Chapter 16: Spirituality
During the admission assessment, a patient tells the nurse that he does not believe there is a God. The nurse should document his religious affiliation as: 1) Agnostic 2) Atheist 3) Christian Scientist 4) Rastafarianism
Answer: 2) Atheist Rationale: Those who actively deny the existence of God are known as atheists. Agnostics believe it is not possible to know whether or not God actually exists. Christian Scientists believe in the presence of God, who is the basis of their health and healing. Rastafarians follow the Old and New Testaments of the Bible and emphasize a deep love of God.
What Are the Main Points in This Chapter?
-Spirituality is a powerful force in the lives of many patients. -Nursing has historical roots in religion and spirituality. -Nurses work with other disciplines to provide spiritual care. -Religion is a sort of "map" that outlines and integrates essential beliefs, values, and codes of conduct into a manner of living. -Spirituality, like a journey, takes place over time and involves the accumulation of life experiences and understandings. It is the attempt to find meaning, value, and purpose in life. -Religion and spirituality affect health and well-being; in turn, health and well-being affect a person's religion and spirituality. -Research suggests that patients' belief in religion and spirituality are important to healthcare outcomes; however, it does not explain how or why this is so. -The more you know about similarities in and differences among the world's major religions, the more you will be able to offer comprehensive, compassionate care to patients. -People, even within the same religion, vary greatly in the degree to which they follow the rituals and practices of their religion. -Self-knowledge helps you to avoid abuses of spiritual care (e.g., imposing your religion on a patient). -Barriers to spiritual care include (1) lack of awareness of spirituality in general and of your own spiritual belief system, (2) differences in spirituality between you (the nurse) and the patient, (3) fear that your spiritual knowledge is insufficient, and (4) fear of where spiritual discussions might lead. -Nursing interventions related to spiritual care require you to be self-aware, fully present, supportive, empathetic, and nonjudgmental and to have a desire to benefit the patient. -When a patient asks you to pray, you must determine whether he wishes you to pray for or with him, and you should ask what he would like you to especially address in the prayer. -A miracle does not necessarily involve the notion of a cure; miracles are more often events that proceed according to natural law but still have a powerful impact on the person's expectations.
What are ways you can support a patient's prayer needs?
Answer: You can support a patient's prayer needs by offering to pray with him, meditate with him, or read spiritual text to him. You can also provide resources the person uses in prayer (e.g., literature, music).
The nurse is admitting a Roman Catholic adult patient who is critically ill. Based on her knowledge of the patient's religion, for which religious practice should she expect to notify the hospital chaplain? 1) Anointing of Sick 2) Baptism 3) Eucharist 4) Sacrament of Reconciliation
Answer: 1) Anointing of Sick Rationale: The sacrament of anointing of the sick is commonly referred to as last rites. It is performed on a seriously ill person and can be repeated if the person recovers and becomes ill later. The sacrament of the Eucharist is communion bread, Reconciliation is confession, and Baptism is the immersion in water practices as a symbol of being re-born and cleansed into Christ.
A Muslim client has asked the nurse to pray with her. Which item should the nurse anticipate that the patient may request before praying? 1) Bathing water 2) Rosary beads 3) Mala beads 4) Prayer cloth
Answer: 1) Bathing water Rationale: Prior to prayer, Muslims participate in Wudhu, which includes ritualistic washing of the hands, feet, hair, mouth, nose, and ears. Cleanliness prior to prayer is a sign of respect to the Creator. Roman Catholics may want to hold their rosary beads while praying. Although rosary beads are commonly associated with Catholicism, many religions may use prayer beads or cloths a symbol of their religion. The mala is the Buddhist rosary beads. Some Buddhists and Hindus meditate with a set of beads, called a mala. The prayer cloth or "handkerchief" is used among several religions associated with Christianity. Others may use a prayer cloth or other religious items.
A patient of Mormon faith is admitted to the hospital with new onset diabetes mellitus. Based on his religious affiliation, which item(s) should the nurse remove from the patient's dinner tray? Select all that apply. 1) Pork 2) Tea 3) Meat 4) Coffee
Answer: 2) Tea 4) Coffee Rationale: Mormons follow a strict health code, known as the Word of Wisdom, which prohibits the consumption of tea, coffee, and alcohol. Conservative Jews avoid pork products. Most Hindus are lacto-vegetarians, which mean they consume milk but not eggs. Buddhists, Hindus, some Rastafarians, and some Christians (on Fridays during Lent) do not consume meat.
True or false? Both religion and spirituality allow a person various ways to access the divine.
Answer: True
True or false: No matter how nonjudgmental and open we may think ourselves, we all carry our own unique biases and prejudices that have the potential to affect patient care.
Answer: True Rationale: The significance of this question is explored further in Think Like a Nurse 16-8 (in Volume 1 of your textbook and on this study guide).
Which statement best describes theology? 1) Discussions and theories related to God and His relation to the world 2) Doctrines about the human soul and its relation to eternal life 3) A lifelong journey involving accumulation of experience and understanding 4) Codes of conduct that integrate beliefs and values
Answer: 1) Discussions and theories related to God and His relation to the world Rationale: Theology is best described as discussions and theories related to God and His relation to the world. Eschatology includes doctrines about the human soul and its relation to death, judgment, and eternal life. Spirituality is considered a lifelong journey. Religion provides codes of conduct that integrate beliefs and values.
Which core issue of spirituality includes a patient's basic human need for achievement? 1) Hope 2) Faith 3) Love 4) Forgiveness
Answer: 1) Hope Rationale: Hope includes the basic human needs to achieve, create, and make something of one's life. Faith addresses our ongoing effort to make sense of our life and our purpose for being. With the aspect of love, we extend our love to others with hope of receiving love. Forgiveness is not a core issue of spirituality.
An agnostic nurse is caring for a devoutly religious patient. The client says, "I am so frightened. Please say a prayer with me." The patient begins praying aloud. What should the nurse do? 1) Remain quietly beside the bed until the client finishes the prayer. 2) Walk quietly from the room while the client is praying. 3) Stop the client and say, "I am not comfortable with prayer. I will get someone to join you." 4) Stay during the prayer and say "Amen" at pauses and when the prayer is finished.
Answer: 1) Remain quietly beside the bed until the client finishes the prayer. Rationale: The nurse might choose to pray or not to; but the nurse must respect the client's dignity and provide spiritual support. Remaining at the bedside during prayer provides support for the client without compromising the nurse's beliefs. The nurse does not need to pray but merely should remain quiet and respectful while the client prays. Only if the client asks should the nurse say she is uncomfortable praying. Secretly exiting the room while the patient is praying is neither respectful nor honest. Participating in the prayer by interjecting and closing with "Amen" is also dishonest because the agnostic nurse does not believe in prayer.
Which of the following questions would provide information about "O" in a HOPE assessment and "S" in a SPIRIT assessment? 1) Do you have any dietary restrictions or needs on religious holidays? 2) What is your religion or what church do you go to? 3) How comfortable are you with discussing spirituality? 4) Do you have an advance directive?
Answer: 2) What is your religion or what church do you go to? Rationale: In the HOPE assessment "O" represents "organized religion." In the SPIRIT tool, "S" represents "spiritual/religious belief system." Dietary needs provide information about ritualized practices and restrictions ("R" in the SPIRIT tool; "E" in the HOPE approach). Asking about the patient's comfort with discussing spirituality addresses personal spirituality ("P" in the SPIRIT tool; "P" in the HOPE approach). Advance directives address terminal events planning ("T" in the SPIRIT tool; "E" in the HOPE approach).
Which of the following is considered a religious denomination within the tradition of Christianity? 1) Buddhism 2) Rastafarianism 3) Mormonism 4) Islam
Answer: 3) Mormon Rationale: Mormonism is a religious denomination within Christianity. Buddhism, Rastafarianism, and Islam are all religious traditions outside of Christianity.
When performing a spiritual assessment, who is the preferred source of information? 1) Durable power of attorney 2) Next of kin 3) Patient 4) Patient's clergyperson
Answer: 3) Patient Rationale: The patient is always the best source of information. Patients who may not participate in an organized religion may be spiritual. Likewise, when confronted with an illness or other medical challenge, patients may reconsider their views and beliefs about religion and/or spirituality. A next of kin should only be used when the patient is unable to communicate for himself. The patient's clergyperson is a source of support for the patient; however, contacting the clergyman without the patient's permission is a breach of patient confidentiality. A durable power of attorney identifies the person who can make decisions for the patient.
A patient remarks to the nurse, "What's the point of going through all these medical treatments? They make me feel so bad, and I will never be well anyway." What is the most helpful action for the nurse to take? 1) Explore with the patient what has triggered his emotions. 2) Treat the patient with dignity and respect. 3) Pray with the patient in a private setting. 4) Assist the patient to identify areas of hope in life.
Answer: 4) Assist the patient to identify areas of hope in life. Rationale: The patient is demonstrating Hopelessness. All of the responses would be appropriate under certain circumstances, but helping the patient identify areas of hope in life most directly addresses Hopelessness. The nurse does not need to explore the trigger for the patient's emotions—he has said that it is the treatments and the lack of hope for returning to wellness. All patients should be treated with dignity and respect; however, this alone would not address Hopelessness. The nurse should pray with the patient only after first learning whether this would be helpful to the patient; in this scenario, that information is not available.
Because of religious beliefs, which of the following patients will most likely refuse a blood transfusion? One who is affiliated with? 1) Islam 2) Mormonism 3) Hinduism 4) Jehovah's Witnesses
Answer: 4) Jehovah's Witnesses Rationale: A core belief of Jehovah's Witnesses is that taking blood into one's body is morally wrong. Thus, they will refuse blood or blood products. There is not a religious rule or objection to receiving blood transfusion or products among the other religions.
Which factor is held in common by many of the world religions? 1) Strict health code, including dietary laws 2) Belief that one must submit to a god or supernatural being 3) Rules prohibiting alcohol consumption 4) Sacred writings that reveal the nature of the Supreme Being
Answer: 4) Sacred writings that reveal the nature of the Supreme Being Rationale: A common factor held by most religions is the sacred writings that are regarded as authoritative and/or reveal the nature of the divine. Not all religions have strict health codes or prohibit the consumption of alcohol. While many religions believe in God or a supernatural being, not all adhere to this belief or practice.
Match the following descriptions with the correct religion: Descriptions A. Teaches reliance on God for healing rather than medicine or surgery B. Will not accept whole blood transfusions but will allow the administration of albumin C. Follows strict health code; avoids alcohol, tea, coffee, and smoking D. Believes all harmony and disease is based in spirituality E. Uses five pillars of faith; forbidden to eat pork F. Observes strict dietary laws, wears skull cap (yarmulke or kippah) and follows written law (Torah) Religions 1. Buddhist 2. Islamic 3. Christian Scientist 4. Catholic 5. Jewish 6. Jehovah's Witness 7. Rastafarian 8. Mormon 9. Native American
Answer: A, 3 B, 6 C, 8 D, 9 E, 2 F, 5
Mary, a young adult female, has experienced a miscarriage after 10 weeks of pregnancy. She is crying and states that this probably happened because her husband does not believe in God. What is your best your best response to Mary? A. "God doesn't punish people for their beliefs." B. "Do you want to talk about your anger at your husband's lack of faith?" C. "You sound very upset. Would you like to talk about these feelings?" D. "You sound really upset. Would you like to see the hospital chaplain?"
Answer: C. "You sound very upset. Would you like to talk about these feelings?" Rationale: This response acknowledges her distress and doubts and offers her an opportunity to verbalize her conflicts. Response A does not validate her feelings. Response B does not keep the focus on her and her own spiritual needs. Response D can be helpful, but you have missed an opportunity to allow her to explore her feelings related to the miscarriage.
A person who spends a great deal of time reviewing his belief system and comparing and contrasting it with alternatives is experiencing which of the following? A. Spiritual growth B. Religiosity C. Religious struggle D. Spiritual distress
Answer: C. Religious struggle Rationale: Religious struggle is conflict that arises within the self, with others, and with God that can lead to spiritual growth, crisis, or despair. Growth is learning and becoming more versed in one's faith and belief system. Religiosity is a preoccupation with religion or religious themes. Spiritual distress is intense conflict between one's faith beliefs and a situation that is counter to or challenges these beliefs.
Mr. Jones, a former patient who survived a serious illness, comes to your patient care unit on Saturday afternoon. He has packets of literature about his religion; its philosophy, values, meeting places; and some prayers. He asks if he can place the information in the family waiting area. What is your best response? A. "Yes, this would be helpful for many of the families. B. "No, hospital policy doesn't allow for it." C. "I would be happy to do it for you. Let's place the literature in the staff lounge." D. "I will need to check the hospital's policy and discuss your request with my manager."
Answer: D. "I will need to check the hospital's policy and discuss your request with my manager. Rationale: The best response is to find out whether the hospital has a policy on literature and solicitation before you either encourage or discourage the patient's action. Response A does not represent respecting those patients or families who may be uncomfortable with this literature. Response B can be correct but does not demonstrate respect or appreciation of the patient's spirituality. Response C avoids the problem and does not address the spiritual issues.
What qualities can you demonstrate that may help you improve the quality of spiritual care you provide?
Answer: Examples of qualities include the following: -Being open to multiple interpretations of reality and multiple ways of believing and being -An open manner of thinking that includes rather than narrows -The desire to acquire more self-knowledge -Awareness of your own biases -Being nonjudgmental -Welcoming challenging experiences that allow for personal growth -Being aware of your limitations; realizing you cannot be all things to all people
Which major religion believes in the anointing of the sick or dying?
Answer: In the Christian faith, Roman Catholics believe in anointing the sick and/or dying. Orthodox Catholics and some Protestant denominations also practice the ritual of anointing (this information is not in the chapter).
Which denomination or religion does not believe in blood transfusions?
Answer: Jehovah's Witnesses
Regardless of their differences, what do many world religions have in common?
Answer: Many religions have the following commonalities: -Theology—that is, discussions and theories related to God and God's relation to the world -Sacred writings that are regarded as authoritative and reveal the nature of the divine (e.g., God) in some way -A notion of created order and purpose -A definition of human beings that includes important life events -A notion of sin (primarily in Western religions) -An explanation of the origin of evil and the nature of suffering -A conception of either salvation (in Judaic religions) or enlightenment (in Eastern religions) -A view toward eschatology, or doctrines about the human soul and its relation to death, judgment, and eternal life (primarily a Western concept) -An explanation of the nature of reality, the higher self or soul, the relationship between human beings and the divine, and the purpose of human existence
What common barriers to spiritual interventions do nurses encounter?
Answer: Nurses encounter the following common barriers: -A lack of awareness of spirituality in general -The lack of awareness of your own spiritual belief system -Differences in spirituality between the nurse and the patient -The fear that your knowledge base is insufficient in this area -The fear of where spiritual discussions may lead
What is prayer?
Answer: Prayer is the way that a person responds to God.
What are some of the ways that religion might positively influence health?
Answer: Religion has the following positive influences on health: -Church attendance has been shown to increase life span and promote mobility with age. -Religious affiliation may prescribe diets and health practices that promote healthful lifestyles (for example, restrictions about eating red meat, smoking, or alcohol may positively influence weight, blood pressure, cholesterol levels, and risk for certain types of cancers).
Which can be compared to a journey: religion or spirituality?
Answer: Spirituality Rationale: Religion is conceived as the "map."
What are the six areas for spiritual assessment summarized in Highfield's (2000) acronym SPIRIT?
Answer: S—Spiritual/religious belief system P—Personal spirituality I—Integration with a spiritual community R—Ritualized practices and restrictions I—Implications for medical care T—Terminal events planning
List three core issues of spirituality.
Answer: The following are core issues of spirituality: Faith Hope Love
What three key dimensions are assessed with the JAREL spiritual well-being scale?
Answer: The following key dimensions are assessed with the JAREL scale: Faith/belief Life/self-responsibility Life satisfaction/self-actualization
When a patient asks you to pray for him, what might be your most effective first response?
Answer: The most effective first response, assuming that the nurse is comfortable with praying with patients, would be something along the lines of, "What would you like for me to include in the prayer?" or "What would you like me to pray for?" or "What would you like for me to especially address in the prayer?"
Consider the following statement: A nursing diagnosis that reflects either an actual or a potential problem may reflect religious and/or spiritual dimensions of the human condition. Is this statement true?
Answer: This is a true statement.
Would it be true for a physical diagnosis (e.g., Disturbed Sleep Pattern)? Explain your thinking.
Answer: This is true for physical diagnoses. Rationale: It is an important point for the student to understand. Many nursing diagnoses will have spiritual and/or religious implications associated with them but may be classified as being more in the physiological, emotional, or psychosocial domains. For example, manifestations of depression may be related to altered feelings of self-worth (worthlessness) or a sense of failure, which may stem from religious feelings of unworthiness, guilt, or shame. To effectively assess, plan, intervene, and strive for positive outcomes that generate feelings of worth, usefulness, value, and self-love, you must address the religious/spiritual domain of care. You need to know what aspects of the patient's religious beliefs are contributing to the person's negative feelings and overt manifestations of depression.
In terms of Native American beliefs and healthcare, who is the traditional healer or the person to be consulted in the event of "illness"?
Answer: Traditional healers are medicine men and women.
True or false: Most Hindus are vegetarian.
Answer: True