Chapter 12 Spirituality and Religious Practices

Buddhism (Overview)

Suffering is a part of human existence, but the inward death of the self and senses leads to a state beyond suffering and existence.

SPIRIT Acronym

S—Spiritual Belief System P—Personal Spirituality I—Integration with a Spiritual Community R—Ritualized Practices and Restrictions I—Implications For Medical Care T—Terminal Events Planning

A—Address in Care (FICA Spiritual History Tool)

"How would you like me, your health care provider, to address these issues in your health care?" (With the newer models, including diagnosis of spiritual distress, A also refers to the Assessment and Plan of patient spiritual distress or issues within a treatment or care plan.)

Which one is the correct definition of spirituality? A) Active and ongoing conversation that assesses the spiritual needs of the client. B) Rituals, practices, and experiences involving a search for the sacred (e.g., God, Allah, etc.)a that are shared within a group. C) Addressing the spiritual needs of the client as they unfold through spiritual assessment. D) A search for meaning and purpose in life, which seeks to understand life's ultimate questions in relation to the sacred.

D) A search for meaning and purpose in life, which seeks to understand life's ultimate questions in relation to the sacred.

Which one is the correct definition of spiritual care? A) A search for meaning and purpose in life, which seeks to understand life's ultimate questions in relation to the sacred. B) Rituals, practices, and experiences involving a search for the sacred (e.g., God, Allah, etc.)a that are shared within a group. C) Active and ongoing conversation that assesses the spiritual needs of the client. D) Addressing the spiritual needs of the client as they unfold through spiritual assessment.

D) Addressing the spiritual needs of the client as they unfold through spiritual assessment.

The nurse is preparing a client for cancer chemotherapy treatment. While talking with the nurse, the client says, "Miracles do happen, and I'm praying for one." The nurse interprets this statement as suggesting which religious preference? A) Judaism B) Buddhism C) Islam D) Christianity

D) Christianity

Judaism (Overview)

Judaism includes religious beliefs and a philosophy for a code of ethics with four major groupings of Jewish beliefs: Reform, Reconstructionist, Conservative, and Orthodox. Prayer shawls are common and are often passed between generations of family. A member of the clergy is known as a Rabbi.

Buddhism (End of Life)

Life is the opportunity to cultivate understanding, compassion, and joy for self and others. Death is associated with rebirth. Serene surroundings are important to the dignity of dying.

Hinduism (Overview)

Nirvana (oneness with God) is the primary purpose of the religion. Many have an altar in their home for worship.

Christianity (Nutrition)

No special or universal food beliefs are common to Christian religions, although there may be regional or cultural beliefs.

Jehovah's Witnesses

Refuse blood transfusions due to their beliefs that the body cannot be sustained by another's blood and accepting a transfusion will bar the recipient from eternal salvation.

Christian scientists:

Rely on prayer alone to heal illnesses, rarely seek mainstream medical care, and have higher rates of mortality than the general population.

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? A) Christianity B) Judaism C) Islam D) Hinduism

C) Islam

Islam (End of Life)

All outcomes, whether death or healing, are seen as predetermined by Allah. It is important for dying clients to face east and to die facing east. Prayer is offered but need not be done by an Imam (religious leader).

Which one is the correct definition of religion? A) A search for meaning and purpose in life, which seeks to understand life's ultimate questions in relation to the sacred. B) Rituals, practices, and experiences involving a search for the sacred (e.g., God, Allah, etc.)a that are shared within a group. C) Active and ongoing conversation that assesses the spiritual needs of the client. D) Addressing the spiritual needs of the client as they unfold through spiritual assessment.

B) Rituals, practices, and experiences involving a search for the sacred (e.g., God, Allah, etc.)a that are shared within a group.

Which ones are not characteristics of religion? Select all that apply. A) Group Oriented B) Formal C) Subjective D) Organized E) Ritualistic

C) Subjective

I—Integration with a Spiritual Community (Question)

Do you belong to any religious or spiritual groups or communities? How do you participate in this group/community? What is your role? What importance does this group have for you? In what ways is this group a source of support for you? What types of support and help does or could this group provide for you in dealing with health issues?

S—Spiritual Belief System (Questions)

Do you have a formal religious affiliation? Can you describe it? Do you have a spiritual life that is important to you? What is your clearest sense of the meaning of your life at this time?

Which one is not a characteristic of spirituality? A) Subjective B) Informal C) Self-reflective D) Nonorganized E) Objective

E) Objective

FICA Spiritual History Tool

F—Faith and Belief I—Importance C—Community A—Address in Care

HOPE Acronym

H: sources of hope O: organized religion P: personal spirituality and practices E: effects on medical care and end-of-life issues

Client's spirituality and religiosity can also be assessed with formal self-assessment instruments such as:

HOPE FICA

Buddhism (Nutrition)

Many are strict vegetarians. Some holy days include fasting from dawn to dusk but considerations are allowed for the frail and elderly, for whom fasting could create problems.

Hinduism (Nutrition)

Many, but not all, are vegetarians. Many holy days include fasting.

Islam (Overview)

Mohammed is believed to be the greatest of all prophets. Worship occurs in a mosque. Prayer occurs five times a day: dawn through sunrise, noon, afternoon, sunset, and evening. Prayers are done facing east toward the sacred place in Mecca and often occur on a prayer rug with ritual washing of hands, face, and feet prior to prayer. Women are to be "modest" and are not to view men, other than their husbands, naked. The Islamic faith is presently one of the fastest growing religious groups in the United States

Christianity (Illness)

Most view illness as a natural process for the body and even as a testing of faith. Others may see illness as a curse brought on by living outside the laws of God and, therefore, retribution for personal evil.

Judaism (Nutrition)

Orthodox or kosher rules involve no mixing of meat with dairy; separate cooking and eating utensils are used for food preparation and consumption. Kosher laws include special procedures for slaughter and food handling. "Keeping kosher" is predominantly an Orthodox practice. When food has passed kosher laws of preparation, a symbol (K) appears on the label. Many holy days include a fasting period.

Buddhism (Illness)

Prayer and meditation are used for cleansing and healing. Terminal illness may be seen as a unique opportunity to reflect on life's ultimate meaning and the meaning of one's relation with the world. Therefore, it is important that medication does not interfere with consciousness.

Christianity (End of Life)

There is belief in miracles, especially through prayer. Western medicine is usually held in high regard. Memorial services rather than funerals and cremation rather than burial are more common in Christian religions than in other sects.

Religion may lead to

o Depression or anxiety over not meeting group expectations o Certain spiritual practices or participation in complementary o Alternative medical practices may delay needed medical care

C—Community (FICA Spiritual History Tool)

"Are you part of a spiritual community? Communities such as churches, temples, and mosques, or a group of like-minded friends, family, or yoga can serve as strong support systems for some patients. Can explore further: Is this of support to you and how? Is there a group of people you really love or who are important to you?"

F—Faith and Belief (FICA Spiritual History Tool)

"Do you consider yourself spiritual or religious?" or "Is spirituality something important to you" or "Do you have spiritual beliefs that help you cope with stress/ difficult times?" (Contextualize to reason for visit if it is not the routine history.) If the patient responds "No," the health care provider might ask, "What gives your life meaning?" Sometimes patients respond with answers such as family, career, or nature. (The question of meaning should also be asked even if people answer yes to spirituality.)

The nurse is assessing a client's spiritual history using the SPIRIT acronym. The nurse should begin the assessment by identifying what aspect of spirituality? A) The client's religious affiliation B) The client's state of health C) The client's sources of hope D) The client's spiritual belief system

C) The client's sources of hope

When taking the Daily Spiritual Experiences Scale, a client says the word "God" in the scale is bothersome. Which response by the nurse would be most helpful in encouraging a client to complete the scale? A) "Substitute whatever word you prefer that would represent the divine or holy." B) "You can skip those questions and answer only those you are comfortable with." C) "Don't be concerned about the wording; just answer the best way you know how." D) "It is perfectly fine to leave out any question that contains the word 'God.'"

A) "Substitute whatever word you prefer that would represent the divine or holy."

A nurse recognizes the need to assess a client's spirituality after the client has been admitted from the emergency department to the medical unit. How should the nurse best initiate this assessment? A) "Would you describe yourself as being a religious or spiritual type of person?" B) "What is the belief system that you most closely adhere to?" C) "What church do you attend at Christmas and Easter?" D) "Do you consider yourself to be a moral person with beliefs about the supernatural?"

A) "Would you describe yourself as being a religious or spiritual type of person?"

Which one is the correct definition of spiritual assessment? A) Active and ongoing conversation that assesses the spiritual needs of the client. B) Addressing the spiritual needs of the client as they unfold through spiritual assessment. C) Rituals, practices, and experiences involving a search for the sacred (e.g., God, Allah, etc.)a that are shared within a group. D) A search for meaning and purpose in life, which seeks to understand life's ultimate questions in relation to the sacred.

A) Active and ongoing conversation that assesses the spiritual needs of the client.

A nurse interviews a pregnant client and learns that her beliefs around health care do not involve participation in comprehensive prenatal care. To which religious view would the client most likely adhere? A) Faith Assembly of Indiana B) Buddhist C) Christian Scientist D) Jehovah's Witness

A) Faith Assembly of Indiana

A nurse is preparing an in-service program about spirituality and religion for a group of colleagues. When describing the effects on clients of religion and spirituality, which of the following should the nurse include? Select all that apply. A) Improved client sense of well-being B) Enhanced coping with end-of-life issues C) Increased mortality levels D) Increased timely use of health care E) Increased adherence to medical regimens

A) Improved client sense of well-being B) Enhanced coping with end-of-life issues E) Increased adherence to medical regimens

A nurse assesses a client's spirituality and religious practices. During the assessment, the nurse notes that the client is very quiet and rarely asks any questions of the health care workers. The nurse recognizes that this behavior may be associated with which religion? A) Islam B) Buddhism C) Hinduism D) Christianity

A) Islam

A nurse is working with a client who has received a terminal diagnosis. To help the nurse identify the client's possible coping responses, which of the following would be most important for the nurse to understand about spirituality? A) It varies in different situations. B) It increases in significance with illness. C) It decreases in importance with age. D) It remains static throughout the lifespan.

A) It varies in different situations.

The nurse is caring for the family of a client who has just died. The family requests that the client's arms not be crossed and that any of the clothing and dressings containing blood be left and be prepared for burial with the client. The nurse understands this family's request as indicative of what religious beliefs? A) Judaism B) Buddhism C) Hinduism D) Christianity

A) Judaism

A nurse is planning a spiritual assessment of a client who is experiencing intractable losses in function as a result of disease. Which of the following principles should inform the nurse's assessment? A) Knowledge of the most common spiritual practices in the community is a priority. B) Reviewing all religious denominations before approaching a client is important. C) It is of little importance for a nurse to understand his or her own spirituality. D) Spirituality is a complex phenomenon that is not normally describable.

A) Knowledge of the most common spiritual practices in the community is a priority.

A nurse is admitting a client to a long-term care facility. In order to elicit reliable and valid data during the spiritual assessment, the nurse understands that the focus must be on which of the following? A) Objectivity when performing the assessment B) Sharing a common religious affiliation with the client C) Repeating the assessment in several weeks D) Providing spiritual interventions prior to assessment

A) Objectivity when performing the assessment

The nurse's assessment of a hospital client's spirituality reveals that the client will accept very few of the standard treatments for her health problems. How should the nurse follow up this assessment finding? A) Report the finding to the appropriate supervisors. B) Prioritize complementary interventions in the client's care. C) Consult the client's clergy to weigh options. D) Document the client's non adherence to treatment.

A) Report the finding to the appropriate supervisors.

The nurse chooses to use a formal assessment technique when doing a client's spiritual assessment. Which of the following techniques would be most appropriate? A) Self-response assessment instrument B) Acronyms related to spirituality C) Open-ended questions D) A systematic guide for question choices

A) Self-response assessment instrument

A nurse is preparing to begin work in a diverse, urban community with members of numerous different religious traditions. The nurse should identify which statement as best reflective of Buddhism? A) Some holy days include fasting from dawn to dusk. B) The soul has no beginning or end. C) Outcomes are predetermined. D) Beliefs focus around the Koran.

A) Some holy days include fasting from dawn to dusk.

A nurse should conduct an assessment of a client's Risk for Complications after gathering data related to the client's spirituality. When planning the client's care, the nurse should be aware that complications are primarily due to the effect of spirituality on what phenomenon? A) Stress B) Pain C) Worry D) Emotional lability

A) Stress

T—Terminal Events Planning

Are there particular aspects of medical care that you wish to forgo or have withheld because of your religion/spirituality? Are there religious or spiritual practices or rituals that you would like to have available in the hospital or at home? Are there religious or spiritual practices that you wish to plan for regarding time of death, or the period following death? From what sources do you draw strength in order to cope with this illness? For what in your life do you still feel gratitude even though ill? When you are afraid or in pain, how do you find comfort? As we plan for your medical care near the end of life, in what ways will your religion and spirituality influence your decisions?

I—Implications For Medical Care (Questions)

Are there specific elements of medical care that your religion discourages or forbids? To what extent have you followed these guidelines? What aspects of your religion/spirituality would you like me to keep in mind as I care for you? What knowledge or understanding would strengthen our relationship as physician and patient? Are there barriers to our relationship based on religious or spiritual issues? Would you like to discuss religious or spiritual implications of health care?

The nurse is reviewing a client's spirituality using the SPIRIT Spiritual Assessment Tool. Which of the following would the nurse assess when addressing the letter "P"? A) Powers B) Personal spirituality C) Spiritual prognosis D) Prayer

B) Personal spirituality

A client expresses frustration that the nurse is assessing his spirituality, stating, "I thought I was here to have my tumor removed, not to figure out what I believe or don't believe about God." How should the nurse best justify the need for a spiritual assessment? A) "It's important that we plan to make sure that we don't offend you." B) "Spirituality actually has a significant effect on your overall health." C) "We need to make plans in case there are unexpected outcomes of your surgery." D) "Your beliefs determine whether we will focus more on your body or on your spirit."

B) "Spirituality actually has a significant effect on your overall health."

A nurse is completing a comprehensive assessment of a client who has been referred to the clinic. Which of the following would be most appropriate for the nurse to ask when beginning to assess the client's spirituality? A) "What religion are you?" B) "What gives you hope or peace?" C) "Do you believe in God?" D) "Would you like to speak to a chaplain?"

B) "What gives you hope or peace?"

A group of students is reviewing material related to the role of religion and spirituality in health care choices. The students demonstrate understanding when they identify which of the following situations as the most prominent ethical dilemma that involves religion? A) Providing life-saving therapy B) Failure to seek timely medical care C) Implementing spiritual care D) Treating clients' psychological needs

B) Failure to seek timely medical care

During a client's spiritual assessment, the client explains that the ultimate purpose of her existence is to achieve a state that she describes as nirvana. The nurse should recognize that this client ascribes to what religion? A) Islam B) Hinduism C) Buddhism D) Judaism

B) Hinduism

Which ones are characteristics of spiritual care? Select all that apply. A) Formal B) Individualistic C) Nonbiased D) Client oriented E) Collaborative

B) Individualistic D) Client oriented E) Collaborative

A nurse is planning care that is grounded in the fact that clients are holistic beings. Which of the following lists of components constitute the view of clients as holistic beings? A) Physical identity, psychosocial identity, religious identity B) Mind, body, spirit C) Id, ego, superego D) Spiritual identity, egocentric nature, naïve identity

B) Mind, body, spirit

A nurse has collected extensive data relating to a client's spirituality. Which type of data would the nurse need to validate the information obtained during this assessment? A) Subjective data B) Objective data C) Informal data D) Formal data

B) Objective data

A nurse is completing an admission assessment of an adult client, during which the client states, "I've never been a religious man, but I'm definitely spiritual." How should the nurse best understand an aspect of the relationship between spirituality and religion? A) Spirituality is an Eastern concept, whereas religion is associated with Western cultures. B) Religion consists of the spiritually focused rituals and practices of a group. C) Spirituality is the codification of principles that are based on religion. D) Religion is the state of spiritual certainty that results from cultural influences.

B) Religion consists of the spiritually focused rituals and practices of a group.

What one is the best description of Buddhism? A) Nirvana (oneness with God) is the primary purpose of the religion. B) Suffering is a part of human existence. C)Worship occurs in a mosque. Prayer occurs five times a day: dawn through sunrise, noon, afternoon, sunset, and evening. D) Beliefs focus around the Old and New Testaments of the Bible and view Jesus Christ as the Savior.

B) Suffering is a part of human existence

Christianity (Overview)

Beliefs focus around the Old and New Testaments of the Bible and view Jesus Christ as the Savior. Prayers may be directed to one or all of the Holy Trinity (God, Holy Spirit, and Jesus Christ). Beliefs usually culturally developed vary within denominations.

When assessing a client's spirituality, the nurse has the client complete a Brief Religious Coping Questionnaire. When reviewing the completed questionnaire, the nurse identifies which of the following as indicating positive religious coping? A) Client feels stress is something from God that is to be endured. B) Client wonders if God has abandoned him or her. C) Client looks to God for support in a crisis. D) Client decides what to do without relying on God.

C) Client looks to God for support in a crisis.

A nurse's colleague states, "I think Mrs. Nguyen in room 412 is a Buddhist, so she'll definitely be a vegetarian." The nurse should understand what principle of religion and spirituality when planning clients' care? A) Decisions around a religious client's care should be deferred to the clergy of that religion. B) Clients who claim to be spiritual generally oppose meat consumption. C) The beliefs of members of a particular religion are not necessarily homogeneous. D) Nurses should avoid planning care on the basis of religion.

C) The beliefs of members of a particular religion are not necessarily homogeneous.

A nurse recognizes the need to perform a spiritual assessment of a newly admitted hospital client, but the circumstances surrounding the client's diagnosis and family dynamics make this challenging. What variable is likely to have the greatest impact on enhancing the quality of data from the nurse's spiritual assessment? A) The nature of the nurse's spiritual beliefs B) The nurse's knowledge of major religions C) The quality of rapport between the nurse and the client D) The setting in which the assessment is performed

C) The quality of rapport between the nurse and the client

Islam (Nutrition)

Consumption of pork or alcohol is prohibited. Other meats must meet ritual requirements and many use kosher (Jewish ritual) foods because these meet the requirements of Islamic believers as well. During the holy days of Ramadan (29 days determined by the moon), neither food nor drink is taken between sunrise and sunset, though frail, ill, and young children are exempt.

A client tells the nurse that the intravenous line must be placed in his right hand. Based on the nurse's understanding of the major religions, the nurse identifies this request as reflecting which of the following? A) Judaism B) Christianity C) Islam D) Hinduism

D) Hinduism

What does Hinduism view illness? A) Prayer and meditation are used for cleansing and healing. B) llness is often believed to be a trial sent by God, and the outcome depends on the person's attitude of pious endurance. C) Most view illness as a natural process for the body and even as a testing of faith. D) Illness is the result of past and current life actions (Karma).

D) Illness is the result of past and current life actions (Karma).

After teaching a group of students about spirituality and religion, the instructor determines that the students need additional teaching when a student states which of the following? A) Spirituality and religion are important factors that can affect health decisions and outcomes. B) Religion and spirituality are separate and distinct, but interrelated concepts. C) There has been a tremendous growth in the understanding of spirituality in the past 20 years. D) Nursing has only recently begun to incorporate spirituality into client care.

D) Nursing has only recently begun to incorporate spirituality into client care.

Which ones are NOT characteristics of spiritual assessment? Select all that apply. A) Formal or informal B) Nonbiased C) Respectful D) Self-reflective E) Objective

D) Self-reflective E) Objective

A client describes herself as "dumbfounded" that she has been diagnosed with cancer, stating, "I had such a clear vision from God that I was negative for cancer. Now I have no idea what I can trust." This client's statement is suggestive of what nursing diagnosis? A) Ineffective role performance B) Complicated grieving C) Social isolation D) Spiritual distress

D) Spiritual distress

Hinduism (End of Life)

Death marks a passage because the soul has no beginning or end. At death the soul may be reborn as another person and one's Karma is carried forward. It is important for Karma to leave this life with as little negativity as possible to ensure a better life next birth. Holy water and basil leaves may be placed on the body; sacred threads may be tied around wrists or neck. The deceased's arms should be straightened.

P—Personal Spirituality (Questions)

Describe the beliefs and practices of your religion that you personally accept. Describe those beliefs and practices that you do not accept or follow. In what ways is your spirituality/religion meaningful for you? How is your spirituality/religion important to you in daily life?

Islam (Illness)

Illness is often believed to be a trial sent by God, and the outcome depends on the person's attitude of pious endurance. Allah is in control of the beginning and end of life, and expressions of powerlessness are rare. To question or ask questions of health care providers is considered a sign of mistrust, thus clients and family are less likely to ask questions.

Members of the Faith Assembly of Indiana

Have a negative view of modern health care and have an especially high rate of infant mortality due to limited prenatal care.

Hinduism (Illness)

Illness is the result of past and current life actions (Karma). The right hand is seen as holy, and eating and intervention (IV) needs to be with the right hand to promote clean healing

Judaism (Illness)

Restrictions related to work on holy days are removed to save a life. However, tests, signatures, and assessments for medical needs that can be scheduled to avoid holy days are appreciated.

Judaism (End of Life)

Psalms and the last prayer of confession (vidui) are held at bedside. At death, arms are not crossed; any clothing or bandages with client's blood should be prepared for burial with the person. It is important that the whole person be buried together.

I—Importance (FICA Spiritual History Tool)

What importance does your spirituality have in your life? Has your spirituality influenced how you take care of yourself, your health? Does your spirituality influence you in your health care decision making (e.g., advance directives, treatment, etc.)?

R—Ritualized Practices and Restrictions (Questions)

What specific practices do you carry out as part of your religious and spiritual life (e.g., prayer, meditation, services, etc.)? What lifestyle activities or practices does your religion encourage, discourage, or forbid? What meaning does these practices and restrictions have for you? To what extent have you followed these guidelines?