Moffit, PhD, ATC, NATA Cultural Competence Workgroup
I lived in a few states during my childhood, but most of my life I have lived in Idaho. To say I understood the term “multicultural” while growing up was doubtful. I graduated from the largest high school in the state (2,400 students in three grades) and in the three years I was there, there was one black student. There were many Basque students, but not much else. However, I did grow up with a different culture (which, at the time, I didn’t know counted) and that was religion.
Most people know Utah as the Mormon state. What most people don’t know is that Idaho follows right behind. This was the religious culture surrounding me as I grew up, and I was in the minority. I didn’t know the significance of Rosh Hashanah, Good Friday or Ramadan until I moved to the east coast for 10 years when I was 34.
There are assumptions made by all people. I’m not going to insult your intelligence and try to list them all, but I’m guessing many of us think we’re culturally competent until a “different” culture is brought into the mix, such as religion.
I grew up thinking Sunday was sacred, and I knew none of my Mormon friends could play on Monday evenings. However, that wasn’t the case at a Catholic school in North Philly. Practices and games were scheduled on Sundays because you can always go to mass on Saturday night. That dirt in the middle of the forehead; ashes on Ash Wednesday. We knew not to expect the Jewish athletes to be available on certain nights when they were preparing for his or her Bar/Bat Mizvah. I have learned all of this in the past 10+ years.
There are many other religious ideologies I realize I’m very naïve about. For example, when a practice or game is scheduled, a Native American is going to follow his Vision Quest requirements rather than attend. Taoism believes stress, fighting and riots bring disharmony, which brings about illness. Filipinos view medical interventions as an attempt to control the length of one’s life; they are willing to accept God’s decision on medical fate rather than allowing an athletic trainer to help. Those who practice Judaism may avoid surgery sundown on Friday through sundown on Saturday. African Americans who follow Coptic Orthodox Christianity may fast 210 days per year, which requires a restriction on all food and drinks from sunrise to sunset. Peyote is part of religious rituals of American Indians, which can be a concern with college athletes and the NCAA drug rules. There are many more views and customs unique to different religions - too numerous to mention - that are often unknown simply because we are afraid to ask.
According to Cartwright & Shingles (2011) religion can be defined as an organized set of beliefs, practices and ethical values focused on a “divine or superhuman power or powers to be obeyed and worshiped as the creator(s) and ruler(s) of the universe.” Churches, mosques, temples or other places of worship teach their members how to behave and develop a framework as to why health and illness occurs. Based on the religion of the athletic trainer or the patient being treated, cultural sensitivity may need to be considered.
Perhaps the patient was raised in a religion that views illness as punishment; how can that be detrimental to the treatment process? Buddhism teaches self-control; how can an athletic trainer treat a patient who demonstrates stoicism, aligned with Buddhist teaching?
Have you ever encountered the laying on of hands or anointing of oils to give strength to a person who is injured or ill? Do you have a patient who refuses treatment due to his/her religious views? Is there a specific diet a patient follows because of his/her religion? Voodoo, witchcraft, Santeria, “funny white underwear”, kosher, holistic medicine and prayer toward Mecca are just a few of the many beliefs you may encounter at your job. What do you know and understand about the patients you treat?
As the health care provider, you need to ask questions. When treating your patient, are protective prayers or ceremonies needed before interventions can occur? Will the patient’s beliefs affect care?
During physical assessment, your responsibility is to the patient. That responsibility includes being aware enough to note whether a patient’s spiritual or religious beliefs may have an effect on how he/she will be cared for. Not all patients want to share their beliefs, which requires us to respect their privacy. Just as would be the case with any other cultural concern, patient-centered care must interact with potential religious beliefs.
The following are imperative when incorporating the religious views held by both the athletic trainer and the patient (Saha et al., 2008):
- Find common ground.
- Build rapport and trust.
- Be aware of one’s own biases/assumptions.
- Respect the patient’s beliefs, values and meaning of illness.
- Allow involvement of family/friends when desired.
Read more about cultural competence in athletic training.
- Cartwright LA, Shingles RR. Cultural Competence in Sports Medicine. Champaign, IL:Human Kinetics: 2011.
- Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Nat Med Assoc. 2008:100(11):1275-1285.