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?" Explanation: Although many Native Americans and many Southeast Asian groups seek spiritual leadership from a traditional tribal healer, 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.

The nursing instructor has been discussing spirituality with a group of nursing students. Which statement by a student would indicate a need for further education?

"Spiritual beliefs and practices do not give strength when a person is in crisis." Explanation: Spiritual beliefs and habits can give meaning to life, illness, other crises, and death; can contribute a sense of security for present and future; can guide daily living habits; can provide strength in meeting life's crises; and can give healing strength and support.

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 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.

An older adult client is spiritual and has a deep faith. The client asks the nurse to say a prayer for the client. 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 printed interfaith prayer to the client. Explanation: A nurse unaccustomed to praying aloud or in public may find it helpful to have a printed interfaith prayer readily available. Interfaith prayers are designed for use regardless of the client's faith. The other action are not therapeutic.

The nurse is taking care of a client who is scheduled for a mastectomy. The client tells the nurse that the client is apprehensive about the operation and asks the nurse to read a passage from the Koran to help prepare the client for surgery. Which action by the nurse is the most appropriate?

Read the Koran passage to the client. Explanation: According to Maslow's hierarchy, self-actualization is a need related to the spiritual and intellectual dimension of a client. Reading a religious passage to a client is not practicing a religion, and asking to call a minister or another staff member to address this spiritual need is deferring the client's needs to someone else.

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.

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?

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.

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 is assessing a client for spirituality using the HOPE acronym. Which statement describes an element of this tool?

O = organized religion Explanation: The HOPE assessment tool asses the client's spirituality. The acronym stands for:H—Sources of hope, meaning, comfort, strength, peace, love, and connectionO—Organized religionP—Personal spirituality and practiceE—Effects on medical care and end-of-life issue

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.

Individuals who are Christian Scientists may not approve of:

immunizations. Explanation: Some groups, such as Christian Scientists and the Amish, have been legally exempted from immunizations; however, many medical decisions are reviewed on a case-by-case basis depending on the client's age and imminence of death.

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.

The nurse is caring for a 6-year-old child who was in a motor vehicle accident and has lost a lot of blood through an open leg wound. The parents inform the nurse that the child cannot have blood transfusions due to their religious beliefs. What decision does the nurse determine that the court will support regarding the child's blood transfusion?

not support the parents' right to refuse treatment for the child Explanation: The courts have not supported the right of Jehovah Witness parents to refuse life-saving treatment for their children such as in traumatic accidents. The courts do not allow the child to make health care decisions nor allow the church pastor to accept or refuse treatment over the parents.

An appropriate goal for the client with a nursing diagnosis of Spiritual Distress related to intense pain and suffering as verbalized by the client would be that the client will:

participate in supportive spiritual practices. Explanation: The goal for the client should focus on supporting the client's strengths.

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.

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:

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.

The nurse is caring for a client that practices Islam in the hospital. When dietary brings the client a food tray for supper, which food on the tray should the nurse remove that is against the dietary laws for a practicing Muslim?

A pork chop Explanation: For practitioners of Islamic religion, Koranic law and customs influence diet; eating pork and drinking alcohol are forbidden. The nurse should remove the pork chop from the tray and have the meat replaced with beef, chicken, or fish as the protein.

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.

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.

A nurse caring for a client of the Jewish faith knows the importance of asking about any food preferences when discussing diet. This is important for which reason?

Religious practices and beliefs can directly influence a client's self-care practices. Explanation: Nurses are better able to meet clients' spiritual needs when they understand their religious beliefs. These beliefs can directly influence clients' responses to illness and suffering, self-care practices such as diet and hygiene, spiritual practices, and moral codes. Religious practices and beliefs can be easy to understand and if asking a client about them, a nurse is exemplifying care and compassion in the client and their beliefs.

The best definition of a spiritual need is:

expression of a person's inner being and meaning. Explanation: A spiritual need represents a normal expression of a person's inner being that seeks meaning in all experiences, and a dynamic relationship with self, others, and to the supreme other as the person defines it.

A client who has suffered a debilitating stroke asks the nurse, "Why did God allow this to happen to me?" What question would the nurse ask to promote a conversation with the client about the client's spiritual needs?

"In the past, what has given you strength during a crisis?" Explanation: A client who is angry at or questioning God is in spiritual distress. Asking what has given the client strength in the past to deal with crises is a good way to begin the conversation about spiritual needs. The client may not be ready to see a spiritual advisor. Asking "Why" questions are not therapeutic. The client in this scenario has not mentioned the possibility of dying.

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.

A nursing instructor, after teaching about the importance of spirituality, identifies a need for further teaching when overhearing a student make which of the following statements?

"You can provide quality nursing care to clients even though you ignore the spiritual dimension of health." Explanation: It is impossible to provide quality nursing care to clients while ignoring the spiritual dimensions of health. Nurses can assist clients to meet spiritual needs by offering a compassionate presence; assisting in the struggle to find meaning and purpose in the face of suffering, illness, and death; and fostering relationships with a higher being that nurture their spirit.

The nurse is caring for a Roman catholic client who is dying. What would be an appropriate action for the nurse?

Contact a local priest to complete the anointing of the sick ritual. Explanation: Roman Catholics believe that people should have the anointing of the sick, as well as the Eucharist and penance, by a priest before death. There are no special care rituals for the body after death

After teaching a staff development program about the major world religions and their view of health and illness, the nurse determines that the teaching was successful when the participants identify which statement as best reflective of Buddhism?

Dietary restrictions on some holy days. Explanation: In Buddhism, there are dietary restrictions on some holy days. In Hinduism, the soul has no beginning or end. In Islam, all outcomes are seen as being predetermined. Christianity involves beliefs that focus on the Old and New Testaments.

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. 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.

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.

The nurse is caring for a 3-year-old girl who is hospitalized following repair of a fractured femur. The child's parents have asked that the hospital chaplain visit this Sunday. Based on the child's developmental stage, what activities would be appropriate during the chaplain's visit? Select all that apply.

Recitation of a simple prayer Singing church hymns Drawing pictures of religious figures Explanation: Biblical legends are more appropriate for school-age children.

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.

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.

Mrs. Dupree is a 55-year-old patient with end-stage renal failure who has asked to be taken off dialysis. She now shares with the nurse that she has mistreated her only daughter in the past and would like to reconcile this before she dies. The nurse knows that this is related to which of the following spiritual needs believed to be common to all people?

Need for forgiveness 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 pursuing reconciliation which is in the need for forgiveness category. The need for basic necessities is related to Maslow's hierarchy of need and include food (including water), shelter and clothing.. The need for love and relatedness corresponds to having meaningful relationships. The need for meaning and purpose is for one to feel that the work they perform or the duties they complete are meaningful and respected.

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?" "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.

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." 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 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 caring for a critically ill client who informs the nurse that there is a conflict between the client's spiritual beliefs and a proposed health option. Which question does the nurse ask to begin a conversation about the conflict that the client is experiencing?

"Would you like to talk to someone to help you make an informed decision?" Explanation: The nurse's role in resolving conflicts between spiritual beliefs and treatments is to assist the client in obtaining the information needed to make an informed decision and to support the client's decision making. The client may not know specifically what to ask of the nurse and the client needs assistance in making an informed decision. The nurse is instrumental in advocating for the client's needs. The health care provider is not usually involved as a client advocate. Asking if the client wishes to refuse the treatment option does not provide the client with information to make an informed decision.

Based on religious practices, which client would be most likely to defer to her husband when making health care decisions?

An Islamic woman Explanation: Some Muslim (Islamic religion) women are not allowed to make independent decisions; husbands may need to be present when consent is sought. This practice does not apply to Jewish, Catholic, or Protestant religions.

A nurse is caring for a client who is upset after being told about a diagnosis of cancer. The client asks the nurse to stay a minute to pray. Which is the nurse's most respectful and appropriate behavior?

Agree to pray with the client and stand in silence by the bed. Explanation: Nurses can assist clients to meet spiritual needs by offering a compassionate presence. Standing quietly at the bedside while the client prays will help accomplish this. Although nurses may differ in their beliefs about how involved they should become in meeting spiritual needs, it is impossible to care for clients well while ignoring this dimension of health. A nurse does not have to hold the same beliefs to pray with the client. The other options are not therapeutic responses and should never be used.

An older adult client who identifies as a devout Catholic has recently relocated to an assisted living facility. The client is pleased with most aspects of the living situation but laments the fact that the church is not nearby, so attending daily mass is not an option. The client is quite upset by this restriction and states, "Going to daily mass was my life." Which action would the nurse take to address the client's spiritual distress?

Actively listen to the client to explore the client's feelings. Explanation: Spiritual distress involves the inability to integrate meaning and purpose in life. The client is in distress over not being able to attend daily mass. The nurse would actively listen to the client with empathy to further explore the client's feelings. Explaining about other facility activities and informing the client that a local church group conducts a service once a week will not relieve the client's distress. The nurse should not interject the nurse's personal feelings into the client's situation.

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.

When reviewing the history of a client admitted to the health care facility, the nurse notes that the client reported being an atheist. Which action will the nurse take to meet spiritual needs when planning nursing care for the client?

Ask the client how he or she expresses spirituality. Explanation: An atheist believes that divine entities do not exist. People can be spiritual and not believe in divine entities. The nurse would explore how the client expresses spirituality. Asking if the client ever participated in organized religion would not meet the client's needs. Spiritual needs should be addressed; the nurse should not just bring spirituality if the client mentions it or arrange for a support group for atheists.

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.

The school nurse is concerned about the week-long absence of Jerry, a third grader. The nurse visits the home and learns that Jerry has been diagnosed with appendicitis by a local clinic doctor. The parents, who are Christian Science church members, have had several church groups in to pray over Jerry. He is not improving and is getting worse. The nurse should do which of the following?

Contact Child Protection Services Explanation: Child Protective Services can intervene immediately, and have the child hospitalized and treated against the parents' wishes. Allowing the parents to make life/death decisions about their minor child could place the child in harm's way. Insisting the parents take the child to a hospital or threatening them will a lawsuit will only cause ill feelings toward you and will not likely change the parents' minds.

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. Afterall, she is dying and waiting for her to ask again is not warranted

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.

A nurse is preparing to give medications to an elderly client who, due to a recent stroke, needs help putting them in her mouth. The family member appears anxious and tells the nurse not to touch the client's mouth. Which religion does the nurse assume this client practices?

Hinduism Explanation: The nurse administering medications should avoid touching the lips of a Hindu client. The other religions do not hold beliefs precluding such contact.

A nursing student is studying spirituality and completing a report on The Church of Jesus Christ of Latter-day Saints. Which fact about this faith should the student include in the report?

Latter-day Saints are not allowed to use tobacco or alcohol. Explanation: The restored gospel of Jesus Christ directs Latter-day Saints to avoid using alcohol, tobacco, and caffeinated beverages. Jehovah's Witnesses are not allowed to have blood transfusions. Roman Catholics do not adhere to birth control measures. Muslims do not allow opposite sexed health care providers to care for them, especially women.

According to Shelly and Fish (1988), which of the following are spiritual needs underlying all religious traditions that are common to all people? Select all that apply.

Meaning and purpose Love and relatedness Forgiveness Explanation: According to Shelly and Fish (1988), there are three spiritual needs underlying all religious traditions and common to all people: need for meaning and purpose, need for love and relatedness, and need for forgiveness.

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. 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?

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?

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.

Mr. V. is recovering from pneumonia. The nurse understands that a well-balanced diet will help him to recover. However, Mr. V. informs the nurse that it is Ramadan and he must fast from sunrise to sunset. What is the nurse's most appropriate nursing action?

Work with the nutrition staff to provide nutritious meals at off hours. Explanation: The most appropriate action is to work with Mr. V to maintain practice that is important to him. If Mr. V decided to suspend religious practice for medical reasons, it would be appropriate to support this decision. Asking to speak with a religious leader to grant a medical exception disregards Mr. V's religious practice. Liquid nutrition may interfere with the fasting rules. Telling Mr. V to eat despite his religious convictions is inappropriate and not empathetic.