Spiritual care in chronic illness

CHRONIC ILLNESS
• A medical condition or health
problem that requires long
term management.
• Results to permanent changes
• Requires special client
education for rehabilitation
• Requires long term care and
support
 CHRONIC ILLNESS
• s/s are wide range with periods of exacerbations
and remissions
• Fulfillment of previous roles and responsibilities
become impossible and significant reorganization
of an individual’s pattern of behavior is required.
• Significantly affects social relationship, future life
plan, self concept, self esteem.
• Family is significantly disrupted in this situation.
• Spiritual wellbeing is central
to coping with physical and
psychological sequelae of
chronic illness.
• Emotional sequelae of chronic
illness:
1. Low self esteem
2. Feelings of isolation
3. Powerlessness
4. Hopelessness
5. anger
 Spiritual needs in chronic illness
• Spirituality is a resource that promote quality of
life
• Spiritual needs can be manifested in many ways:
Monotheism : spiritual needs are associated with
one’s relationship with God.
• God is a source of meaning and purpose and love,
relatedness and forgiveness.
Agnostics/atheists: the absence of belief results to
spiritual need.
• Manifestation of spiritual needs include : the need for hope,
creativity, assurance and self esteem
Spiritual needs of clients with chronic
illness
 HOPE
 Anticipation that something desired will occur
 A patient that losses hope losses will to live and
death may result.
 Supporting hope is vital part of the nursing care
plan.
• TRUST:
– Having confidence on
something or someone.
– Trusting gives a sense of
security that God’s healing
power will be operative in
their life.
• Healing may be spiritual or
emotional in nature rather than
physical healing
• COURAGE
– Ability to transcend one’s fears. Choose
to actively face what needs to be
• FAITH
– Belief or trust in someone or something
– A basis for our personal relationship with
God on whose strength and absolute
sureness w can literally stake our life.
– A critical element in surviving a loss and a
prerequisite for spiritual growth.
• PEACE
– Sense of being undisturbed, feeling
from freedom and anxiety
– The right fellowship with God which
entails forgiveness, reconciliation
and union.
• LOVE
– To care for or treasure someone or
something
– God’s unconditional love during a
crisis such as illness.
 SPIRITUAL NEEDS OF CANCER
PATIENTS
• Cancer – uncontrollable growth of mutated
cells,
• Religion or belief is a source of strength and
comfort in coping with illness.
• There is an association of spiritual wellbeing
and the level of anxiety.
• Patients with breast cancer who internalized
their religious beliefs demonstrated spiritual
wellbeing.
 Spiritual need of the HIV patient
• Some HIV positive clients become alienated
from their churches and may not be receiving
formal religious ministry because of stigma of
the disease.
Spiritual needs of the patient with CRF
• Coping with the altered quality of life imposed
by the disease and patients regimen.
• Reports moderate to severe symptoms of
fatigue and general malaise that periodically
interfered with social and professional work
activities.
 Spiritual needs of a mentally
challenged client
• Mental situations such as anxiety, depression,
to frank psychosis.
• MENTAL HEALTH
– A state of dynamic equilibrium characterized by
hope, joy and peace in which positive self regard
is developed through love, relationship,
forgiveness, meaning and purpose resulting from
vital relationship with God and responsible
interdependence with others.
 Spiritual needs of a mentally
challenged client
• Spiritual needs can be with individual’s altered
thought process.
• The manifestation of the spiritual concerns are
manifested in the client’s pathology.
– Clients distort things that intensely meaningful to
them
• Many patients in the psychiatric unit have
spiritual needs that when addressed help unearth
important issues and strengthen therapeutic
relationship.
• Caring as a key dimension of psychiatric
mental health nurses role:
– Sensitivity to the values, belief and practices of an
individual which is the first step towards nursing
competence in the provision of spiritual care for
the patient with mental health deficit
 Spiritual intervention for psychiatric
patient
• Being with
• Doing for
• Employing personal and environmental;
resources to care for the patient.
– Encouraging patient to look inward for strenght
and look outward for people and objects that
could be resources to help.
 THE COGNITIVELY IMPAIRED
CLIENT
• Have some degree of mental
retardation
• senile dementia
• Confusion still exist about spiritual
and religious capabilities of persons
with cognitive disabilities
• Faith is not an intellectual exercise
but a relational understanding
• Relationship with God is a mystery
beyond understanding.
 SPIRITUAL NEED OF PHYSICAL
DISABILITY AND REHAB
• Person with disability:
– Those that require special attention such as
infants and children or the very old.
– Also includes person that are incapacitated due to
illness or accident
– Those who are to some degree permanently
impaired, whose capacity of mind and body are
diminished
• Rehabilitation:
– To bring to the person as much pre-illness
functioning and Independence as possible.
• SPIRITUAL CARE is an appropriate dimension
of rehab nursing since it is concerned with the
promotion of client’s wholeness
 SPIRITUAL NEEDS OF CLIENTS ON THE
COMMUNITY
• COMMUNITY HEALTH NURSING:
– A synthesis of nursing practice and public health
practice applied to promoting and preserving the
health of populations.
– The responsibility of the CHN is to the community as a
whole.
• Does the client’s formal religious tradition or denomination
provide a good structure for spiritual care?
• Does the way the client speaks or does not speak reveal
spiritual needs?
• Does the client’s religious contact seem to provide strength
and comfort?
• Home health care is a component of
comprehensive health care where services are
provided to individuals and families to their place
of residence for the purpose of promoting,
maintaining or restoring health or minimizing the
effects of illness and disability.
• Assisting with dealing with illness in the home
• Spiritual assessment and if appropriate provision
of spiritual care are important activities in home
health care.
– Primarily, the nurse is a client advocate
 THE HOMELESS CLIENT
• Homelessness – absence of fixed regular night
time residence. Lacks shelter, food clothing and
healthcare.
• Feelings of despair or hopelessness
• Unemployment
• Family instability
• Lowered self-esteem
• Self concept
• poverty
• Need to be sensitive to the many
material and sociocultural needs of
the client as well as being non-
judgmental in their attitude.
• Providing spiritual care for the
homeless include:
Moving beyond the basic need for food
and shelter
Unconditional acceptance
Speaking in a caring manner
Providing with small devotional
materials supportive of spiritual
practices to be carried privately
Planning religious services that are
supportive and not condemning
Praying with the person if acceptable.
Clergy counselling
 SPIRITUAL CARE
• Assisting the patient in the
presence of life circumstances as
a basis of future growth and
accomplishment.
• Maximizing the client’s wellness
and assisting to move out of the
sick role.
• Supporting the client’s present
talents and abilities
• Teaching the client to conserve
energy and to avoid focusing on
deficits to promote activities to
enhance self esteem
 The role of the nurse in spiritual care
of the client with chronic illness
o To exhibit sensitivity to diverse cultural and
religious tradition
o Assessment to determine religious belief, practices
and spiritual support
o The recognition of the uniqueness of the
individualized spiritual experiences of the patient.
o Help patient to return to former spiritual and
religious practices
o Set aside time to discuss spiritual care.
oRead meditation poetry
oPlay spiritual music
Addressing spiritual assessment of the
home healthcare patient:
1. Determine how one’s belief or lack of belief
in a supreme being relates to illness.
2. Determine Specific people who provide
spiritual support, religious symbols of
importance,
3. Determination of religious restrictions,
requirement for church attendance and
religious leaders
• The four qualities a nurse
should possess to develop a
caring relationship:
1. Receptivity – open and
responsive to ideas and
suggestions
2. Humanity – tenderness,
compassion and sympathy
3. Competency-ability
4. Positivity –optimistic and
constructive, accepting and
affirming
• Spiritual care behavior
of the nurse :
1. Praying with the patient
2. Supporting the patients family
3. Facilitating the use of religion
• Prayer materials
• Religious music
• Recommending a spiritual counselor
• Linking stories. Biblical references may
help the person find meaning and
ability to transcend the chronic illness
4. Being with, listening to patient’s
stories which are spiritually
significant.
5. Touching, empathy and compassion
6. Supporting and non judgmental
attitude
• Non-religious
interventions:
The need to
belong
To feel attached
to a person or a
group
To reach out
beyond oneself
To have a
meaningful life
To be creative.
Spiritual needs of the child and
family
• Child includes persons after infancy to the onset
of adolescent (1-12 years old)
• FOWLER’S STAGES OF FAITH
• 1. Stage 0: Primal or undifferentiated (0-2years)
– Nurturing environment can support infant in
developing trust.
• 2. Stage 1: inductive- projective faith (3-7 years)
– Religion is earned through narrative images
 FOWLERS STAGES OF FAITH
3. Stage 2: Mythical literal faith (school age)
– strong belief in justice and reciprocity
– Metaphors and symbolic messages are taken literally.
4. Stage 3: Synthetic conventional faith (adolescence)
– Conformity to religious authority/development of personal
identity
– Conflict with one’s belief are generally overlooked.
5. Stage 4: Individuative reflective faith(mid twenties to late
thirties)
– takes responsibilities for and reflects on own beliefs
6. Stage 5: conjunctive faith (Mid life)
– Resolves conflicts from previous understanding of truth
7.Stage 6: Universalizing faith or enlightenment (most never
reach this stage)
– Believes that everyone should be treated wwith universal
principles of love and justice.
• CHILDREN live in their spirit more than adults
since they are uninhibited. The child has the
capacity to search for meaning in life a sense
of relationship to self, others and God.
• Spirituality is the deepest core of the child’s
being.
Burkhardt
• SICK CHILD
• The child do not make distinction
between spirituality and religion
• Children draw on previous experiences
to cope with crisis
• Prayer and religious devotion can
provide a source of comfort and
stability
• Presence of devotional articles can
provide a sense of security and
stability
• Pre-schoolers – school age
– Bedtime bible stories, reading
religious stories
– During illness encourage
children to participate in rituals
to help maintain normalcy in the
child’s life.
– Spiritual symbols help the child
to cope with frightening nature
of illness experiences
• Adolescent
– Experience anxiety for not
being able to attend
spiritual activities
– May cherish privacy can
engage in individual
worship
– May request for church
associated ritual
 Assessment of the child’s spiritual
needs
A. Observe the child’s unusual behavior such as
nightmare:
B. Ask (Van Heukelem spiritual assessment
questions):
1. How a child behaves when frightened.
2. Who provides support in times of trouble
3. What is the child’s understanding of God and prayer
4. Is there family support
5. What are the family’s spiritual strengths.
 Spiritual care for a child
• Help the child and family achieve their
optimum health potential
• Be direct and frank in talking about spirituality
to a child.
– They potentially have same faith needs a adults.
– They need to view God as one who will care for
them and support them.
 Spiritual needs of a sick child
1. Loneliness related to isolation from peers
2. Anxiety about future goals
3. Anger to God “Why me?”, frustrations
4. Separation from family
5. Fear of pain, physical injury or the unknown
6. Guilt and inadequacy felt by the sick child
7. Family: crisis situation in the family.
– Sibling relationship is affected because parental
attention is on the sick child. Jealosy and emotional
distress can happen on the well children
 Spiritual care
• Therapeutic play : child’s perception of
spirituality
• Bibliotherapy – story telling and journaling to
help explore the meaning of life,
• Devotional materials
General suggestions in caring for a sick
child:
1. Be flexible in one’s approach
2. Be sensitive to non-verbal communication
3. Respect child’s desire for privacy
4. Be literal in questions about illness and death
5. Do not neglect spiritual need of the family
6. Encourage the family to continue to function
as family
7. Non-judgmental caring support
 SPIRITUAL NEED OF THE FAMILY
• The family’s presence is a resource in spiritual
support.
• Prayer and belief in God is the most important
coping strategy for the family in dealing with
illness.
 Need of the family in illness of the
member
1. Desire for competent care
2. Pain management
3. Compassion
4. Extended family support
5. Assistance to face reality of the situation. Provide information
about the changes in te patient condition and honest answers to
questions.
6. Encourage family to verbalize anxiety
7. Suggest some coping strategies
8. Spiritual support from religious counselling.
 The most important source of hope are family, friends and religion.
(especially in chronic disease)
9.
• HOMELESS FAMILY:
• Spiritual needs of a homeless family
1. Empowerment to develop self esteem
2. Empathy and respect

• The behavior of the nurse:

– Welcoming accepting, respectful
– Supportive, nonjudgmental attitude
 Nursing competencies for providing
spiritual care:
1. Awareness of the use of self
a. Handles own feelings and beliefs professionally with patients of
different values and religions
b. Addresses the topic of spirituality with patients from different
culture in a caring manner.
2. Spiritual dimension of nursing
a. Collect information related to patient’s spirituality and identifies the
need.
b. Discuss with team members how spiritual care will be provided,
planned and reported.
c. Encourage a multidisciplinary effort to meet spiritual needs.
3. Dimension of assurance of quality and expertise.
a. Contributes to quality assurance and
b. improvement of spiritual care with in the organization.