Exam 4 study guide- ch 45

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? a) Hope b) Religion c) Faith d) Love

c) Faith 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. (less)

Islam

BELIEF: 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 HEALTH CARE PRACTICES: • 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.

Baha'i International Community

BELIEF: Believe in a basic harmony between religion and science HEALTH CARE PRACTICES: • 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.

American Muslim Mission

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

Daoism (Taoism)

BELIEF: 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. HEALTH CARE PRACTICES: • 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)

A client who is admitted for a debilitating disease is talking to the nurse. She relates that family is the only thing that matters, stating that family helps fulfill all the spiritual needs by first fulfilling the most basic of all needs. What is this basic need? a) Belonging b) Self-reliance c) Love d) Autonomy

c) 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.

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? a) Jewish b) Jehovah's Witnesses c) Roman Catholic d) Christian Scientist

c) Roman Catholic

Nursing diagnosis: Spiritual Guilt

RELATED FACTORS: Failure to live according to religious rules DEFINING CHARACTERISITCS: 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?"

Spiritual distress

impaired ability to experience and integrate meaning and purpose of life through one's connectedness with self, others, art, music, literature, nature, or a greater power.

Spiritual counseling

• Articulate spiritual beliefs. • Explore the origin of the patient's spiritual beliefs and practices. • Identify life factors that challenge the patient's spiritual beliefs (cause spiritual distress). • Explore alternatives given these challenges: modify lifestyle; deny, modify, or reaffirm beliefs; develop new beliefs. • Develop spiritual beliefs that meet needs for meaning and purpose, care and relatedness, forgiveness.

Promoting forgivness

• Explore with the patient the importance of learning to accept oneself and others, including strengths, limitations. • Explore negative feelings that make it difficult for the patient to seek forgiveness and to believe that one is forgiven • Allow the patient to verbalize shame, guilt, and anger, and counsel about the importance of expressing negative emotions.

Promoting love and relatedness

Always treat the patient with respect, empathy, and genuine caring. encourage patient to talk about relationships with others and conversations about the patients experiences with God. Encourage and facilitate visits from the patient's family, friends, and spiritual advisor

Buddhism

BELIEF: 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 right views, aspirations, speech, conduct, mode of livelihood, effort, mindfulness, and concentration—leads to the cessation of suffering. HEALTH CARE PRACTICES: • 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.

Church of Jesus Christ of Latter Day Saints (Mormons)

BELIEF: 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. HEALTH CARE PRACTICES: • Disapprove of alcohol, tobacco, and caffeinated beverages • A special undergarment worn by some members should be removed only in an emergency

Native American Religions

BELIEF: 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). HEALTH CARE PRACTICES: • 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

BELIEF: Doctrine of Transmigration. Moral factors, linked with the all-embracing doctrine of "karma," are believed to be significant in promoting health or causing disease. HEALTH CARE PRACTICES: • This 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.

Unitarian Universal Association of Churches and Fellowships

BELIEF: 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. HEALTH CARE PRACTICES: Free to accept what they take to be best for their health

Judaism

BELIEF: 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). HEALTH CARE PRACTICES: • 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

BELIEF: 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. HEALTH CARE PRACTICES: • Most members are still healthy young adults. There is little information available on their interactions with the health care team.

Confucianism

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

Christian Scientist

BELIEF: 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. HEALTH CARE PRACTICES: • 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

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

Roman Catholicism

BELIEF: 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 HEALTH CARE PRACTICES: • 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

BELIEF: 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. HEALTH CARE PRACTICES: • Religious practices vary according to denomination; may include prayer, faith healing, "laying on of hands," and anointing. • Sacraments: baptism, communion, confirmation

Adventist

BELIEF: • Believe in the person's choice and God's sovereignty. The body is believed to be the temple of the Holy Spirit. HEALTH CARE PRACTICES: • The taking of all narcotics and stimulants is prohibited because the body is the temple of the • Holy Spirit and should be protected. Many groups prohibit meat. • Many regard Saturday as the Sabbath. • Approach to health care is holistic.

Spirituality assessment

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

Nursing diagnosis: Spiritual Anxiety

RELATED FACTORS: Challenged belief and value system DEFINING CHARACTERISTICS: 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.

Nursing diagnosis: Spiritual Pain

RELATED FACTORS: Inability to accept death of son DEFINING CHARACTERISTICS: 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.

Nursing diagnosis: Spiritual Anger

RELATED FACTORS: Inability to accept illness DEFINING CHARACTERISTICS: 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.

Nursing diagnosis: Spiritual Alienation

RELATED FACTORS: Separated from "faith community" DEFINING CHARACTERISTICS: 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."

Nursing diagnosis: Spiritual Loss

RELATED FACTORS: Terminal illness; anticipatory grieving; inability to find comfort in religion DEFINING CHARACTERISTICS: 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."

Nursing diagnosis: Spiritual Despair

RELATED FACTORS: Feeling that no one (not even God) cares DEFINING CHARACTERISTICS: 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?"

Conflict between spiritual beliefs and treatments

The nurses role is to help the patient obtain the information needed to make an informed decision and to support the patient's decision making • It is important to maintain objectivity

Which client statement most clearly suggests the potential of a nursing diagnosis of Spiritual Anxiety? a) "Now that I'm nearing the end, I'm worried that God won't think I lived a good enough life." b) "I've never been a religious man, and all these Catholic crosses and pictures in the hospital make me a bit uncomfortable." c) "I always tried to do the right thing, so I don't understand why I have to suffer so much now." d) "I guess I should have taken a lot more time to go to church when I was younger."

a) "Now that I'm nearing the end, I'm worried that God won't think I lived a good enough life." 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.

As the nurse admits a new client to the unit for elective surgery, the nurse should facilitate the practice of religion by doing which of the following? Choose all that apply. a) Attempt to meet religious dietary restrictions. b) Arrange for the client's pastor to visit if desired. c) Discuss similarities and differences between the nurse's religion and the client's religion. d) Respect the need for privacy during periods of prayer. e) Offer to pray with the client whenever she likes.

a) Attempt to meet religious dietary restrictions. b) Arrange for the client's pastor to visit if desired. d) Respect the need for privacy during periods of prayer. The following are means the nurse can use to help the client continue normal spiritual practices in the unfamiliar environment of the hospital or care center: • Familiarize the client with the religious services and materials available within the institution. • Respect the client's need for privacy or quiet during periods of prayer. • Assist the client to obtain devotional objects and protect them from loss or damage. • Arrange for the client wishing to receive the sacraments to do so. • Attempt to meet the client's religious dietary restrictions. • Arrange for the client's minister, priest, or rabbi to visit if the client so wishes. Proselytizing is never acceptable in professional settings. Addressing spiritual issues should not be coercive. Praying with clients should not be initiated by the nurse unless there is no pastoral care available and the client requests it. Comparing and contrasting religious beliefs is not likely to benefit the client. (

The nurse understands that spiritual care is dynamic and embodies some of the basic tenets of nursing. What is a factor supporting this concept? Select all that apply. a) Client centeredness b) Spiritual nurturing environment c) Therapeutic use of self d) Nurse's availability for the client e) Family support

a) Client centeredness b) Spiritual nurturing environment c) Therapeutic use of self d) Nurse's availability for the client Spiritual care is dynamic and embodies some of the basic tenets of nursing. The nurse's use of presence, therapeutic use of self, client centeredness, intuitive sense, and the creation of a spiritually nurturing environment are integral to providing spiritual care. Such care has positive effects for clients, including healing and the promotion of psychological and spiritual well-being

A client who is on hospice care and has no immediate family has been given less than 1 week to live. The nurse caring for the client recognizes that providing presence is most important, especially when a client is dying. What would be the best way for this nurse to provide presence to this client? a) Hold the client's hand and sit by the bedside as often as possible. b) Tell the client that you are there when needed and to just ring the call bell. c) Check on this client every hour. d) Sit in the chair on the other side of the room for 10 minutes each hour.

a) Hold the client's hand and sit by the bedside as often as possible. The nurse can offer supportive presence by holding the patient's hand to show that he or she is sincerely concerned, or simply by being present to communicate value and respect. The other options do not show that the nurse truly cares.

While studying religion and spirituality, the nursing student exhibits an understanding of the concepts when making which of the following statements? a) Religion is a collection of spiritual beliefs and practices. b) Spirituality is the behavioral manifestation of religious beliefs. c) Spirituality is a recently developed alternative to traditional religious belief. d) Religion and spirituality are synonymous.

a) Religion is a collection of spiritual beliefs and practices. 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.

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? a) Separation from spiritual ties b) Change in beliefs c) Spiritual crisis d) Depression

a) 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.

The nurse caring for a bedridden hospitalized client who states that this will be the first time that he has missed a Methodists church service in 50 years plans care based on which of the following NANDA diagnosis? a) Spiritual distress related to inability to attend church services evidenced by verbal states of guilt b) Dysfunctional grieving related to inability to attend church services as a result of his medical condition c) Spiritual need as evidenced by verbalizations and distress at missing Methodist church services d) Potential for enhanced spiritual well-being related to distress at missing Methodist church services

a) Spiritual distress related to inability to attend church services evidenced by verbal states of guilt Persons suffering spiritual dysfunction or distress may verbalize such distress or express a need for

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: a) faith. b) forgiveness. c) trust. d) love and relatedness.

a) faith. The following are adaptive behaviors of faith: 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.

A client scheduled for outpatient surgery is requesting that the operating room be sprayed with holy water. Which is an appropriate response? a) "This is not possible since not everyone in the room will allow to it." b) "Are you concerned how the surgery will go?" c) "The operating room must be kept free of any infection." d) "Surgical aseptic technique requires that fluids used must be sealed from the manufacturer."

b) "Are you concerned how the surgery will go?" When providing spiritual care, nurses must be careful neither to avoid assisting clients nor to involve themselves without the desire of the client, but to base their decisions on the cues provided by the client. Cues occur when the client verbally or nonverbally invites the nurse to share a deeper spiritual connection. Such behaviors may include direct requests, singing of religious hymns, chanting, or praying.

A nurse is caring for a 55-year-old man found unconscious at a construction site. He has not regained consciousness in 6 days and is on full life support. His wife and children are present at his bedside. The family members are practicing Orthodox Jews. Based on this information, how would the nurse expect the family to respond to a discussion regarding the client's care? a) The family will do whatever is necessary to continue life support. b) Continued life support is appropriate as long as the measures are not heroic. c) The Orthodox Jewish faith does not speak to the use of life support. d) The family will plan to withdraw support in the next few days.

b) Continued life support is appropriate as long as the measures are not heroic. Life support is appropriate as long as measures are not heroic.

The nurse's client states that his pastor is coming in a few hours to pray with him and offer sacrament. The nurse plans to do the following things in preparation for this. Choose all that apply. a) Complete your work so you may join them b) Have a chair available near the bed c) Clear the bedside table; cover with clean towel d) Clear the room of unnecessary items

b) Have a chair available near the bed c) Clear the bedside table; cover with clean towel d) Clear the room of unnecessary items When expecting a visit from a patient's spiritual counselor, preparations may vary, but the following are usually recommended: • The room should be orderly and free of unnecessary equipment and items. • There should be a seat for the religious counselor at the bedside or near the patient so that both can be comfortable. • The bedside table should be free of items and covered with a clean, white cover if a sacrament is to be administered. • The bed curtains should be drawn for privacy if the patient can't be moved to a more private setting. The nurse should not expect or plan to join a private group such as described.

The 3-year-old son of a practicing Protestant family is a new client. The family is interested in teaching the son some of their religious traditions. Based on his age, which activities would be appropriate? Select all that apply. a) Stories about religious symbols b) Prayer before meals c) Bedtime prayer d) Holy day celebrations

b) Prayer before meals c) Bedtime prayer d) Holy day celebrations Stories and religious symbols are best introduced to children during the school-age years.

A new nurse observes a priest visiting the clients every Saturday afternoon and praying with them. This activity supports which of the nursing outcomes? a) The client expresses satisfaction with life. b) The client uses a type of spiritual experience that provides her comfort. c) The client will experience alternate venues of spiritual expression. d) The client expresses hope and sense of meaning.

b) The client uses a type of spiritual experience that provides her comfort. 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 (Griffin, Salman, Lee, & Fitzpatrick, 2008). Interventions that were effective included being involved in family activities, serving others, and recalling positive thoughts and memories. Most older adults studied reported participating in conventional religious practices such as worship and prayer either alone or in groups. Since these activities, traditions, and rituals are meaningful to older adults, encouraging participation in these or a reconnection with these activities can be beneficial.

Mr. V. is recovering from pneumonia. You know that a well-balanced diet will help him to recover. However, Mr. V. informs you that it is Ramadan and he must fast from sunrise to sunset. What is your most appropriate nursing action? a) Provide liquid nutrition only as this does not interfere with religious practice. b) Work with the nutrition staff to provide nutritious meals at off hours. c) Encourage Mr. V. to speak with a religious leader to grant a medical exception. d) Tell Mr. V. he must eat to maintain his health.

b) Work with the nutrition staff to provide nutritious meals at off hours. 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.

While interviewing a client, a nurse is told that the client practices Catholicism. This client is identifying: a) his spirituality. b) his faith. c) his values. d) his culture.

b) his faith. Faith is a term also used to describe a cultural or institutional religion such as Judaism, Islam, Catholicism, or Confucianism. Spirituality refers to anything that pertains to a person's relationship with a higher power or force. Values refer to those beliefs most meaningful to a person. Culture pertains to a person's background.

Nurturing spirituality

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

When asked about his religious preference, the client becomes very upset with the nurse. Which response is appropriate for this situation? a) "You need to understand that I am just doing my job here." b) "There is nothing to be upset about. This is part of my assessment." c) "I can see that this question upsets you. Do you have any questions about this?" d) "I can see that this upsets you. Let me come back later when you are feeling better."

c) "I can see that this question upsets you. Do you have any questions about this?" Assist the client in understanding that his nursing history is a review of the whole human being and that questions will be wide ranging, including spiritual health, physical health, and emotional health. A client who appears angry, anxious, depressed, or defensive when asked spiritual questions may need to hear something like, "I can see from your response that you might not have expected these questions; however, they do let you know that we are interested in how you are experiencing your current situation. Do you have a question or concern in this area?" Some clients are relieved to know that the spiritual aspect of their being is worthy of the nurse's concern. Still other clients indicate that they have spiritual concerns, but they will deal with them in their own time and way.

A recently graduated nurse is talking to the charge nurse about spirituality and tells the charge nurse that it is difficult to understand why people have a hard time giving spiritual care to clients. The charge nurse identifies the new nurse's lack of understanding when the new nurse makes which statement? a) "Spirituality is anything that pertains to a person's relationship with a higher power." b) "Spirituality and religion have distinctions." c) "Spirituality and religion are the same thing." d) "Spirituality and faith are the same thing."

c) "Spirituality and religion are the same thing." Although some people use the words spirituality, faith, and religion interchangeably, there are distinctions. Spirituality is anything that pertains to a person's relationship with a higher power.

In which religion are members encouraged to obtain health care provided by members of the African-American community? a) Baha'i International Community b) Islam c) American Muslim Mission d) Native American religion

c) American Muslim Mission The American Muslim Mission religious order is encouraged to seek health care provided by members of the African-American community. The Baha'i International Community seek out competent medical care and pray for health. Native American religion seek the assistance of medicine men and women who have specialized spirits from whom they receive the mission to cure. Islam religion believes in Koranic law and customs that influence birth, diet (eating pork and drinking alcohol are forbidden), care of women, death and prayer rituals.

The nurse is differentiating beliefs of atheists from agnostics. Which statement is accurate? a) Both deny the existence of God. b) Nurses offer religious counseling to change the beliefs of both groups. c) Both are guided by a philosophy of living that does not include a religious faith. d) Both have religious influences that are life denying.

c) Both are guided by a philosophy of living that does not include a religious faith. An atheist is a person who denies the existence of a higher power; an agnostic is one who holds that nothing can be known about the existence of a higher power. Nurses do not offer religious counseling for any reason. Neither belief is life denying.

The nurse caring for a bedridden hospitalized client who states that this will be the first time that he has missed a Methodists church service in 50 years plans care based on which of the following NANDA diagnosis? a) Spiritual need as evidenced by verbalizations and distress at missing Methodist church services b) Potential for enhanced spiritual well-being related to distress at missing Methodist church services c) Spiritual distress related to inability to attend church services evidenced by verbal states of guilt d) Dysfunctional grieving related to inability to attend church services as a result of his medical condition

c) Spiritual distress related to inability to attend church services evidenced by verbal states of guilt Persons suffering spiritual dysfunction or distress may verbalize such distress or express a need for help.

The nursing diagnosis Spiritual Distress related to crisis of illness as evidenced by loss of meaning in life and overuse of pain medication is created for a client who attempted to take his life. Which intervention is appropriate for these problems? a) Provide client education on negative spiritual implications on suicide. b) Encourage the client to watch movies when alone. c) Explore past negative coping mechanisms used. d) Plan and coordinate a multidisciplinary team conference including the chaplain.

d) Plan and coordinate a multidisciplinary team conference including the chaplain. Nursing Intervention Scientific Rationale 1. Offer client opportunity for one-on-one nurse-client relationship. Actively listen to the client. Allow expression of negative feelings. 2. Plan and coordinate a multidisciplinary team conference including the chaplain. Facilitate a care-planning conference involving the social support network including family and friends. 3. Explore past coping mechanisms, including use of music, scripture, prayer, and relaxation techniques. Help client identify times when he can use various alternative strategies. 4. Use the "life review" technique focusing on faith/spiritual development. Help client explore ways to use this experience in a unique way such as sharing in a group or with medical students or other health care professional students. 1. Initiating a one-on-one relationship establishes a climate of acceptance and builds trust and safety. 2. Initiating a multidisciplinary social network of conferences facilitates a sense of acceptance, love, and belonging. 3. Building on past positive coping mechanisms enhances a sense of self-control and self-esteem. 4. By focusing on personal faith/spirit, the client can gain new insights into his relationship with God and can sense hope and the potential for creativity or self-actualization.

A nurse is caring for a client who is spiritually distressed. Which of the following are the factors that affect the spiritual distress of a client? Select all that apply. a) Inability to reconcile a current life situation with spiritual beliefs b) Ability to introspect c) Seeking a religious leader d) Separation from the religious community or supports

d) Separation from the religious community or supports a) Inability to reconcile a current life situation with spiritual beliefs Factors affecting spiritual distress include inability to reconcile a current life situation with spiritual beliefs and separation from the religious community or supports. Disconnectedness to self can be expressed through an inability to seek a religious leader or an inability to introspect.

A terminally ill patient tells the nurse that he does not belong to an organized religion. It is safe for the nurse to assume what? a) The patient has no belief system. b) The patient is an atheist. c) The patient is an agnostic. d) The patient may still be deeply spiritual.

d) The patient may still be deeply spiritual. The nurse should 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 profess to belong to an organized religion. An atheist is a person who denies the existence of a higher power; an agnostic is one who holds that nothing can be known about the existence of a higher power.

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? a) Tell the husband to think before saying anything negative. b) Call the pastor into the room to speak with the husband. c) Leave the room and do not be part of this situation. d) Use silence and allow the husband to express his emotions.

d) Use silence and allow the husband to express his emotions. Much healing and spiritual growth can occur without professional assistance because some clients find ways to meet their spiritual needs independently. Therefore, a sensitive and non-intrusive approach on the nurse's part is crucial; nurses cannot force clients to deal with spiritual issues or to assume religious beliefs. Spiritual health is one area that cannot be put onto a specific "road map" or trajectory. However, assisting clients to reconnect to their faith community or to utilize the resources of a faith community has health benefits

Promoting meaning a purpose

help patients searching for meaning, explore with them what has given their life meaning and purpose up to the present, sources of meaning to other people, and possible meanings for patient's current experience of illness, pain, suffering, or impending death.

Nursing interventions

• 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.

Goals and outcomes for patients in spiritual distress

• Exploring the origin of spiritual beliefs and practices • Identifying factors in life that challenge spiritual beliefs • Exploring alternatives given these challenges: denying, modifying, or reaffirming beliefs; developing new beliefs • Identifying spiritual supports (e.g., spiritual reading, faith, community) • Reporting or demonstrating a decrease in spiritual distress after successful intervention

Children's description of God

• 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