SPIRITUALITAS, KEPERCAYAAN, AGAMA,

DAN IMPLIKASINYA BAGI KEPERAWATAN

DEFINITIONS
Spirituality: 'spirare' (Latin) = 'to breathe life',
expressing one's values and beliefs about self,
humanity, life and God.
Literature  spirituality  religion, spirituality 
religion
Spirituality: the unifying force of person;the
essence of being that permeates all of life and is
manifested in one’s being, knowing, and doing;
the interconnectedness with self, others, nature,
and God/life (Dossey & Guzzetta, 2000)
DEFINITIONS (Cont.)
Spirituality: a belief in or relationship with some
higher power, creative force,divine being, or
infinite source of energy (God, Allah, a higher
power)
Faith: a universal; a feature of living, acting, and
self understanding
Religion: a belief system and practices of
worship related to that system.
 SPIRITUAL DEVELOPMENT

Undifferentiated Faith (Infancy-Toddler)

The seeds of trust, courage, hope, and love are
joined to combat such issues as possible
“inconsistency and abandonment in the infant’s
environment”
Intuitive-Projective Faith (3-6 years)
“Fantasy-filled” period, a young child is
strongly influenced by examples, moods,
actions and stories of visible faith primarily
related adults
 SPIRITUAL DEVELOPMENT (Cont.)

Mythic-Literal Faith (7-12 years)

The time when the child begins to internalize
“stories, beliefs, and observances that
symbolize belonging to his or her own faith
community”
Synthetic-Conventional Faith (13-20 years)
Adolescent’s experiences outside the family
unit (school, peers, media, religion). Faith
provide a “basis for identity and outlook”
Individuative- Reflective Faith (21- 30 years)
A young adult begins to claim a faith identity no
longer defined by “the composite of one’s roles or
meanings to others”.  time of personal creativity,
individualism, and autonomy
Conjunctive Faith (31- 40 years)
A time of opening to the voices of one’s deeper self,
and the development of one’ social conscience 
more mature spirituality especially finding meaning
of his/her illness
Universalizing Faith (> 40 years)
Culmination of the work of all of the previous faith
stages, a time of relating to the “imperative of
absolute love and justice” toward all humankind
SPIRITUAL NEEDS
 A person’s need to maintain,
increase, or restore beliefs and
faith and to fulfill religious
obligations
 Certain spiritual needs underlie
all religion;
(1) need for meaning and purpose
(2) need for love and relatedness
(3) need for forgiveness
SPIRITUAL, RELIGION AND ILLNESS
Spiritual and religious beliefs are important in many
people’s lives  influence life-style, attitudes, and feeling
about illness and death
Spiritual beliefs may assume greater importance at time
of illness than at any other time in a person’s life
Some people may look illness as a test of faith, or
punishment for past sins
Spiritual beliefs help people to accept illness and to plan
for the future, religion help people prepare for death and
strengthen them during life
Certain spiritual beliefs are in conflict with accepted
medical practice
THEORETICAL FOUNDATIONS
FOR SPIRITUAL CARE
 Whole person care as the essence
of nursing care
 Spiritual component of Nursing
 Supportive theories in other
disciplines (e.g., Lazarus stress
and coping framework  spiritual
beliefs and religious practices can
be viewed as coping strategies)
RELIGIOUS BELIEFS RELATED TO HEALTH
CARE

Agnosticism and Atheism

 Agnostic : a person who doubts the
existence of God or a supreme being
 Atheist: denies the existence of God
 Monotheism: belief in the existence of one
God
RELIGIOUS BELIEFS RELATED TO HEALTH CARE (Cont.)
Islam
 Islam for Muslim is not only a religion but a complete
way of life that advocate peace, mercy and forgiveness
 Beliefs; all Muslims have to fulfill five essential
religious duties (To declare that there is no other god
but Allah, and that the Prophet Mohammed is his
messenger, To offer prayers five times a day; during
illness, prayers can be performed sitting up or lying
down, providing that the chair or bed is facing Mecca,
To fast in the month of Ramadan, To give money to
charity, To go on a pilgrimage to Mecca (Hajj) at least
once in a lifetime if they can afford it
 The Holy Qur’an; the sacred book of Islam, the essential
guide for all aspects of a Muslim’s life
 Gender and modesty; Muslims prefer to be cared for by
someone of the same sex, however, men are not seen as
superior to women
 Cleanliness; the Islamic faith emphasizes cleanliness
(cloth, house, environment) before any type of worship
(Ghusal or Wudlu/ablution), Muslim prefer to wash their
genitals with running water after using the toilet (Istinja)
 Family and marriage; family as the building block of
society, marriage is sacred and the foundation of Islamic
society, providing stability and security, Men are seen as
the protectors of women, and important decision in giving
consent for treatment. The patient’s immediate and
extended family structure, even the community elders,
should be considered where there are important treatment
issues
 Homosexuality; is condemned, considered sinful
and punishable by Allah
 Children; as a gift from Allah, listening adzan to the
ears of newborn baby, tahnic, aqiqah
 Contraception; Muslim couple are encouraged to
have children, sex outside marriage is discouraged,
however contraception and family planning are
allowed, health care professionals should discuss
appropriate methods with either the woman or the
couple
 Abortion; is not permitted, except if the pregnancy
threatens the mother’s life
 Circumcision; baby boys are circumcised as it
enables them to maintain Wudlu by preventing urine
for collecting in the foreskin
 Diet; Muslim eat with their right hand and consider it
rude to be handed anything in the left hand, eat only
permissible and good food (halal & thayib), non-
permissible (haram) food include pork, non-halal
meat, alcoholic drinks, gelatin products, and illegal
drugs
 Organ donation and blood transfusion; acceptable
 End of life issues, suicide and euthanasia; human
life is regarded as precious and taking a life is
considered a major sin
 Life support; a person certified as brain-stem dead
should not be kept alive artificially, resuscitation is
allowed, but in some cases the will of Allah should be
allowed to prevail
 Death/rituals; believe in life after death, the Day of
judgment. Sickness and suffering in this life are seen as
a form of purification or recompense for wrong deeds.
Terminally ill patients should be treated with sympathy
and compassion and their spiritual need should be
accommodated. When dying, privacy is appreciated
while declare their faith (Talkin), or recitation the Qur’an.
Died person; close the eyes and mouth, straighten the
body and limbs, a complete Ghusal performed by family
or the same sex, covered with a plain sheet, prayer,
some Muslim may request that non-muslim do not touch
the body (or use disposable gloves), buried
Roman Catholicism
 Belief that an infant has soul from the
moment of conception  baptized
 Encouraged anointing of the sick
(sacrament of the sick) as a source of
strength or healing and preparation for
death
 Donor transplant, biopsies, amputations,
autopsy  accepted
 Strict laws govern birth control,
sterilization, and abortion, both demand and
therapeutic abortion are prohibited, even to
save the mother’s life
 Some Catholics observe certain dietary and
fasting (abstain from animal dairy products)
practices but are excused from otherwise
obligatory fasting or abstaining from meat on
Ash Wednesday and Good Friday
 Sunday is the day of worship
 Oppose euthanasia, however they do not
support the excessive use technology to
prolong life
 Belief in life after death, cremation is not
condemned, but rare, the body is buried
complete to await resurrection
Seventh-Day Adventist (Church of God, Advent Christian
Church)
 Conduct baptism of adults by immersion
 Diet; prohibits alcohol, tobacco, tea, coffee, and the use
of illegal drugs, some members advocate
ovolactovegetarian diets
 Some sects practice divine healing and anointing with oil
 Saturday  Sabbath by some
 Avoid drugs, but blood transfusion, vaccines, and drugs
are sometimes necessary
 Birth control and sterilization are left to individual
conscience
 Abortion is approved if the mother’s life is endangered or
if pregnancy is due to rape or incest
 The use of hypnotism is opposed
Salvation Army
 No restitutions on medical procedures,
including transplants and autopsies
 Birth control and and sterilization are
acceptable within marriage
 Demand abortions are opposed, but
therapeutic ones are approved
 Has many hospitals and social centers
for people
Lutheran
 No restitutions on medical procedures,
including autopsies and therapeutic
abortions
 No dietary restrictions
 Birth control and sterilization are left to
individual conscience
 Members are baptized 6 to 8 weeks after
birth, those who wish may be anointed
and blessed before death  buried
Pentecostal (Assemblies of God)
 No doctrine against modern medical
science
 Members are encouraged to abstain
from use of alcohol, tobacco, and illegal
drugs, some members don’t eat pork
 Pray for divine healing, and anointing
with oil in some congregations
Hinduism
 Beliefbegins with the assumption that all
living things have a soul, which passes
through successive cycles of birth and rebirth
 Belief
in karma laws, reincarnation, and
transmigration of the soul, that avoid killing
even the smallest insect
 Personis viewed as a combination of mind,
soul and body in the context of family, culture,
and environment
 Thesociety is divided according to a caste
system (social divisions) including Brahmins,
Kshatriaya, Vaisya, and Sudra
 Have many dietary variations according to the
particular sect (avoid beef and its derivatives,
vegetarians)
 Accept modern medical practices, artificial
insemination is rejected
 When giving medication, avoid touching the client’s
lips
 Death is considered rebirth  special rites, the priest
pours water into the mouth of the corpse and ties a
thread around the wrist or neck to indicate blessing,
dead body undergoes cremation, and the ashes are
disposed of in holy rivers
 Some injuries, such as loss of a limb are considered
signs of wrongdoing in a previous life
Buddhism
 Buddhism is a chameleon religion that exist in many
forms  central teaching of the Buddha amalgamated
with the cultures and people that embrace it
 Has no beliefs (a religion with no god), instead of
teachings to guide one through daily life, focus on
individual effort and commend reflective practice
 Aim of the Buddhist is to achieve Nirvana (state of
liberation, which is characterized by freedom from
suffering, death and rebirth)
 Commends mindfulness; being aware of the impact
and effect of one’s behavior
 Buddhist chant teaching, practice silent meditation,
chant meditative mantras, burn incense, light candles,
and try to sit in the lotus position
 No childbirth ritual, no concern about birth control, no
consent to abortion
 Diet, some prefer vegetarian, vegan (refuse food after
midday)
 Alcohol, psychotropic drugs, opiates, sedatives,
tranquilizers are likely to be resisted
 Blood donation, transplantation  be received
 Euthanasia is not countenanced
 Resuscitation is an acceptable procedure
 Dying Buddhist may request a monk or nun be present
to chant or assist in the passing from this life
 Cremation for the dead body
SPIRITUAL HELATH AND THE NURSING PROCESS
Assessing
 Spiritual health, or spiritual well-being is a feeling
of being”generally alive, purposeful, and fulfilled”
(Ellison,1983)
 Spiritual wellness is “a way of living, a lifestyle
that views and live life as purposeful and
pleasurable, that seek out life sustaining and life-
enriching options to be chosen freely at every
opportunity, and that sinks its roots deeply into
spiritual values and/or specific religious belief
(Pilch, 1988)
SPIRITUAL HELATH AND THE NURSING PROCESS
Spiritual well being (Ellison & Paloutzian, 1982):
Religious component;
 I believe that God loves me and care about me
 I have a personal and meaningful relationship with
God
 I believe God is concerned about my problem
 My relationship with God helps me not to feel
lonely
 I feel most fulfilled when I am in close
communication with God
 My relationship with God contributes to my sense
of well being
Meaning and purpose in life;
 I feel that life is a positive experience
 I feel very fulfilled and satisfied with life
 I feel a sense of well-being about the
direction my life is headed in
 I feel good about my future
 I believe there is some real purpose in
life
Nursing History
Stoll (1979)  four areas of spiritual history:
 The person's concept of God or deity
 The person’s source of hope and strength
 The significance of religious practices and
ritual to the person
 The relationship between the individual’s
spiritual beliefs and state of health
Spiritual assessment is best taken at the end of
the assessment process or following the
psychosocial assessment
Nursing History (continued)
Clinical assessment  spiritual distress, one or more of the following:
 Affect and attitude; Does the client appear lonely, depressed,
angry, anxious, agitated, apathetic?
 Behavior; pray before meals or other times, read religious
literature,need unusually high doses of sedation, pace the halls at
night, joke inappropriately
 Verbalization; Mention God, prayer, faith, the
mosque/church/temple, or religious topic, ask to be visited by
clergy, express fear of death, concern with meaning of life,inner
conflict about religious beliefs,concern relationship with the God,
meaning of existence, meaning of suffering, and moral/ethical
implications of therapy
 Interpersonal relationships; who visits, how respond to visitors
 Environment; having Qur’an, bible, prayer book, religious books, a
rosary
Nursing Diagnosis
Spiritual distress; a disruption in the life principle that
pervades a person’s entire being and that integrates and
transcends one biologic and psychological nature (Kim
et.al, 1989), or, the state in which the individual
experiencing a disturbance in the belief or value systems
which provides strength, hope, and meaning to life
(Carpenito, 1989)
O’Brien (1982) subcategories spiritual distress as follows:
 Spiritual pain, i.e difficulty accepting the loss of loved one
or intense suffering (physical or emotional)
 Spiritual alienation, i.e separation from religious or faith
community
 Spiritual anxiety, i.e challenge to beliefs and value
systems ( e.g by moral/ethical nature or therapy such as
abortion, blood transfusion, surgery, etc.)
O’Brien (1982) subcategories spiritual distress as follows:
 Spiritual guilt, i.e failure to abide by religious rule
 Spiritual anger, i.e difficulty accepting illness, loss, or
suffering
 Spiritual loss, i.e difficulty finding comfort in religion
 Spiritual despair, i.e feeling that no one cares

NANDA Spiritual distress related to:

 Crisis of illness/suffering/death (e.g terminal illness,
debilitating disease, chronic pain, or death or illness of
significant other
 Inability to practice spiritual beliefs
 Conflict between religious or spiritual belief and
prescribed health regimen (e.g blood transfusion, dietary
restrictions, amputation, or medication)
Planning
Should be designed to meet one or more of the
following needs:
 Fulfill religious obligations
 Draw on and use inner resources more
effectively to meet the present situation
 Maintain a dynamic, personal relationship with
the supreme being in the face of unpleasant
circumstances
 Find meaning in existence and present situation
 Promote sense of hope
 Provide spiritual resources otherwise
unavailable
Clients who may desire spiritual assistance:
 Appear lonely and have few visitors
 Express fear and anxiety
 Having surgery
 Having illness related to the emotions or
religious or social implication
 Life-style change as a result of illness or
injury
Outcome Criteria of spiritual distress, the client:
 Expresses comfort with spiritual beliefs
 Continuous spiritual practices appropriate to health
status
 Expresses decreased feeling of guilt
 States acceptance of moral decision
 Displays positive affect
 Expresses finding positive meaning in the present
situation and in own existence
 Verbalizes relief from or acceptance of suffering
 Verbalizes relief of anger toward transcendent being,
self, and other
 Verbalizes a closeness with God
 Experiences a sense of forgiveness
Implementation
 To be effective intervention, nurses should have already
examine and clarified their own spiritual beliefs and values
 To decrease spiritual distress  nurses should focus
attention on the client’s perception of his or her spiritual
needs rather than on the practices or beliefs of the client’s
religious affiliation
 Ns should not assume that client has no spiritual needs
because has no religious affiliation
 When orienting client, Ns can provide information about
hospital services to help client meet spiritual needs
 If there is a conflict between spiritual beliefs and medical
therapy, Ns encourages the client and physician to discuss
and consider alternative methods of therapy

Evaluation
 whether or not the client achieved the goal of care
Terima Kasih