Spirituality

Because many patients find it difficult to talk about their spiritual beliefs and problems, also observe the patient's behavior for signs of spiritual distress. A family member or close friend may share significant observations:

"He's been awfully moody since his heart attack. I can't believe how hopeless he seems now." "I've never seen my father so depressed. He's never in his life been away from the synagogue at Passover. I don't know how to help him."

Love

"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."

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 help clients meet spiritual needs by assisting in their struggle to find meaning in suffering." -"You can provide quality nursing care to clients even though you ignore the spiritual dimension of health." -"Nurses can better assist clients by meeting their spiritual needs." -"Nurses can meet spiritual needs by offering a compassionate presence."

"You can provide quality nursing care to clients even though you ignore the spiritual dimension of health."

effective questions for significant behavioral changes

"You've been lying there so quietly. What are you thinking about?" "After all you've been through, you must have done a good bit of soul searching. Experiences like these are enough to shake anyone's faith—how is yours holding up?"

faith

(1) spiritual dimensions of a person's life regardless of religious affiliation (2) confident belief in something for which htere is no proof or material evidence

Baha'i International Community

- Believe in a basic harmony between religion and science - Seek out competent medical care and pray for health - Obligatory prayers, holy days, and the 19 day fast - Permanent sterilization is prohibited and abortion is discouraged

Defining char for nursing dx of spiritual guilt

A 23-year-old, single, Baptist woman being treated for premenstrual syndrome "I was raised in a strict Baptist home but had to leave . . . I needed more room to be me. I like life here at the university but there's a restlessness in me I can't describe. I've dated several men, one or two I really liked, but I always do something to mess up the relationship. It would kill my mother if she knew I lived with Gary for 3 months." "What it really comes down to is my own sense of betraying myself, my family, and my religion. Who am I anyway?"

Defining char for nursing dx of spiritual anxiety

A 37-year-old previously healthy male executive recovering from massive myocardial infarction "My parents were strict Methodists, but when I left home for college I stopped going to church . . . never gave it much thought . . . there was always something else to do. I started going again but it never meant much." "I haven't exactly done anything awful but I've also not been a saint and I find myself wondering if there is a God, what does he think of me." "Funny, I guess I thought I'd live forever. I sure never thought about dying and what happens after that." Often observed lying quietly in bed awake; asked to see minister.

Defining char for nursing dx of spiritual anger

A 38-year-old homosexual man recently diagnosed with AIDS "My parents are fundamentalists . . . all I ever heard at home was how much Jesus loves me . . . all the while my mom was beating the daylights out of me. . . . Does He love me? Does He love me so much that He had my parents throw me out when I finally told them I was gay? Does He love me so much that I got AIDS and now no one comes near me?" Facial features are tight; body held rigidly; speech is sharp, appears angry with God, the world, himself.

Defining char for nursing dx of spiritual loss

A 40-year-old mother of three sons who was diagnosed with ovarian cancer 18 months ago; currently in advanced stage of disease "I've tried hard to do it all right . . . I read my Bible, prayed every day, went to church each Sunday, loved my husband and kids . . . why is this all happening to me? Why must I lose it all? Where is God now that I need him? Some mornings I wish I could shoot myself and end it all—instead another day drags on. Who can help me?" Cries frequently, no longer interested in everyday activities of family, no interest in praying, told family not to have pastor call anymore. "No one can help now."

Defining char for nursing dx of spiritual pain

A 46-year-old woman, agnostic, only son died 6 months ago (lung cancer) "I've often wondered throughout my life if there is a God—thought maybe if I had tried harder I'd have recognized him. Now, I don't care if God exists or not because if he allows this I don't want to know him." "My son was my whole life; there's nothing left for me to live for." Lost 10 lb in 6 months since son died; leaves home only when necessary to purchase food, go to bank, and engage in other routine activities.

Defining char for nursing dx of spiritual alienation

A 72-year-old Orthodox Jewish man, recently admitted to Protestant long-term care facility following 3-week hospitalization for stroke "I guess Yahweh has written me off; first the stroke that killed half my body and then I'm abandoned here where I can't even observe the Sabbath." "I want to go home."

Defining char for nursing dx of spiritual despair

A 92-year-old frail widow who lives alone in a two-room apartment; crippled with arthritis; has two married sons she has not seen for years. Says to community nurse who visits every week, "No one should have to live like this. If it weren't for the neighbor who comes on Saturday with a few groceries and you, I'd be dead. I guess that would be for the best. It's been a long time since I felt like my living or dying would matter to anyone. Because I'm 92 now, I guess even God doesn't want me. Couldn't you do something to put me out of my misery?"

Developmental considerations for spirituality for children

A child must have developed some capacity for abstract in order to understand the spiritual self spirituality is not meaningless for children Central themes in children's descriptions of spirituality include: Notion of a God who works through human intimacy and the interconnectedness of lives Belief that God is involved in self-change and growth and transformations that make the world fresh, alive, and meaningful Attributing to God tremendous and expansive power and then showing considerable anxiety in the face of this power Image of light As the child matures, life experiences usually influence and mature the child's spiritual beliefs. Tendency to think about life after death prompts some people to re-examine and reaffirm their spiritual beliefs

atheist

A person who denies the existence of a god

What is often the most important intervention for spirituality?

A well-timed referral to a professional spiritual caregiver

American Muslim Mission

Accept the Koran as their sacred scripture most stress importance of cooperation among blacks in business and education to build self-esteem Members encouraged to obtain health care provided by members of black community Major tenets involve prayer rituals, dietary restrictions (prohibitions against pork and alcohol), hygiene (extreme cleanliness), lifestyle modifications, and marital faithfulness

What does the American Academy of Pediatrics urge as far as spirituality is concerned?

All child abuse, neglect, and medical neglect statues be applied without potential or actual exemption for religious beliefs

Islam

Allah, one God, who is only one, all seeing, all hearing, all speaking, all knowing, all willing, all powerful Must be able to practice the Five Pillars of Islam May have a fatalistic view of health Obligatory prayers, holy days, and fasting (Ramadan), and almsgiving Koranic law and customs that influence birth, diet (eating pork and drinking alcohol are forbidden), care of women, death and prayer rituals Some Muslim women are not allowed to make independent decisions; husbands may need to be present when consent is sought.

Focus assessment questions for spiritual beliefs

Are there particular spiritual or religious beliefs that are important to you? Have these beliefs changed recently? Is your illness challenging these beliefs? Do your religious beliefs in any way dictate a course of action that puts you in conflict with what your physicians are recommending?

Focus assessment questions for spiritual deficit or distress

Are your spiritual beliefs causing you any distress?

Focus assessment questions for need for significant behavioral observations

Be alert to sudden changes in spiritual practices, mood changes, sudden interest in spiritual matters, and sleep disturbances—any of which may point to unresolved spiritual needs.

Attempting to measure the degree to which a person expresses religious faith or thinks about spiritual things

Be aware of the wide variety of definitions of spirituality and religiousness and the lack of consensus regarding their definitions Acknowledge and consider the foundation of earlier work Build on prior work rather than, for example, creating new instruments Be aware of the wide variety of measures and be guided by being clear about what they want to measure Consider using the Spiritual Well-Being Scale (SWBS) because it is the most widely used measure, if appropriate to the research purpose(s). This enhances the ability to compare findings across studies. Carefully formulate research questions and definitions Be clear and focus on clinically useful findings that can guide inquiry and practice.

Nursing interventions for nursing outcomes of quality of faith, quality of hope, meaning and purpose in life, ability to love, ability to forgive, ability to worship, and spiritual contentment

Be open to the patient's expressions of loneliness and powerlessness. Encourage chapel service attendance, if desired. Encourage use of spiritual resources, if desired. Refer to the spiritual adviser of the patient's choice. Use values clarification techniques to help the patient clarify beliefs and values, as appropriate. Be available to listen to the patient's feelings. Express empathy with the patient's feelings. Assure the patient that a nurse will be available to support the patient in times of suffering. Be open to the patient's feelings about illness and death.

Assessment of patient's spirituality included in comprehensive assessment

Beliefs Practices Effect of these beliefs on everyday living, spiritual distress, and spiritual needs

Buddhism

Buddha--or "the Great Physician"--taught the Four Noble Truths to indicate the range of "suffering," its "origin," its "cessation," and the "way" that leads to its cessation. The real cause of human suffering is ignorant craving. The Noble Eightfold Path--which consists of livelihood, effort, mindfulness, and concentration--leads to the cessation of suffering Buddhists do not outwardly proclaim healing through faith. However, spiritual peace and liberation from anxiety attained through the awakening to Buddha's wisdom may be an important factor in expediting healing and the recovery process. Accepts modern science. The doctrine of avoidance of extremes is applied to the use of drugs, blood, vaccines. Buddhism does not condone taking lives of any form. Check with the patient about any special diet restrictions and the observance of holy days.

Ethnic background's role in spirituality

Clear distinctions b/w Eastern and Western spiritual traditions as well as among those of individual ethnic groups, like native americans Peron's culture and formal religion affect whether the approach to religion is doing something, being someone, or continually striving for harmony

Focus assessment questions for relation between spiritual beliefs and everyday living

Describe ways your spiritual beliefs affect everyday living (daily schedule, diet, hygiene, sense of self and the world, relationships). Do you find this influence to be healthy (life affirming) or destructive (life denying)?

Focus assessment questions for spiritual practices

Describe your usual spiritual practices and anything interfering with your ability to perform them. Can I help in any way to secure the aids necessary for these practices (prayer shawl, Bible, crystals, amulets, beads, icons)?"

Church of Jesus Christ of Latter Day Saints (Mormons)

Devout adherents believe in divine healing through the "laying on of hands," though many do not prohibit medical therapy. The Church maintains an extensive and well-funded welfare system, including financial support for the sick. Disapprove of alcohol, tobacco, and caffeinated beverages A special undergarment worn by some members should be removed only in an emergency.

Native American Religions

Difficult to generalize; notion of cosmic harmony, emphasis on directly experiencing powers and visions and a common view of the cycle of life and death. Death is not the end but the beginning of new life (reincarnation or transcendent hereafter). Rituals mark important life changes: birth, puberty, initiation rites, death. Medicine men and women have specialized spirits from whom they receive the mission to cure. Common therapeutic measures: sucking, blowing, and drawing out with a feather fan

Hinduism

Doctrine of Transmigration. Moral factors, linked with the all-embracing doctrine of "karma," are believed to be significant in promoting health or causing disease. Hindu medicine shows a surprising openness to new ideas, at least in respect to practical treatment. Many Hindu dietary restrictions conform to individual sect doctrine. The nurse administering medications should avoid touching the patient's lips. Certain prescribed rites are followed after death; disposal of the body is by cremation.

The parents of three children ages 4, 7, and 11 years are interested in fostering spiritual development in their children. The nurse informs the parents that the development of a child's spirituality is best accomplished by: -educating through parental behaviors. -educating the child about God. -educating through religious-based schools. -educating the child about religion.

Educating through parental behaviors Rationale: 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 parent's behavior.

Hope

Enables a person both to consider a future and to work to actively bring that future into being Originates in imagination but must become a valued and realistic possibility in order to energize action Allows one to embrace the reality of suffering without escaping from it (false hope) or being suffocated by it (despair, helplessness, hopelessness) Unique to each person

Unitarian Universal Association of Churches and Fellowships

Encourage creativity, reason, and living an ethical life. No member is required to adhere to a given creed or set of religious beliefs. The inherent worth and dignity of every person is affirmed. Free to accept what they take to be best for their health

When having issues with the moral autonomy of caregivers and the integrity of the healing professions as religious freedom is concerned, who should the nurse consult?

Ethics committee or ethics consultation service

Self-care behaviors for spirituality

Explore personal values and beliefs of self and others. Set aside regular periods to nurture spiritual self. Explore practices that are spiritually supportive. Demonstrate in interaction with others peace, inner strength, warmth, joy, caring, creativity. Respect the belief systems of others. Practice loving relationships with self and others. Seek spiritual assistance to help cope with stress, crisis, or loss.

Ways to help the patient continue normal spiritual practices in the hospital or care center

Familiarize the patient with the pastoral and religious services and materials available within the institution. Respect the patient's need for privacy or quiet during periods of prayer. Assist the patient to obtain devotional objects and protect them from loss or damage. Arrange for the patient wishing to receive the sacraments to do so. Attempt to meet the patient's religious dietary restrictions. Arrange for the patient's minister, priest, or rabbi to visit if the patient so wishes. assist patient in discussing conflict b/w spiritual beliefs and the proposed medical therapy with the physician help patients find ways to meet spiritual needs

Judaism

Formation closely bound with a divine revelation and with commitment to obedience to God's will. The Hebrew Bible is the authority, guide, and inspiration of the many forms of religion of the Jews (currently Reform, Conservative, Orthodox). For observant Jews: special needs in the areas of diet, birth rituals, male and female contact, and death Treatment and procedures should not be scheduled on the Sabbath.

Unification Church

God is the living, eternal person who represents universal love and care. God created the world and humans to reflect his nature. The goal of the Unification Church is to unite Christians everywhere as one family under God. Most members are still healthy young adults. There is little information available on their interactions with the health care team.

Daoism (Taoism)

Health is a manifestation of the harmony of the universe, obtained through the proper balancing of internal and external forces. Implicit throughout the Daoist tradition is the tendency to understand salvation in the biomedical sense of health and qualitative improvement and prolongation of human life. The universal principle of the Tao is the mysterious biologic and spiritual life rhythm or order of nature. There is a "medicinal" concern for maintaining and prolonging human health and life (sheng). Knowing and living a natural life—following the Tao—is the secret of both health and sagehood. Long tradition of seeking pragmatic medical techniques, along with its religious techniques of meditation and ritual for establishing a harmony of body and spirit, humanity, and nature (holistic approach)

Outcomes for enhancing spiritual health

Identify spiritual beliefs that meet needs for meaning and purpose, love and relatedness, and forgiveness Derive from these beliefs strength, hope, and comfort when facing the challenge of illness, injury, or other life crisis Develop spiritual practices that nurture communion with inner self, with God/higher power, and with the world Express satisfaction with the compatibility of spiritual beliefs and everyday living

Spiritual distress may affect other areas of human functioning. In the following nursing diagnoses, spiritual distress is the etiology of another problem.

Impaired Adjustment to Illness related to inability to reconcile illness with spiritual beliefs Ineffective Individual Coping related to loss of religion as primary support (feels abandoned by God/higher power) Fear related to feeling unprepared for death and afterlife experience Dysfunctional Grieving: Despair related to belief that religion is meaningless Hopelessness related to belief that no one cares, including God/higher power Powerlessness related to feeling victimized by a tyrannical and arbitrary God/higher power Self-Esteem Disturbance related to failure to live according to dictates of religion Sexual Dysfunction related to values conflict Sleep Pattern Disturbance related to spiritual distress Risk for Self-Directed Violence related to feeling that life is meaningless

Focus assessment questions for spiritual needs

In what ways can I and the other nurses help you meet your spiritual needs? Would you like me to contact your spiritual adviser or the hospital's pastoral care minister?

Focus assessment questions for need for forgiveness

In what ways do your religious beliefs help or hinder you to feel at peace?

Focus assessment questions for need for love and relatedness

In what ways do your religious beliefs help or hinder you to meet your need to love and be loved?

Focus assessment questions for need for meaning and purpose

In what ways do your religious beliefs help or hinder you to understand your current situation and face it with peace and courage?

Confucianism

Inherent in Confucianism is the appreciation of life and the desire to keep the body from untimely or unnecessary death. Appreciate life and desire to keep the body from untimely or unnecessary death Historically emphasized public health solutions to impending health problems

Spirituality hints for professional boundaries

Keep the spiritual history patient centered. Recognize pastoral care professionals as experts in this field and consult them appropriately. Proselytizing is never acceptable in professional settings. Addressing spiritual issues should not be coercive. More in-depth spiritual counseling should be under the direction of chaplains and other spiritual leaders. Praying with patients should not be initiated by the nurse unless there is no pastoral care available and the patient requests it or in situations in which the nurse and patient have a long-standing relationship or share a similar belief system. The nurse can stand in silence as the patient prays in her or his tradition. The nurse can always make a referral to pastoral care for chaplain-led prayer (p. 241).

Formal religion and spirituality

Major religious groups share several characteristics Basis of authority or source of power Scripture or sacred word An ethical code that defines right and wrong A psychology and identity, so that its adherents fit into a group and the world is defined by the religion Aspirations or expectations Ideas about what follows death

Spirituality and everyday living

Major wisdom traditions address the invisible spirit-a creative, mysterious, guiding power by creating principles and practices that: Cultivate love of ourselves, our neighbors, of a higher being, and of nature Cultivate wisdom that helps us find meaning in life; be in relationships with others; be true to ourselves; live in uncertainty and mystery; deal with suffering, sickness, and death; and honor life's transitions (birth, marriage, death) Cultivate awareness of the sacred dimension of life through practices such as worship, prayer, meditation, and singing Respect our connectedness as fellow human beings while acknowledging our differences Help us be generous in service to others Life affirming influences enhance life, give meaning and purpose to existence, strengthen one's feelings of self-worth, encourage self-actualization, and are health giving and life sustaining Life denying influences restrict or enclose life patterns, limit experiences and associations, place burdens of guilt on people, encourage feelings of unworthiness, and are generally health denying and life inhibiting

Guide to daily living habits

Many religions have dietary requirements and restrictions Acceptable birth-control practices are determined by some religious faiths, as are some types of medical treatments

Loving Kindness Meditation

May you be at peace. May your heart remain open. May you awaken to the light of your own true nature. May you know the power of your higher self. May peace of mind be your only goal and forgiveness your only task. May you be healed of all pain and hurt. May you be a source of healing for others. May you know the inner beauty of the person you truly are. May you be at peace.

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 basic necessities of life -need for forgiveness -need for love and relatedness -need for meaning and purpose

Need for love and relatedness

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 forgiveness -Need for love and relatedness -Need for meaning and purpose -Need basic necessities of life

Need for love and relatedness

According to Shelly and Fish, which of the following is a spiritual need underlying all religious traditions? -need for justice -need for meaning and purpose -need for formal ceremony -need for power in relationship with God

Need for meaning and purpose

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 love and relatedness -Need for basic necessities of life -Need for meaning and purpose -Need for forgiveness

Need for meaning and purpose

Three spiritual needs

Need for meaning and purpose Need for love and relatedness Need for forgiveness

Spiritual health and healing

O'Brien's conceptual model of spiritual well-being in illness identifies 3 elements of spiritual well-being: personal faith, spiritual contentment, and religious practice

Steps for being a healing presence

Open yourself Intend to be a healing presence prepare a space for healing presence to take place honor the one in your care offer what you have to give receive the gifts that come live a life of wholeness and balance

Source of strength and healing

People endure extreme physical distress bc of strong faith families have taken on almost unbelievable rehabilitative tasks bc they had faith int he eventual positive result of their effort

Adventist

Persons choice and God's sovereignty Body believed to be temple of Holy Spirit Taking of all narcotics and stimulants is prohibited because body is temple of the Holy Spirit and should be protected Many groups prohibit meat May regard Saturday as the Sabbath Approach to health care is holistic

NANDA nursing dx related to spirituality

Readiness for Enhanced Hope: A pattern of expectations and desires that is sufficient for mobilizing energy on one's own behalf and can be strengthened Hopelessness: Subjective state in which an individual sees limited or no alternatives or personal choices available and is unable to mobilize energy on own behalf Readiness for Enhanced Spiritual Well-Being: Ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, or a power greater than oneself Impaired Religiosity (or Risk for Impaired Religiosity): Impaired ability to exercise reliance on beliefs and/or participate in rituals of a particular faith tradition Readiness for Enhanced Religiosity: Ability to increase reliance on religious beliefs and/or participate in rituals of a particular faith tradition Spiritual Distress (or Risk for Spiritual Distress): Impaired ability to experience and integrate meaning and purpose in life through one's connectedness with self, others, art, music, literature, nature, or a power greater than oneself

Jeff Levin's seven principles of theosomatic medicine

Religious affiliation and membership benefit health by promoting healthy behavior and lifestyles. Regular religious fellowship benefits health by offering support that buffers the effects of stress and isolation. Participation in worship and prayer benefits health through the physiologic effect of positive emotions. Religious beliefs benefit health by their similarity to health-promoting beliefs and personality styles. Simple faith benefits health by leading to thoughts of hope, optimism, and positive expectations. Mystical experiences benefit health by activating a healing bioenergy, or life force, or altered state of consciousness. Absent prayer for others is capable of healing by paranormal means or divine intervention

Sources of conflict

Religious beliefs conflict with prevalent health care practices Navajos use a lengthy religious ceremony to cure certain diseases, such as tb

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 -Spiritual crisis -Depression -Change in beliefs

Separation from spiritual ties 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.

*HOPE acronym in spiritual assessment*

Sources of hope, meaning comfort, strength, peace, love, and connection Organized religion Personal spirituality and practice Effects on medical care and end-of-life issue

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? -Dysfunctional Grieving related to inability to attend church services as a result of his medical condition -Spiritual Need as evidenced by verbalizations and distress at missing Methodist church services -Spiritual Distress related to inability to attend church services evidenced by verbal states of guilt Potential for -Enhanced Spiritual Well-Being related to distress at missing Methodist church services

Spiritual Distress related to inability to attend church services evidenced by verbal states of guilt

How might spiritual distress be further specified as?

Spiritual pain alienation anxiety guilt anger loss despair

Christian Scientist

They deny the existence of health crises; sickness and sin are errors of the human mind and can be overcome by altering thoughts, not by using drugs or medicines. They will use orthopedic services to set a bone but decline drugs and, in general, other medical or surgical procedures. They do not allow hypnotism or any form of psychotherapy, which alters the "Divine Mind." A Christian Science Practitioner may be called to administer spiritual support. Alcohol and tobacco are not used.

Jehovah's Witnesses

They oppose the "false teachings" of other sects; opposition often extends to modern science, including medicine. Blood transfusions violate God's laws and, therefore, are not allowed. The courts have not supported the right of Jehovah's Witness parents to refuse lifesaving treatment for their children. Use of alcohol and tobacco are discouraged.

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. -Tell the husband to think before saying anything negative. -Call the pastor into the room to speak with the husband. -Leave the room and do not be part of this situation

Use silence and allow the husband to express his emotions

Major questions that religious beliefs, attitudes, and values can affect

What is the meaning of suffering? How should we regard the physical body and its functions? What are the meaning and role of gender differences, sexuality, and reproduction? How are we to understand and respond to birth, aging, and death? What constitutes the self, and how is selfhood assessed? How are sin and moral culpability understood? What makes something sinful, and how is sin relieved or absolved? What are the tradition's specific bioethical teachings?

Roman Catholicism

Worship of the one God revealed to the world through Jesus Christ. Love of neighbor is a central tenet. Other beliefs include sin, redemption, salvation, and a final accounting with God. Care of the sick is encouraged. God the author and giver of life is also the healer. Human life is a gift of God. Many take an antiabortion stance; most accept modern medical science. Importance of private devotions and Mass attendance on Sunday Seven sacraments (importance of baptism, Eucharist, penance, and the anointing of the sick) Dietary habits Sexual ethical norms Only natural means of birth control; abortion, euthanasia, and sterilization are forbidden

Protestantism

Worship of the one God revealed to the world through Jesus Christ. Love of neighbor is a central tenet. Other beliefs include sin, redemption, salvation, and a final accounting with God. Care of the sick is encouraged. God the author and giver of life is also the healer. Most accept modern medical science. Religious practices vary according to denomination; may include prayer, faith healing, "laying on of hands," and anointing. Sacraments: baptism, communion, confirmation

agnostic

a person who believes nothing can be known about the existence of a god

spiritual distress

an alteration in spiritual health (e.g., spiritual pain, alienation, anxiety, guilt, anger, loss, despair)

spirituality

anything that pertains to a person's relationship with a nonmaterial life force or higher power

How can a nurse promote meaning and purpose?

explore with patients what has given their life meaning and purpose up to now sources of meaning rfor other people possible meanings for patients' current experience of illness, pain, suffering, or impending death referral to spiritual adviser Explore spiritual practices that may give them strength and hope referring patients to appropriate support groups

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: -forgiveness. -love and relatedness -trust -faith

faith

Significant behavioral changes in mood

frequent crying depression apathy anger

Common etiologies for spiritual distress

inability to reconcile a current life situation with spiritual beliefs separation from the religious community or supports

hope

ingredient in life responsible for a positive outlook, even in life's bleakest moments

Spiritual nurturing for patient's family caregivers

interventions that enhance a caregiver's ability to take part in church activities to satisfy spiritual needs work with church groups to secure helpful services clergy praryer forgiveness spiritual reading materials

spiritual needs

lack of anything necessary for spiritual health (e.g., meaning and purpose, love and relatedness, forgiveness)

Source of support

many seek support from their religious faith during times of stress support is vital to acceptance of an illness, especially if it brings a prolonged period of convalescence or may lead to a questionable outcome Prayer, devotional reading,and other practices do for the person spiritually what protective exercises do for the body physically

spiritual healing

movement toward integration, from brokenness to wholeness

Religion

nurse is better able to meet patients' spiritual needs when we understand their religious beliefs and practices can directly influence client responses to illness and suffering, self-care practices such as diet and hygiene, birth and death rituals, gender roles, spiritual practices, and moral codes Most Americans who are affiliated with a religion do not believe their religion is the only way to salvation. Most also believe that there is more than one true way to interpret the teachings of their religion. More than half of Americans rank the importance of religion very highly in their lives, attend religious services regularly, and pray daily. A plurality of adults who are affiliated with a religion want their religion to preserve its traditional beliefs and practices rather than either adjust to new circumstances or adopt modern beliefs and practices. Significant minorities across nearly all religious traditions see a conflict between being a devout person and living in a modern society. The relationship between religion and politics is particularly strong with respect to political ideology and views on social issues such as abortion and homosexuality, with the more religiously committed adherents across several religious traditions expressing more conservative political views. Americans are very similar in some basic religious beliefs. For instance, Americans are nearly unanimous in saying they believe in God (92%); large majorities believe in life after death (74%) and believe that Scripture is the word of God (63%). More than three quarters of American adults (78%) believe there are absolute standards of right and wrong, with a majority (52%) saying they rely primarily on practical experience and common sense for guidance regarding right and wrong. Far fewer say they rely mainly on their religious beliefs (29%), and fewer still say they rely on philosophy and reason (9%) or scientific information (5%). The United States has largely avoided the secularizing trends that have reshaped the religious scene in recent decades in European and other economically developed nations—but not entirely. The Landscape Survey documents, for example, that the number of Americans who are not affiliated with a religion has grown significantly in recent decades, with the number of people who today say they are unaffiliated with a religious tradition (16% of U.S. adults) more than double the number who say they were not affiliated with a religion as children (7%). Nurses who are unfamiliar with a patient's religion can gain knowledge by discussions w/patient and patient's family and spiritual adviser Never presume to know what a patients' religious beliefs or practices are Do not interpret the fact that a patient does not belong to an organized religion to mean that the patient has no spiritual needs-a person may be deeply spiritual yet not belong to an organized religion

How can nurses assist patients to meet spiritual needs?

offering a compassionate presence assisting in the struggle to find meaning and purpose in the face of suffering, illness, and death fostering relationships (with a higher being/humans) that nurture the spirit facilitating the patient's expression of religious or spiritual beliefs and practices

Spirituality

one person may describe it in terms of coming to know, love, and serve God another may speak of transcending limits of the body and experiencing a universal energy elements include Spirituality is experienced as a unifying force, life principle, essence of being. Spirituality is expressed and experienced in and through connectedness with nature, the earth, the environment, and the cosmos. People express and experience spirituality in and through connectedness with other people. Spirituality shapes the self-becoming and is reflected in one's being, knowing, and doing. Spirituality permeates life; providing purpose, meaning, strength, and guidance; and shaping the journey products of relationships, some physical (presencing, touch, healing) and others emotional (meaning, empathy/compassion, hope, love, and religion/transcendence): connection

religion

organized system of beliefs about a higher power; often includes set forms of worship, spiritual practices, and codes of conduct

Family's role in spirituality

parents play a key role in development of child's spirituality what parents explicitly teach a child about spirituality and religion is generally less important than what the child learns about spirituality, life, and self from the parents' behavior

Faith

person, idea, thing followed by action related ot ideals or values of this belief those who believe in a loving and all-powerful being who knows them and cares for them are often better able to cope with the suffering related to injury and illness Link among faiths: A conviction of the fundamental unity of the human family, of the quality and dignity of all human beings A sense of the sacredness of the individual person and the person's conscience A sense of the value of the human community A belief that love, compassion, unselfishness, and the force of inner truthfulness and of the spirit have ultimately greater power than hate, enmity, and self-interest A sense of obligation to stand on the side of the poor and the oppressed as against the rich and the oppressors A profound hope that good will finally prevail used to describe a cultural or institutional religion, like judaism, islan, or confucianism all deserve respect for what they choose to believe, just as do those who accept a particular religious creed

Life events and spirituality

positive and negative life experiences can influence spirituality--influenced by the meaning a person's spiritual beliefs attribute to them

spiritual beliefs

practices associated with all aspects of a person's life, including health and illness, that address the invisible "spirit"-- a creative, mysterious guiding power

Sudden interest in spiritual matters

reading religious books watching religious programs on tv visits to clergy disturbed sleep

how can a nurse nurture spirituality?

recommending means to develop a relationship with one's inner world (prayer, reflection, dream analysis, nature walks, enjoying art) manifest spiritual energy in one's outer world (loving relationships, compassion, forgiveness, joy, service).

Significant behavioral changes in spiritual practices

rejection neglect fanatical devotion

how can a nurse promote love and relatedness?

treat patient with respect, empathy, and genuine caring encourage patient to talk about relationships with others and to identify the origin of any negative beliefs about people encourage conversation about how a patient experiences God or a higher being introduce or reinforce the belief that God is a loving and person God who is concerned about the patient Encourage and facilitate visits form the patient's family, friends, and spiritual adviser

If a patient reveals a spiritual problem, what should be done?

use interview questions to determine the specific nature of the problem its probable causes, its related signs and symptoms when it began and how often it occurs how it affects everyday living its severity and whether it can be treated independently by nursing or needs to be referred how well the patient is coping.