SPIRITUALITY & HIV PATIENTS

Yuanita Wulandari, S. Kep., Ns., MS

 When someone criticises or disagrees with you, a small
ant of hatred and antagonism is born in your heart. If you
do not squash that ant at once, it might grow into a snake,
or even a dragon.
WHEN PEOPLE ARE UNWELL, THEY MAY
SIGNAL THEIR DESIRE TO DISCUSS
SPIRITUAL ISSUES
The only lasting beauty
(Rogers is Suffering
M & Wattis J., 2015) is a gift. In it is
the beauty of the heart hidden mercy.

Jalaluddin al-Rumi
Jangan tanya apa agamaku. Aku bukan yahudi, bukan
zoroaster, bukan pula islam. Karena aku tahu, begitu
suatu nama kusebut, kau akan memberikan arti yang lain
daripada makna yang hidup di hatiku.
 OUTLINE
 Definition of Spirituality
 The different between spirituality &
religiosity
 Spirituality Dimension
 Spirituality Care
 Middle east Theory Spirituality care
 Spirituality Assessment tools
 DEFINITION: SPIRITUALITY
is a way of finding hope, meaning and purpose in a frenetic
world.
definitions of spirituality include the concept of providing
meaning, hope and purpose to an individual
(Narayanasamy 2002, 2004, Cook 2004)
 ‘spirituality is defined as the essence of being and it gives
meaning and purpose to our existence‟ (Narayanasamy
2004).

(Rogers M & Wattis J., 2015)

It is especially important when individuals feel

vulnerable, for example when FACING ILLNESS and
CRISIS, whether as a patient or a nurse.
 DEFINITION: RELIGIOUS
The Oxford Dictionaries (2015) give the primary definition
of religion as „BELIEF IN… a superhuman controlling
power, especially a personal god or gods‟.
Curran (2006), writing in a healthcare context, suggested
that religion is connected with the beliefs and RITUALS
FOUND IN MANY FAITHS and is often associated with
power structures.

(Rogers M & Wattis J., 2015)

many would assert that you can be spiritual without

being religious, or religious without being spiritual
(Cook et al 2010).
 SIX DIMENSIONS OF
PSYCHO-SPIRITUAL INTEGRATION
According to Kang (2003)
 Becoming – volitionally directed growth of the self
through active doing.
 Meaning – the sense of intrinsic purposefulness and
vitality rooted in personal, collective or transpersonal
spaces.
 Being – a pervasive quality that forms the foundation of
our existence as human beings.
 Centeredness – an inner stability based on knowing and
recognizing what lies at the core of one‟s being.
 Connectedness – seeing the self as a „fluid process‟
embedded in a larger inter-relational context.
 Transcendence – this has two aspects. First, the innate
human drive to find ultimate meaning and happiness;
and, second, the goal sought by this drive.
(Rogers M & Wattis J., 2015)
 DEFINITION: SPIRITUAL CARE
 Taylor, Amenta, and Highfield (1995) described spiritual care in nursing
rather broadly as encompassing behaviors that attend to the promotion of
health in response to stressors that may affect the spiritual perspectives
of individuals.
 Spiritual care in nursing encompasses a variety of diverse behaviors such
as ACTIVE LISTENING, FACILITATING A TRUSTING RELATIONSHIP,
COMMUNICATING ACCEPTANCE, and CONNECTING WITH PATIENTS
(McEwen, 2005; Narayanasamy & Owens, 2001; Taylor et al., 1995;
Treloar, 1999), as well as concrete RELIGIOUS PRACTICES such as
prayer (Stiles, 1990).
 although some authors have suggested that active listening, creating
trust, connecting, and being present (Greenstreet, 1999; Stiles, 1990)
(Chism, L.A & Magna, M. A., 2009)

 According Gordon et al (2011) The key to providing spiritual care is TO

UNDERSTAND WHAT SPIRITUALITY MEANS TO THE PERSON YOU ARE
CARING FOR‟ (Rogers M & Wattis J., 2015)
 the Middle-Range Theory of Spiritual
Empathy (MTSE)

 A patient‟s level of spiritual distress has a direct but inverse effect on

his or her level of spiritual well-being.
 Nurse-expressed spiritual empathy as well as patient-perceived
empathy are joint determinants of the level of patient spiritual distress
experienced.
 Nurse-expressed spiritual empathy directly and positively affects
patient-perceived empathy.
 The nurse‟s own spiritual care perspectives directly affect the quality
and quantity of nurse-expressed spiritual empathy.
(Chism, L.A & Magna, M. A., 2009)
SPIRITUAL CARE COMPETENCE
1. An ability to describe
and substantiate a
working definition of
spiritual and religious
needs.
2. An ability to refer
effectively and
articulately to other
spiritual care resources
Skills
Appropriate documentation
of referrals following a
spiritual assessment
1.Spiritual self-awareness
2.Understanding of the
nature of spiritual
Knowledge assessment.
3.Understanding of the
skills that other members
of the team have in
relation to spiritual care.
(Rogers M & Wattis J., 2015)
Action
 FACTORS INFLUENCE
NURSE‟S SPIRITUAL CARE
 These spiritual care perspectives are believed to be influenced by THE
DEMOGRAPHIC and SPIRITUALITY CHARACTERISTICS OF NURSES
 NURSES‟ ATTITUDES ABOUT SPIRITUAL CARE greatly influence their
provision of spiritual care (Chan et al., 2006).
 nurses with a HIGHER PERSONAL SENSE OF SPIRITUAL WELL-BEING
(Hall & Lanig, 1993; Musgrave & McFarlane, 2004; Soeken & Carson, 1986;
Stranahan, 2001; Taylor & Amenta, 1994; Taylor, Highfield, & Amenta,
1994)
 CONSIDER ONESELF SPIRITUAL, GENDER (BEING FEMALE), CHURCH
ATTENDANCE, RELIGIOUS AFFILIATION. However, The variables of “age,”
“spiritual training,” and “level of education” did not correlate significantly
with SCPS scores.
 Chan et al. (2006) reported a strong positive association between NURSES‟
PERCEPTIONS OF SPIRITUAL CARE AND SPIRITUAL CARE PRACTICES.
 Stranahan (2001) reported significant positive relationships between
ATTITUDES ABOUT SPIRITUALITY AND SPIRITUAL CARE PRACTICES
(such as praying with patients).
(Chism, L.A & Magna, M. A., 2009)
PROBLEMS IN SPIRITUAL CARE
• Despite a growing body of evidence that suggests SPIRITUAL CARE
IS IMPORTANT TO NURSING, nurses OFTEN FAIL to regularly provide
spiritual care to their patients (Lundmark, 2006; Narayanasamy, 1993;
Taylor et al., 1995).
– CONFUSION ABOUT THE NURSE‟S ROLE VERSUS THE
CHAPLAIN‟S ROLE in providing spiritual care has been cited as
one reason nurses fail to assess patients‟ spiritual needs
(Narayanasamy, 1993; Treloar, 1999).
– FEELING UNPREPARED TO MEET PATIENTS‟ SPIRITUAL NEEDS
acts as a barrier to the provision of spiritual care (Narayanasamy,
1993).
– LOWER LEVELS OF NURSING EDUCATION and NURSES‟ FEELING
UNCOMFORTABLE ABOUT PROVIDING SPIRITUAL care have
been associated with the provision of less spiritual care (Taylor et
al., 1995; Treloar, 1999).
(Chism, L.A & Magna, M. A., 2009)
 SUGGESTIONS FOR INCREASING
SPIRITUAL COMPETENCY
 BE AWARE OF YOUR OWN SPIRITUALITY, of where your
own sense of meaning and purpose and values come from.
 LISTEN FOR CUES AND BE ATTENTIVE TO PATIENTS
RAISING ISSUES of what their illness means for them.
 BE FULLY PRESENT, PAY ATTENTION TO THE PERSON
WHEN UNDERTAKING PRACTICAL TASKS WITH PATIENTS,
so they understand that you respect them as valued fellow
human beings.
 PROMOTE PERSON-CENTRED, rather than TASK-CENTRED,
WAYS OF NURSING.
 REFLECT DAILY ON HOW COMPASSIONATE and MINDFUL
you have been in dealing with patients and colleagues.
(Rogers M & Wattis J., 2015)
 ASSESING SPIRITUALITY

Skevington, S.M, Gunson, K.S, &

O‟Connell, K.A. (2013)
 Multidimensional Assessment of
Spirituality/Religion in Patients with HIV
 The BMMRS framework also considers that various health outcomes
can be affected by spirituality/religion (positively or negatively),
distinguishes several types of causal pathways from
spirituality/religion to health (behavioral, social, psychological, and
physiological), and acknowledges a cumulative effect of
spirituality/religion across the life span (Idler et al. 2003).
 The BMMRS captures 12 domains of spirituality/religion: Daily
Spiritual Experiences, Meaning, Values/Beliefs, Forgiveness, Private
Religious Practices, Religious/Spiritual Coping, Religious Support,
Religious/Spiritual History, Commitment, Organizational
Religiousness, Religious Preference, And Overall Self-ranking As A
Religious/ Spiritual Person (Fetzer Institute and National Institute on
Aging Working Group 1999).

(Skevington, S.M, Gunson, K.S, & O‟Connell, K.A., 2013)

JOINT COMISSION ON ACCREDITATION
OF HEALTH CARE 2004

Hodge, D.R. (2006).

 SPIRITUALITY MEASUREMENTS
Ruohollah Seddigh, Amir-Abbas Keshavarz-Akhlaghi, & Somayeh
Azarnik. (2016).
 Competence in Spiritual
Nurses‟ Professional
Care
Mohsen Adib-Hajbaghery & Samira Zehtabchi. (2016)
 Nurses‟ Professional
Competence in Spiritual
Care
SPIRITUALITY UNIQUELY PREDICTS HEALTH
AND WELL-BEING OUTCOMES IN THOSE
WITH HIV/ AIDS

 it is important for health care providers to understand that

SPIRITUALITY PLAYS A CRITICAL ROLE IN THE PROGNOSIS
OF HIV in many patients.
 The TYPE OF SPIRITUAL BELIEFS AND PRACTICES determines
whether SPIRITUALITY IS A PROTECTIVE OR RISK FACTOR TO
THE PROGRESSION OF HIV.

Joni L. Utley & Amy Wachholtz. (2011)

 RECOMMENDATIONS FOR SERVICE PROVIDERS
(Trevino et al., 2010)
 Assess positive religious coping and spiritual struggle early in
treatment; assessing early is especially important to mitigate the
effects of patients experiencing spiritual struggle;
 Support and encourage patients utilizing religious resources to
cope
 Be open to incorporating religious coping techniques into
treatment plans. Appropriate interventions include discussing
religious/spiritual beliefs, referral to pastoral counselor or
religious clergy, referral for psychotherapy to address spirituality;
and
 Consider manualized psychological/spiritual interventions for
patients with HIV such as “Lighting the Way: A Spiritual Journey to
 Wholeness” (Pargament et al., 2004), a spiritual coping
intervention for adults living with HIV/ AIDS (Tarakeshwar, Pearce,
& Sikkema, 2005), or a Spiritual Self-Schema therapy for treatment
of addiction and HIV (Avants et al., 2005).
Joni L. Utley & Amy Wachholtz. (2011)
 REFERENCE
 Chism, L.A & Magna, M. A. (2009). The Relationship of Nursing Students‟ Spiritual
Care Perspectives to Their Expressions of Spiritual Empathy. Journal of Nursing
Education, 48(11)
 Joni L. Utley & Amy Wachholtz. (2011). Spirituality in HIV+ Patient Care. Psychiatry
Issue Brief, 8(3)
 Rogers M & Wattis J (2015) Spirituality in nursing practice. Nursing Standard. 29,
39, 51-57.
 Ruohollah Seddigh, Amir-Abbas Keshavarz-Akhlaghi, & Somayeh Azarnik. (2016).
Questionnaires Measuring Patients‟ Spiritual Needs: A Narrative Literature
Review. Iran J Psychiatry Behav Sci. In Press(InPress):e4011
 Hodge, D.R. (2006). A template for spirituality assessment: a review of JCAHO
requirements and guideline for implementation. Social Work, 51(4)
 Mohsen Adib-Hajbaghery & Samira Zehtabchi. (2016). Developing and Validating
an Instrument to Assess the Nurses‟ Professional Competence in Spiritual Care .
Journal of Nursing Measurement, 24(1)
 Skevington, S.M, Gunson, K.S, & O‟Connell, K.A. (2013). introducing the WHOQOL-
SRPB BREF: developing a short-form instrument for assessing spiritual, religious
and personal beliefs within quality of life. Quality Life Res, 22:1073–1083
 Szaflarski, M., Kudel, I., Cotton, s., Leonard, A.C, Tsevat, J., & Ritchey, P.N. (2012)
Multidimensional Assessment of Spirituality/Religion in Patients with HIV:
Conceptual Framework and Empirical Refinement. Journal Religion Health,
51:1239–1260