Mod 9 Spiritual Health

Successful Critical Thinking requires a synthesis of? What do Clinical Judgements require a nurse to do? * Read book more when studying critical thinking - there is a lot of info*

A synthesis of: - knowledge - experience - information gathered from patients - critical thinking attitudes - intellectual and professional standards Clinical judgements require you to anticipate information, analyze the data, and make decisions regarding your patient's care

Hope: What does the concept of it provide? When is it a valuable personal resource?

Concept that provides comfort while people endure life-threatening situations, hardships, and other personal challenges It is a valuable personal resource whenever someone is facing a loss or a difficult challenge

Constructs of Spirituality: Connectedness - What does it consist of? - What does it help with? - Through connectedness, patients move beyond what? * On study guide

Consists of being: - Intrapersonally connected within oneself - Interpersonally connected with others and the environment & - Transpersonally connected with God, or an unseen higher power ATI: Helps clients find comfort and empowerment despite life's stressors Book: Through connectedness patients move beyond the stressors of everyday life and find comfort, faith, hope, and empowerment, and religion

Patient Centered Care: Death Rituals Pain Nutrition Communication Family Patterns and Gender Roles Repatterning Using an Interpreter

Death Rituals - vary with each culture - nurse should facilitate whenever possible Pain - may need alternative to numeric pain scales - explore meaning of pain Nutrition - allow family to bring food from home as long as they meet dietary restrictions - communicate food intolerance/allergies to staff Communication - establish rapport, use approved interpreters, use nonverbal communication with caution - apologize if beliefs or traditions are violated Family Patterns and Gender Roles - identify, communicate, and include those in the family who are seen as having the authority to make family decisions Repatterning - accommodate the client's belief as much as possible but attempt to repattern that belief to a belief that is compatible with health promotion while respecting the client and family and cultural differences Using an Interpreter - the Joint Commission requires that an interpreter be available in healthcare facilities in the client's language - use only a facility-approved medical interpreter - do not use the client's family or friends, or a non-designated employee or interpreter

Assessment: Assessment Tools - why is listening essential? - why type of questions should you ask? - what is the SWB scale? - what is the FICA assessment tool?

Listening - listening to a patient's story is an essential method for obtaining a spiritual assessment Ask direct questions Spiritual well-being (SWB) scale - 20 questions that assess a patient's relationship with God and his or her sense of life purpose and life satisfaction FICA evaluates spirituality and is closely related to quality of life F = Faith or belief I = Importance and Influence C = Community A = Address

Factors Influencing Spirituality: Chronic Illness - How does chronic illness affect a person? What does it cause/create? - As a nurse, you are in a unique position to do what?

Many chronic illnesses threaten a person's independence, causing fear, anxiety, and spiritual distress - dependence on others for routine self-care needs often creates feelings of powerlessness As a nurse, you are in a unique position to help patients reevaluate their lives and achieve spiritual health

________, _______, and ______ are interrelated

Mind, body, and spirit

Implementation: Health Promotion What are nurses contributing to when they spend time with their patients? - What does presence involve? What 3 factors are evident when a healing relationship develops between the nurse and patient? * On study guide

Nurses contribute to a sense of well-being and provide hope for recovery when they spend time with their patients - presence involves "being with" a patient vs. "doing for" a patient - presence involves giving attention, answering questions, having an encouraging attitude, and expressing a sense of trust 1. Realistically mobilizing hope for the nurse and patient 2. Finding an interpretation or understanding the illness, pain, anxiety, or other stressful emotion that is acceptable to the patient 3. Helping the patient use social, emotional, and spiritual resources

Factors of a Spiritual Assessment: Culture - Spirituality is a ________ within a ______ - It is important to know a patients _______ and assess his or her _______ - Ask patients about their ______ in order to _______ * On study guide

Spirituality is a personal experience within a cultural context It is important to know a patient's cultural background and assess his or her values about the healthcare problem and impending treatment Ask patients about their faith and belief system in order to understand the relationship between culture and spirituality

What is Health? What does Spirituality help individuals achieve?

State of wellbeing in which there is a balance of physical, psychosocial, sociological, cultural, developmental, and spiritual factors Achieve the balance needed to maintain health and well-being and cope with illness

Factors Influencing Spirituality: Acute Illness - Acute illness is a _____ illness that often creates _______? - Nurses use _____ & implement _____ in order to maximize ______?

Sudden, unexpected illness often creates spiritual distress - the sudden illness or injury creates an unanticipated scramble to integrate and cope with new realities (a disability) Nurses use knowledge of person's spiritual well-being and implement spiritual interventions to maximize inner peace and healing

Constructs of Spirituality: Transcendence - What is it? * On study guide

The belief in a force outside the person and material world that is superior

What does a person's spiritual faith bring?

A spiritual person's faith brings hope - when a person has the attitude of something to live for and look forward to, hope is present

What is Religion associated with/what is it?

- Associated with the "state of doing," or a specific system of practices associated with a particular denomination, sect, or form of worship - It is a system of beliefs practiced outwardly to express one's spirituality ATI: Spirituality can include religious practices but does not always

Constructs of Spirituality - What are the different constructs? * On study guide & Learning Objective

1. Transcendence & Self-transcendence 2. Connectedness 3. Faith & Hope 4. Inner strength and peace 5. Meaning and purpose in life

Constructs of Spirituality: Hope - A concept that includes _____ and ____ and provides ______ - Why does it have several meanings? - What does it usually refer to? * On study guide

ATI: - A concept that includes anticipation and optimism and provides comfort during times of crisis Book: - Has several meanings that vary on the basis of how it is being experienced - It usually refers to an energizing source that has an orientation to future goals and outcomes

What 4 factors influence spirituality, causing spiritual distress?

Acute Illness Chronic Illness Terminal Illness Near-Death Experiences

Constructs of Spirituality: Faith - What does it allow people to have? - What does it enable people to do? - What does faith exist without? * On study guide

Allows people to have firm beliefs despite lack of physical evidence It enables them to believe in and establish transpersonal connections Although many people associate faith with religious beliefs, it exists without them * One might have faith that all people are good, without being a practitioner of a religion

What is Spirituality? What are integral components of spirituality? (ATI)

An awareness of one's inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself Hope, faith, and transcendence

What does atheist mean? What does agnostic mean?

Atheist = People who do not believe in the existence of God Agnostic = People who believe that there is no known ultimate reality

Assessment: Why is is Spiritual Assessment therapeutic? What are the different components? Primary = Initial = Focused =

Bc it expresses a level of caring and support Primary = self-reflection (nurses) on personal beliefs and spirituality Initial = identifying the clients religion if any Focused = Ongoing, as nurses identify the clients at risk for spiritual distress

______________ and ____________ are powerful resources for healing

Beliefs and convictions

Physical and psychological well-being results from ____________ and ____________

Beliefs and expectations

Nursing Diagnosis - What are 9 potential diagnoses? * On study guide

Book: 1. Risk for Spiritual Distress 2. Decreased Spiritual Distress 3. Hopelessness 4. Powerlessness 5. Spiritual Distress PP adds in a few more: 6. Anxiety 7. Ineffective Coping 8. Complicated Grieving 9. Risk for Impaired Religiosity

Implementation: Acute Care What type of presence and touch should you display? What do support systems provide patients with? They are a source of? What are integral parts of a patient's beliefs and spirituality? How do nurses provide spiritual care? What do supporting rituals include? * On study guide

Display soothing presence and supportive touch Support systems provide patients with the greatest sense of well-being and serve as a human link, connecting patient, nurse, and patient's lifestyle before an illness - they are a source of faith and hope Food and rituals are often an integral part of a patient's beliefs and spirituality - consult a dietitian to integrate patients' dietary preferences into daily care Nurses provide spiritual care by supporting patients' participation in spiritual rituals and activities - plan care to allow privacy, time, and resources Supporting rituals include: - Clergy visits (grief work) - Prayer - Meditations - Music

Factors Influencing Spirituality: Terminal Illness - What type of process is dying? What does it encompass? - What does terminal illness cause a fear of? - Terminal illness creates uncertainty about what? - Some patients have a ________ that enables them to face death without _______? - When caring for dying patients, how do you help them as a nurse?

Dying is a holistic process encompassing a patient's physical, social, psychological, and spiritual health It causes fear of: - physical pain - loss of independence - isolation - the unknown - dying Creates uncertainty about what death means, making patients susceptible to spiritual distress Some patients have a spiritual sense of peace that enables them to face death without fear Help them gain a greater sense of control over their illness, whether they are in a healthcare setting or at home

Diagnosis: What does exploring a patient's spirituality reveal? Why do you analyze data? Accurate selection of diagnoses requires the use of? What are you reviewing and analyzing when selecting a diagnosis? What do patients commonly have? * On study guide

Exploring a patient's spirituality sometimes reveals responses to health problems that require nursing interventions or the existence of a strong set of resources that allow the patient to cope effectively Analyze data to find risk factors or patterns of assessment findings, and to select an appropriate nursing diagnosis Use of critical thinking Review and analyze - all concrete data (religious rituals and sources of fellowship) - your assessment of previous patient experiences - your own spirituality - your appraisal of the patient's spiritual well-being *Patients commonly have multiple nursing diagnoses

Factors of a Spiritual Assessment: Vocation - How do individuals express their spirituality? What is it a part of? - Determine whether ______, ______, or ______ alters the ability to ________ - What should the nurse understand and provide when a patient is prevented from expressing their spirituality? * On study guide

Express spirituality on a daily basis in life routines, work, play, and relationships - It is a part of person's identity and vocation Determine whether illness, injury, or hospitalization alters the ability to express some aspect of spirituality as it relates to the person's work or daily activities When illness or loss prevents patients from expressing their spirituality, understand the psychological, social, and spiritual implications and provide appropriate guidance and support

Faith or Belief - What questions do you ask? Importance and Influence - What questions do you ask? Community - What questions do you ask? Address - What questions do you ask? *From ATI book

Faith/Belief - "Can you tell me what gives you a sense of purpose, or what guides your life and how you handle it" Importance and Influence - "How do your beliefs affect how you make life decisions? - "How do these beliefs impact your current situation" Community - "Is there a group of people you meet or interact with regularly, who share these beliefs?" Address - "How would you like these personal beliefs to affect your healthcare? - "Will it affect how you make treatment choices?"

Factors of a Spiritual Assessment: Faith/Belief - When assessing a patient's faith, what do you do first? - Assess to what extent your patient interrelates with? - Faith in an ________ provides what? How do you assess this? - Determine if a patient has a? - It is important to understand a patient's? *Give examples on questions to ask * On study guide

First determine his or her beliefs, especially those that influence hope Assess to what extent your patient interrelates with self, others, and/or a source of authority Faith in an authority (healthcare provider or senior family member) provides a sense of confidence that guides a person in exercising beliefs and experiencing growth - Assess a person's faith in an authority by asking, "To whom do you look for guidance in life?" Determine if a patient has a religious source of guidance that conflicts with medical treatment plans and affects the option that nurses and other healthcare providers are able to offer patients It is important to understand a patient's philosophy of life - "Describe for me what is most important in your life" - "Tell me what gives your life meaning or purpose"

How do people gain Spiritual Health? How do Spiritual Beliefs change? - When does spirituality begin? - What do nurses need to understand? - As children mature, they experience what?

Gain by finding a balance between their values, goals, and beliefs and their relationship within themselves and others Change as patients grow and develop - spirituality begins as children learn about themselves and their relationships with others, including a higher power - nurses who understand a child's spiritual beliefs are able to care for and comfort the child - as children mature into adults, they experience spiritual growth by entering into lifelong relationships with people who share similar values and beliefs

Planning: Goals and Outcomes - what does a spiritual plan include? - in establishing a plan of care, an example of a goal and associated outcomes follows: Setting Priorities - when establishing a mutually agreed-on plan with the patient, the patient is able to? - spiritual priorities do NOT need to be? Teamwork and Collaboration - if a patient participates in a formal religion, what should you do? - what is a valuable resource in a hospital setting?

Goals and Outcomes - Includes realistic and individualized goals with relevant outcomes 1. The patient will improve personal harmony and connections with members of his or her support system 2. The patient expresses an acceptance of illness 3. The patient reports the ability to rely on family members for support 4. The patient initiates social interactions with family and friends Setting Priorities - He or she is able to identify what is most important - Do not need to be sacrificed for physical care priorities Teamwork and Collaboration - You should involve members of the clergy or church, temple, mosque, or synagogue in the plan of care when appropriate; Involve family and significant others - Pastoral care is a valuable resource

Planning: What does the planning step include?

Goals and Outcomes Setting Priorities Teamwork and Collaboration

Constructs of Spirituality: Meaning and Purpose in Life - What does spirituality help people find? * On study guide

Helps people find meaning and purpose in both positive and negative life events

Planning: Why is critical thinking important when developing a plan of care? - Give an example of a critical thinking attitude Why do you use a concept map? Bc spiritual care is so _______, what is critical in supporting the patient's decisions about the plan of care?

Important bc you reflect on previous experiences and apply knowledge and critical thinking attitudes (confidence - builds trust between patient and nurse) and standards in selecting the most appropriate intervention To organize patient care and show how the patient's medical diagnosis, assessment data, and nursing diagnoses are interrelated Bc spiritual care is so personal, standards of autonomy and self-determination are critical in supporting the patient's decisions about the plan of care

Factors of a Spiritual Assessment: Life and Self-Responsibility - What does spiritual well-being include? Who has a higher level of spiritual-well being? - Assess the extent to which a patient understands what? *Give examples on questions to ask * On study guide

Includes life and self-responsibility - Individuals who accept change in life, make decisions about their lives, and can forgive others in times of difficulty have a higher level of spiritual well-being Understands the limitations or threats posed by an illness and the manner in which he or she chooses to adjust to them - "Tell me how you feel about the changes caused by your illness" - "How do these changes affect what you now need to do?"

In addition to being a component of spirituality, the concept of faith has other definitions - What is it? - What does it have a relationship with?

It is a cultural or institutional religion such as Judaism, Buddhism, Islam, or Christianity It is also a relationship with a divinity, higher power, or spirit that incorporates a reasoning faith (belief) and a trusting faith (action)

Nurses who are comfortable with their own spirituality are more likely to do what? Nurses who foster their own personal, emotional, and spiritual health become what for the patient? After becoming comfortable with your own spirituality, a nurse should use what?

Nurses who are comfortable with their own spirituality are more likely to care for their patient's spiritual needs Nurses who foster their own personal, emotional, and spiritual health become resources for their patients and use their own spirituality as a tool when caring for themselves and their patients After becoming comfortable with your own spirituality, use your nursing knowledge to anticipate your patients' personal issues and the resulting effect on spiritual-well being

Spiritual well-being has two dimensions - What are they?

One dimension supports the transcendent relationship between a person and God or a higher power The other dimension describes positive relationships and connections that people have with others

When illness, loss, grief, or a major life change occurs, what do people use? If not used, what happens?

People either: Use Spiritual resources to help them cope and search for meaning OR Spiritual needs and concerns develop

Factors of a Spiritual Assessment: Connectedness - Who usually reports higher levels of physical and emotional health? - What is one way patients remain connected with their God? - Ask about the patient's ability to?/Assess a patient's connectedness by asking? *Give examples on questions to ask * On study guide

People who are connected to themselves, others, nature, and God or another Supreme Being usually report higher levels of physical and emotional health - they cope with the stress brought by crisis and chronic illness Remain connected by praying Ask about the patient's ability to express a sense of relatedness to something greater than self - assess a patient's connectedness by asking open-ended questions - "Whom do you believe is the most important person in your life?" - "In what way do you stay connected spiritually" - "Is prayer something helpful to you?" - "What feeling do you have after you pray?"

Implementation: Restorative and Continuing Care What can prayer be an opportunity to do? How is it effective? What does meditation create? Patients who experience terminal illness or who have suffered from permanent loss of body function require what from a nurse? * On study guide

Prayer can be an opportunity to renew personal faith and belief in a higher power - It is an effective coping resource for physical and psychological symptoms Meditation creates a relaxation response to reduce daily stress They require a nurses support in grieving and coping with their loss - your ability to enter into a caring, therapeutic, and spiritual relationship with patients supports them during times of grief

Factors Influencing Spirituality: Near-Death Experience - What is NDE? - NDE is not associated with _______; Instead experts agree that NDE describes what? - Patients who have experienced an NDE describe the feeling how? - After patients have survived this, what should nurses promote?

Psychological phenomenon of people who either have been close to clinical death or have recovered after being declared death Not associated with a mental disorder; Instead, experts agree that it describes a powerfully close brush with pysical, emotional, and spiritual death Feeling totally at peace, having an out-of-body experience, being pulling into a dark tunnel, seeing bright lights, and meeting people who have preceded them in death Promote spiritual well-being by remaining open, giving patients a chance to explore what happened, and supporting them as they share the experience with significant others

Book: When providing spiritual care, it is important to understand the differences between religion and spirituality: Religious practices encompass _______ but spirituality does not need to _______? Religious care helps patients do what? Spiritual care helps people do what? * On study guide

Religious practices encompass spirituality, but spirituality does not need to include religious practice Religious care helps patients maintain their faithfulness to their belief systems and worship practices Spiritual care helps people identify meaning and purpose in life, look beyond the present, and maintain personal relationships and a relationship with a higher being or life force

Assessment: Understanding a patient's spirituality and then appropriately identifying the level of support and resources needed requires what? What does a Spiritual Assessment reveal?

Requires a broad perspective and an open mind - be open to successfully promoting an honest discussion about each patient's spiritual beliefs A spiritual assessment reveals the patients beliefs about life, health, and a Supreme Being or power

What does the Joint Commission require healthcare organizations to do?

Requires them to acknowledge patients' rights to spiritual care and to provide for patients' spiritual needs through pastoral care or others who are certified, ordained, or lay individuals

Constructs of Spirituality: Self-Transcendence - What is it? - What does it allow? - What are Examples? * On study guide

Self- Transcendence - A sense of authentically connecting to one's inner self - It is a positive force - It allows people to have new experiences and develop new perspectives that are beyond ordinary physical boundaries - Examples of transcendent moments include the feeling of awe when holding a new baby or looking at a beautiful sunset

Q: A sense of authentically connecting to one's inner self is which?

Self-transcendence

What is Spiritual Distress? - What is it a result of?/When does it occur? - What actions might someone display during spiritual distress? Nursing interventions are directed at what? (ATI) * On study guide

Spiritual distress is a challenge to belief systems or spiritual well-being - It often arises as a result of catastrophic events; It occurs when conflict arises between a person's beliefs and prescribed health regimens or inability to practice usual rituals - The client can display hopelessness and decreased interactions with others Nursing interventions are directed at identification, restoration, and/or reconnection of clients and families to spiritual strength

Factors of a Spiritual Assessment: Life Satisfaction - Spiritual well-being is tied to a person's satisfaction with? - What happens when a person is satisfied with life? *Give examples on questions to ask * On study guide

Spiritual well-being is tied to a person's satisfaction with life and what he or she has accomplished, even in the case of children When ppl are satisfied with life and how they are using their abilities, more energy is available to deal with new difficulties and resolve problems Questions to ask: "How happy or satisfied are you with your life" "Tell me how satisfied you feel about what you have accomplished in life"

Factors of a Spiritual Assessment: Ritual and Practice - Assessing the use of rituals and practices helps you understand a patient's? - What do rituals include? Why/when do you use them? - What do you ask the patient? * On study guide

Spirituality Rituals include: - Participation in worship - Prayer - Sacraments (baptism, Holy Eucharist) - Fasting - Singing - Meditating - Scripture reading - Making offerings or sacrifices * If rituals are important to a patient, use them as part of nursing intervention Ask about life practices used to assist in structure and support during difficult times

Spirituality and Religion are not the same. Spirituality is ________ than religion Book: While Religion is an organized ______, Spirituality focuses on what?

Spirituality = Much broader and more unifying concept than religion Pg. 723 While religion is an organized, institution-related practice that is commonly associated with particular beliefs, spirituality focuses on an individual's connection to a higher being, nature, or some purpose greater than oneself

Constructs of Spirituality: Inner Strength & Peace - What does spirituality give people the ability to do? - What does inner peace do? * On study guide

Spirituality gives people the ability to find a dynamic and creative sense of inner strength to be used when making difficult decisions Inner peace fosters calm, positive, and peaceful feelings despite life experiences of chaos, fear, and uncertainty

The American Nurses Association Code of Ethics for Nurses requires nurses to practice nursing with what? What does an ethic of caring provide?

To practice nursing with compassion and respect for the inherent dignity, worth, and uniqueness of every person An ethic of caring provides a framework for decision making and places the nurse as the patients' advocate

Q: A nurse is caring for a client who share the nurse's religious background. Which of the following information should the nurse anticipate?

The same religious beliefs can influence individuals differently

Factors of a Spiritual Assessment: Fellowship and Community - To assess a patient's supportive community, what questions might you ask? - Explore the extent and nature of a person's? * On study guide

To assess a patient's supportive community: - "Who do you find to be the greatest source of support in times of difficulty?" - "When you've faced difficult times in the past, who has been your greatest resource?" Explore the extent and nature of a person's support networks and their relationship with the patient

Personal experience in caring for patients going through spiritual distress is valuable when? - what type of nurse may be better able to help their patients? - what does a nurse learn from?

Valuable when helping patients select coping options - nurses who sense a personal faith and hope regarding life may be better able to help their patients - a nurse learns from his or her personal faith system and previous professional experiences how to provide spiritual care comfortably

When should you use critical thinking? What do effective nurses show to the patient? How do nurses demonstrate integrity? What should nurses avoid when using critical thinking?

When assessing each patient's reaction to illness, injury, and loss and determining whether spiritual intervention is necessary Effective nurses show genuine concern as they assess their patients' beliefs and determine how spirituality influences their patients' health You demonstrate integrity by refraining from voicing your opinions about religion or spirituality when your beliefs conflict with those of your patient Avoid making assumptions about their religion and beliefs

Integrating a patients _______ into ________ provides what type of care?

When you integrate a patient preferences, values, and beliefs into spiritual care, you are providing patient-centered care with sensitivity and respect for the diversity of human experience