SPIRITUALITY

BACKGROUND
• Nurses provide holistic care
• Diverse spiritual beliefs and practices that
their clients may possess
• Spiritual beliefs and practices are coping
resources for person  how such beliefs
and practices help or hinder a client’s
health is VITAL !!!
 Spirituality Described
• Refers to that part of being human that seeks
meaningfulness through intra-, inter-, and transpersonal
connection
• Aspects :
- Meaning (having purpose, making sense of life)
- Value (belief, standards)
- Transcendence (dimension that is beyond the self)
- Connecting (other, nature, Ultimate Other)
 Spiritual Needs
• Nurses to be sensitive to indications of the spiritual need
and respond appropriately
• “Why me ????”  challenging questions
• Spiritual needs :
- related to the self
- related to others
- related to the Ultimate Others
- needs among and within groups
 Spiritual Well being
• Manifested by a feeling of being ‘generally alive,
purposeful, and fulfilled’
• Connectedness with self, other, higher power, all life,
nature and the universe that transcends and empowers
the self
• People enhance their spirituality in many ways (focus
on inner or outer)
 Spiritual Distress
• A challenge to the spiritual well being or the
belief system that provides strength, hope,
and meaning to life
• Factors that may be associated : physiologic
problem, treatment, situational
 Spiritual Development
DEVELOPMENTAL STAGE CHARACTERISTIC
0-3 years Fundamental spiritual qualities of trust, mutuality, hope, love
3-7 years Imitative phase, can be influenced by examples, actions,
stories and image
7-12 years Demanding proofs or demonstrations of reality. Ability to
learn the beliefs and practices of the religion
Adolescence Examine beliefs objectively. Conform to the beliefs of those
around them
Young adulthood Development of self identity. Forms independent
commitment, lifestyle, beliefs, and attitudes
Mild adulthood Remain open to others’ truths
Mild to late adulthood Live with sense of participation in a nonexclusive community.
May work to resolve social, political, economics, or
ideological problems in society
 Guidelines to Ethical Conduct
• Seek a basic understanding of clients’ spiritual needs,
resources
• Follow the client’s expresses wishes regarding spiritual
care
• DO NOT prescribe clients to adopt certain spiritual
beliefs or practices
• Understand personal spirituality and how it influences
caregiving
• Provide spiritual care in a way that is consonant with
personal beliefs
 Spiritual Practices
Affecting Nursing Care
• Holy days
• Sacred writings
• Sacred symbols
• Prayer and meditation
• Beliefs affecting diet and nutrition
• Beliefs related to healing
• Beliefs related to dress
• Beliefs related to birth
• Beliefs related to death
NURSING MANAGEMENT
 Assessing
• Initial spiritual assessment is best taken at the end
of the assessment process (or following
psychosocial assessment) AFTER the nurse has
developed a relationship with the client or support
person
• Two-tiered approach to spiritual assessment :
1. What spiritual beliefs or practices are important to you
now while you live with illness?
2. How would you like your health care team to support your
spiritually?
 Assessing
• Cues to spiritual and religious preferences,
concern or distress :
1. Environment
2. Behavior
3. Verbalization
4. Affect and attitude
5. Interpersonal relationship
 NNN linkages
NANDA NOC NIC
Spiritual Acceptance: health status Active listening
Dignified life closure Forgiveness facilitation
Distress (00066) Grief resolution Grief work facilitation
Impaired ability to Hope Hope inspiration
experience and Spiritual health Humor
integrate meaning Suffering severity Music therapy
and purpose in life Presence
through Referral
connectedness with Reminiscence therapy
self, other, art, Self awareness enhancement
music, literature, Simple guided imager
nature, and/or Simple massage
power greater than Simple relaxation therapy
oneself Spiritual support
Therapeutic touch
Touch
 NNN linkages
NANDA NOC NIC
Risk for Acceptance: health status Active listening
Dignified life closure Forgiveness facilitation
Spiritual Health beliefs Grief work facilitation
Distress (00067) Grief resolution Hope inspiration
At risk for an Hope Humor
impaired ability to Quality of life Music therapy
experience and Spiritual health Presence
integrate meaning Suffering severity Referral
and purpose in life Reminiscence therapy
through Self awareness enhancement
connectedness with Simple guided imager
self, other, art, Simple massage
music, literature, Simple relaxation therapy
nature, and/or Spiritual support
power greater than Therapeutic touch
oneself Touch
 NNN linkages
NANDA NOC NIC
Impaired Client satisfaction : Cultural Abuse protection support :
needs fulfillment religious cultural brokerage
religiosity (00169) Religious addiction prevention
Impaired ability to Religious ritual enhancement
exercise reliance on
religious beliefs and/
or participate in
rituals of a particular
faith tradition
 NNN linkages
NANDA NOC NIC
Readiness for Client satisfaction : Cultural Cultural brokerage
needs fulfillment Religious ritual enhancement
enhanced Spiritual health Spiritual growth facilitation
religiosity (00171)
Impaired ability to
exercise reliance on
religious beliefs and/
or participate in
rituals of a particular
faith tradition
 NNN linkages

NANDA NOC NIC

Risk for impaired Client satisfaction : Cultural Abuse protection : religious
religiosity (00170) needs fulfillment Cultural brokerage
At risk for an Spiritual health Religious addiction prevention
impaired ability to Religious ritual enhancement
exercise reliance on
religious beliefs and/
or participate in
rituals of a particular
faith tradition
 Implementing
Most common :
- Providing presence
- Supporting religious practices
- Assisting client with prayer (private or group)
- Referring client for spiritual counseling
 Providing presence
• Presencing : being present, being there, or just being with
client  one of competencies by expert nurse
• Often the best and sometimes the only intervention to
support a client who suffers under circumstance that medical
intervention cannot address
• 4 ways being present for clients :
1. Presence (physically present but not focused on client)
2. Partial presence (physically present, attending to some task on the client’s
behalf but not relating to client, the most superficial level)
3. Full presence (mentally, emotionally, and physically present, intentionally
focusing on the client)
4. Transcendent presence (physically, mentally, emotionally, and spiritually
present for client, involves a transpersonal and transforming experience)
 Supporting religious practices
• Create s trusting relationship with the client
• Ask how nurses can assist in having these needs met
• Do not discuss personal spiritual beliefs unless the client
requests it
• Inform client and family about spiritual support available
(mosque, chapel, meditation room, etc)
• Make arrangements with dietitian so that dietary needs can be
met. If can not, ask family to bring
• Ask another nurse to assist you if a particular religious practice
makes you uncomfortable
• All spiritual interventions must be done within agency
guidelines
 Assisting Client with Prayer
• Prayer  has many health benefit and healing
properties (Dossey, 1996)
• Before praying assess what they would like for you
to pray
• Personalize the prayer
• Follow a prayer with non verbal communication
• Praying with a client may not involve verbalization
• Facilitate the clients’ prayer practice (room, time,
articles, etc.)
Referring Clients for Spiritual Counseling

• Referral may be necessary when the nurse

makes a diagnosis of spiritual distress
• Nurse and religious counselor can work
together to meet the client’s need
• One situation the nurse may encounter : client
refusal of necessary medical intervention
because of religious tenets  discuss the
conflict !
 Happy
International Nurses Day…