When the nursing staff attempted to explore Jack's beliefs to explain his conflicting behaviour, he did not openly provide answers, the emphasis on Zoe's safety. However, during private meetings with the clinical nurse specialist, Jack was able to identify his awareness of his wife's impending death and that there were cultural preparations that needed to take place. Continuous support was provided to Jack to assist him with anticipatory grief such as suggestions on how to present the notion of death to his children and mobilize community resources. jack was receptive to these initiatives, as they supported his caregiving goals and cultural beliefs. When asked if he thought the medical system was failing him, Jack did provide one reason for the culture clash. He perceived that the medical team's belief was in opposition to his faith that Zoe's life and death were in "God's hands." Jack felt the team believed that her dying phase and death could be controlled or managed by them and was very much opposed to this Western, medical belief.//
Although a full cultural assessment did not take place with Zone and her family, there were importent details that emerged about her husband's beliefs and cultural background that provided some insight into his goals and purpose in providing care for her. This information was valuable, and had it been thoroughly communicated and disseminated to her entire nursing team, it could have provided further guidance for her nursing staff to develop improved communication with Jack. It can be surmised that a more therapeutic relationship between the family and the nursing team would have been possible if the nursing staff had been more focused on developing their cultural competence and had the internal communication amongst the medical team members been more complete.//
Nursing implications
In order to carry out holistic care, culturally-competent care must be included in our nursing approach. First and foremost it is essential to be aware of our own spirituality, as nursing, before attempting to understand others' views (Charnes & Moore, 1992 ). Cultural and spiritual assessments of the patient and family are an extension of psychosocial assesmests and, as in all evaluations, prioritizing concerns and using intuition should be key. The degree to which spirituality and religion influence a patient's care should be determined by exploring patient and family expectations of care, identifying sings of spiritual distress that could manifest as guilt, fear and anxiety and anger at one's own faith (Charnes & More, 1992 ), and addressing perspectives on quantity versus quality of life (Prosser et al.,2012).//