SPIRITUALITY

To provide holistic care, nurses need to care not only for the physical body and mind, but also need to care in ways that are
sensitive to the client’s spirit. Recognizing a client’s spirituality is like standing on holy ground. The nurse cannot approach
care for the spirit as if it were a pressure ulcer or even as if it were an emotional problem. Spiritual matters are not intangibles
that can be fixed, cured, solved, or manipulated. Rather, the nurse’s stance toward spiritually sensitive care must be one that
seeks to accompany, support, and nurture.

Spirituality and Related Concepts Described

Spirituality, faith, and religion are words that are often used interchangeably by clients and professionals alike, yet the
nursing literature typically distinguishes them as separate concepts.
 Spiritual- derives from the Latin word spiritus, which means “to blow” or “to breathe,” and has come to
connote that which gives life or essence to being human.
o Nursing Definition: “that most human of experiences that seeks to transcend self and find meaning
and purpose through connection with others, nature, and/or a Supreme Being, which may or may
not involve religious structures of traditions”
 Religion- is typically an organized system of beliefs and practices. It offers means for accessing and
expressing spirituality, and provides support for believers in responding to life’s ultimate questions and
challenges.
o The organized religions offer (a) a sense of community bound by common beliefs; (b) the collective
study of scripture (the Torah, Bible, Koran, or others); (c) the performance of ritual; (d) the use of
disciplines and practices, commandments, and sacraments; and (e) ways of taking care of the
person’s spirit (such as fasting, prayer, and meditation).
 Spirituality generally involves a belief in a relationship with some higher power, creative force, divine
being, or infinite source of energy (a person may believe in “God,” “Allah,” the “Great Spirit,” or a “Higher
Power”).
o some persons do not accept that there is an Ultimate Other or do not accept that there is a spiritual
reality
 agnostic- a person who doubts the existence of God or a supreme being or believes the
existence of God has not been proved.
 atheist- one without belief in a deity

Spiritual Care or Spiritual Nursing Care?

Spiritual care should not be prescriptive (i.e., the following of a set guideline for intervening to resolve a client’s spiritual
problem). Instead it should be descriptive of ways nurses can offer spiritual support. Therefore, they suggest that:
[S]piritual nursing care is an intuitive, interpersonal, altruistic, and integrative expression that is contingent on
the nurse’s awareness of the transcendent dimension of life but that reflects the client’s reality. At its
foundational level, spiritual nursing care is an expression of self. Spiritual nursing care begins from a
perspective of being with the client in love and dialogue but may emerge into therapeutically oriented
interventions that take direction from the client’s religious or spiritual reality.

Spiritual Needs, Spiritual Distress, and Spiritual Health

If one assumes that everybody has a spiritual dimension, then it may also be assumed that all clients have needs that reflect
their spirituality. Such needs are not problems to be processed, but perhaps better understood as inner movements, yearnings,
or experiences. An awareness of such needs is often heightened by an illness or other health crisis. Nurses need to be
sensitive to indications of the client’s spiritual needs and respond appropriately.
a. Examples of Spiritual Needs:
 Needs related to the self:
o Need for meaning and purpose
o Need to express creativity
o Need for hope
o Need to transcend life challenges
o Need for personal dignity
o Need for gratitude
o Need for vision
o Need to prepare for and accept death
 Needs related to others:
o Need to forgive others
o Need to cope with loss of loved ones
 Needs related to the Ultimate Other:
o Need to be certain there is a God or Ultimate Power in the universe
o Need to believe that God is loving, and personally present
o Need to worship
 Needs among and within groups:
tktcacantilado19
 o Need to contribute or improve one’s community
o Need to be respected and valued
o Need to know what and when to give and take
b. Spiritual distress
Refers to “a disturbance in the belief or value system that provides strength, hope, and meaning to life”
Factors that contribute to Spiritual Distress:
1. Physiological Problems
- medical diagnosis of a terminal or debilitating disease, experiencing pain, experiencing the loss of a
body part or function, or experiencing a miscarriage or stillbirth.
2. Treatment-related
- blood transfusions, abortion, surgery, dietary restrictions, amputation of a body part, or isolation
3. Situational
- the death or illness of a significant other, inability to practice one’s spiritual rituals, or feelings of
embarrassment when practicing them

Characteristics of Spiritual Distress:

 Expresses lack of hope, meaning and purpose in life, forgiveness of self
 Expresses being abandoned by or having anger toward God
 Refuses interaction with friends, family
 Sudden changes in spiritual practices
 Requests to see a religious leader
 No interest in nature, or reading spiritual literature.
c. Spiritual health, or spiritual well-being
Manifested by a feeling of being “generally alive, purposeful, and fulfilled”
a. Spiritual well-ness is “a way of living, a lifestyle that views and lives life as purposeful and pleasurable,
that seeks out life-sustaining and life-enriching options to be chosen freely at every opportunity, and
that sinks its roots deeply into spiritual values and/or specific religious beliefs”
b. Spiritual health is thought to not occur by chance, but by choice. That is, spiritual health results when
persons intentionally seek to strengthen their spiritual muscles, as it were, through various spiritual
disciplines (e.g., prayer, meditation, service, fellowship with similar believers, learning from a spiritual
mentor, worship, study, fasting).

Spiritual Development
Stages of Spiritual Development

DEVELOPMENTAL STAGE CHARACTERISTICS

0–3 years Neonates and toddlers are acquiring fundamental spiritual qualities of trust,
mutuality, courage, hope, and love. Transition to next stage of faith begins when
child’s language and thought begin to allow use of symbolism.
3–7 years Fantasy-filled, imitative phase when child can be influenced by examples, moods,
actions. Child relates intuitively to ultimate conditions of existence through stories
and images, the fusion of facts and feelings. Make-believe is experienced as reality
(Santa Claus, God as grandfather in the sky).
7–12 years, even Child attempting to sort fantasy from fact by demanding proofs or demonstrations
into adulthood of reality. Stories are important for finding meaning and organizing experience.
Child accepts stories and beliefs literally.
Ability to learn the beliefs and practices of the culture, religion.
Adolescence Experience of the world now beyond the family unit and spiritual beliefs can aid
understanding of extended environment. Generally, conform to the beliefs of those
around them; begin to examine beliefs objectively, especially in late adolescence.
Young adulthood Development of a self-identity and worldview differentiated from those of others.
The individual forms
independent commitments, lifestyle, beliefs, and attitudes. Begins to develop
personal meaning for
symbols of religion and faith.
Mid-adulthood Newfound appreciation for the past; increased respect for inner voice; more
awareness of myths, prejudices, and images that exist because of social background.
Attempts to reconcile contradictions in mind and experience and to remain open to
others’ truths.
Mid- to late adulthood Able to believe in, and live with a sense of participation in, a nonexclusive
community. May work to resolve social, political, economic, or ideological
problems in society. Able to embrace life, yet hold it loosely. (Martin Luther King,
Jr., Mahatma Gandhi, and Mother Teresa illustrate this stage.)
tktcacantilado19
Spiritual Practices Nurses Should Know
The most common practices that can have an impact on health care include holy days, sacred texts, sacred symbols, prayer,
meditation, and those practices and beliefs associated with diet, nutrition, healing, dress, birth, and death.
Guidelines for ethical conduct in spiritual caregiving:
 First seek a basic understanding of clients’ spiritual needs, resources, and preferences (i.e., assess).
 Follow the client’s expressed wishes regarding spiritual care.
 Do not prescribe or urge clients to adopt certain spiritual beliefs or practices, and do not pressure them to
relinquish such beliefs or practices.
 Strive to understand personal spirituality and how it influences caregiving.
 Provide spiritual care in a way that is consistent with personal beliefs.
a. Holy Days
 A holy day is a day set aside for special religious observance, and all the world religions observe certain
holy days. (Christians observe Easter and Christmas, Jews observe Yom Kippur and Passover,
Buddhists observe the birthday of the Buddha, Muslims observe the month-long holy period of
Ramadan, and Hindus observe Mahashivarathri, a celebration of Lord Shiva.)
 Many religions require fasting, extended prayer, and reflection or ritual observances on sacred (or high
holy) days. Believers who are seriously ill are often exempted from such requirements.
 Clients who are devout in their religious practices may want to avoid any special treatments or other
intrusions on their day of rest and reflection.
b. Sacred Texts
 Each religion has sacred and authoritative scriptures that provide guidance for its adherents’ beliefs and
behaviors.
 In most religions, these scriptures are thought to be the word of the Supreme Being as written down by
prophets or other human representatives. (Christians rely on the Bible; Jews on the Torah and Talmud;
and Muslims on the Koran; Hindus have several holy texts, or Vedas; and Buddhists value the teachings
of the Tripitakas.
 This religious law may be interpreted in various ways by subgroups of a religion’s adherents and may
affect a client’s willingness to accept treatment suggestions; for example, blood transfusions are in
conflict with the religious admonitions of Jehovah’s Witnesses.
c. Sacred Symbols
 Sacred symbols include jewelry, medals, amulets, icons, totems, or body ornamentation (e.g., tattoos)
that carry religious or spiritual significance.
 Worn to pronounce one’s faith, to remind the practitioner of the faith, to provide spiritual protection,
or to be a source of comfort or strength. (Roman Catholic may carry a rosary for prayer; a person who
is Muslim may carry a mala, or string of prayer beads)
 Hospitalized clients or long-term care residents may wish to have their spiritual icons or statues with
them as a source of comfort.
d. Prayer and Meditation
 Prayer is a spiritual practice; for many, it is also a religious practice. An encyclopedia of religion
defines prayersimply as “human communication with divine and spiritual entities”
 Different Types of Prayer Practice:
o Ritual (e.g., Hail Mary, memorized prayers that can be repeated)
o Petitionary (e.g., “God, cure me!” or intercessory prayers when one is requesting something of
the divine)
o Colloquial (i.e., conversational prayers)
o Meditational (e.g., moments of silence focused on nothing, a meaningful phrase, or a certain
aspect of the divine
 Meditation is the act of focusing one’s thoughts or engaging in self-reflection or contemplation. Some
people believe that, through deep meditation, one can influence or control physical and psychological
functioning and the course of illness
e. Beliefs Affecting Diet
 Many religions have prescriptions regarding diet. It is important that health care providers prescribe
diet plans with an awareness of the client’s dietary and fasting beliefs.
 There may be rules about which foods and beverages are allowed and which are prohibited. (Orthodox
Jews are not to eat shellfish or pork, and Muslims are not to drink alcoholic beverages or eat pork.
Members of the Church of Jesus Christ of Latter-Day Saints (Mormons) are not to drink caffeinated or
alcoholic beverages. Older Catholics may choose not to eat meat on Fridays because this was prescribed
in years past. Buddhists and Hindus are generally vegetarian, not wanting to take life to support life.)
 Religious law may also dictate how food is prepared (Jewish people require kosher food, which is food
prepared according to Jewish law).

tktcacantilado19
  Some solemn religious observances are marked by fasting, which is the abstinence from food for a
specified period of time. Some religions also restrict beverages during a fast; others allow drinking of
water or other sustaining beverages on fast days. (Islam, Judaism, and Catholicism.)
f. Beliefs About Illness and Healing
 Clients may have religious beliefs that attribute illness to a spiritual disease or sin. While some clients
may ascribe disease to the innate presence of sin and evil in this world, others may believe the disease
is a punishment for sin in their past.
 Healing for such clients may appear to be unrelated to current treatment practices. When relevant the
nurse should assess the client’s beliefs related to health and, if possible, include some aspects of healing
that are part of the client’s belief system in the planning of care.
g. Beliefs About Dress
 Many religions have laws or traditions that dictate dress. (Orthodox and Conservative Jewish men
believe that it is important to have their heads covered at all times and therefore wear yarmulkes.
Orthodox Jewish women cover their hair with a wig or scarf as a sign of respect to God. Many Muslim
women also cover their hair in accordance with their particular ethnic or national background. Mormons
may wear temple undergarments in compliance with religious law.)
 Some religions require that women dress in a conservative manner, which may include wearing sleeves
and modestly cut tops, and skirts that cover the knees.
 Clients may be especially disconcerted when undergoing diagnostic tests or treatments, such as
mammography, that require body parts to be bared.

h. Beliefs Related to Birth

 For all religions the birth of a child is an important event giving cause for celebration. Many religions
have specific ritual ceremonies that consecrate the new child to God.
o Muslim child is born, “someone recites the call to prayer in the infant’s ear.”
o Seventh day after birth, the child is named, and a tuft of hair is shaved from the head
o Christian faith- baptism and christening ceremonies to confirm that the “infant [was] born into
a Christian family
o Jewish religion, the ritual circumcision conducted on male children on the eighth day after birth
is an expression of the religious bond between the prophet Abraham, his descendants, and their
God. Girls are named in the synagogue on the Sabbath after the birth
 When nurses are aware of the religious needs of families and their infants, they can assist families in
fulfilling their religious obligations. This is especially important when the newborn infant is seriously
ill or in danger of dying
i. Beliefs Related to Death
 Many believe that the person who dies transcends this life for a better place or state of being.
 Some religions have special rituals surrounding dying and death that must be observed by the faithful.
Observance of these rituals provides comfort to the dying person and their loved ones.
 Some rituals are carried out while the person is still alive, and can include special prayers, singing or
chants, and reading of sacred scriptures.
o Roman Catholic priests perform the Sacrament of the Sick
o Muslims who are dying want their body or head turned toward Mecca
o Jews have a tradition of burial within 24 hours following death, except on the Sabbath
o Tibetan Buddhists read the Tibetan Book of the Dead within 7 days of the death to release the
soul of the deceased from the Bardos, or nether worlds.
o Hindus cremate the body within 24 hours to release the soul from any earthly attachment

Spiritual Health and the Nursing Process

Nursing Management
Although nurses can play a pivotal role in supporting clients’ spirituality, it is important to remember that the nurse is a
spiritual care generalist. Spiritual care experts include chaplains, clergy, and other spiritual mentors with whom clients may
identify.

A. Assessment
Warnings about spiritual assessment are as follows:
 It is assumed that spirituality can be assessed, and that nurses are appropriate clinicians for conducting an
initial or relatively superficial level of assessment. Both of these assumptions, however, may be debated.
 A nurse-conducted spiritual assessment should limit itself to client spirituality vis-à-vis health. That is, it is
not the prerogative of nurses to delve into client spirituality unless it has a purpose related to providing
health care.
 Nurses should never assume that a client follows all of the practices of the client’s stated religion. Similarly,
it is important to remember that the degree of religious commitment and orthodoxy (i.e., how strictly one

tktcacantilado19
 integrates traditional religious prescriptions into daily life) is highly variable within religious traditions.
How one Baptist, for example, interprets and lives his religion will be different from his Baptist neighbor.
 As with other subjective experiences, nurses often misjudge client perceptions. A Swedish study exploring
whether nurses and cancer clients assess spirituality similarly observed significant differences; that is, the
nurses underestimated how much spirituality supported coping and quality of life compared to their clients’
reported estimations.

The questions provided in the accompanying Assessment Interview may be suitable. Remembering an acronym
such as FICA can also help the nurse to ask appropriate questions:
F (faith or beliefs)—for example, “What spiritual beliefs are most important to you?”
I (implications or influence)—for example, “How is your faith affecting the way you cope now?”
C (community)—for example, “Is there a group of like-minded believers with which you regularly meet?”
A (address)—for example, “How would you like your health care team to support you spiritually?”

Cues to spiritual and religious preferences, strengths, concerns, or distress may be revealed by one or more of the
following:
1. Environment. Does the client have a Bible, Torah, Koran, other prayer book, devotional literature,
religious medals, a rosary, cross, Star of David, or religious get-well cards in the room? Does a church send
altar flowers or Sunday bulletins?
2. Behavior. Does the client appear to pray before meals or at other times or read religious literature? Does
the client have nightmares and sleep disturbances or express anger at religious representatives or at a deity?
3. Verbalization. Does the client mention God or a higher power, prayer, faith, the church, synagogue,
temple, a spiritual or religious leader, or religious topics? Does the client ask about a visit from the clergy?
Does the client express any of the following: fear of death, concern with the meaning of life, inner conflict
about religious beliefs, concern about a relationship with the deity, questions about the meaning of existence
or the meaning of suffering, or about the moral or ethical implications of therapy?
4. Affect and attitude. Does the client appear lonely, depressed, angry, anxious, agitated, apathetic, or
preoccupied?
5. Interpersonal relationships. Who visits? How does the client respond to visitors? Does a minister come?
How does the client relate to other clients and nursing personnel?

B. Diagnosing
SPIRITUAL ISSUES AS THE DIAGNOSTIC LABEL
NANDA International recognizes three diagnoses related to spirituality:
 Spiritual Distress is “impaired ability to experience and integrate meaning and purpose in life
through connectedness with self, others, art, music, literature, nature, or a power greater than
oneself”.
 Readiness for Enhanced Spiritual Well-Being recognizes that spiritual well-being is the “ability to
experience and integrate meaning and purpose in life through connectedness with self, others, art,
music, literature, nature, and/or a power greater than oneself that can be strengthened. This wellness
diagnosis describing spiritual health acknowledges that some people respond to adversity with an
increased sensitivity to spirituality or spiritual maturation.
 Risk for Spiritual Distress is defined by NANDA as being “at risk for an impaired ability to
experience and integrate meaning and purpose in life through connectedness with self, other
persons, art, music, literature, nature, and/or a power greater than oneself”. This diagnosis may be
appropriate for a client who presently shows no indication of this disruption of spirit yet may if a
nurse fails to intervene.
RELIGIOUS ISSUES AS THE DIAGNOSTIC LABEL
NANDA International (2009) accepts three nursing diagnoses that reflect client religious issues:
 Impaired Religiosity “Impaired ability to exercise reliance on religious beliefs and/or participate in
rituals of a particular faith tradition”.
 Risk for Impaired Religiosity “At risk for an impaired ability to exercise reliance on religious
beliefs and/or participate in rituals of a particular faith tradition”.
 Readiness for Enhanced Religiosity “Ability to increase reliance on religious beliefs and/or
participate in rituals of a particular faith tradition”.
SPIRITUAL OR RELIGIOUS DISTRESS AS THE ETIOLOGY
Spiritual distress may affect other areas of functioning and indicate other diagnoses.
 Fear related to apprehension about soul’s future after death and unpreparedness for death
 Chronic Low or Situational Low Self-Esteem related to failure to live within the precepts of one’s
faith
 Disturbed Sleep Pattern related to spiritual distress
 Ineffective Coping related to feelings of abandonment by God and loss of religious faith
 Decisional Conflict related to conflict between treatment plan and religious beliefs.

tktcacantilado19
C. Planning
In the planning phase, the nurse identifies therapeutics to support or promote spiritual health in the context of illness.
Planning in relation to spiritual needs may involve one or more of the following:
 Supporting clients to practice their religious rituals
 Helping clients recognize and incorporate spiritual beliefs in health care decision making
 Helping clients to recognize positive meanings for health challenges
 Promoting a sense of hope and peace
 Providing spiritual resources when requested.

D. Implementing
Spiritual nursing care includes actions as diverse as recognizing and validating inner resources of an individual,
such as coping methods, humor, motivation, self-determination, positive attitude, and optimism.
PROVIDING PRESENCE
Presencing, which is defined as being present, being there, or just being with a client, is a term that
identifies one of the competencies incorporated by expert nurses.
4 Features of Presencing:
 Giving of self in the present moment
 Being available with all of the self
 Listening, with full awareness of the privilege of doing so
 Being there in a way that is meaningful to another person
Multiple Levels of Presencing:
 Presence (when a nurse is physically present but not focused on the client)
 Partial presence (when a nurse is physically present and attending to some task on the client’s behalf
but not relating to the client on any but the most superficial level)
 Full presence (when a nurse is mentally, emotionally, and physically present; intentionally focusing
on the client)
 Transcendent presence (when a nurse is physically, mentally, emotionally, and spiritually present
for a client; involves a transpersonal and transforming experience).
CONVERSING ABOUT SPIRITUALITY
Sometimes clients do not want to talk about difficult emotions. Nurses can provide a healing response by
incorporating principles of empathic communication. The nurse can respond to clients’ comments about spirituality
with a restatement of what is most central in their comments, an open question to prompt their further reflection, or
a statement that tentatively names their feeling. The following are Dimensions of a verbal response that promotes
spiritual healing:
Healing:
 Client centered (e.g., “It seems you’re feeling like no one cares.”)
 Neutral (e.g., “Tell me more about your thinking regarding. . . .”)
 Immediate contributors to spiritual pain (e.g., “Perhaps underneath all the ‘why’
questions you’re asking, you feel abandoned.”)
 Accurately names feelings, engages emotion (e.g., “I’m sensing that your belief makes you
calm now.”)
Not Healing:
 Nurse centered (e.g., “But I care about you!”)
 Judgmental (e.g., “Why do you think that?”)
 Distant, tangential, or abstract contributors to spiritual pain (e.g., “You were wondering
what caused your cancer.”)
 Inaccurately or never names feelings, engages thinking (e.g., “What do you believe
about. . .?”)
SUPPORTING RELIGIOUS PRACTICES
During the assessment of the client, the nurse will have obtained specific information about the client’s religious
preference and practices.
Supporting Religious Practices Practice Guidelines:
 Create a trusting relationship with the client so that any religious concerns or practices can be openly
discussed and addressed.
 If unsure of client religious needs, ask how nurses can assist in having these needs met. Avoid relying
on personal assumptions when caring for clients.
 Do not discuss personal spiritual beliefs with a client unless the client requests it. Be sure to assess
whether such self-disclosure contributes to a therapeutic nurse–client relationship.
 Inform clients and family caregivers about spiritual support available at your institution (e.g., chapel or
meditation room, chaplain services).
 Allow time and privacy for, and provide comfort measures prior to, private worship, prayer, meditation,
reading, or other spiritual activities.
 Respect and ensure safety of the client’s religious articles (e.g., icons, amulets, clothing, jewelry).

tktcacantilado19
  If desired by client, facilitate clergy or spiritual care specialist visitation. Collaborate with chaplain (if
available).
 Prepare client’s environment for spiritual rituals or clergy visitations as needed (e.g., have chair near
bedside for clergy, create private space).
 Make arrangements with dietitian so that dietary needs can be met. If institution cannot accommodate
client’s needs, ask family to bring food. (Most religions have some recommendations about diet, such
as espousing vegetarianism, rejecting alcohol.)
 Acquaint yourself with the religions, spiritual practices, and cultures of the area in which you are
working.
 Remember there can be a difference between facilitating/supporting a client’s religious practice and
participating in it yourself.
 Ask another nurse to assist you if a particular religious practice makes you uncomfortable.
 All spiritual therapeutics must be done within agency guidelines.
ASSISTING CLIENTS WITH PRAYER
Prayer involves a sense of love and connection, as well as a reaching out. It has many health benefits and healing
properties (Dossey, 1996). It offers a means for someone to talk to, a mechanism for expressing care, and a sense
of serenity and connection with something greater than oneself.
 Clients may choose to participate in private prayer or want group prayer with family, friends, or
clergy. In such situations the nurse’s responsibility is to ensure a quiet environment and privacy.
 Nursing care may need to be adjusted to accommodate periods for prayer.
 Prayers with clients should only be done when there is mutual agreement between the clients and
those praying with them.

Praying with Clients Practice Guidelines:

 Clients’ preferences for prayer reflect their personalities. That is, introverts may prefer being alone to pray,
and their prayers will reflect their capacity for introspection. In contrast, extroverts’ prayers may revolve
around their relationships with others and be expressed in creative, verbal ways. Similarly, a
 prayer of a feeling type of client may be emotion filled, whereas the prayer of a thinking-type client may
be based on ideas and logic. Structure prayer interventions accordingly.
 When assessing whether a client would like you to pray, ask to pray in a way that allows both of you to feel
comfortable if the answer is no. (“Some people tell me prayer helps them to cope with rough times like this.
Would you feel comfortable if I prayed with you?”)
 Assess how the client approaches the addressee of prayer. For example, a Baptist may pray to Jesus, whereas
a Jew would pray directly to God, or Yahweh. This assessment can usually be made while listening to a
client talk about religious beliefs.
 Before praying, assess what they would like for you to pray. Listen carefully. The answer may provide
greater insight into their fears and concerns.
 Personalize the prayer. Present your client’s name and personal concerns to the Divine.
 Prayer can be used to summarize a conversation. This lets the client know you have heard what was said.
It may also help the client to view circumstances more objectively.
 Prayer may be the springboard to further discussion or catharsis. Stay with the client after a prayer until
there has been time for conversation.
 Follow a prayer with nonverbal communication (e.g., eye contact or touch) to convey “See, I am me, a
person, and you are you, and we have returned from our brief journey inward.”
 Remember some clients would like to pray aloud with you, just as you may with them. This can be a
beautiful
 experience that nurtures both the client and nurse. It allows the client to reciprocate caring.
 Be mindful of one difference between magic and prayer. Magic invokes a greater power for personal gain.
Prayer allows the greater power to do the greater good (“Thy will be done”).
 Praying with a client may not involve verbalization. You may feel it will be more comfortable or appropriate
if you remain quiet and fully present, praying silently.
 Facilitate the clients’ prayer practices. Schedule time for them when they will be undisturbed, palliate
distressing symptoms that interfere with praying, help with articles that accompany prayers (e.g., rosaries,
prayer garments, books of prayers), and so on.
 In times of distress, a client or loved one may not be able to construct a prayer spontaneously. You may
want to teach a centering prayer that is very brief (e.g., “Lord, have mercy/healing”). Nurses can discuss
with care recipients what prayer would benefit them most and encourage them to use it while alone. These
prayers may be more beneficial when they are framed in a positive sense. To illustrate, “Jesus loves me” or
“The Lord has mercy.”
 Encourage clients to think (privately or with you) about what prayer means to them. Offer questions like
these: Why do you pray? What do you expect from your praying? Are these expectations appropriate? How
content are you with your prayer experiences? Is there a yearning for something more in your prayer
experience?
tktcacantilado19
 E. Evaluation
 Does spiritually sensitive nursing care lead to observable and measurable client outcomes? If it does not,
then is
 it unsuccessful or unimportant?
 What outcomes indicating movement toward improved spiritual health are appropriate for nurses to
consider?
 Taylor (2007b) suggested that clinicians’ spiritually healing responses often move a client incrementally
toward spiritual healthiness.
 Nurses with theistic religious beliefs might add that a client’s movement toward spiritual health is evidence
of God’s grace, and ultimately something that is not within the purview of any clinician or person.
Nurse Spiritual Self-Awareness
 A nurse’s spiritual needs, pains, or woundedness can affect how he or she cares for clients. Nurses who are unaware
of, afraid of, or misunderstand their spiritual needs will be very limited in their ability to accurately identify and
explore a client’s spiritual needs.
 When clients realize the nurse does not understand them they become quiet, change the topic, give superficial
responses to queries, or in other ways indicate disinterest in continuing to talk about their spirituality.
 The nurse can use his or her woundedness and spiritual self-awareness as a bridge or tool for healing communication.
A healing response requires recognizing a client’s innermost feelings.
 Healers do not need to have shared the same experiences as have clients, but to be compassionate they do need to
recognize how they have shared similar emotions.
 The following strategies for nurses who wish to increase their spiritual awareness so that it can impact client care
positively:
o Write a self-epitaph. Sum up in a couple lines what is significant about your life, or how you would like to
be remembered.
o Explore personal end-of-life issues. Imagine having a terminal diagnosis. What feelings would you have?
What would be your priorities for the time and energy you had left?
o Create a personal loss history. Answer questions such as these: What was your first experience of death?
What was the most recent or difficult death in your life? How did you cope? What is your coping style at
times like this? How did you feel your grief?
o List significant values. Write down what possessions, persons, activities, roles, personal attributes, and so
forth, you prize most.
o Conduct a spiritual self-assessment. Consider what gives you strength and hope. What makes you joyful or
despaired? How do you explain or relate to suffering? What is your sense of purpose or mission in life?
What nurtures your spirit?

tktcacantilado19