Casey Gatto, Bobbi Rempe, and Madison Ellis

Case Study for Spirituality

Mrs. Lilac is an 86 year old German woman and is in the end of life care stage or on

hospice care in the Daliah Nursing Care Center (nursing home). She speaks English very well

upon coming to the United States when she was young as an exchange student for her

college's swimming team. She is oriented x3 and loves to visit with guests. She was placed on

hospice care when her chronic kidney disease developed into stage 5 renal failure or end stage

renal failure. Mrs. Lilac also has a history of hypertension, breast cancer, and chronic

pneumonia. Mrs. Lilac experiences symptoms of fatigue, decreased appetite, and fluid retention

causing edema in the residents lower extremities related to her diagnosis of stage 5 renal failure

(Chronic kidney disease, 2021). She struggles with movement in her lower extremities due to

the increased fluid retention (Chronic kidney disease, 2021). She prefers to be sitting in bed at

an incline of the head and feet as this allows her to stay awake and visit with guests while

ensuring comfort. Helping the patient in and out of bed puts a lot of stress on her body as her

body will not allow her to perform activities like she was once able to. This lack of activity and

increased fatigue has saddened her but she understands her limitations. Recently Mrs. Lilac

has been struggling with her self worth and asks the nurses questions about their beliefs and

wishes. Mrs. Lilac has told the hospice nurse and the nurse at her care facility that she is scared

of death and that she has not made peace with her creator or situation. The hospice nurse visits

Mrs. Lilac twice a week but the nurse on duty needs to keep a watchful eye on Mrs. Lilac in

between visits to assure Mrs. Lilac is comfortable and safe.

What is an issue Mrs. Lilac is struggling with? What is evidence that suggests this struggle?

- Decreased self worth, fatigue, decreased appetite, and decreased ability to move lower

extremities are all issues she is struggling with. Her self worth issue can be evidenced

by her history of asking the medical staff about their personal beliefs and wishes. Patient

has also said she is “scared of death and has not made peace with her creator or

situation”. The medical issues can all be evidenced by her history of renal failure,

edema, hypertension, pneumonia, and breast cancer.

What is a possible nursing diagnosis for Mrs. Lilac?

- spirtual anger (due to her not being able to accept her diagnosis/illness), spiritual loss

(due to her terminal illness and her inability to find comfort in religion), spiritual anxiety

(due to her experiencing challenges with her spiritual beliefs), spiritual alienation (due

to her being in hospice she is separated from her faith community), spiritual despair

(due to her feelings of having problem with God). (Bartlett, p. 1806)

How can the nurse include the patient in their care?

- The nurse can start by first performing a spiritual assessment of the client, this helps

recognize the difference between religious and spiritual needs; identify appropriate

spiritual care interventions; and determine when it is appropriate to deliver spiritual care.

From here the nurse can make sure to be an active listener while providing a calm and

peaceful environment. The nurse can make sure they speak with the client about their

life and talk with them about other related topics to gain more perspective on how to

help. Any decision made after all of this can be done in order to provide the patient with

the correct resources to help them continue their religious practices.

Who does the nurse need to collaborate with in order for the patient to receive the best care?
 - The nurse should collaborate with the patient (Mrs. Lilac) first in this situation since she

is alert and oriented x3. This will keep the patient at the center of her care. Depending

on her input the nurse and patient can move forward and collaborate with other medical

staff and her family members/the guests that visit her often. If the patient was not

oriented or alert the best option would be to talk with family but since she can make

decisions herself that is how the problem should be approached and then solved. It is

important for the nurse to share the patient's wishes with her other medical staff so that

the hospice workers are always up to date with the patient's information.

What tools are needed in order for the nurse to provide competent safe care?

- Some tools that can be used are the FICA and HOPE assessment tools. These are used

to elicit a spiritual history from the patient. There is also a list of common beliefs in the

Lippincott Coursepoint Enhanced for Taylor’s Fundamentals of Nursing (9th edition) on

table 46-1. These tools can help the nurse understand each of their patients specific

spiritual beliefs and know how to approach them in pertaining to their healthcare. These

assessment tools can also be used to dictate what spiritual activities can be planned for

the resident home. By keeping an up to date chart, the patient's spiritual preferences will

be easily accessible. The data from this patients spiritual preference, along with other

patient data, can be used to implement a stronger spiritual system in the resident home

that Mrs. Lilac is at. We can also offer some of the spiritual opportunities to other

residents as well. By looking at the attitudes and preferences of the residents in Mrs.

Lilacs facility, this data can be analyzed and used to further benefit the spiritual system

in

-
 - health care.

HOPE:

H - sources of hope, meaning, comfort, strength, peace, love, and connection.

O - organized religion

P - Personal spirituality and practice

E - effects on medical care and end-of-life issue

FICA:

F - faith, belief, meaning (determining if a patient identifies with a particular belief)

I - Importance and influence (understand the importance of spirituality in the patients life and

how it influences their health care experience.

C - community (find out if the patient is part of a religious community or if they rely on

community for support)

A - address/ action in care (learn how to address spiritual issues with regards to caring for the

patient/ know how to address the patient's care if there spirituality causes limitations)

(Bartlett, p. 1804)

List some of the interventions the nurse can implement to ensure the comfort, happiness,

safety, and overall well being of the resident and also of other patients in similar situations.

- Be an active listener

- Provide support

- provide a calm and peaceful environment

- Familiarize the patient with religious materials and sources available

- Meet religious dietary restrictions if need be

- Contact a spiritual counselor or religious leader if necessary

- Pray with/for the patient

- Intend to be a healing presence

- Open yourself to the patient

- Prepare a space for religious practices to take place if they cant be done in their room

- Help the patient think about what their spiritual beliefs/practices were like before, during,

and after the illness

- Collaborate with other healthcare professionals such as therapists and psychiatrists if

need be
Notes:

QSEN COMPETENCIES:

● 1 Patient Centered Care - Recognize the patient as the source of control and full partner

in providing compassionate and coordinated care based on respect for the patient's

preferences, values, and needs.

● 2 Safety - Minimizes risk of harm to patients and providers through both system

effectiveness and individual performance.

● 3 Teamwork/ Collaboration - Function effectively within nursing and inter-professional

teams, fostering open communication, mutual respect, and shared decision-making to

achieve quality patient care.

● 4 Evidence Based Practice - Integrate best current evidence with clinical expertise and

patient/family preferences and values to deliver optimal care.

● 5 Quality Improvement - Use data to monitor the outcomes of care processes and use

improvement methods to design and test changes continuously to improve the

healthcare system.

● 6 Informatics - Use information and technology to communicate, manage knowledge,

mitigate error, and support decision making.

QSEN COMPETENCIES AND THE CASE STUDY

● Patient Centered Care - The nurse should be able to provide the resident with resources

of their choosing to continue practicing beliefs and look into different belief systems that

resonate with them. The nurse should be able to create a nurse-patient relationship that

can lead to further communication ensuring the patient is in a preferable environment

surrounded by things they enjoy.

● Safety - The nurse needs to provide a safe environment for all patients. In this situation

where patients are depressed and anxious the nurse needs to be aware of any self harm

or threats of self harm. The case study is a spirituality case study, so not only does the

nurse have to be aware of the patient's physical safety, the patient is also hinting at

mental health concerns.

● Teamwork/ Collaboration - The nurse will work with the hospice nurse and family

members to ensure that the patient is safe and comfortable. If the patient prefers to

speak with someone of the same spirituality or religious leader this can be arranged. It is

also important to provide the patient with proper resources to enhance the patient's care.

This could include scheduling for different activities to take place, ensuring the patient

has access to therapy, and being able to provide the patient the proper material/tools in

order for the patient to participate in their everyday living (ex. magnifying equipment to

read or watch television if the resident has a visual impairment which was not stated in

the case study).

● Evidence Based Practice - By using a source from a nursing journal and an institution

we can use up to date information on healthcare to ensure the best care. The sources

used were 4 end-of-Life Care (Hospice Care) Nursing Care Plans and Chronic kidney

disease. These were used to detail information regarding kidney disease and how to

perform care on someone during the final stages of renal failure.

● Quality Improvement - Keeping notes of what activities like to do to plan events for the

future. This can also be kept track of in regards to the patient's moods and attitudes

towards events and during what time frames would the patients prefer to perform

different activities.

● Informatics - Keeping up to date charts is important for spirituality. Knowing if the

patient's spirituality can be changing should be noted in the chart when the change

occurs. Keeping a list of things the patient likes to talk about and participate in is
 important for the different nurses that will be taking care of that patient. This can be used

to help dictate communication with the patient and reminding the patient of activities they

would maybe like to be a part of.

QSEN COMPETENCIES AND END OF LIFE CARE/ MENTAL HEALTH NURSING

(VULNERABLE POPULATIONS)

● Patient Centered Care - Each patient will experience a different spiritual journey and it is

the nurses responsibility to supply the patient with reasonable materials of interest for

the patient to continue this practice or further look into spiritual practices. The patient

should be given personalized care based on their spiritual beliefs. Table 46-1 on page

1796 lists Common beliefs and traditions that influence healthcare practices in the

United States. This is a great resource in understanding different practices and will

better prepare the nurse and aid in a personalized care plan. (Everyone is entitled to

practice their spiritual beliefs their own way but this list is generalized, patient

communication is always key)

● Safety - A safe environment should be kept for every resident. As for the spirituality

topic, the patient may need more guidance mentally. This can mean being more aware

of cues that the patient may harm themselves and taking the proper steps in ensuring

they do not hurt themselves or others. Providing the patient with the right resources for

professionals that can provide the best help mentally is the responsibility of the nurse.

These professionals can include psychiatrists, therapists, and religious leaders.

● Teamwork/ Collaboration - For end of life care the nurse needs to work with the hospice

nurse that will come to visit. The nurse can also work with different members of religious

groups in order to organize some form of spiritual activity specific to the patient.

Providing the best care in this situation can also include working with different mental

health professionals like psychiatrists and therapists.

● Evidence Based Practice - Using up to date sources is pertinent when providing the

most accurate and safe care. The sources used for this population were titled Spiritual

support interventions in nursing care for patients suffering death anxiety in the final

phase of life and Death anxiety in hospitalized end-of-life patients as captured from a

structured electronic health record.

● Quality Improvement - By holding different activities for the patients it can be determined

which activities are best for this population. By exposing the patients to different

activities it gives them the option in deciding what activity they would prefer to do more

often. This was outlined in Spiritual support interventions in nursing care for patients

suffering death anxiety in the final phase of life. This nursing journal highlights methods

used during times where patients in the Czech Republic would experience death anxiety.

The most frequently used activities to ensure patient comfort were “treating individuals

with dignity and respect” and “praying with the individuals”. This is patient and

nationally specific but could be used as an idea for other healthcare facilities if a patient

is struggling with their spirituality. In the case study we are following a German woman

in an American nursing home. There should be no discrimination but instead

communication to determine what the patient is most comfortable with. In the journal

originating in Czech Republic it was found that, Czech Republic nursing home residents

preferred those specific activities but there is no limitation on what your specific patient

prefers (as long as it does not harm themself or others).

● Informatics - Keeping up to date charts of spiritual preferences and activities will help the

nurse initiate and continue conversations between the patient and the nurse. This can

further help the nurse understand the patient's background and the patient's limitations
due to their spirituality. Understanding the patient's spirituality is important when

providing patient centered care. Their spirituality can cause health care limitations.
 WORK CITED

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