Chapter 41 Spirituality
A client is critically ill. The policy in the critical care unit is that no more than 2 visitors are allowed at one time. A group of 12 church members arrives for laying on of hands, anointing, and prayers of healing. The nurse's best option is to: a. Be kind but firm about the policy. Explain that there are no exceptions, and the unit adheres to the policy. b. Call the client's physician for approval. Write the instructions as an order and explain the orders to the client and church members. c. Discuss the situation with the client and respect the client's wishes with the least disruption possible. d. With the client's permission, allow the church members to pray in the waiting room.
C. Discuss the situation with the client and respect the client's wishes with the least disruption possible. [The nurse is an advocate for the client before others. If a critically ill client desires prayer and a healing ceremony, the nurse should do his best to accommodate that situation while keeping in mind the needs of other clients in the critical care unit. It may be that only half of the group will be able to enter. A physician's order is not necessary unless that is the unit's policy.]
A 16-year-old client is involved with church activities and active in the youth group. According to Westerhoff's stages of faith, the client's behavior is indicative of which stage of spiritual development? a. Searching faith b. Reconciled faith c. Experienced faith d. Owned faith
C. Experienced Faith [The client is a typical adolescent who accepts faith as an experience. Searching faith, reconciled faith, and owned faith reflect faith development of one more nature]
A client informs the nurse that he is reading the Torah. To what religion does this sacred writing belong? a. Buddhism b. Hindu c. Judaism d. Islam/Muslim
C. Judaism [The Torah belongs to Judaism. The sacred teachings of Buddhism are Four Noble Truths and Noble Eightfold Ways. The sacred Scripture of Hindu is the Vedas. The sacred book of Islam/Muslim is the Qur' an]
a client reports, "Cancer was the best thing that happened to me! It is making me appreciate life so much more." This statement is best with which NANDA diagnosis? a. Spiritual Distress b. Risk for Spiritual Distress c. Readiness for Enhanced Spiritual Well-Being d. Cognitive Denial
C. Readiness for Enhanced Spiritual Well-Being [This client portrays no distress or risk for distress but rather the potential for enhanced spiritual health as a result of the transformative illness experience. Cognitive Denial is not a valid diagnosis]
A client in the emergency department needs a transfusion of RBC. The client tells the nurse that, as a Jehovah's Witness, blood transfusions are not permitted. Which statements most likely lead to a resolution for this conflict. a. you must accept the transfusion or else leave b. don't worry, you can ask for pardon after taking the blood c. may i please call a representative of your religious so that i can understand your position better? d. i understand your position; I'll be here with you as you die.
C. may i please call a representative of your religious so that i can understand your position better?
A client is experiencing severe pain that cannot be controlled by analgesics. An appropriate intervention is full presencing, which involves which of the following?? a. physical presence b. physical presence with mental awareness of the client c. physical, mental and emotional presence d. physical, mental and spiritual presence
C. physical, mental and emotional presence [the key term is FULL]
Research evidence that supports providing spiritual care to older adults that a. older adults are not very religious, but are very spiritual. b. older adults who are more religious have more illness c. spiritual health and mental health are correlated d. increased spiritual well-being is found among older adults with depression
C. spiritual health and mental health are correlated [Many older adults are religious and spiritually aware. Options A, B, and D, are disputed by recent research evidence]
A home health nurse is caring for a 68-year-old client whose husband recently died. The client is depressed and tearful. Which of the following statements by the client most likely indicates spiritual distress? a. "I don't feel like going out, but the ladies from the church are taking me to lunch." b. "I wish the Lord had taken me instead of my husband." c. "The minister is coming to see me every week." d. "I've gone to church all these years for nothing. What a waste of time."
D. "I've gone to church all these years for nothing. What a waste of time." [This type of distress is one that that disrupts one's very nature of being]
When planning care for an older client residing in your skilled nursing facility who is searching to make life meaningful, which nursing action would be most beneficial? a. assess for depression b. diagnose and document that the client has "spiritual distress." c. Keep the client busy with social activities d. Explore with the client their desire legacy
D. Explore with the client their desire legacy
A nurse employed in a large city hospital cares for clients from many different cultures. Which of the following practices will help the nurse meet the spiritual needs of these clients? a. Applying the nurse's spiritual beliefs to the needs of the client b. Studying the Christian Bible c. Approaching each client in exactly the same manner d. Learning about various religious traditions
D. Learning about various religious traditions [The nurse is most likely unfamiliar with some of the spiritual practices of other cultures.]
A dying client states, "Part of what makes dying hard is that I don't know for sure where I'm going. Nurse, what do you believe in the hereafter?" which ethical guideline should guide your response? a. never share personal spiritual beliefs b. share all spiritual beliefs, favoring none c. share only your beliefs d. first assess for what prompts the client's question
D. first assess for what prompts the client's question [Assessment is always the first step of the process of spiritual caregiving or any nursing activity]
A preoperative client asks the nurse to pray along with the client and spouse. The nurse is not accustomed to praying. What would be the most helpful nursing action? a. It is best that the nurse prays with the client or offers to stay during private prayer. b. The nurse should offer to call the client's religious counselor and request a visit. c. The nurse should ask the supervisor to find a nurse who belongs to the same religion as the client. d. The nurse should explain that prayer is not part of a nurse's duties, and offer to contact the hospital chaplain.
A. It is best that the nurse prays with the client or offers to stay during private prayer. [The client is preoperative. This could mean 15 minutes or an hour. One cannot assume there is time to call another person. The client did not ask the nurse to lead prayer, only to pray along. Even one who does not know how to pray is able to respect this request]
A 27-year-old client with a bleeding duodenal ulcer has refused blood transfusions because of religious beliefs. What is the best action for the nurse to take? a. Provide information that the client needs to make an informed decision, and support the decision. b. Seek a court order forcing the client to accept the blood transfusion. c. Administer the blood transfusion after the client becomes unconscious. d. Explain that God doesn't want the client to die, and ask the client to reconsider.
A. Provide information that the client needs to make an informed decision, and support the decision. [The nurse is a client advocate who practices within the framework of the state's Nurse Practice Act and standards of practice. Some institutions have resorted to this action, and some courts have acknowledged the client's right to choose and refuse care. Answer 3 is a decision made at a level higher than the nurse, but the nurse may or may not decide to participate based on an individual ethical decision. The nurse does not know God's wishes]
The mother of a pediatric client states," I can't understand why God would allow this to happen to my innocent child!" Which NANDA diagnosis is most accurate? a. Spiritual distress related to search for meaning of child's illness b. Impaired religiosity related to anger at God c. Ineffective Coping related to anger d. Risk for spiritual distress related to threatened sense of hope
A. Spiritual distress related to search for meaning of child's illness [although the mother is arguable angry, it is unknown whether this anger is impairing her religiosity or her coping]
When asked about religious beliefs, a client describes personal beliefs as agnostic. How should the nurse interpret this information? a. The client neither believes nor disbelieves in a God. b. The client believes in more than one God. c. The client believes in the existence of one God. d. The client belongs to the agnostic sect of Catholicism.
A. The client neither believes nor disbelieves in a God. [An agnostic is not an atheist (i.e. someone who does not believe in God).]
According to Carson, what is the "greatest tool" available to nurses for meeting clients' spiritual needs? a. The nurse's presence in the form of a personal relationship with the client b. Arranging visits from the client's spiritual adviser or healer c. Allowing sacraments or other rituals to be performed d. Informing the client about religious services provided by the agency
A. The nurse's presence in the form of a personal relationship with the client [All of the answers help to meet the client's spiritual needs. None of the answers is as powerful as the gift of self]
Which of the following is an appropriate spiritual screening or assessment question? a. "tell me more about your religion?" b. "how can we support your spiritual beliefs and practices?" c. how was your prayer experience been affected by your illness?" d. "what do you see as the purpose or mission for your life?"
B "how can we support your spiritual beliefs and practices?" [a nurse does not have time or authority to conduct a complete spiritual assessment for every client. What is important for the nurse to assess, however, is how the client's spiritual beliefs and practices may affect the response to illness and how the health care team can support spiritual health. Options A, C, and D are for more specific assessment if screening suggests it's necessary]
An adult survivor of child sexual abuse by a relative felt great anguish for many years over the abuse, including spiritual distress. Which statement to the client's support group provides evidence that the client is recovering from spiritual distress? a. 'I see the pain we all suffer, even the perpetrators." b. "I am finally beginning to forgive the person who did this to me." c. "I was so sad before, but now I finally understand, and it feels so good I could sing and dance." d. "I can understand why my family didn't help me. We all had problems."
B. "I am finally beginning to forgive the person who did this to me." [Forgiveness is a defining characteristic of spiritual wellness]
An 88-year-old woman, has just been admitted to a skilled nursing facility she tells the nurse that she has been a Sunday school teacher and volunteers for many of her church's projects. Which of the following NANDA diagnosis is most appropriate? a. Risk for Spiritual Distress b. Risk for Impaired Religiosity c. Readiness for Enhanced Spiritual Well-Being d. Impaired Religiosity
B. Risk for Impaired Religiosity [residing in the SNF likely will curb the client's participation in her church
A client's wife asks the nurse to pray for her. What would be the best initial response for a nurse who believes in prayer? a. "may I call the chaplain to come and pray with you? b. "I know your faith is important to you. It is to me, too." c. "What should I pray for?" d. "Isn't it wonderful that we have a God with whom we cans hare our concerns?"
C. "What should I pray for?" [the best initial response is to assess]
