Spirituality

Religion

"State of doing"— specific practices involved System of organized beliefs about a higher power Helps the person outwardly express spirituality Difference between religion and spirituality Religious practices help patients maintain their faithfulness

Spirituality, Health & Illness

-guide to daily living habits -source of support -source of strength and healing -source of conflict

Christian holy days

1. Lent 2. Christmas 3. Easter 4. Ash Wednesday 5. Good Friday

C

A hospice nurse is caring for a patient who is dying of pancreatic cancer. The patient tells the nurse "I feel no connection to God" and "I'm worried that I find no real meaning in life." What would be the nurse's best response to this patient? A. Give the patient a hug and tell him that his life still has meaning. B. Arrange for a spiritual adviser to visit the patient. C. Ask if the patient would like to talk about his feelings. D. Call in a close friend or relative to talk to the patient.

C

A man who is a declared agnostic is extremely depressed after losing his home, his wife, and his children in a fire. His nursing diagnosis is Spiritual Distress: Spiritual Pain related to inability to find meaning and purpose in his current condition. What is the most important nursing intervention to plan? A. Ask the patient which spiritual adviser he would like you to call. B. Recommend that the patient read spiritual biographies or religious books. C. Explore with the patient what, in addition to his family, has given his life meaning and purpose in the past. D. Introduce the belief that God is a loving and personal God.

A,B,D,F

A nurse is caring for patients admitted to a long-term care facility. Which nursing actions are appropriate based on the religious beliefs of the individual patients? Select all that apply. A. The nurse dietitian asks a Buddhist if he has any diet restrictions related to the observance of holy days. B. A nurse asks a Christian Scientist who is in traction if she would like to try nonpharmacologic pain measures. C. A nurse administering medications to a Muslim patient avoids touching the patient's lips D. A nurse asks a Roman Catholic woman if she would like to attend the local Mass on Sunday. E. The nurse is careful not to schedule treatment and procedures on Saturday for a Hindu patient. F. The nurse consults with the medicine man of a Native American patient and incorporates his suggestions into the care plan.

C

A nurse is performing spirituality assessments of patients living in a long-term care facility. What is the best question the nurse might use to assess for spiritual needs? A. Can you describe your usual spiritual practices and how you maintain them daily? B. Are your spiritual beliefs causing you any concern? C. How can I and the other nurses help you maintain your spiritual practices? D. How do your religious beliefs help you to feel at peace?

A

A nurse performing a spiritual assessment collects assessment data from a patient who is homebound and unable to participate in religious activities. Which type of spiritual distress is this patient most likely experiencing? A. Spiritual Alienation B. Spiritual Despair C. Spiritual Anxiety F. Spiritual Pain

C

A nurse who is caring for patients on a pediatric ward is assessing the children for their spiritual needs. Which is the most important source of learning for a child's own spirituality? A. The child's church or religious organization B. What parents say about God and religion C. How parents behave in relationship to one another, their children, others, and to God D. The spiritual adviser for the family

B

A nurse who is comfortable with spirituality is caring for patients who need spiritual counseling. Which nursing action would be most appropriate for these patients? A. Calling the patient's own spiritual adviser first B. Asking whether the patient has a spiritual adviser the patient wishes to consult C. Attempting to counsel the patient and, if unsuccessful, making a referral to a spiritual adviser D. Advising the patient and spiritual adviser concerning health options and the best choices for the patient

C

A nurse who was raised as a strict Roman Catholic but who is no longer a practicing Catholic stated she couldn't assist patients with their spiritual distress because she recognizes only a "field power" in each person. She said, "My parents and I hardly talk because I've deserted my faith. Sometimes I feel real isolated from them and also from God—if there is a God." Analysis of these data reveals which unmet spiritual need? A. Need for meaning and purpose B. Need for forgiveness C. Need for love and relatedness D. Need for strength for everyday living

C

A nurse working in an emergency department assesses how patients' religious beliefs affect their treatment plan. With which patient would the nurse be most likely to encounter resistance to emergency lifesaving surgery? A. A patient of the Adventist faith B. A patient who practices Buddhism C. A patient who is a Jehovah's Witness D. A patient who is an Orthodox Jew

D

A patient states she feels so isolated from her family and church, and even from God, "in this huge medical center so far from home." A nurse is preparing nursing goals for this patient. Which is the best goal for the patient to relieve her spiritual distress? A. The patient will express satisfaction with the compatibility of her spiritual beliefs and everyday living. B. The patient will identify spiritual beliefs that meet her need for meaning and purpose. C. The patient will express peaceful acceptance of limitations and failings. D. The patient will identify spiritual supports available to her in this medical center.

D

A patient whose last name is Goldstein was served a kosher meal ordered from a restaurant on a paper plate because the hospital made no provision for kosher food or dishes. Mr. Goldstein became angry and accused the nurse of insulting him: "I want to eat what everyone else does—and give me decent dishes." Analysis of these data reveals what finding? A. The nurse should have ordered kosher dishes also. B. The staff must have behaved condescendingly or critically. C. Mr. Goldstein is a problem patient and difficult to satisfy. D. Mr. Goldstein was stereotyped and not consulted about his dietary preferences.

A

After having an abortion, a patient tells the visiting nurse, "I shouldn't have had that abortion because I'm Catholic, but what else could I do? I'm afraid I'll never get close to my mother or back in the Church again." She then talks with her priest about this feeling of guilt. Which evaluation statement shows a solution to the problem? A. Patient states, "I wish I had talked with the priest sooner. I now know God has forgiven me, and even my mother understands." B. Patient has slept from 10 PM to 6 AM for three consecutive nights without medication. C. Patient has developed mutually caring relationships with two women and one man. D. Patient has identified several spiritual beliefs that give purpose to her life.

sacred texts

Authoritative scripture Provides guidance

common characteristics of religion

Basis of authority or source of power Portion of scripture or sacred word Ethical code defining right or wrong A psychology and identity Aspirations or expectations Some ideas about what follows death

Buddhist holy days

Buddha's birthday Folk dances , lotus lanterns, baby washing of the stone (Mostly in Asia)

Hindu women

Cover all of the body expect arms and feet

Jewish women

Cover head and hair with scarf

Orthodox and conservative Jewish men

Cover head at all times Wear mulkis

Faith

Describe cultural or institutional religion

Factors affecting spirituality

Developmental considerations Family Ethnic background Formal religion Life events

Muslims dietary restrictions

Do not eat pork do not drink alcohol No food or beverages during daylight hours during Ramadan (month long)

Orthodox Jewish diet

Do not eat shell fish, or pork Fast on yun kipper?

E

Effects on medical care and end of life issue

D

Even though the nurse performs a detailed nursing history in which spirituality is assessed on admission, problems with spiritual distress may not surface until days after admission. What is the probable explanation? A. Patients usually want to conceal information about their spiritual needs. B. Patients are not concerned about spiritual needs until after their spiritual adviser visits. C. Family members and close friends often initiate spiritual concerns. F. Illness increases spiritual concerns, which may be difficult for patients to express in words.

How nurses can facilitate the religious practice

Familiarize the patient with religious services within the institution Respect patients need for privacy during prayer Assist the patient to obtain Devotional objects and protect them from loss or damage Arrange for the patient to receive sacraments if desired Attempt to meet dietary restrictions Arrange for a priest minister or rabbi to visit if the patient wishes

Islam

Five daily prayers

Anandarajah HOPE acronym

H O P E

Counseling clients spiritually

Have the patient articulate spiritual beliefs Explore the origin of the patients spiritual beliefs and practices Identify life factors that challenge the patients spiritual beliefs Explore alternatives when giving these challenges Develop spiritual beliefs that meet the need for meaning and purpose care and relatedness and forgiveness

Islamic women

Have torso arms legs and head covered

Adventist health care practices

Holistic approach to healthcare; narcotics & stimulants prohibited; may regard Saturday as the Sabbath day Approach to health care holistic Body is the temple of holy spirit

Evaluating Expected Outcomes

Identify some spiritual belief that gives meaning and purpose to life. Move toward healthy acceptance of the current situation. Develop mutually caring relationships. Reconcile interpersonal differences causing anguish. Verbalize satisfaction with relationship with God. Express peaceful acceptance of limitations and failings. Express ability to forgive others and live in the present. Demonstrate interior state of joy, freedom from anxiety and guilt.

Catholism

Importance of Mass attendance; diet; only natural means of birth control; abortion, sterilization, & euthanasia prohibited Worship of the one God revealed to the world through Jesus Christ. Love of neighbor is a central tenet. Other beliefs include sin, redemption, salvation, and a final accounting with God. Care of the sick is encouraged. God the author and giver of life is also the healer. Human life is a gift of God. Many take an antiabortion stance; most accept modern medical science.

Prayer of Meditation

Involves human pleading or experiencing for the divine can be moments of silence

Sacred symbols

Jewelry Metals Angulous cons totem Body ornamentation (Rosary or saint Christopher pendant) Pronounce ones faith For protection comfort and strength

Pastoral care if requested

Joint commission requires

Room Preparation for Spiritual Counselor Visit

Make sure the room is orderly and free of unnecessary equipment. Provide a seat for the counselor near the patient's bed. Clear the top of the bedside table and cover with a clean white cloth for sacraments. Draw the bed curtains if the patient cannot be moved to a private setting.

C

Mr. Brown's teenage daughter had been involved in shoplifting. He expresses much anger toward her and states he cannot face her, let alone discuss this with her: "I just will not tolerate a thief." Which nursing intervention would the nurse take to assist Mr. Brown with his deficit in forgiveness? A. Assure Mr. Brown that many parents feel the same way. B. Reassure Mr. Brown that many teenagers go through this kind of rebellion and that it will pass. C. Assist Mr. Brown to identify how unforgiving feelings toward others hurt the person who cannot forgive. D. Ask Mr. Brown if he is sure he has spent sufficient time with his daughter.

holy days

Observances and feast days occur

Meeting spiritual needs

Offering a compassionate presence Assisting in the struggle to find meaning in the face of suffering, illness, and death Fostering relationships that nurture the spirit Facilitating patient's expression of religious or spiritual beliefs and practices

O

Organized religion

Spiruality

Permeates life providing purpose meaning strength and guidance

P

Personal spirituality and practice

Spiruality

Positive and negative life experience can influence Each person has a unique

Roman Catholic

Seven canonical prayers

objective assessment data

Significant behavioral observations Sudden changes in spiritual practices Mood changes Sudden interest in spiritual matters Disturbed sleep

H

Sources of hope meaning comfort strength Peace love and connection

spiritual dimension

Spiritual needs Need for meaning and purpose Need for love and relatedness Need for forgiveness

Concepts related to spirituality and spiritual health

Spirituality Faith Religion Hope Love Spiritual health and healing

D

The Roman Catholic family of a baby who was born with hydroencephalitis requests a baptism for their infant. Why is it imperative that the nurse provides for this baptism to be performed? Baptism frequently postpones or prevents death or suffering. It is legally required that nurses provide for this care when the family makes this request. It is a nursing function to assure the salvation of the baby. Not having a Baptism for the baby when desired may increase the family's sorrow and suffering.

Christian Scientist

They deny the existence of health crises; sickness and sin are errors of the human mind and can be overcome by altering thoughts, not by using drugs or medicines. will use ortho services to set bone; decline drugs and other medical services; ETOH & tobacco are not used

Mormons (Latter Day Saints)

Wear temple garments

Jewish holy day

Yom Kippur Hanukkah Tishri Ruhashona

Buddhism

accept modern medicine; check with client regarding diet restrictions Buddha—or "the Great Physician"—taught the Four Noble Truths to indicate the range of "suffering," its "origin," its "cessation," and the "way" that leads to its cessation. The real cause of human suffering is ignorant craving. The Noble Eightfold Path—which consists of right views, aspirations, speech, conduct, mode of livelihood, effort, mindfulness, and concentration—leads to the cessation of suffering.

Confucianism

appreciate life; desire to keep body from untimely or unnecessary death Historically emphasized public health solutions to impending health problems.

religious beliefs

beliefs affecting diet about illness and healing about dress and modesty Beliefs related to birth Related to death

Jehovah's Witness

blood transfusions violate God's laws; courts have not supported right of parent to refuse treatment for children; ETOH & tobacco discourage They oppose the "false teachings" of other sects; opposition often extends to modern science, including medicine.

Religion, Law, Ethics and Medicine

challenges Protection under veil of religious freedom Painful care deemed medically futile Cruel and abusive care administration Ethics committee consultation

love

connectedness with others

Mormons (Latter Day Saints)

disapprove ETOH, tobacco, & caffeinated beverages; special undergarment worn by some should only be removed in case of emergency Devout adherents believe in divine healing through the "laying on of hands," though many do not prohibit medical therapy. The Church maintains an extensive and well-funded welfare system, including financial support for the sick.

Mormons (Latter Day Saints) diet

do not drink caffeinated beverages or alcohol

American Muslim Mission

encouraged to obtain health care by members of the Black community; major tenets involve prayer rituals, hygiene, & marital faithfulness Major tenets involve prayer rituals, dietary restrictions (prohibitions against pork and alcohol), hygiene (extreme cleanliness), lifestyle modifications, and marital faithfulness. Koran sacred scripture

Unitarian

free to accept what they feel best for their own health Encourage creativity, reason, and living an ethical life. No member is required to adhere to a given creed or set of religious beliefs. The inherent worth and dignity of every person is affirmed.

religious practices

holy days Sacred texts Sacred symbols Prayer and meditation

Daiosm / Taoism

knowing and living natural life is secret to health; long tradition of meditation to establish harmony of body & spirit, humanity, and nature (holistic approach) Balance of internal and external forces

Roman Catholic diet

no meat on fridays during lent

Islam

obligatory prayers; some women are not allowed to make independent decisions; husbands needed for consent death and prayer rituals Allah, one God, who is only one, all seeing, all hearing, all speaking, all knowing, all willing, all powerful. Must be able to practice the Five Pillars of Islam. May have a fatalistic view of health.

How nurses implement spiritual care

offer supportive presence Facilitate patients practice of religion Nurture spirituality Pray with a patient Pray for a patient Counsel the patient spirituality Contact a spiritual counselor Resolve conflicts between treatment and spiritual activities

Buddhist and Hindus diet

often vegetarians

Hinduism

open to new ideas; nurse should avoid touching client's lips; death rituals Doctrine of Transmigration. Moral factors, linked with the all-embracing doctrine of "karma," are believed to be significant in promoting health or causing disease. prescribed rites are followed after death; disposal of the body is by cremation.

Protestantism

religious practices common (baptism, communion, confirmation) but vary according to denomination Worship of the one God revealed to the world through Jesus Christ. Love of neighbor is a central tenet. Other beliefs include sin, redemption, salvation, and a final accounting with God. Care of the sick is encouraged. God the author and giver of life is also the healer. Most accept modern medical science.

Skihism

respect dress code; removal of turban w/o permission considered an insult; prefer HCP or nurse of the same sex Draws on features from Islam and Hinduism to establish a reformist movement with the aim of creating a new world order based on equality and social justice for all. The holy book is a code of conduct for daily life and an instruction for reaching true understanding and unity with God, the ultimate goal.

Native Americans

ritualistic for important life changes; medicine men & women have specialized spirits for curing; common therapeutic measures Difficult to generalize; notion of cosmic harmony, emphasis on directly experiencing powers and visions and a common view of the cycle of life and death. Death is not the end but the beginning of new life (reincarnation or transcendent hereafter).

Baha'i

seek competent medical care; permanent sterilization prohibited; abortion discouraged; obligatory prayers, holy days and 19-day fast Believe in a basic harmony between religion and science

Judaism

special needs for diet, birth, death, & male/female contact; no procedures on Sabbath Formation closely bound with a divine revelation and with commitment to obedience to God's will. The Hebrew Bible is the authority, guide, and inspiration of the many forms of religion of the Jews (currently Reform, Conservative, Orthodox).

Patient Goals/Outcomes

• Identify spiritual beliefs that meet needs for meaning and purpose, love and relatedness, and forgiveness. • Derive strength, hope, and comfort from these beliefs. • Develop spiritual practices that nurture communion with inner self, God, and the world. • Express satisfaction with compatibility of spiritual beliefs and everyday living.