Chap 45 Spirituality
A nurse is caring for a client who is spiritually distressed. Which of these are factors that affect the spiritual distress of a client? Select all that apply.
Inability to reconcile a current life situation with spiritual beliefs Separation from the religious community or supports Explanation: Factors affecting spiritual distress include inability to reconcile a current life situation with spiritual beliefs and separation from the religious community or supports. Disconnectedness to self can be expressed through an inability to seek a religious leader or an inability to introspect.
A client who is admitted for a debilitating disease is talking to the nurse. The client relates that family is the only thing that matters, stating that family helps fulfill all the spiritual needs by first fulfilling the most basic of all needs. What is this basic need?
Love Explanation: Love develops from the basic human need to love and be loved, and we cannot be spiritually whole, spiritually healthy, unless this need is met. Autonomy is freedom from external control or influence. Self reliance is reliance on one's own powers and resources rather than those of others. Autonomy and self reliance are higher level of needs. A sense of belonging is a human need, just like the need for food and shelter but love is more important.
Which client statement most clearly suggests the potential of a nursing diagnosis of Spiritual Anxiety?
"Now that I'm nearing the end, I'm worried that God won't think I lived a good enough life." Explanation: Worry about one's spiritual condition is indicative of the nursing diagnosis of Spiritual Anxiety. Unfamiliarity with the religious character of a care setting suggests Spiritual Alienation, while questions of suffering often indicate Spiritual Pain or Spiritual Despair. Regrets over previous religious or spiritual apathy may suggest a nursing diagnosis of Spiritual Guilt.
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. 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. After all, she is dying and waiting for her to ask again is not warranted.
When asked about his religious preference, the client becomes very upset with the nurse. Which response is appropriate for this situation?
"I can see that this question upsets you. Do you have any questions about this?" Explanation: The nurse should assist the client in understanding that his nursing history is a review of the whole human being and that questions will be wide ranging, including spiritual health, physical health, and emotional health. A client who appears angry, anxious, depressed, or defensive when asked spiritual questions may need to hear something like, "I can see from your response that you might not have expected these questions; however, they do let you know that we are interested in how you are experiencing your current situation. Do you have a question or concern in this area?" Telling the client that the nurse is just completing his or her job or telling the client that it is part of the assessment is not appropriate or therapeutic.
A teenage client comes to the clinic and tells the nurse that she has not had a period for the last 2 months. After assessment and lab work, the client is told that she is 3 months' pregnant. She begins to sob and says she is too young to have a baby. When the nurse offers counseling for an abortion, the client gets even more upset and says that she cannot have an abortion as it is not permitted in her church. This client is most likely which of the following?
Catholic Explanation: In the Catholic religion, only natural means of birth control are allowed; abortion, euthanasia, and sterilization are forbidden. Reform and Liberal schools of Judaism allow birth control for a wide range of reason. Orthodox Judaism is more restrictive. The methods of contraception allowed are the contraceptive pill and the IUD. The Adventists and Protestants do not have a position on abortion.
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. 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 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 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?
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.
A nurse working in a facility that cares for clients with Alzheimer's includes spirituality in client care. A family caregiver tells the nurse that faith has been broken and asks about help in getting through the day. What approaches can the nurse use to help the family member? Select all that apply.
Help the family member get relief so church services can be attended Contact the family church group members for assistance Give the family member some spiritual reading materials Explanation: Spiritual nurturing for the client's family caregiver(s) also is important. Recent research findings support the importance and value of caregivers' spirituality, yet this resource is often overlooked. Consider using interventions that enhance a caregiver's ability to take part in spiritual activities to satisfy his or her spiritual needs and to work with religious groups to secure helpful services. Using clergy, prayer, forgiveness, and spiritual reading materials as resources for caregivers may also be helpful.
While interviewing a client, a nurse is told that the client practices Catholicism. This client is identifying:
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.
The nurse admits a new client to the unit for elective surgery. What would be the best way for the nurse to facilitate the practice of religion for this client? Choose all that apply.
Arrange for the client's pastor to visit if desired. Attempt to meet religious dietary restrictions. Respect the need for privacy during periods of prayer. Explanation: The following are means the nurse can use to help the client continue normal spiritual practices in the unfamiliar environment of the hospital or care center: • Familiarize the client with the religious services and materials available within the institution. • Respect the client's need for privacy or quiet during periods of prayer. • Assist the client to obtain devotional objects and protect them from loss or damage. • Arrange for the client wishing to receive the sacraments to do so. • Attempt to meet the client's religious dietary restrictions. • Arrange for the client's minister, priest, or rabbi to visit if the client so wishes. Proselytizing is never acceptable in professional settings. Addressing spiritual issues should not be coercive. Praying with clients should not be initiated by the nurse unless there is no pastoral care available and the client requests it. Comparing and contrasting religious beliefs is not likely to benefit the client.
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 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.
A nurse is educating staff members about the importance of meeting the spiritual needs of clients on the unit. What spiritual needs should be met in the delivery of care? Select all that apply.
need for meaning and purpose need for love and relatedness need for forgiveness Explanation: There are three spiritual needs that underlie all religious traditions and are common to all people: need for meaning and purpose, need for love and relatedness, and need for forgiveness. Need for comfort and money, as well as need for complete health and freedom, are nice but are not part of spirituality.
The nursing instructor is teaching about spirituality and asks a nursing student about the factors that can influence a client's spirituality. Which responses by the student are accurate? Select all that apply.
Developmental considerations Family Ethnic background Formal religion Explanation: Among the many factors that can influence a person's spirituality, the most important are developmental considerations, family, ethnic background, formal religion, and life events. Economics does not influence a client's spirituality.
A nurse overhears a client telling a family member that a belief in God is the only thing helping in the fight against a terminal illness. What is this client demonstrating?
Faith Explanation: Faith refers to a confident belief in something for which there is no proof or material evidence. It can involve a person, idea, or thing, and it is usually followed by action related to the ideals or values of that belief. Hope is a feeling of expectation and desire for a certain thing to happen. Love is an intense feeling of deep affection. Religion is a particular system of faith and worship.
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?
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.
While interviewing a hospitalized client, he states, "The holy days of Ramadan are coming soon. I am not to have any food or drink from sunrise to sunset during this time." Further assessment reveals that the client's request is associated with which religion?
Islam Explanation: According to the Islamic religion, neither food nor drink is taken between sunrise and sunset during the holy days of Ramadan. There are no special or universal food beliefs common to Christianity. According to Judaism, Kosher food is eaten, meat cannot be mixed with dairy, and separate cooking and eating utensils are used for food preparation and consumption. According to Hinduism, pork and alcohol are forbidden and other meats must meet ritual requirements.
The nurse working on a hospice unit is giving an in-service on the importance of faith and religion in client care. What does the nurse tell the group is a benefit of religious fellowship?
It offers support for the client. Explanation: Regular religious fellowship benefits health by offering support that buffers the effects of stress and isolation. Fellowships provide a way for the client to be involved in another activity related to their spirituality rather than a distraction. It does not put a label on a person that allows others to discriminate.
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 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.
Mr. Baker is an 81-year-old patient who can no longer live alone safely and is being admitted to a long-term-care facility. He grew a large garden every summer and took pleasure in sharing the produce with neighbors. He now tells the nurse that he feels he is of no use to anyone. 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 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 the need for meaning and purpose. The garden provided a needed element for the client to provide for others. The need for love and relatedness is have a sense of companionship. The need for forgiveness is reconciling with others. Basic necessities are something necessary or indispensable such as food, water, and shelter.
The nursing diagnosis Spiritual Distress related to crisis of illness as evidenced by loss of meaning in life and overuse of pain medication is created for a client who attempted to take his life. Which intervention is appropriate for these problems?
Plan and coordinate a multidisciplinary team conference including the chaplain. Explanation: The nurse should facilitate a care-planning conference involving the social support network including family and friends. Initiating a multidisciplinary social network of conferences facilitates a sense of acceptance, love, and belonging. The nurse should work with the client to explore and build on past positive coping mechanisms, which helps enhance a sense of self-control and self-esteem. Encouraging the client to watch movies when alone does not allow the client to interact and find positive elements of his or her life. Although spiritual review can be helpful, the nurse should not "scare" the client away from action by mentioning negative spiritual outcomes.
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?
Read a passage from the Bible to the client Explanation: A nurse unaccustomed to praying aloud or in public may find it helpful to have a Bible passage or formal prayer readily available. The other options are not therapeutic.
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. 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.
An appropriate nursing diagnosis for a bedridden hospitalized client who tells the nurse that he has not missed a Methodist church service in 50 years would be:
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.
The nurse caring for a bedridden hospitalized client who states that this will be the first time that he has missed a Methodist church service in 50 years plans care based on which of the following NANDA-I diagnoses?
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. Developing a three-part nursing diagnosis consists of data analysis, problem identification, and the formulation of the nursing diagnosis. There are four different types of nursing diagnoses: actual nursing diagnosis, wellness (or health promotion) nursing diagnosis, risk nursing diagnosis, and syndrome diagnosis. The other three statements are missing part of the nursing diagnosis.
A college foreign exchange student is living with a family in England and is confused about the daily Catholic prayers and rituals of the family. The student longs for the comfort of her fundamentalist Protestant practices and reports to the campus nurse for direction. The nurse recognizes the student is experiencing which type of spiritual distress?
Spiritual alienation Explanation: Spiritual alienation occurs when an individual is separated from one's faith community. Spiritual guilt is the failure to live according to religious rules. Spiritual anger is the inability to accept illness. Spiritual loss occurs when one is not able to find comfort in religion.
The nurse planning spiritual care for a client understands which of the following to be true about spirituality according to Burghardt and Nagai-Jacobson (1997)?
Spirituality permeates life, providing purpose, meaning, strength, and guidance and shaping the journey. Explanation: According to Burghardt and Nagai-Jacobson (1997) spirituality permeates life, providing purpose, meaning, strength, and guidance and shaping the journey.
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 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. 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.
After being informed that his wife only has a few hours to live, the nurse hears the husband say; "If you take my wife now. I will never pray to you!" What should be the nurse's reply?
Use silence and allow the husband to express his emotions. Explanation: During times of grief, a nurse should exhibit a sensitive and non-intrusive approach in caring for the client and client's family. Therefore the nurse should use silence and allow the husband to express his emotions. Telling the client's husband to think before he speaks or leaving the room is inappropriate and rude. However, assisting clients to reconnect to their faith community or to utilize the resources of a faith community such as a pastor has health benefits but is not the priority in this situation.
A client recently diagnosed with cancer informs the nurse that they value faith and finds comfort in their faith. The nurse is aware that faith is best defined as:
a belief in something for which there is no proof or material evidence. Explanation: Faith is a belief in something for which there is no proof or material evidence. The client is expressing a sense of faith to the nurse. Hope is a positive outlook even in the bleakest moments. Religion is an organized belief system about a higher power. Spiritual beliefs are practices associated with all aspects of a person's life.
Mrs Jones is an 81-year-old client who can no longer live alone safely and is being admitted to a long-term-care facility. She had to leave her elderly cat, Baby, with neighbors. She tells the nurse that her cat was the only family she had and that she misses her. The nurse knows that this is related to which of the following spiritual needs believed to be common to all people?
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 the need for love for her cat. The need for forgiveness is reconciliation for past relationship issues. The need for meaning and purpose is finding connectiveness with jobs or people. Basic needs are something necessary or indispensable such as food, water, and shelter.
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. 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:
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.
Which set of terms best reflects nursing's view of clients as holistic beings?
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.
According to Shelly and Fish, which of the following is a spiritual need underlying all religious traditions?
need for meaning and purpose Explanation: Shelly and Fish recognized that all religious traditions have the spiritual need for meaning and purpose, the need for love and relatedness, and the need for forgiveness.
A nurse is assisting a terminally ill female client with bathing. The client tells the nurse that she has great respect and faith in a particular spiritual leader. The nurse interprets this information as fulfilling which need for the client?
sense of security for present and future Explanation: Whatever the spiritual or religious beliefs the person holds and practices, these beliefs contribute to a sense of security for the present and future; give meaning to life, illness, other crises, and death; guide daily living habits; drive acceptance or rejection of other people; furnish psychosocial support within a group of like-minded people; provide strength in meeting life's crises; and give healing strength and support. However, spiritual beliefs do not guarantee that a person gains financial power and strength, the power to perform miracles, or the ability to live longer.
When preparing for a spiritual counselor to visit a hospitalized client, the nurse should:
take measures to ensure privacy during the counselor's visit. Explanation: Visits between a client and a spiritual counselor require privacy. The details of the meeting are not typically documented in the client's chart, though the fact that the visit took place is often noted. The nurse may be present during the meeting, but this should take place at the client's request. Spiritual counselors do not require administrative approval; clients and their families are normally able to seek spiritual help from whomever they prefer.
A terminally ill client tells the nurse that he does not belong to an organized religion. It is safe for the nurse to assume:
the client may still be deeply spiritual. Explanation: The nurse should not interpret the fact that a client does not belong to an organized religion to mean that he or she has no spiritual needs; a person may be deeply spiritual yet not profess to belong to an organized religion. An atheist is a person who denies the existence of a higher power; an agnostic is one who holds that nothing can be known about the existence of a higher power.
