UNIVERSITY OF NUEVA CACERES
COLLEGE OF NURSING
Spirituality &
Religious Practices
NURSING ASSESSMENT
Objectives:
1. Describe the difference between religion and spirituality.
2. Review the current statistics on spiritual and religious beliefs and practices in the Philippines.
3. Discuss how understanding the client’s spirituality assists the nurse to understand the client’s
decision making processes and support systems.
4. Discuss risk factors associated with spiritual distress.
5. Perform an objective assessment of a client’s spirituality and religious practices.
6. Differentiate between skills needed for general routine screening and skills needed for focused
specialty assessment of one’s spirituality and religious practices.
7. Differentiate between normal and abnormal findings of a client’s spirituality and religious practices, as
well as analyze data from interview & objective assessment to formulate nursing diagnoses.
8. Communicate interview and assessment findings of the client’s spirituality and religious practices
through clear concise documentation and verbal reports.
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How Are Religion and Spirituality
Different From Each Other?
Religion
FUNCTION CONTEXT
frequently has a formal frequently linked with
structure, including established organized groups and
doctrines, rituals, and institutions such as churches,
institutions mosques, temples, and
religious traditions are synagogues
frequently communal, with religious doctrines and
structured meetings such as practices are frequently passed
worship services, ceremonies, down through generations and
and festivals have historical and cultural
often have a set of beliefs, implications
principles, and moral norms religion can have a considerable
that adherents are required to impact on cultural norms,
follow ethics, and legislation.
Spirituality
FUNCTION CONTEXT
more individualistic, more personal and can be
emphasizing personal practiced independently of
development, inner tranquility, religious affiliations
and connection to something often about seeking meaning,
larger than oneself purpose, and transcendence
can encompass a diverse set of in life
ideas and practices, including spiritual beliefs and practices
meditation, mindfulness, can vary widely among
introspection, and self-reflection individuals and may draw
more adaptable and can be from diverse cultural,
practiced both within and philosophical, or religious
outside of religious contexts sources.
How Are Religion and
Spirituality Alike?
Religion & Spirituality in the
Philippines
THE PHILIPPINES
The Philippines is proud to be Asia's sole Christian nation.
More than 86% of the population is Roman Catholic,
6% belong to various nationalized Christian cults, and the other 2%
adhere to more than 100 Protestant denominations.
In addition to the Christian majority, there is a strong 4% Muslim
minority located on Mindanao, Sulu, and Palawan. The remaining
2% live in isolated highland areas and adhere to non-Western,
indigenous beliefs and traditions.
Although statistically modest, the Chinese minority has had a
cultural impact on Filipino Catholicism, infusing it with many
Buddhist, Daoist, and Confucian ideas and practices.
The Relationship between
Religion, Spirituality, and Health
Wright (2005) calls suffering, beliefs, and spirituality analogous to
three close cousins. Suffering, be it psychological or physical, is often
associated with illness.
A person's beliefs about the cause and meaning of suffering and pain
affect the illness.
Spiritual beliefs about the meaning of life affect the course of illness
and how a person handles suffering and pain as well.
Nurses can benefit from understanding this three-part relationship
when assessing a client's spiritual health.
Impact of Religion & Spirituality
on Health
A large number of clients use spiritual resources during times of high stress (e.g.,
hospitalizations). Religion and spirituality have been shown to relate to a person's
greater sense of well-being in the face of chronic disease management and ability to
adhere to medical regimens.
Religion and spirituality can be powerful coping mechanisms when a person faces
end-of-life issues. A substantial amount of evidence shows the positive effects of
spirituality on health.
Spiritual practices have the potential to encourage greater mental and physical health.
A limited list of spiritual activities may include prayer, dietary restrictions, pilgrimage,
confessions, reflection, forgiveness, and any other activity that includes a search for
meaning and purpose in life.
If the client reports spiritual activities; these activities should be encouraged if found
beneficial to the client's overall health.
Religious groups frequently view the body as a gift and encourage a
lifestyle to mirror that belief. (e.g. avoidance of promiscuous sexual
activity, shunning of alcohol and tobacco use, and following dietary
guidelines each promote a healthy life-style)
If discovered in discussion with the client, these positive health
behaviors can be encouraged and supported
Religious beliefs can express a wide variety of values and practices,
including rituals (eg., birth, death, illness) and ways of dealing with end-
of-life issues that may significantly affect the religion-health
relationship.
Particular religious views may also negatively affect health.
Failure to seek timely medical care and withholding standardized
medical care based on religious dogma are usually the most prominent
ethical dilemmas faced by health care providers.
Christian scientists frequently rely on prayer alone to heal illnesses,
rarely seek mainstream medical care, and have higher rates of mortality
than the general population.
Jehovah's Witnesses refuse blood transfusions due to their beliefs that the
body cannot be sustained by another's blood and accepting a transfusion
will bar the recipient from eternal salvation.
Controversy has erupted when a child of a Jehovah's Witness is in need
of a blood transfusion and the parents wish to withhold a possible
lifesaving therapy.
The U.S. Supreme Court has generally sided against parents'
withholding medical therapies for religious reasons. The hospital's
ethics committee should be consulted immediately to assist in this
complex decision.
Members of the Faith Assembly of Indiana have a negative view of
modern health care and have an especially high rate of infant mortality
due to limited prenatal care. While these are only specific denominational
examples of the negative impact of religion on health, there are also
generalized manifestations of religion's negative effects.
Religion may lead to depression or anxiety over not meeting group
expectations, and certain spiritual practices or participation in
complementary and alternative medical practices may delay needed
medical care
If a nurse is presented with a situation in which religious or spiritual views
have the potential to compromise adequate nursing care, the situation should
be presented to a supervising staff member immediately.
For complex cases, the situation may also be presented to the ethics
committee of the institution or organization to assure that appropriate
measures are followed. Refer to the institutional or organizational handbook
for specific instructions regarding individual cases.
Incorporating Religion &
Spirituality into Care
MAJOR WORLD RELIGIONS & COMMON HEALTH BELIEFS
BUDDHISM
HINDUISM
ISLAM
CHRISTIANITY
JUDAISM
Why do we complete an
Spiritual Assessment?
Spiritual care cannot be provided without a spiritual assessment.
According to Culliford, there are a few benefits of spiritual care to the
client which includes:
Support for healthy grieving
Support for improved self-esteem and confidence
Assistance with maximation of potential in current circumstances
Support to improve relationship with self, others, and with an
Absolute/God
Assistance in renewing a sense of meaning and hope
Enhancement of the client’s sense of belonging
Assistance in improving problem solving
Help in finding renewed hope
Spiritual Assessment
Techniques
NON-FORMAL
The FICA Spiritual History Tool
uses an acronym to guide health
professionals through a series of
questions designed to elicit patient
spirituality and its potential effect
on health care.
Starting with queries about faith
and belief, it proceeds to ask about
their importance to the patient, the
patient’s community of faith, and
how the patient wishes the
physician to address spirituality in
his or her care.
The Hope Spiritual Assessment
Tool is a questionnaire designed to
assess an individual’s spiritual needs,
strengths, and resources to provide
holistic care in healthcare settings.
The questionnaire includes questions
about religious beliefs, practices, and
coping mechanisms.
The Open Invite, is a patient-focused
approach to encouraging a spiritual
dialogue. It is structured to allow patients
who are spiritual to speak further, and to
allow those who are not to easily opt out.
First, it reminds healthcare professionals
that their role is to open the door to
conversation and invite (never require)
patients to discuss their needs.
Preaching or prescribing spiritual practices
generally is beyond the proper bounds of
the nurse-patient relationship. Second,
Open Invite provides a mnemonic for the
general types of questions a physician may
use The tool provides questions that allow
the physician to broach the topic of
spirituality.
EXAMPLE
Using the FICA model, let's perform a spiritual assessment on two patients:
1. Ms. Garcia is a twenty-five-year-old female admitted to the hospital with new onset
diabetes. She is crying and has been refusing finger stick blood sugars and lab work.
2. Mr. Brown, is a sixty-nine-year-old male, recently diagnosed with liver cancer. He is
withdrawn and quiet, answering questions with a yes or no. There are no literature, religious
icons or symbols in either patient's room to cue the nurse regarding their beliefs.
EXAMPLE
F-Faith or beliefs: What are your spiritual beliefs? "I don't really have any spiritual beliefs or
religion, but I like to go to the woods and sit quietly, listening to nature. Sometimes I take a
meditation book and think about the words and sayings."
I-Implications or Influence: Does reading your meditation book and sitting quietly in the
woods provide strength and support for you during times of stress? "Yes. I am able to cope
with my stressful job. When I was urinating too much and feeling sluggish and nauseated, I
even prayed for my health. Now I don't think I could sit quietly. I am too upset."
C-Community: Is there a group or person whom you have met with, meditated with or you
think of providing spiritual support and/or guidance? "Yes, my friend is definitely a support to
me. Even though I have never considered it spiritual, he comes over, and we talk, share
meditation books and even go on walks to vent."
A-Address: As your nurse, is there something I can do to provide spiritual support for you? "You
have already helped me. I realized by talking with you that I need to call my friend and talk
with him about what is going on. He can bring my meditation book."
EXAMPLE
Using the FICA spiritual assessment, we discovered that:
Ms. Garcia says she is not spiritual, yet she practices spirituality in her life. We see
that she has spiritual support through her friend and through meditation books.
Ms. Garcia's assessment reveals her spiritual needs, but also communicates that the
nurse is caring and open to discussing her issues. This begins a rapport between the
nurse and the patient, laying the foundation for further spiritual discussions and
caring nursing interventions.
Later the nurse can check with Ms. Garcia and see how she is doing, continuing to
assess and develop a relationship with her.
Eventually the nurse might ask permission to talk further about spiritual beliefs and
offer to pray with Ms. Garcia.
EXAMPLE
F-Faith or beliefs: Do you have any spiritual or faith beliefs? "I'm Buddhist."
I-Implications/Influence: Are there spiritual items or practices that give you spiritual
support?" “Yes, meditation and prayer. It is important for me to keep my mind calm and
clear of disturbing thoughts, so I can focus on healing and strength. I usually have my CD
player for music and chants. I also have some sacred teachings of Buddha that inspire and
strengthen me. But I forgot them at home."
C-Community: How about people or a group-is there someone that provides spiritual
support?
"I usually attend the temple and meet with other Buddhists."
A-Address: Is there something I or someone else can assist you with? "I would like some quiet
time. My wife is bringing my CD player and some meditation books. This will help me to be
calm and gain strength for my healing."
EXAMPLE
Using the FICA spiritual assessment, we discovered that:
Mr. Brown has a specific spiritual belief, which is Buddhist.
The assessment explained that his previous quietness was possibly related to his
spiritual practices. He mentioned an important component of his spiritual life was to
have quiet time. As his nurse, I would schedule uninterrupted quiet times for him to
meditate and listen to his CDs.
Another intervention for Mr. Brown would be a referral to the chaplain or spiritual
care coordinator to visit with him. A referral to these professionals within the health
care system can be appropriate, especially when the nurse may be unfamiliar with
specific spiritual needs of the patient.
A referral can also be made for any patient needing to connect with a faith
organization in the community such as a temple, synagogue or church.
FORMAL
The Daily Spiritual Experience Scale
(DSES) is a 16-item self-report measure
designed to assess ordinary experiences of
connection with the transcendent in daily
life. It includes constructs such as awe,
gratitude, mercy, sense of connection with
the transcendent and compassionate love.
It also includes measures of awareness of
discernment/inspiration and a sense of
deep inner peace.
Originally developed for use in health
studies, it has been increasingly used more
widely in the social sciences, for program
evaluation, and for examining changes in
spiritual experiences over time. Also it has
been used in counseling, addiction
treatment settings, and religious
organizations.
The Brief RCOPE is a 14-item measure of
religious coping with major life stressors. As
the most commonly used measure of
religious coping in the literature, it has
helped contribute to the growth of
knowledge about the roles religion serves
in the process of dealing with crisis,
trauma, and transition.
Assessment
Procedures &
Findings
Explore the client’s
religious and spiritual
background.
Listen to client’s story and seek clarification where needed.
Observe nonverbal and verbal communication patterns in the presence of
others.
Support the client to develop trust.
NORMAL FINDINGS:
Client makes reference to involvement in religious groups and/or spiritual practices that have
provided comfort and social support; describes belief that prayer reduces stress and heals disease.
Eye contact is maintained (appropriate to cultural groups) with nonverbal cues correlating with the
conversation.
ABNORMAL FINDINGS:
Reports lost connections to religious groups, while continuing to focus on negative aspect of
spirituality; comments and body language reveal a lack of hope with symptoms of depression;
deficiencies in the social network are identified an appear to affect the client’s well-being and
attitude towards recovery
Clients displays poor eye contact; the presence of others strongly influences information the client
shares.
Begin to focus questions.
Use the spiritual assessment tools if needed.
Begin the conversation with general dialogue about global concepts such as
hope, comfrot, strength, peace, love, connection.
Continue to assess other dimensions of spirituality within groups; ask about
organizational or formal religious involvement.
NORMAL FINDINGS:
Reports spirituality giving a sense of peace that transcends illness or disease; meditation or exercise
facilitate a sense of peace; family mentioned as source of strength.
Client may report regular attendance at a local church, mosque, or other religious meeting place and
highlights importance of attendance as a recovery period; attendance may also serve as giving meaning
or purpose in life.
Client relates full spport for beliefs and practices from family and religious leaders; relates no
differences with community.
ABNORMAL FINDINGS:
Describes no connection to others such as God, nature, family or peers; shares pessimistic and
fatalistic attitude towards recovery; identifies limited coping mechanisms with little to no desires
to adapt a new one.
Involvement in religious groups in the area but unable to provide details regarding the affiliation.
Client describes disagreement among family, religious or community members regarding choice of
spirituality based health care decisions.
Ask transition questions
fro m organizations to
personal beliefs.
Directly address beliefs that may conflict with or affect one’s care
If the client is dying: ask to how his/her beliefs affect the kind of nursing care
they would like to be provided over the next few days, weeks or months
NORMAL FINDINGS:
Reports personal beliefs that coincides with denominational beliefs; reports relationship with God as
healthy and positive; there is a desire in having time in the hospital to meditate and read scriptures to
gain focus and relieve stress.
Client views present diagnosis as “part of God’s will for their life” or there is a desire to continue mature
walks and other spiritual practices to develop closer relationship with God; there is a desire to have a
clergy from her local church for visitation time.
ABNORMAL FINDINGS:
Reporting very limited similarities between denomination and personal beliefs; past utilization of prayer
and listening to religious music, but no current avenue for fostering sense of spirituality
Client appears traumatized with diagnosis; views illness as a fault of their pas lifestyle or a punishment
from God; refuses visits from local clergy and hospital chaplains; declines conversation and just want to
be sent home to die.
Selected Nursing
Diagnoses
NURSING DIAGNOSES
ANY
QUESTIONS?
thank you!
ACOB, AUDREY ANN G. BSN 4 (BSN 1D)
HEALTH ASSESSMENT
