Spirituality and Nursing

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   Spirituality
     Term is used interchangeably with religion and faith;
      refers to seeking life’s meaning; includes:
       Making   sense of life
       Cherished standards/beliefs
       Appreciating a dimension that is beyond the self
       Connecting to others, nature, God or Higher Power
       Reflection & self knowledge

     High  level of spiritual assurance helps people/clients
      survive losses and changes in life
     Because nurses provide holistic care, they must attend to
      pt’s spiritual needs in addition to physical and emotional
 Awareness   of spiritual diversity helps the nurse to
 accommodate pt’s spiritual practices and beliefs when
 providing nursing care. This is another aspect of cultural
   Examples of spiritual needs
     Needs    related to self
       Meaning  & purpose, hope, creativity, dignity, vision,
       transcendence over challenges of life, gratitude, preparation
       for death
     Needs    related to others
       Forgiveness,   cope with losses of loved ones
     Needs    related to Ultimate Other
       To   be certain there is a loving, present God; to worship
     Needs    among & within groups
                 to one’s community, be respected & valued, know
       Contribute
       what and when to give and take
   Indicators of spiritual health
       Faith
       Hope
       Purpose   in life
       Peaceful feeling
       Ability to love, pray, worship, forgive
       Meditation, participation in spiritual rites
       Expression through music/art/writing
       Connection with self & others
       Ability to share thoughts, feelings, beliefs with others
   Spiritual distress: challenge to spiritual well-being
     Physiologic   problems
       Terminal/debilitating   illness of self or significant other
       Pain
       Lossof body part/function
       Miscarriage/stillbirth
       Near-death experience

     Treatments
       recommendations    for abortion
       dietary  changes
       Transfusions
       Amputation
       Isolation
   NANDA – spiritual distress
     Expresses lack of hope, meaning, 7 purpose in life,
      forgiveness of self
     Expresses abandonment by or anger at God

     Refuses contact with family/friends

     Sudden change in spiritual practices

     Requests to see a religious leader (?)
   Definitions
     Religion– organized system of beliefs & practices
      associated with a form of worship
       Atheistdoes not believe in God
       Agnostic believes that God’s existence is unknowable,
     Faith   – belief in/commitment to something or someone
       Gives   client emotional strength & hope under duress
             Can be faith in higher power, health care team, self
     Transcendence/self-transcendence              – recognition of
      something greater than oneself
     Forgiveness – of self or others
       Some    clients believe illness is due to past transgression
   Fowler’s stages of spiritual development
       Not   everyone reaches last 2 stages (esp. not last stage)
 Identification of your own spiritual needs, beliefs, and
  values is important so that you can provide appropriate
  spiritual care.
 Guidelines for ethical spiritual care
   Assess: find out ct’s needs, resources, & preferences
   Do not pressure cts to adopt or relinquish practices
   Try to understand personal spirituality & its’ influence on
   Provide spiritual care that is consistent with personal beliefs
 Knowledge   of a patient’s faith and belief system may help in
  providing spiritual care; culture can provide additional
 Scared writings/scriptures – Bible, Torah/Talmud, Koran,
  Vedas, Tripitakas,
 Sacred symbols – jewelry, medals, amulets, icons, totems,
  body ornamentation (tattoos, body paint)
 Prayer & meditation – some specified in books
      Ritual
      Petitionary
      Colloquial
      Meditational
 Holydays – special
   Diet & nutrition
     Kosher

     Halal

     Lent

     Vegetarian

   Beliefs related to dress
     Mormons

     Hindu

     Muslim

     Hebrew

   Beliefs related to birth & death
     Specialized   rituals common
   Nursing management
     Assessment   - FICA
      F   (faith/belief) – what spiritual beliefs are important to you?
       I (implications/influence) – how is your faith affecting the
        way you cope?
       C (community) – Do you meet regularly with others to
        worship/pray/meditate/discuss spiritual issues?
       A (address) – How can the health care team best support
        you spiritually?
–   Assessment – another assessment tool, BELIEF
    •   B belief system
    •   E ethics or values
    •   L lifestyle
    •   I involvement in spiritual community
    •   E education
    •   F future events

–   Fellowship & community – the kind of relationship an
    individual can have with immediate family, close friends,
    associates, neighbors, & church members. Assessment
    should explore the extent and nature of the patient’s
    spiritual support network.
 Clinical   assessment
   Environment   – scriptures or sacred objects, religious cards,
    flowers or bulletins from church
   Behavior – does ct. pray at meals or other times; read
    religious literature; express anger at deity or representative
    of religion?
   Verbalization – does ct. speak about religious, moral, or
    ethical topics?
   Affect & attitude – is ct. lonely, depressed, angry, anxious,
    apathetic, preoccupied?
   Interpersonal relationships – who visits & how does ct.
    interact with them?
 Diagnosing    (NANDA)
   (Riskfor) Spiritual Distress; Readiness for Enhanced Spiritual
   (Diagnosing) Religious issues as diagnostic label
     (Risk for) Impaired Religiosity; Readiness for Enhanced
 Spiritual/Religious     Distress as Etiology
     Fearr/t apprehension about soul’s future after death
     Chronic or Situational Low Self-Esteem r/t failure to live within
      precepts of one’s faith
 Planning:    should be designed to
     Help client fulfill religious obligations, be hope, find meaning,
      draw on inner resources, promote vibrant relationship with
      supreme being
 Implementing
   Validate inner resources/talents
   Encourage creative expression
   Foster contact with nature
 Implementing       (cont.)
   Providing presence – especially beneficial when pt. is
    vulnerable, helpless, hopeless, more important than the right
         Partial, full, (physical, mental, emotional) transcendent (& spiritual)
   Supporting     religious practices

   Assisting   ct. with prayer
         Quiet environment; assist with positioning as needed; personalize
          prayer; ask ct. what they want you to pray for; encourage ct. to
          think about what prayer means to them
   Refer   clients for spiritual counseling
         May be necessary if dx is spiritual distress
         Sometimes primary care provider & religious counselor need to
          confer when important health interventions conflict with religious