Ch 43: Spiritual Health

Which statement by a nurse would nurture spirituality by promoting love and relatedness?

"Tell me about how you get along with others." Explanation: The nurse can help the client nurture his own spirituality by promoting meaning and purpose, love and relatedness, and forgiveness. To promote love and relatedness, encourage the client to talk about relationships with others and to identify the origin of negative beliefs about people. Reading the bible and sharing about their job are not ways to promoting meaning and purpose for a client. Assuming that the client is angry about their diagnosis is not as appropriate way to discuss a client's spirituality.

The nurse is taking care of a client who is scheduled for a mastectomy. The client tells the nurse that the client is apprehensive about the operation and asks the nurse to read a passage from the Koran to help prepare the client for surgery. Which action by the nurse is the most appropriate?

Read the Koran passage to the client. Explanation:According to Maslow's hierarchy, self-actualization is a need related to the spiritual and intellectual dimension of a client. Reading a religious passage to a client is not practicing a religion, and asking to call a minister or another staff member to address this spiritual need is deferring the client's needs to someone else.

A nurse interviews a client and finds that, because of religious beliefs, the client's view on health care does not involve blood transfusions. How can the nurse best handle this client situation?

Record this information in the client's chart. Explanation:Jehovah's Witnesses refuse blood transfusions due to the belief that they violate God's law. The nurse would make sure that this information is recorded in the client's chart. Explaining to the client that there may be times when a blood transfusion is necessary to save the client's life will not change the belief and will cause a loss of trust with the nurse. This belief is not a reason to transfer the client to another health care facility. The nurse should be accepting of the client's beliefs and should not praise or ridicule the client for these beliefs.

A client expresses confidence in his traditional healer to relieve symptoms of an illness. What is the client demonstrating?

Faith Explanation:Faith generally refers to a confident belief in something for which there is no proof or material evidence. It can involve a person, idea, or thing and is usually followed by action related to the ideals and values of the belief. A client who has faith in a health care provider is more likely to follow the plan of care, and experience benefits. Hope is an optimistic state of mind that is based on an expectation of positive outcomes with respect to events and circumstances in one's life or the world at large. Spirituality is the quality of being concerned with the human spirit or soul as opposed to material or physical things. The practice of charity means the voluntary giving of help to those in need, as a humanitarian act.

A nurse has developed a plan of care to meet the needs of a client with the nursing diagnosis of Spiritual Distress. What would be an expected outcome?

Identify factors in life that challenge spiritual beliefs. Explanation:Goals and expected outcomes for clients in spiritual distress do not need to be individualized. An appropriate expected outcome would be that the client will identify factors in life that challenge spiritual beliefs. Interventions may include: attend church services, reading bible verses, and sharing feelings.

A client who has suffered a debilitating stroke asks the nurse, "Why did God allow this to happen to me?" What question would the nurse ask to promote a conversation with the client about the client's spiritual needs?

"In the past, what has given you strength during a crisis?" Explanation:A client who is angry at or questioning God is in spiritual distress. Asking what has given the client strength in the past to deal with crises is a good way to begin the conversation about spiritual needs. The client may not be ready to see a spiritual advisor. Asking "Why" questions are not therapeutic. The client in this scenario has not mentioned the possibility of dying.

While reviewing the chart of a client before beginning care, the nurse notices that the spiritual assessment form is blank. Which question will the nurse use to begin the assessment process?

"Tell me about spiritual beliefs that are important to you." Explanation:Spiritual assessment is a required part of the initial assessment when a client is admitted to a health care facility. A client leaving the form blank means that the nurse will sensitively begin a discussion to complete the assessment. Asking an open-ended question like "tell me about your beliefs" is a good way to begin this discussion. Religion refers to an organized system of beliefs about a higher power. A client may not belong to an organized religion, but still have spiritual needs. A person may be deeply spiritual yet not profess a religion. Asking if the client wants to see a priest or minister will not provide much information to the nurse about the client's spiritual needs. Asking if the client is a spiritual person is a closed-ended question. It is much better to ask about what beliefs are important to the client.

The nurse is caring for a client that practices Islam in the hospital. When dietary brings the client a food tray for supper, which food on the tray should the nurse remove that is against the dietary laws for a practicing Muslim?

A pork chop Explanation:For practitioners of Islamic religion, Koranic law and customs influence diet; eating pork and drinking alcohol are forbidden. The nurse should remove the pork chop from the tray and have the meat replaced with beef, chicken, or fish as the protein.

An older adult client who identifies as a devout Catholic has recently relocated to an assisted living facility. The client is pleased with most aspects of the living situation but laments the fact that the church is not nearby, so attending daily mass is not an option. The client is quite upset by this restriction and states, "Going to daily mass was my life." Which action would the nurse take to address the client's spiritual distress?

Actively listen to the client to explore the client's feelings. Explanation:Spiritual distress involves the inability to integrate meaning and purpose in life. The client is in distress over not being able to attend daily mass. The nurse would actively listen to the client with empathy to further explore the client's feelings. Explaining about other facility activities and informing the client that a local church group conducts a service once a week will not relieve the client's distress. The nurse should not interject the nurse's personal feelings into the client's situation.

When reviewing the history of a client admitted to the health care facility, the nurse notes that the client reported being an atheist. Which action will the nurse take to meet spiritual needs when planning nursing care for the client?

Ask the client how he or she expresses spirituality. Explanation:An atheist believes that divine entities do not exist. People can be spiritual and not believe in divine entities. The nurse would explore how the client expresses spirituality. Asking if the client ever participated in organized religion would not meet the client's needs. Spiritual needs should be addressed; the nurse should not just bring spirituality if the client mentions it or arrange for a support group for atheists.

A client informs the nurse that his pastor is coming in a few hours to pray with him and offer sacrament. The nurse should take which actions to assist with the pastoral visit? Select all that apply.

Assist the client with personal hygiene. Clear the bedside table; cover with clean towel. Have a chair available near the bed. Clear the room of unnecessary items.

The nurse is differentiating beliefs of atheists from agnostics. Which statement is accurate?

Both are guided by a philosophy of living that does not include a religious faith. Explanation: An atheist is a person who denies the existence of a higher power; an agnostic is one who holds that nothing can be known about the existence of a higher power. Nurses do not offer religious counseling for any reason. Neither belief is life denying.

The nurse cares for a client admitted with an exacerbation of multiple sclerosis. How would the nurse best assess the spiritual beliefs of the client to integrate those beliefs into nursing care?

Listen actively to determine what the client is saying and not saying. Explanation:Spirituality is highly variable and differs from one client to the next. Knowing how spirituality can vary helps a nurse to plan care using possible coping responses. The best method of assessing a client's spiritual beliefs is through active, compassionate listening to determine what the client is saying, and equally important, what the client is not saying. The nurse can ask the client to fill out a formal questionnaire, but active listening is a better way to get the client's information. Referring the client to a hospital chaplain is not the best way to provide the nurse with information to plan the client's care. Previous life experiences, in general, influence responses to subsequent life experiences. However, active listening would provide the nurse with better information than asking about previous hospital experiences.

The nurse is caring for a client who asks that the special undergarments not be removed for an upcoming procedure. The nurse is aware that these undergarments are related to the client's religion. This religion is:

The Church of Jesus Christ of Latter-day Saints. Explanation:Members of the Church of Jesus Christ of Latter-Day Saints wear a special undergarment that should only be removed in emergencies, or when absolutely necessary. The other religions have no special undergarments related to their beliefs.

Mr. J. is a 78-year-old man, who is actively dying of unknown causes. Mr. J. is a practicing Muslim. His wife, children, and grandchildren are present. The physician in charge of Mr. J.'s care plans to discuss Mr. J.'s impending death with the family. Based on the nurse's knowledge of the Muslim faith, which of the following is not true?

The family will likely want an autopsy. Explanation:Ritualistic care of the body following death is an important piece of the Muslim culture.

A nurse is preparing the client for a visit from a spiritual counselor. Which topic would be helpful for the nurse to discuss with the client prior to the visit?

What is needed to prepare for the visit? Explanation:Preparations of the client's room for the visit may vary, but the following are generally recommended practices: the room should be orderly and free of unnecessary equipment and items; there should be a seat for the religious counselor at the bedside or near the client so that both can be comfortable; the bedside table should be free of items and covered with a clean, white cover if a sacrament is to be administered; and the bed curtains should be drawn for privacy if the client cannot be moved to a more private setting. It would be helpful for the nurse to discuss these topics with the client before the visit. Normally, the client visits with the spiritual counselor alone. Food is not provided. Locking the door would be unnecessary but the nurse should inform other health care members to help dismiss the possibility of interruption.

A client recently diagnosed with cancer informs the nurse that they value faith and finds comfort in their faith. The nurse is aware that faith is best defined as:

a belief in something for which there is no proof or material evidence. Explanation:Faith is a belief in something for which there is no proof or material evidence. The client is expressing a sense of faith to the nurse. Hope is a positive outlook even in the bleakest moments. Religion is an organized belief system about a higher power. Spiritual beliefs are practices associated with all aspects of a person's life.

What factor is necessary to express and experience spirituality?

connectedness with other people Explanation:People express and experience spirituality through love and connectedness with other people. Love develops from the basic human need to love and be loved and is necessary to spiritual wholeness. Membership in an organized religion is if a person has religious beliefs. Long term suffering and pain and isolation are not associated with a client having spirituality.

The nurse is assessing a 27-year-old Navajo male who is being admitted for surgery. The client requests a visit from the spiritual healer. Which is the best response from the nurse?

correct response: "Do you have a preference as to which spiritual leader you would like to visit?" Explanation:Although many Native Americans and many Southeast Asian groups seek spiritual leadership from a traditional tribal healer, the nurse should not assume that this is true with each client. The other choices would be inappropriate and not provide the best nursing care.

The parents of three children ages 4, 7, and 11 years are interested in fostering spiritual development in their children. The nurse informs the parents that the development of a child's spirituality is best accomplished by:

educating through parental behaviors. Explanation:A child's parents play a key role in the development of the child's spirituality. What is important is not so much what parents teach a child about God and religion, but rather what the child learns about God, life, and self from the parents' behavior.

A client self identifies as a member of the Jewish faith. When discussing diet and food preferences with the client, which assessment would be useful?

Ask the client what diet is followed at home. Explanation:Jewish dietary laws are known as kashrut and food that follows these criteria is called kosher. The intervention most useful in this situation would be to ask the client what diet is followed at home. If the client does follow a kosher diet, pork and pork products are not permitted. Directing the client to list favorite foods does not provide the type of diet the client follows in at home. Suggesting the client replace traditional fish with shellfish foods is not appropriate as the type of diet the client follows should be determined.

After being informed that his wife only has a few hours to live, the nurse hears the husband say; "If you take my wife now. I will never pray to you!" What should be the nurse's reply?

Use silence and allow the husband to express his emotions. Explanation:During times of grief, a nurse should exhibit a sensitive and non-intrusive approach in caring for the client and client's family. Therefore the nurse should use silence and allow the husband to express his emotions. Telling the client's husband to think before he speaks or leaving the room is inappropriate and rude. However, assisting clients to reconnect to their faith community or to utilize the resources of a faith community such as a pastor has health benefits but is not the priority in this situation.

The mother of a child diagnosed with leukemia starts crying and states "We are being cursed because my husband changed his religion." The nurse identifies this as:

spiritual distress. Explanation:It is important to differentiate between Impaired Religiosity and Spiritual Distress. Spiritual Distress is characterized by a disturbance in an individual's personal belief system. Impaired Religiosity, however, involves challenges in exercising the beliefs of an individual's chosen faith community. Spiritual quests are religious tour for the meaning in life. Spiritual well being is ability to experience and integrate meaning and purpose in life through a person's connectedness with self, others art, music, literature, nature, or a power greater than oneself.

A client scheduled for outpatient surgery is requesting that the operating room be sprayed with holy water. Which is an appropriate response?

"Are you concerned how the surgery will go?" Explanation:When providing spiritual care, nurses should listen to for cues either verbally or nonverbally. In this situation, the client is expressing a verbal cue about spirituality. The nurse should address the behavior with an open ended statement to allow for a flow of communication and feelings. Telling the client that the operating room personnel will not adhere to the request and stating about surgical aseptic technique requires fluids to be sealed are all correct, but nontherapeutic.

The client has been hospitalized following an accident. Recovery has been slow with many complications. The client states, "I don't believe I am going to survive. God is punishing me." What is the best statement for the nurse to make?

"Let's talk about your beliefs." Explanation:"Let's talk about your beliefs" is the only statement that is therapeutic and encourages the client to verbalize his spiritual distress. The statement "I am sorry you feel that way" acknowledges the client's feelings but does not encourage the client to open up or engage in conversation. The other two statements are negative and closes communication.

Upon assessment, the nurse is addressing the beliefs of a newly admitted man who reports practicing the Seventh Day Adventist religion. Based upon the nurse's familiarity with this religion, which question will the nurse appropriately asks the client?

"What are your beliefs about the use of opioids for pain?" Explanation:The Seventh Day Adventist religion prohibits the taking of opioids and stimulants because the body is a "temple." Jehovah's Witnesses prohibit blood transfusions because it violates God's law. Native American religions incorporate medicine men or women for health care needs. Members of the Church of Jesus Christ of Latter-day Saints are required to wear special undergarments that should be removed only in an emergency.

Members of which religious tradition are likely to have the most stringent restrictions and parameters placed on their medical care?

Christian Scientist Explanation:Christian Science places significant restrictions of the use of drugs, medical procedures, therapies, and surgeries. Hindu religious belief begins with the assumption that all living things have a soul, which passes through successive cycles of birth and rebirth. Hinduism includes ideas of karma and rebirth, collective versus individual identity, an emphasis on purity and a preference for sons. Buddhism and Protestants have very few if any health care restrictions.

A nursing instructor is preparing a class presentation on spiritual care. What would the instructor include as an essential component? Select all that apply.

Empathy Trust Self-awareness Explanation:Essential elements in implementing spiritual care are commitment to the nurse-client relationship, good communication skills, trust, empathy, self-awareness, and acceptance of a broad definition of spirituality.

new client is on the hospital unit. He was recently diagnosed with metastatic pancreatic cancer and was told that any treatment would be palliative. He tells a nurse that there is no God that he knows of who would subject someone to this. The client's statement is most reflective of:

spiritual crisis. Explanation:A spiritual crisis can occur with an acute illness, sudden loss, or a new challenging diagnosis. These turning points often result in the questioning of one's beliefs.

A nurse is providing care to a terminally ill client and family. The family practices Buddhism. When preparing the client and family for death, which action would be most important for the nurse to integrate into the plan of care?

supporting the belief that death is temporary and needed for rebirth Explanation:With Buddhism, the belief is that life is a temporary state and thus death is temporary and necessary for rebirth. Anointing before death reflects Roman Catholic religious practices. Placing the body on the floor and cremation reflect Hinduism.

When preparing for a spiritual counselor to visit a hospitalized client, the nurse should:

take measures to ensure privacy during the counselor's visit. Explanation:Visits between a client and a spiritual counselor require privacy. The details of the meeting are not typically documented in the client's chart, though the fact that the visit took place is often noted. The nurse may be present during the meeting, but this should take place at the client's request. Spiritual counselors do not require administrative approval; clients and their families are normally able to seek spiritual help from whomever they prefer.

A recently graduated nurse is working with a client who is suffering from excruciating pain with no relief. The client tells the nurse that religion and spirituality are a big part of her life. The nurse wants to help nurture this client's spirituality and can do so in which of the following ways? Select all that apply.

promoting meaning and purpose promoting love and relatedness promoting forgiveness Explanation: The nurse can help the client to nurture her own spirituality by promoting meaning and purpose, promoting love and relatedness, and promoting forgiveness. Although promoting pain relief and independence are both good nursing actions, they do not help in nurturing one's spirituality.

Which factor should be the primary factor in a nurse's decision whether to pray with a client?

the client's openness to being prayed for Explanation:Many factors influence the nurse's decision to pray with a client. Central among these, however, is the question of whether the client is open to this possibility. This factor is more important than the nurse's familiarity with specific prayer traditions, the client's medical condition, or the presence or absence of a chaplain.

The nurse is admitting a client to the hospice unit. Which assessment by the nurse provides information regarding personal resources?

"Do you have spiritual beliefs? If so, what are they?" Explanation:The purpose of assessing the client's personal resources is to identify strengths within the person that contribute to a healthy pattern of grieving. Spirituality may serve to ease grieving by helping to process and deal with death. Asking about a history of anxiety or depression are aspects of the mental health assessment. Asking about participation in activities of daily living provides an idea of the client's independence. Asking if the church community is a source of support is assessing the client's social support systems, not personal resources.

When asked about his religious preference, the client becomes very upset with the nurse. Which response is appropriate for this situation?

"I can see that this question upsets you. Do you have any questions about this?" Explanation:The nurse should assist the client in understanding that his nursing history is a review of the whole human being and that questions will be wide ranging, including spiritual health, physical health, and emotional health. A client who appears angry, anxious, depressed, or defensive when asked spiritual questions may need to hear something like, "I can see from your response that you might not have expected these questions; however, they do let you know that we are interested in how you are experiencing your current situation. Do you have a question or concern in this area?" Telling the client that the nurse is just completing his or her job or telling the client that it is part of the assessment is not appropriate or therapeutic.

A nurse is conducting a spiritual assessment on a client recently admitted to the hospital unit. Which questions would be appropriate to ask the client about his religious and spiritual practices? Select all that apply.

"Is religion a significant part of your life?" "Are there any spiritual practices that you would like to continue while hospitalized?" "Does the present situation interfere with any spiritual or religious practice?" Explanation:A spiritual and religious assessment attempts to identify and document any practices or beliefs that are important for the client to maintain or that may alter medical or nursing treatment.

When conducting a spiritual assessment, the nurse must be sensitive to the client's personal beliefs. Which questions should the nurse ask? Select all that apply.

"Is religion or God significant to you?" "Do you feel your faith is helpful to you?" "Is there anyone from your church you would like to talk to?"

The nurse is caring for a hospice client who states worry about how the client treated a younger sibling. The client asks the nurse how to make things right. Which is the nurse's best response?

"It seems as though you feel bad about how you treated your sibling. Can you tell me more about your feelings?" Explanation:Facilitating a discussion on forgiveness begins with active listening and open-ended questions that encourage expansion and a wider range of facts and feelings. As such, the best response by the nurse is, "It seems as though you feel bad about how you treated your sibling" which restates the nurse's understanding of the message. "Can you tell me more about your feelings?" encourages the client to share feelings and thoughts. Telling the client to "Just call your sibling and tell him or her you are sorry" may be the wrong statement, as the full "story" is not known. Asking the client if the nurse should intervene on behalf of the client is inappropriate, as the client and sibling need to talk. Telling the client not to worry about it is dismissing the client's concern and is not therapeutic.

Which client statement most clearly suggests the potential of a nursing diagnosis of Spiritual Anxiety?

"Now that I'm nearing the end, I'm worried that God won't think I lived a good enough life." Explanation:Worry about one's spiritual condition is indicative of the nursing diagnosis of Spiritual Anxiety. Unfamiliarity with the religious character of a care setting suggests Spiritual Alienation, while questions of suffering often indicate Spiritual Pain or Spiritual Despair. Regrets over previous religious or spiritual apathy may suggest a nursing diagnosis of Spiritual Guilt.

Which statement by a nurse would nurture spirituality by promoting love and relatedness?

"Tell me about how you get along with others." Explanation:The nurse can help the client nurture his own spirituality by promoting meaning and purpose, love and relatedness, and forgiveness. To promote love and relatedness, encourage the client to talk about relationships with others and to identify the origin of negative beliefs about people. Reading the bible and sharing about their job are not ways to promoting meaning and purpose for a client. Assuming that the client is angry about their diagnosis is not as appropriate way to discuss a client's spirituality.

Upon assessment, the client reports not belonging to an organized religion. Which assessment question would the nurse ask to assess the client's spirituality?

"Tell me about spiritual or religious beliefs that are important to you." Explanation:The nurse should not interpret the fact that a client does not belong to an organized religion to mean that the client has no spiritual needs. A person may be highly spiritual yet not profess a religion. The nurse should invite the client to tell the nurse about spiritual or religious beliefs that are important to the client. "Why" questions are not therapeutic. The reason why the client does not belong to an organized religion will not provide the nurse with information about the client's spirituality. Asking an open-ended question rather than the close-ended "Do you think of yourself as a religious person?" will provide more information about the client's spirituality. The client may seek spiritual counseling or ask to see the hospital chaplain during the hospitalization related to spiritual needs, but this is not the best way for the nurse to assess the client's spirituality.

The nurse overhears a client, who is scheduled to begin chemotherapy, tell a family member that everything will eventually be okay and the cancer will be in remission. Which question will the nurse ask to begin a conversation about hope with the client?

"What provides you with strength to deal with this health situation?" Explanation:Hope is demonstrated by a positive outlook. It enables a person to consider a future and to work to actively bring that future into being. Asking the client, "What provides you strength?..." is an open-ended question and allows a conversation to begin about hope. Asking what the health care provider has told the client is seeking information, not initiating a conversation about hope. Asking about the most important thing in the client's life is beginning a discussion about meaning and purpose and not specifically about hope. Asking about the role of a higher power would begin a discussion on faith.

The nurse is caring for a critically ill client who informs the nurse that there is a conflict between the client's spiritual beliefs and a proposed health option. Which question does the nurse ask to begin a conversation about the conflict that the client is experiencing?

"Would you like to talk to someone to help you make an informed decision?" Explanation:The nurse's role in resolving conflicts between spiritual beliefs and treatments is to assist the client in obtaining the information needed to make an informed decision and to support the client's decision making. The client may not know specifically what to ask of the nurse and the client needs assistance in making an informed decision. The nurse is instrumental in advocating for the client's needs. The health care provider is not usually involved as a client advocate. Asking if the client wishes to refuse the treatment option does not provide the client with information to make an informed decision.

The nurse admits a new client to the unit for elective surgery. What would be the best way for the nurse to facilitate the practice of religion for this client? Choose all that apply.

Arrange for the client's pastor to visit if desired. Attempt to meet religious dietary restrictions. Respect the need for privacy during periods of prayer. Explanation:The following are means the nurse can use to help the client continue normal spiritual practices in the unfamiliar environment of the hospital or care center:• Familiarize the client with the religious services and materials available within the institution.• Respect the client's need for privacy or quiet during periods of prayer.• Assist the client to obtain devotional objects and protect them from loss or damage.• Arrange for the client wishing to receive the sacraments to do so.• Attempt to meet the client's religious dietary restrictions.• Arrange for the client's minister, priest, or rabbi to visit if the client so wishes.Proselytizing is never acceptable in professional settings. Addressing spiritual issues should not be coercive. Praying with clients should not be initiated by the nurse unless there is no pastoral care available and the client requests it. Comparing and contrasting religious beliefs is not likely to benefit the client.

The nurse is reviewing the medical record of a client scheduled for a left hip replacement the following morning. The client lists Jehovah's Witness as the religious belief. Which action should the nurse take?

Assess the client's belief regarding blood transfusions. Explanation:The nurse should assess the client's personal beliefs regarding blood transfusions. Preferences related to religious beliefs should not be assumed; rather, each client should be assessed individually regarding personal beliefs. In this situation, if the client refuses blood products, other arrangements acceptable to the client such as non-blood product volume expanders could be on stand-by if needed. Notifying the surgeon of the client's religious preference should not be done until the client's personal beliefs are assessed. Calling the surgical department to cancel the surgery should not be done, as the client needs to be assessed. Action needs to be taken to clarify the client's beliefs and consent regarding blood products if needed, and highlighting the record is not taking action.

A nurse caring for a client of the Jewish faith knows the importance of asking about any food preferences when discussing diet. This is important for which reason?

Religious practices and beliefs can directly influence a client's self-care practices. Explanation:Nurses are better able to meet clients' spiritual needs when they understand their religious beliefs. These beliefs can directly influence clients' responses to illness and suffering, self-care practices such as diet and hygiene, spiritual practices, and moral codes. Religious practices and beliefs can be easy to understand and if asking a client about them, a nurse is exemplifying care and compassion in the client and their beliefs.

The son of a dying female client is surprised at his mother's adamant request to meet with the hospital chaplain and has taken the nurse aside and said, "I don't think that's what she really wants. She's never been a religious person in the least." What is the nurse's best action in this situation?

Contact the chaplain to arrange a visit with the client. Explanation:The nurse's primary responsibility is to honor the client's request for a meeting with a spiritual advisor. Completing a spiritual assessment is not necessary at this time. Organizing a meeting between the chaplain, the son, and the client is not an accurate intervention at this time unless requested by the client. Documentation of the conversation with the client and calling for a spiritual advisor should be recorded in the client's health record. It is not necessary to document and wait for the client to ask again before the nurse considers the request. Afterall, she is dying and waiting for her to ask again is not warranted.

A nurse is educating staff members about the importance of meeting the spiritual needs of clients on the unit. What spiritual needs should be met in the delivery of care? Select all that apply.

need for meaning and purpose need for love and relatedness need for forgiveness Explanation:There are three spiritual needs that underlie all religious traditions and are common to all people: need for meaning and purpose, need for love and relatedness, and need for forgiveness. Need for comfort and money, as well as need for complete health and freedom, are nice but are not part of spirituality.

A nurse is caring for a hospitalized client. Which intervention can the nurse use to help the client continue normal spiritual practices?

Request dietary consultation for the client's dietary restrictions. Explanation:It is a responsibility of the nurse to help the client in an unfamiliar environment continue normal spiritual practices. One intervention that can facilitate the practice of religion is to attempt to meet the client's dietary restrictions. The nurse should not discuss their own religious preference nor request medication for the client. Telling the client that the spiritual practices can be resumed later is inappropriate.

Allen is an 82-year-old retiree who recently relocated to senior apartments. The apartments are not affiliated with any religious beliefs. Allen was raised in the Roman Catholic church and has attended mass every Sunday since childhood. He has not attended mass for 3 weeks. What best describes Allen's situation?

Separation from spiritual ties Explanation:Separation from spiritual ties occurs when an individual changes location and does not have access to spiritual services, or feels uncomfortable joining a new group. This separation can be temporary or permanent.

A nurse overhears a client telling a family member that a belief in God is the only thing helping in the fight against a terminal illness. What is this client demonstrating?

Faith Explanation:Faith refers to a confident belief in something for which there is no proof or material evidence. It can involve a person, idea, or thing, and it is usually followed by action related to the ideals or values of that belief. Hope is a feeling of expectation and desire for a certain thing to happen. Love is an intense feeling of deep affection. Religion is a particular system of faith and worship.

The nurse is caring for a female client today. As the nurse is giving the client her morning medications, she begins a conversation about her belief in a higher power. The nurse knows that this can be interpreted as which of the following? Select all that apply.

Faith Spirituality Religion God Explanation:Spirituality is anything that pertains to a person's relationship with a nonmaterial life force or higher power. An atheist is a person who denies the existence of a higher power. Faith generally refers to a confident belief in something for which there is no proof or material evidence, such as a higher power. God is defined as a higher power. Religion refers to an organized system of beliefs about a higher power.

An 80-year-old woman who identifies herself as a devout Catholic has recently relocated to an assisted-living facility. The woman is pleased with most aspects of her new living situation, but laments the fact that she is no longer close to the church where she was in the habit of attending daily mass each morning. What nursing diagnosis may apply to this problem that the woman has identified?

Impaired Religiosity Explanation:The nursing diagnosis of Impaired Religiosity encompasses the inability to participate in rituals of a particular faith tradition. Spiritual Distress involves the inability to integrate meaning and purpose in life, while Spiritual Pain involves angst over the nature and actions of a higher power. The woman's statements do not directly reflect an outlook of hopelessness.

When the nurse assesses the spirituality of a client diagnosed with an HIV infection, the client becomes angry and defensive. The client also exhibits signs of anxiety and depression and states, "I do not know why God would allow this to happen to me." Which action will the nurse take to decrease the client's distress?

Inform the client that the spiritual aspect of care is important. Explanation:A client who appears angry, anxious, depressed, or defensive when asked spiritual questions may need to hear something like, "I can see from your response that you might not have expected these questions, but these questions let you know that we are interested in how you are experiencing your current situation." Some clients are relieved to know that the spiritual aspect of their being is worthy of the nurse's concern. Obtaining a prescription for antidepressant medication may treat the client's symptoms, but it does not treat the spiritual distress causing the symptoms. Asking if the client wants to see a spiritual counselor may indicate that the nurse is "passing the buck." The nurse should first use nursing interventions to deal with the client's spiritual distress. Leaving the client alone will not decrease the distress.

A nurse is preparing a presentation for a group of staff nurses about spirituality and the importance of meeting clients' spiritual needs. As part the presentation, the nurse plans to address the major religious groups. Which characteristic would the nurse identify as being common to the major religions? Select all that apply.

Involvement of a sacred word or scripture Ideas related to after death Ethical code for right and wrong An identity as a group

A nursing student is studying spirituality and completing a report on The Church of Jesus Christ of Latter-day Saints. Which fact about this faith should the student include in the report?

Latter-day Saints are not allowed to use tobacco or alcohol. Explanation:The restored gospel of Jesus Christ directs Latter-day Saints to avoid using alcohol, tobacco, and caffeinated beverages. Jehovah's Witnesses are not allowed to have blood transfusions. Roman Catholics do not adhere to birth control measures. Muslims do not allow opposite sexed health care providers to care for them, especially women.

How can religious, life-affirming influences be compared with basic human needs?

Life-affirming influences encourage self-actualization. Explanation:Religious influences may be life affirming or life denying. Life-affirming influences encourage self-actualization, the highest level of basic human needs. Basic physiological needs are food, water, and security and do not involve spirituality. Enhancing life and wisdom are life influences and not religious influences.

The nurse cares for a client admitted with an exacerbation of multiple sclerosis. How would the nurse best assess the spiritual beliefs of the client to integrate those beliefs into nursing care?

Listen actively to determine what the client is saying and not saying. Explanation:Spirituality is highly variable and differs from one client to the next. Knowing how spirituality can vary helps a nurse to plan care using possible coping responses. The best method of assessing a client's spiritual beliefs is through active, compassionate listening to determine what the client is saying, and equally important, what the client is not saying. The nurse can ask the client to fill out a formal questionnaire, but active listening is a better way to get the client's information. Referring the client to a hospital chaplain is not the best way to provide the nurse with information to plan the client's care. Previous life experiences, in general, influence responses to subsequent life experiences. However, active listening would provide the nurse with better information than asking about previous hospital experiences.

A client who is admitted for a debilitating disease is talking to the nurse. The client relates that family is the only thing that matters, stating that family helps fulfill all the spiritual needs by first fulfilling the most basic of all needs. What is this basic need?

Love Explanation:Love develops from the basic human need to love and be loved, and we cannot be spiritually whole, spiritually healthy, unless this need is met. Autonomy is freedom from external control or influence. Self reliance is reliance on one's own powers and resources rather than those of others. Autonomy and self reliance are higher level of needs. A sense of belonging is a human need, just like the need for food and shelter but love is more important.

A nurse is conducting online research for information related to spiritual needs and religious traditions. The nurse demonstrates understanding of the information by identifying which need as common to all? Select all that apply.

Love Meaning Forgiveness Explanation:Three spiritual needs underlie all religious traditions and are common to all people: need for meaning and purpose; need for love and relatedness; and the need for forgiveness.

The nurse cares for a client who has just received a diagnosis of brain cancer. The client refuses to talk about the diagnosis. Which action will the nurse take in determining the client's spiritual needs?

Observe the client for signs of anger, withdrawal, or anxiety. Explanation:Various behaviors and expressions may be warning signs that clients are experiencing spiritual distress. When the client refuses to talk about a negative diagnosis, the nurse needs to observe the client for changes in behavior that may be a manifestation of spiritual dysfunction or a clue that the client has spiritual needs that are not being met. These behaviors include anger, withdrawal, or anxiety. Asking if the client observes a religion or would like to see a chaplain will not provide the nurse with information about the client's spiritual needs at the moment. Providing distracting activities, like watching a movie, will not provide the nurse with information about the client's spiritual needs.

A client tells a nurse that he does not think he can have the recommended heart surgery because transfusions are against his religion. What is the best response of the nurse in this situation?

Obtain all the information needed for the client to make an informed decision. Explanation:The nurse's role is to assist the client in obtaining the information needed to make an informed decision and to support the client's decision making. Because what the nurse says, and the way it is said, may powerfully influence the client's decision, it is important to maintain objectivity. Conflicts that resist resolution may be referred to an ethics committee or consult team. Telling the client that the surgery is necessary to keep him alive and is the only choice is inappropriate.

The nurse's client today is Robert, who is hospitalized for a cystectomy related to bladder cancer. He reveals that he feels some spiritual distress without getting into specifics. Which of the following is the appropriate priority action?

Perform a spiritual assessment. Explanation:If the client reveals a spiritual problem, use interview questions to determine the specific nature of the problem, its probable causes, related signs and symptoms, when it began and how often it occurs, how it affects everyday living, the severity of the problem, whether the problem can be treated independently by nursing or needs to be referred, and how well the client is coping with the problem. Praying with clients should not be initiated by the nurse unless there is no pastoral care available and the client requests it.

The nursing diagnosis Spiritual Distress related to crisis of illness as evidenced by loss of meaning in life and overuse of pain medication is created for a client who attempted to take his life. Which intervention is appropriate for these problems?

Plan and coordinate a multidisciplinary team conference including the chaplain. Explanation:The nurse should facilitate a care-planning conference involving the social support network including family and friends. Initiating a multidisciplinary social network of conferences facilitates a sense of acceptance, love, and belonging. The nurse should work with the client to explore and build on past positive coping mechanisms, which helps enhance a sense of self-control and self-esteem. Encouraging the client to watch movies when alone does not allow the client to interact and find positive elements of his or her life. Although spiritual review can be helpful, the nurse should not "scare" the client away from action by mentioning negative spiritual outcomes.

The client was told of a terminal illness and has been questioning his faith. A spiritual counselor will be visiting the client following a referral. What interventions would the nurse perform to provide an environment that is conducive for both the client and the spiritual counselor? Select all that apply.

Provide privacy for the client from visitors during the visit from the spiritual counselor Place a chair facing the client next to the bed Clean clutter and unnecessary items from the bedside table Close the door to the client's room after the spiritual counselor has arrived

A client in a long-term care facility has recently begun to refuse to cooperate with the staff, is having difficulty agreeing with the treatment goals suggested by the nurse, and is showing more stress when the family goes home. What is the best response from the nurse?

Question the client concerning spiritual concerns Explanation:Refusing to cooperate with staff, not forming goals and being stressed or worried when separated from loved ones are signs of maladaptive behavior of spiritual needs and should be addressed by the nursing staff. These findings would not suggest an infection is occurring, nor are they signs of an addiction or use of a substance.

A client states that his life has meaning and purpose, he feels loved, and has experienced forgiveness in his life. What is the term that describes this state of spirituality?

Spiritual health Explanation:Defined most simply, spiritual health or well-being is the condition that exists when the universal spiritual needs for meaning and purpose, love and belonging, and forgiveness are met. Spiritual beliefs include the relationship to a superior being and are related to an existential perspective on life, death, and the nature of reality. Spiritual alienation is a nursing diagnosis, as evidenced by expressions of loneliness or the feeling that God seems very far away and remote from one's everyday life, verbalization that one has to depend upon one's self in times of trial or need, and/or a negative attitude toward receiving any comfort or help from God. Spiritual bliss comes from being totally connected with self, soul, body, and a higher power.

A nurse is developing a plan of care to meet a client's spiritual needs. When identifying appropriate interventions, which concept would the nurse need to integrate as the foundation for all the interventions?

Supportive presence Explanation:A nurse's supportive presence must underlie all other types of intervention to meet the client's spiritual needs. The aim of this intervention is to create a hospitable and sacred space ("holy ground") in which clients can share their vulnerabilities without fear. Supportive presence communicates value and respect. Prayer, strength and religion are not foundational to spiritual interventions.

The nurse is creating a plan of care for a client experiencing spiritual distress. What is the priority outcome for this care plan?

The client expresses meaning and purpose in life. Explanation:Examples of outcomes for the client with (or at risk for) spiritual distress include the following:• The client expresses a sense of connectedness with self, others, the arts, or a power greater than self.• The client expresses meaning and purpose in life.• The client has a sense of optimism and hope in the future.• The client discusses personal response to dying.• The client expresses satisfaction with life circumstances.

A middle-aged female client visits the clinic to confirm pregnancy. "I cannot believe this is happening. I cannot be pregnant. My parents will kill me. I was raised in a strict Roman Catholic home. I was not supposed to get pregnant before marriage."

The client is exhibiting signs of spiritual guilty related to the inability to live up to devout practices disengagement from faith community Explanation:The client is exhibiting spiritual guilt related to the inability to live up to devout practices. Because the Roman Catholic doctrine prohibits getting pregnant before marriage, the client feels that they have betrayed their family and their religion. Spiritual anger pertains to feelings of outrage or frustration against an ultimate or higher power. Spiritual alienation refers to feelings of separation or estrangement from a supreme power or being. Clients experiencing spiritual alienation may feel that they are detached from their faith source. Birth control and abortion are prohibited in the Roman Catholic religion. These rules may make the client feel disengaged from their faith if this situation is making the client reconsider their options related to pregnancy. The feeling of questioning their belief and value systems is characteristic of spiritual anxiety. The client's comments indicate that the client has not yet fully accepted the pregnancy. The client is displaying risk factors characteristic of spiritual pain because the client is unable to reconcile being pregnant before marriage and the religious teachings.

A new nurse observes a priest visiting the clients every Saturday afternoon and praying with them. This activity supports which of the nursing outcomes?

The client uses a type of spiritual experience that provides comfort. Explanation:As with other age groups, listening and support are essential as older adults deal with health and illness. Older adults used several religious or spiritual interventions with health professionals and also in isolation. Most older adults enjoy participating in conventional religious practices such as worship and prayer either alone or in groups to facilitate effective relationships and coping. A client expressing a sense of hope, meaning in life, and satisfaction can only communicated but not witnessed. A client may tell a nurse this to be looked as having communicated happiness in their life. A client, if satisfied with religious influence, will not seek alternative venues for spiritual expression.

A client is in the late stages of lung cancer with bone metastases. Since receiving the terminal diagnosis, the client has often made mentioned an estranged child and being a "miserable parent." Which conversation will the nurse have with the client to attend to unfinished business?

The need for forgiveness Explanation:While a need for love may be a factor in the client's request, the fact that the client admits parental failings suggests that the client may feel a need for forgiveness to repair past behavior. The need for meaning focuses on the past, while the need for purpose looks to the future. The purpose of a person is often related to the individual's values, which may be social in nature. The need for love is the need for togetherness with another person.

The nurse understands that spiritual care is dynamic and embodies some of the basic tenets of nursing. What is a factor supporting this concept? Select all that apply.

Therapeutic use of self Client centeredness Spiritual nurturing environment Nurse's availability for the client Explanation:spiritual care is dynamic and embodies some of the basic tenets of nursing. The nurse's use of presence, therapeutic use of self, client centeredness, intuitive sense, and the creation of a spiritually nurturing environment are integral to providing spiritual care. Such care has positive effects for clients, including healing and the promotion of psychological and spiritual well-being. Family support is not part of the nurse-client relationship in spiritual care.

The client states "I have lifted my cancer to God and am accepting of God's plan for me." This is an example of an adaptive expression of spiritual needs labeled:

faith. Explanation:The nurse should be aware of adaptive behaviors of faith. These include: Faith depends on divine wisdom/God; faith is motivated toward growth; faith expresses satisfaction with explanation of life after death; faith expresses a need to enter into and/or understand the larger drama of human history; faith expresses a need for the symbolic, or ritual; faith expresses a need for sense of a shared faith/community. In this case, the client believes that he will depend on the divine wisdom of God for guidance. Trust is believing in the truth. Forgiveness is seeking out peace between two people. Love and relatedness is to support and cherish the relationship between two.

Mrs. Jones is an 81-year-old client who can no longer live alone safely and is being admitted to a long-term-care facility. She had to leave her elderly cat, Baby, with neighbors. She tells the nurse that her cat was the only family she had and that she misses her. The nurse knows that this is related to which of the following spiritual needs believed to be common to all people?

need for love and relatedness Explanation:According to Shelly and Fish (1988), the three spiritual needs underlying all religious traditions and common to all people are the need for meaning and purpose, the need for love and relatedness, and the need for forgiveness. The client is experiencing the need for love for her cat. The need for forgiveness is reconciliation for past relationship issues. The need for meaning and purpose is finding connectiveness with jobs or people. Basic needs are something necessary or indispensable such as food, water, and shelter.

A nurse is educating staff members about the importance of meeting the spiritual needs of clients on the unit. What spiritual needs should be met in the delivery of care? Select all that apply.

need for meaning and purpose need for love and relatedness need for forgiveness Explanation: There are three spiritual needs that underlie all religious traditions and are common to all people: need for meaning and purpose, need for love and relatedness, and need for forgiveness. Need for comfort and money, as well as need for complete health and freedom, are nice but are not part of spirituality.