Chapter 46 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? "Do you have a preference as to which spiritual leader you would like to visit?" "Would you like me to contact the hospital chaplain to come and visit with you?" "I will see who is available and ask him or her to come by and visit with you." "I will get a phone number for you so you can call a healer to ask for a visit."
"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 shaman, 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.
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?" "You would like the priest to come and visit you, right?" "Does the present situation interfere with any spiritual or religious practice?"
"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?" "Why do you still not believe in God?" "Do you feel your faith is helpful to you?" "Why can't you share your feelings with me? I am your nurse." "Is there anyone from your church you would like to talk to?"
"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?" Explanation: Several nurses have developed spiritual assessment tools. Stoll's (1979) Guidelines for Spiritual Assessment is an early widely recognized spiritual assessment tool. This tool is built around a definition of spirituality that encompasses religion and belief in a higher power. It identifies four areas and suggests questions for each: (a) concept of God or deity, (b) source of hope and strength, (c) religious practices and rituals, and (d) relationship between spiritual beliefs and state of health. "Is religion or God significant to you?" is a question asking about the concept of God or deity. "Do you feel your faith is helpful to you?" focuses on the relationship between spiritual beliefs and state of health. "Is there anyone from your church you would like to talk to?" asks about their source of hope and strength. Asking the client why they do not believe in God and why they will not share their belief are questions focusing on belittling and degrading the client.
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." "Why do you not belong to an organized religion?" "Do you think of yourself as a religious person?" "Can I set up an appointment for you with our hospital chaplain?
"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 has the health care provider told you about your treatment?" "What provides you with strength to deal with this health situation?" "What is the most important thing in your life right now?" "What role does a higher power play in your life?"
"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 performing the initial assessment on a client admitted with pneumonia. The client tells the nurse, "Last time I was here, the nurse gave me the wrong medication!" Which statement by the nurse will help establish trust with the client? Reply that the nurse is not the nurse last time and will not make a mistake. Tell the client the nurse has no control over what happened last time. Call and report the client's behaviors to the hospital's legal team. Actively listen to the client and allow expression of negative feelings.
Actively listen to the client and allow expression of negative feelings. Explanation: Active listening and permitting expression of feelings allows the client to communicate about experiences and feelings in a nonjudgmental environment. This will foster a nurse-client relationship based on trust. Replying that the nurse is not the nurse when the problem occurred dismisses the client's concerns. Telling the client the nurse has no control over what happened last time may make the client feel defensive and cause more distrust. Calling and reporting the client's behaviors to the legal team is not addressing the client's needs.
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? Determine if the client prefers pork or pork products. Direct the client to list favorite food selections. Ask the client what diet is followed at home. Suggest replacing traditional fish with shellfish foods.
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.
The nurse receives a "do not resuscitate" (DNR) order for a dying client. What should the nurse do next? Assess the client's spiritual needs Inform the client that a priest will be in to see her very soon. Avoid talking about suicide and its effects. Inform the family that this order does not keep the nurse from doing her job.
Assess the client's spiritual needs Explanation: Conducting a spiritual assessment is an essential aspect of maintaining health and providing holistic and sensitive nursing care especially in a DNR. Following the spirituality assessment, if the client has additional questions or concerns related to spirituality, the nurse may suggest follow-up with a chaplain or a priest, but there is no indication the client requested spiritual guidance. A nurse should not discuss suicide and its affects as that is inappropriate. The order may impact the nurse's interventions but this is not the priority at this point.
The nurse's client states that his pastor is coming in a few hours to pray with him and offer sacrament. The nurse plans to do the following things in preparation for this. Select all that apply. Clear the bedside table; cover with clean towel. Complete your work so you may join them. Have a chair available near the bed. Clear the room of unnecessary items. Keep the bed curtains open so as to allow others to join in prayer
Clear the bedside table; cover with clean towel. Have a chair available near the bed. Clear the room of unnecessary items. Explanation: When expecting a visit from a client's spiritual counselor, preparations may vary, but the following are usually recommended:• 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.• The bed curtains should be drawn for privacy if the client can't be moved to a more private setting.The nurse should not expect or plan to join a private group such as described.
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. Perform a detailed spiritual assessment of the client. Organize a meeting between the chaplain, the son, and the client to achieve a resolution. Document the client's request and wait to see if the client reiterates the request.
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.
The nurse is caring for a dying male client who practices Islam. What is the most appropriate action for the nurse after the client's death? Ensure that a male washes the client's body. Place the body on the floor to facilitate the soul's journey. Ensure that no one is in the room when the client dies. Ensure that someone performs the anointing of the sick sacrament prior to the client's death.
Ensure that a male washes the client's body. Explanation: Islamic beliefs about death are that the family should be with the dying person so they can read the Koran and pray. There are also special procedures for care of the body after death; men wash male bodies and women wash female bodies and a variety of other rituals are performed. Hinduism beliefs include placing the body on the floor to facilitate the soul's journey. The anointing of the sick sacrament is part of the Roman Catholic faith.
The nurse is caring for a client diagnosed with human immunodeficiency virus (HIV) 10 years ago. The client states, "my relationship with God has helped me to survive this long". The nurse determines that the client's spiritual well-being is demonstrated by being at peace with which entities? Select all that apply. God Self Community Environment Family
God Self Community Environment Explanation: Spiritual well-being is the condition in which a person is at peace with God, self, community, and environment.
A client who is on hospice care and has no immediate family has been given less than 1 week to live. The nurse caring for the client recognizes that providing presence is most important, especially when a client is dying. What would be the best way for this nurse to provide presence to this client? Check on this client every hour. Sit in the chair on the other side of the room for 10 minutes each hour. Hold the client's hand and sit by the bedside as often as possible. Tell the client that you are there when needed and to just ring the call bell.
Hold the client's hand and sit by the bedside as often as possible. Explanation: The nurse can offer supportive presence by holding the patient's hand to show that he or she is sincerely concerned, or simply by being present to communicate value and respect. The other options do not show that the nurse truly cares. Checking on the client every hour demonstrates the nurse wanting to take care of physical needs rather than spiritual needs. Sitting in the chair on the other side of the room is not a caring behavior. Telling a client who is close to death to use the call bell demonstrates a nurse's inability to give caring behaviors.
A client who is admitted to the ER with severe right-sided abdominal pain is diagnosed with appendicitis. The surgeon is called and proceeds to explain the procedure to the client and asks her to sign the consent. The client refuses and informs the doctor that her husband needs to be called to do this. Which of the following religions does this client likely practice? Hinduism Catholicism Islam Judaism
Islam Explanation: Some Muslim women are not allowed to make independent decisions; husbands may need to be present when consent is sought. The other religions, Hinduism, Catholicism, and Judaism, do not restrictions on women to make independent health care decisions.
Mrs. Dopson is a 75-year-old widow who lost her last offspring to cancer last month. She shares with the nurse that she fears being alone. The nurse knows that this is related to which of the following spiritual needs believed to be common to all people? Need for meaning and purpose Need for love and relatedness Need basic necessities of life Need for forgiveness
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 a loss of love and relatedness. A need for meaning and purpose can be related to loss of a job or function. Need for forgiveness is reconciling differences with other persons. Basic necessities are something necessary or indispensable such as food, water, and shelter.
The nurse is preparing to complete a spiritual assessment of a client. What step should the nurse complete first? Perform a self-assessment of her own spiritual beliefs. Provide for privacy during the assessment. Determine if the client would like any family members present during the assessment. Gather the needed paperwork for the assessment.
Perform a self-assessment of her own spiritual beliefs. Explanation: Prior to assessment, nurses should be aware of their own spiritual condition. Acknowledging and recognizing select spiritual beliefs as personal will allow the nurse to discern and focus on the specific needs of the client.
A nurse is caring for a client with terminal illness who believes that death and reincarnation are the ultimate gifts from a higher power. What would be most appropriate to integrate into this client's plan of care when providing spiritual support? Consult the pastoral care department to assist the client. Provide support that builds on the client's faith. Only provide foods that are halal. Document "no blood or blood products due to religious beliefs" on the care plan.
Provide support that builds on the client's faith. Explanation: The nurse should support and build on the client's faith. Nurses should not attempt to change the faith that a client already possess. Consulting the pastoral care department should only be done upon request of the client. Providing foods that are halal is assuming that the client is of Muslim faith, which is not indicated in the scenario. Documenting "no blood products..." on the client's plan of care is assuming the client is of the Jehovah's Witness faith, but again there is no clear indication of a specific faith identified in the scenario.
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 Review the client's medication list for possible side effects Conduct a focused assessment to eliminate any potential infections Search the client's room for any drugs or other substances
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 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? Explain to the client that there are times when a blood transfusion may be necessary. Recommend that the client be transferred to another health care facility. Praise the client for sticking to religious beliefs. Record this information in the client's chart.
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.
While studying religion and spirituality, the nursing student exhibits an understanding of the concepts when making which of the following statements? Religion is a collection of spiritual beliefs and practices. Religion and spirituality are synonymous. Spirituality is the behavioral manifestation of religious beliefs. Spirituality is a recently developed alternative to traditional religious belief.
Religion is a collection of spiritual beliefs and practices. Explanation: Spirituality may or may not include religion, which is a codified system of spiritual beliefs. The two terms are not interchangeable, and spirituality is not solely concerned with outward behavior. Spirituality is not necessarily an "alternative" to religion; nor is it a recent development.
The family members of a dying client have asked for the hospital chaplain's help in having a member of the clergy come to the client's bedside to perform the anointing of the sick. The nurse who is providing care for the client should recognize that the family is likely which religion? Roman Catholic Christian Scientist Jehovah's Witnesses Jewish
Roman Catholic Explanation: Among the sacraments of the Roman Catholic Church is the anointing of the sick or the sacramental anointing with blessed oil. This specific rite is not a component of Jehovah's Witnesses, Christian Science, or Judaism.
When a nurse supports the client's spiritual needs, the nurse supports which level of the Maslow's hierarchy of needs? Physiologic needs Security needs Ego needs Self-actualization needs
Self-actualization needs Explanation: In the hierarchy of human needs, spiritual well-being appears to connote fulfillment of needs beyond the self-actualization level. Spiritual well-being has been associated with health and general well-being. Safety needs in Maslow's hierarchy refer to the need for security and protection. When we have our physiological needs for food and water met, our safety needs dominate our behavior. Physiological needs deal with the maintenance of the human body. This lowest category includes the most basic needs that are vital to survival, such as the need for water, air, food, and sleep. There are no ego needs in the hierarchy.
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? Change in beliefs Spiritual crisis Separation from spiritual ties Depression
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 bedridden hospitalized client expresses a belief that missing weekly church service is a failure to live by the church's rules. The notes not missing a service in the past 50 years. Which is an appropriate nursing diagnosis for this client? Spiritual Distress related to inability to attend church services evidenced by verbal states of guilt Spiritual Need as evidenced by verbalizations and distress at missing Methodist church services Dysfunctional Grieving related to inability to attend church services as a result of his medical condition Potential for Enhanced Spiritual Well-Being related to distress at missing Methodist church services
Spiritual Distress related to inability to attend church services evidenced by verbal states of guilt Explanation: Persons suffering spiritual dysfunction or distress may verbalize such distress or express a need for help
A client informs the nurse about being unsure of some of the health practices as a newly practicing Jehovah's Witness. What information can the nurse share with the client regarding cultural beliefs about blood products? Spiritual care consultants can provide support to the client. Medical professionals know what is best for the client. Church elders will make health care decisions for the client. Nursing leadership can explain blood transfusion policy to the client.
Spiritual care consultants can provide support to the client. Explanation: Jehovah's Witnesses do not accept blood transfusions. If the client is unsure of what decision to make regarding blood transfusions, the nurse may request a spiritual care consult. The spiritual care team can give the client support needed to make an informed decision. The medical team can offer the client information regarding risks and benefits, but ultimately, the client decides what is best. Although church elders may provide support, they cannot legally make decisions for the client. Hospital policies do not force a client to make a decision without regarding cultural or religious preferences.
The nurse enters a client's room as the client and family are praying. Which is the most appropriate action of the nurse? Stand quietly by the inside the room until the prayer is finished. Step outside the door until the prayer is finished. Walk up to the client's bedside and join in the prayer. Walk up to the client's bedside and stand quietly.
Step outside the door until the prayer is finished. Explanation: By stepping outside the door, the family and client will not be rushed to finish the prayer. Stepping up to the bedside may distract the client and or family.
An older adult client who is very sick but very spiritual and has a deep faith asks the nurse to say a prayer for her. The nurse, who is not very comfortable praying out loud, wants to honor the client's request. What would be the best action by the nurse? Tell the client that they are not comfortable praying out loud. Take the lead from the client by asking, "How would you like us to pray?" Inform the client that they will try to get another nurse to pray with the client. Tell the client the nurse is busy at the moment and hope the client will forget.
Take the lead from the client by asking, "How would you like us to pray?"
An older adult client who is very sick but very spiritual and has a deep faith asks the nurse to say a prayer for her. The nurse, who is not very comfortable praying out loud, wants to honor the client's request. What would be the best action by the nurse? Tell the client that they are not comfortable praying out loud. Take the lead from the client by asking, "How would you like us to pray?" Inform the client that they will try to get another nurse to pray with the client. Tell the client the nurse is busy at the moment and hope the client will forget.
Take the lead from the client by asking, "How would you like us to pray?" Explanation: Because there are many forms of prayer—quiet reflection, silent communion with God or a higher power, reading or recitation of formal prayers, silent or loud calling on God or a higher power or conversation with God or a higher power, lamentations, or reading a holy book or other religious materials—the nurse can take the lead from the patient by asking, "How would you like us to pray?" Consider the patient's religious background along with the type of prayers that have been meaningful in the past. Ask whether the patient has a particular prayer request. A nurse unaccustomed to praying aloud or in public may find it helpful to have a Bible passage or formal prayer readily available. The prayer may also be a simple expression aloud of the patient's needs and hopes. The other options are not therapeutic.
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 expresses hope and sense of meaning. The client expresses satisfaction with life. The client uses a type of spiritual experience that provides comfort. The client will experience alternate venues of spiritual expression.
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 dying client requests that the nurse pray with him. The nurse is not accustomed to praying aloud but is comfortable praying silently. What is the best approach for this nurse to follow to pray with this client? The nurse should select a formal prayer or Bible passage to use to pray aloud. The nurse should defer the client's request to pray. The nurse should inform the client that she will pray for the client but not with him. The nurse should ask the client's roommate to pray with the client.
The nurse should select a formal prayer or Bible passage to use to pray aloud. Explanation: A nurse unaccustomed to praying aloud or in public may find it helpful to have a Bible passage or formal prayer readily available for praying. If the nurse is not comfortable praying with the client, they should call the hospital chaplain or find another individual who is comfortable.
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. educating the child about religion. educating the child about God. educating through religious-based schools.
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.
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: trust. forgiveness. love and relatedness. faith.
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.
While interviewing a client, a nurse is told that the client practices Catholicism. This client is identifying: his spirituality. his faith. his values. his culture.
his faith. Explanation: Faith is a term also used to describe a cultural or institutional religion such as Judaism, Islam, Catholicism, or Confucianism. Spirituality refers to anything that pertains to a person's relationship with a higher power or force. Values refer to those beliefs most meaningful to a person. Culture pertains to a person's background.
Which set of terms best reflects nursing's view of clients as holistic beings? physical, psychosocial, religious mind, body, spirit id, ego, superego spiritual, egocentric, naive
mind, body, spirit Explanation: Nursing has a long history of incorporating spirituality into client care. References to spirituality underlie a primary idea in nursing, that clients are viewed as holistic beings in body, mind, and spirit. Id, ego, and superego are concepts associated with psychoanalytic theory. A holistic view is more than physical, psychosocial, religious, egocentric, and naïve.
When the client tells the nurse that she believes God's reality is personal, and that God is the creator of all beings, the nurse determines the client is expressing: deism. agnosticism. atheism. theism.
theism. Explanation: Theism is the belief that God's reality is personal, without a body, perfect in all things, and creator and sustainer of the universe.
