NURSING ASSESSMENT OF SPIRITUAL NEEDS

• Spirituality is defined as a search for meaning and

purpose in life; it seeks to understand life's ultimate
questions in relation to the sacred.
• Spirituality is open to everything, for there is no
absolute standard of truth
• Any spiritual practice that brings comfort, strength
or apparently healing is considered equally good
and can be incorporated into health care.
• Religion is defined as the rituals, practices, and
experiences shared within a group that involve a
search for the sacred (i.e., God, Allah, etc.)
• Harvard & Duke medical research on Christian
church-goers:
• Regular church attenders live longer; have a lower
risk of dying from arteriosclerosis, emphysema,
cirrhosis of the liver and suicide, and recover faster.
• Diastolic blood pressures are lower than
nonattenders, their mental health is better and
their marriages are more stable.

The Joint Commission for Accreditation of Healthcare

Organizations Mandate on Assessment of Spiritual
Needs

• Reflects the need to recognize and meet the spiritual

needs of patients:

1. Standards R1 1.3.5 (hospitalized) - addresses the

SPIRITUAL DEVELOPMENT
• Must be central in assessing a patient's spirituality
Theories to track spiritual development:
rights of patients to have pastoral care and other
spiritual services, the scoring of an organization's
compliance with this standard, the inclusion of a
definition of a qualified chaplain, tighter language on
what are the components of a pastoral care program
2. Standard PE1 1.5.1 (nursing homes)

1. James Fowler's Stages of Faith Development
• described faith as not always religious in its content
or context, but one's finding coherence in life, with
seeing oneself in relation to others against a
background of shared meaning and purpose
• age-associated categorization present some
guidelines to assist in broadly estimating a patient's
level of spiritual development
Short comings of the framework
Holistic care- /contemporary – mandates attention to
the concerns of problems of the spirit as well those the
body and mind
Spirituality and religion- powerful coping mechanism
Nursing Assessment: Spiritual
• A systematic approach to assessing spiritual well-
being is recommended. (Govier, 2000)

1. it’s not universal enough

2. it has a lot of focus on each group • Spiritual Dimensions of Holistic Care:

3. James did not interview Gandhi or Luther king 1. Nurse should have first-hand knowledge of the
spiritual practices and needs of patients.

2. Excellent communication between pastoral care-

givers and nursing staff.

• The need for spiritual assessment is identified

specifically for ICU & CCU patients and families of those
who are ill.

Six Dominant Themes:

1. Loss of or separation from God and/or
institutionalized religion
Break barrier
2. The experience of evil and disillusionment
1. assess
3. A sense of failing God
2. Keep eyes and ears open for cues
4. He recognition of one's own sinfulness
3. know interpersonal relationship
5. Lack of reconciliation with God 6. Perceived
4. do not coerce our belief to the other person
loneliness of spirit
SAS subscales (each have 7 items)
1. personal faith
Spiritual Pain
2. religious practice
• an individual's perception of hurt or suffering 3. spiritual contentment
associated with that part of his or her person that
seeks to transcend the realm of the material Construct Validity of the SAS
• it is manifested by a deep sense of hurt stemming • Based on David Oberg (1979) 8 characteristics of
from feelings of loss or separation from one's God spiritual well-being
or deity; 1. Peace with God (PG) - item 2
• a sense of personal inadequacy or sinfulness before 2. Inner Peace (IP)-items 13, 14
God and man; or a pervasive condition of loneliness 3. Faith in Christ/God (FG) - items 1, 3, 5, 6
of spirit 4. Good Morals (GM) – items 8,9
5. Faith in People (FP) – items 7, 11, 12
Spiritual pain- question that the patient is asking and 6. Helping Others (HO) - item. 10
feeling such as “Why me?” feelings of hopelessness and 7. Good Health (GH) – item 7 8. Being Successful (BS) -
despair and guilt item 4
Religious pain -rooted in guilt leading to punishment
and experienced as fear. • Based on James Fowler's Stages of Faith Development:
1. Prestage - items 3, 6
Spiritual pain- rooted in shame leading a patient to 2. Stage 1 - items 11, 12
abandon in hope in God 3. Stage 2 - items 1,4
4. Stage 3 &4 - items 2,5
Spiritual distress 5. Stage 5 - items 7, 13, 14
1. The person’s spirituality has the potential to affect 6. Stage 6-items 8, 9, 10
every aspect of being
2. sudden changes in spiritual practice
-frequent crying apathy and anger
3. sudden changes in spiritual matter

Spiritual need- anything that required to establish to

maintain a dynamic relationship with God

- to be loved, to love in return

-to experience forgiveness and to expend it to others

- to find meaning and purpose in life and hope in the

future

Primary barriers to spiritual care include:

1. The Bravado Barrier (Hidden Needs) -Burying

spiritual needs (spiritual care & support of others)
beneath a veneer of composure -Needs may not appear
obvious-because people hesitate to express them or
because we fail to hear them when they do.

2. Fear of treading on private territory, thereby

offending the other person

3. Lack of time

4. Feeling unprepared or ill-equipped


Spiritual Well-Being
The term spiritual well-being is described historically as
having emerged following a 1971 White House
Conference on Aging. Sociologist of religion David
Moberg (1979) identified SWB as relating to the
“wellness or health of the totality of the inner resources
of people, the ultimate concerns around which all other
values are focused, the central philosophy of life that
guides conduct, and the meaning-giving center of
human life which influences all individual and social
behavior”
SWB is described as “an integrating aspect of human
wholeness, characterized by meaning and hope”
For the Christian, SWB is identified as “a right
relationship of the person to God, and, following that, a
right relationship to neighbor and self ” (Christy & Lyon,
1979, p. 98). Spirituality is generally identified as being
related to issues of transcendence and ultimate life
goals. Nurse theorist Barbara Dossey (1989) explained
spirituality as encompassing “values, meanings, and
purpose” in life; it includes belief in the existence of a
“higher authority”; and it may or may not involve
“organized religion” (p. 24). O’Brien (1989), in reporting
on research with the chronically ill, suggested that
spirituality is a broad concept relating to transcendence
[God]; to the “non-material forces or elements within
man [or woman]; spirituality is that which inspires in
one the desire to transcend the realm of the material”
(p. 88). Religiousness, or “religiosity,” as it is sometimes
identified in the sociological literature, refers to
religious affiliation and/or practice. Kaufman (1979)
described religiousness as “the degree to which
religious beliefs, attitudes and behaviors permeate the
life of an individual”
Personal faith, as a component concept of the SWB
construct, has been described as “a personal
relationship with God on whose strength and sureness
one can literally stake one’s life” (Fatula, 1993, p. 379).
Personal faith is a reflection of an individual’s
transcendent values and philosophy of life. Religious
Practice Religious practice is primarily operationalized in
terms of religious rituals such as attendance at formal
group worship services, private prayer and meditation,
reading of spiritual books and articles, and/or the
carrying out of such activities as volunteer work or
almsgiving.
Spiritual Contentment
Spiritual contentment, the opposite of spiritual distress,
is likened to spiritual peace (Johnson, 1992), a concept
whose correlates include “living in the now of God’s
love,” “accepting the ultimate strength of God,”
knowledge that all are “children of God,” knowing that
“God is in control,” and “finding peace in God’s love and
52 Chapter 3 Nursing Assessment of Spiritual Needs
forgiveness” (pp. 12–13). When an individual report
minimal to no notable spiritual distress, he or she may
be considered to be in a state of “spiritual
contentment.”
Spiritual Assessment Tool, developed to identify the
spiritual needs of nursing home residents; the JAREL
Spiritual Well-Being Scale, a tool to assess the spiritual
attitudes of older adults (Hungelmann, Kenkel-Rossi,
Klassen, & Stollenwerk, 1996); Puchalski’s (2000)
“Spiritual History,” which includes four do mains:
“Faith, Importance, Community, and Address” (p. 129);
the multidimensional “Spiritual Needs Survey,” which
includes seven major constructs: “belonging, mean ing,
hope, the sacred, morality, beauty, and acceptance of
dying”
1. Spiritual Pain, as evidenced by expressions of
discomfort or suffering relative to one's relationship
with God; verbalization of feelings of having a void or
lack of spiritual fulfillment, and/or lack of peace in
terms of one's relationship to one's creator.
2. Spiritual Alienation, as evidenced by expressions of
loneliness, or the feeling that God seems very far away
and remote from one's everyday life; verbalization that
one has to depend upon oneself in times of trial or
need, and/or a negative attitude toward receiving any
comfort or help from God.
3. Spiritual Anxiety, as evidenced by an expression of
fear of God's wrath and punishment; fear that God
might not take care of one, either immediately or in the
future; and/or worry that God is displeased with one's
behavior.
4. Spiritual Guilt, as evidenced by expressions
suggesting that one has failed to do the things which he
or she should have done in life, and/or done things
which are not pleasing to God; articulation of concerns
about the kind of life one has lived.
5. Spiritual Anger, as evidenced by expressions of
frustration, anguish, or outrage at God for having
allowed illness or other trials; comments about the
"unfairness" of God; and/or negative remarks about
institutionalized religion and its ministers or spiritual
caregivers.

6. Spiritual Loss, as evidenced by expression of feeling

of having temporarily lost or terminated the love of
God, fear that one's relationship with God has been
threatened; and/or feeling of emptiness with regards to
spiritual things.

7. Spiritual Despair, as evidenced by expressions

suggesting that there is no hope of ever having a
relationship with God, or of pleasing and/or a feeling
that God no longer can or does care for me.

NANDA
Nursing Diagnosis Domain 10. Life principles

Class 1. Values
This class does not currently contain any diagnoses
Class 2. Beliefs
Readiness for enhanced spiritual well-being
Class 3. Value/belief/action congruence

• Readiness for enhanced decision-making

• Decisional conflict
• Impaired emancipated decision-making
• Risk for impaired emancipated decision-making
• Readiness for enhanced emancipated decision-
making
• Moral distress Spiritual Care Interventions:
• Impaired religiosity 1. Providing a time of silence for the client may
• Risk for impaired religiosity encourage spiritual practices such as meditation, or the
• Readiness for enhanced religiosity nurse may gather family members or clergy to
• Spiritual distress participate in a prayer ritual.
• Risk for spiritual distress 2. Collaboration and referral with pastoral chaplains or
clergy are also extremely important when dealing with
Spiritual Care religious issues in a health care setting.
• Addressing the spiritual needs of the client as they Ex: A nurse from a Protestant faith faced with a Muslim
unfold through spiritual assessment. client who has just been diagnosed with terminal cancer
may not be able to speak to the client's end-of-life
• Characteristics issues and may require referral to the appropriate
1. Individualistic professional.
2. Client oriented
3. Collaborative