Spirituality

A nurse is with the parents of a 3-year-old child who has just died. What is the most therapeutic question for the nurse to ask the parents? "Do you feel ready to consent to an autopsy?" "Have you made a decision about organ donation?" "Would you like to talk about how you'll tell your other children?" "Can I be of any help with traditional practices that are important to you?"

"Can I be of any help with traditional practices that are important to you?" The nurse should be sensitive to any cultural or religious beliefs that may help the parents cope with their grief. Immediately discussing the topic of autopsy or organ donation is insensitive to the parents' grief at this time. The parents are too involved with their own grief at this time to consider their other children's grief.

A pregnant client whose first child has Down syndrome is about to undergo amniocentesis. The client tells the nurse that she does not know what she will do if this fetus has the same diagnosis. The client asks the nurse, "Do you think abortion is the same as killing?" How should the nurse respond? "Some people think that that's what an abortion is." "No, I don't think so, but it's your decision to make." "I really can't answer that question. Are you ambivalent about abortion?" "I don't want to answer that question at this time. How do you feel about it?"

"I really can't answer that question. Are you ambivalent about abortion?"

A recent immigrant from mainland China is critically ill and dying. Which question should the nurse ask when collecting information to meet this client's emotional needs? "Do you like living in this country?" "How long have you been in this country?" "Is there a family member who can translate for you?" "Which family member do you prefer to receive information?"

"Which family member do you prefer to receive information?" Studies have shown that people from China, Greece, and Ethiopia view honesty about diagnosis and prognosis as heartless, unnecessary, and even harmful to the client. Usually family members from these cultures decide what is most important to share with the client. Asking whether the client likes living in this country and when the client came to this country are not relevant when caring for a dying client. Based on the client's culture, "Is there a family member who can translate for you?" is not a relevant question because the healthcare team will be speaking to the family who will then decide which medical information the client will receive.

what is religion?

"doing". The system of practices associated with a particular denomination. A system of organized beliefs.

What are the potential diagnoses a nurse may come across during the diagnosis phase of the nursing process?

-Anxiety -Ineffective Coping -Complicated Grieving -Hopelessness -Powerlessness -Readiness for Enhanced -Spiritual Well-Being -Spiritual Distress -Risk for Spiritual Distress -Risk for Impaired Religiosity

Why do some nurses neglect spiritual care?

-Failure to recognize spiritual needs -Feeling inadequate to meet the needs (knowledge and skills) -Lack of time -Insufficient focus on spirituality in nursing education -Belief nurse must be personally "religious" to meet the spiritual needs of the patient -Personal discomfort by nurses discussing area that does not have concrete answers

What types of questions are important during a nursing assessment of spirituality?

-Faith/belief -Life and self-responsibility -Connectedness -Life satisfaction -Culture -Ritual and practice -Vocation

What should a nurse do during the evaluation phase of the nursing process in terms of addressing spirituality?

-Patient outcomes established during the planning phase serve as the standards to evaluate the patient's progress. -Were outcomes met?

when does spiritual care take place? what type of approach does it require?

-Takes place in the context of a relationship. -Requires an holistic approach

What should a nurse do during the implementation phase of the nursing process in terms of addressing spirituality?

-focus on communication -Establishing presence—involves giving attention, answering questions, having an encouraging attitude, and expressing a sense of trust; "being with" rather than "doing for" -supportive healing relationship: mobilize hope, provide interpretation of suffering that is acceptable to patient, help patient use resources, diet therapies, support rituals, prayer, meditations, support grief

What should a nurse do during the planning phase of the nursing process in terms of addressing spirituality?

1. goals and outcomes: includes realistic and individualized goal with relevant outcomes (ex: they want to run a marathon, see their child graduate, I want to be able to dress myself, go home and do what they had been doing before) -find out what is most important to the patient 2. setting priorities: the patient identifies what is most important 3. teamwork and collaboration: In a hospital setting, the pastoral care department is a valuable resource

What is prayer?

A conversation with God or Higher Power. Does not have to be verbal, could be meditation or stillness in the presence of the higher power.

The mother of a preschool-age child tells the school nurse that her husband is dying of cancer and that she is worried about how her child will cope. As part of their discussion, what does the school nurse include that preschool-age children view death as? Universal Irreversible A form of sleep A frightening ghost

A form of sleep Between the ages of 3 and 5 years death is viewed as a departure or sleep and as reversible. The universality and irreversibility of death are concepts held by children starting at 8 to 9 years of age. The early school-age child of 6 or 7 years personifies death, possibly envisioning it as a ghost, and sees it as horrible and frightening; this is consistent with the concrete thinking present at this age.

what is active listening?

An active process where the nurse is attentive to what the patient is saying, the meaning of what is being said, and attention to body language.

As the nurse is discussing psychiatric care with an older adult client, the client says, "When I was growing up I was taught to accept my lot in life and not complain. I'm proud of the fact that despite my issues I can still function independently. I don't want to be just put away." The nurse understands that the factors that influence the client's mental health are examples of what? Setting of care Anxiety disorder Attitudes and beliefs Cultural and ethnic disparities

Attitudes and beliefs Some attitudes and beliefs include reluctance by older people to seek help because of pride in their independence, stoic acceptance of difficulty, unawareness of resources, and fear of being "put away." Although the client mentions "being put away", that is an attitude. The client is not talking about all the resources that might be available. Anxiety is defined as an unpleasant and unwarranted feeling of apprehension. The client does not mention any cultural or ethnic issues, just his or her own feelings.

Before effectively responding to a sexually abused victim on the phone, it is essential that the nurse in the rape crisis center do what? Get the client's full name and address. Call for assistance from the psychiatrist. Know some myths and facts about sexual assault. Be aware of any personal bias about sexual assault.

Be aware of any personal bias about sexual assault.

What is hope?

Beliefs, wishes, or actions taken in situations of uncertainty. Hope is linked to faith but tends to have an emphasis on the fear of the unknown.

A resident in a nursing home recently immigrated to the United States (Canada) from Italy. How does the nurse plan to provide emotional support? By offering choices consistent with the client's heritage By assisting the client in adjusting to American culture By ensuring that the client understands American beliefs By correcting the client's misconceptions about appropriate health practices

By offering choices consistent with the client's heritage Adherence to a plan of care is enhanced by the nurse's providing choices consistent with the client's cultural beliefs and practices. The nurse's cultural or personal beliefs and biases should not influence or interfere with the implementation of appropriate care. Helping the client adjust to American culture is not the priority at this time; care should be adapted to the client's needs and culture. The person's cultural practices should not be addressed unless they are detrimental to the person's health.

How should nurses provide effective nursing care to clients from different cultural backgrounds? By advising clients that some cultural practices may be harmful to health By providing care that fits the clients' cultural beliefs By strictly adhering to organization policies regarding nursing care By ignoring the cultural aspect and focusing on the medical aspect of care

By providing care that fits the clients' cultural beliefs

What is faith and preferences?

Can refer to a specific religious tradition or belief in something that cannot be perceived through the 5 senses.

A public health nurse is working with a family with three school-aged children as the unit of service. What should the nurse consider when caring for this family? Certain members of the family may be capable of giving more support than the nurse. Assessing each family member is not necessary to plan care for the family as a whole. Family values are not as important as other factors regarding how assistance is perceived. Helping the family requires separating health problems from other aspects of the family's life.

Certain members of the family may be capable of giving more support than the nurse. Family strengths must be identified and used by the nurse. It is necessary to assess each family member to plan care for the whole family. Family values, beliefs, and attitudes greatly influence perceptions. The family members and their problems must be viewed as an integrated whole.

Which behavior is seen in children at the undifferentiated stage of spiritual development, as propounded by Fowler? Children have no concept of right or wrong to guide their behaviors. Children imitate the religious behaviors without comprehending any meaning. Children reason and question some of the established parental religious standards. Children have a reverence for religious matters and are able to articulate their faith.

Children have no concept of right or wrong to guide their behaviors. The first stage of spiritual development, as described by Fowler, is the undifferentiated stage. During this stage children have no concept of right or wrong to guide their behaviors. The beginnings of faith are established as they develop trust in their parents or primary caregivers. Imitation of religious behavior without comprehending any meaning takes place in the intuitive-projective stage during toddlerhood. As children grow older and approach adolescence, they reason and question some of the established parental religious standards. They realize that prayers are not always answered and so they abandon some practices. A reverence for religious matters and articulation of faith takes place in the mythical-literal stage during the school-age years.

what is presence?

Close physical proximity, but includes active-listening, welcoming body language, and empathetic responses.

A mother brings her 9-month-old infant to the clinic. The nurse is familiar with the mother's culture and knows that belly binding to prevent extrusion of the umbilicus is a common practice. The nurse accepts the mother's cultural beliefs but is concerned for the infant's safety. What variation of belly binding does the nurse discourage? Coin in the umbilicus Tight diaper over the umbilicus Binder that encircles the umbilicus Adhesive tape across the umbilicus

Coin in the umbilicus A coin may be dislodged, allowing the infant to put it in his or her the mouth, resulting in a safety issue. A diaper fastened tightly around the waist, a binder, or adhesive tape over the umbilicus will not endanger the infant. Cultural beliefs that do not place the infant at risk should not be discouraged.

A hospice nurse is caring for a dying client and the client's family members during the developing awareness stage of grief. What is the most important thing about the family that the nurse should assess before providing care? Cohesiveness Educational level Cultural background Socioeconomic status

Cultural background

A pregnant client states, "Abortion is banned in our community because it interferes with God's creative work." According to the nurse, which variable influences the client's health belief? Emotional factors Cultural background Socioeconomic factors Perception of functioning

Cultural background

Which nursing interventions are examples of the nurse as a caregiver? Select all that apply. Encouraging the client to exercise daily Setting goals for the client to reduce weight Arranging for the client to meet a spiritual advisor Evaluating the client's understanding of prescribed diet Demonstrating the procedure to self-administer insulin injection

Encouraging the client to exercise daily Setting goals for the client to reduce weight Arranging for the client to meet a spiritual adviso

What assessment tool is helpful when assessing spirituality?

FICA (Faith, Importance, Community, Address) Faith or beliefs: What are your spiritual beliefs? Do you consider yourself spiritual? What things do you believe in that give life meaning? Importance and influence: is faith/spirituality important to you? How has your illness and/or hospitalization affected your personal practices/beliefs? Community: Are you connected with a faith center in the community? Does it provide support/comfort for you during times of stress? IS there a person/group/leader that supports/assists you in your spirituality? Address: What can I do for you? What support/guidance can health care provide to support your spiritual beliefs/practices? -part of the assessment phase of the nursing process

During a survey, the community nurse meets a client who has not visited a gynecologist after the birth of her second child. The client says that her mother or sister never had annual gynecologic examinations. Which factor is influencing the client's health practice? Spiritual belief Family practices Emotional factors Cultural background

Family practices

Which theory proposes that older adults experience a shift from a materialistic to cosmic view of the world? Activity theory Continuity theory Disengagement theory Gerotranscendence theory

Gerotranscendence theory The gerotranscendence theory is a recent theory that proposes that the older adult experiences a shift in perspective with age. The person moves from a materialistic and national view of the world to a more cosmic and transcendent one. The activity theory considers the continuation of activities performed during middle age as necessary for successful aging. The continuity theory suggests that a person's personality remains stable and behavior becomes more predictable as people age. The disengagement theory states that aging individuals withdraw from customary roles and engage in more introspective, self-focused activities.

A client who is in the advanced stages of illness asks the nurse to contact pastoral services for support. According to the Macmillan model, what is the best nursing intervention in this situation? Immediately involve pastoral services while caring for the client. Involve the family member in the client's care instead of pastoral support. Listen to the client's request for support then carry on with the clinical work. Falsely promise that pastoral services has been contacted and plan to see the client.

Immediately involve pastoral services while caring for the client.

The nurse starts a new job and recognizes that the client population is very diverse. What action will help the nurse to provide culturally competent care? Read about all of the cultural groups in the local population. Treat all of the clients the same, regardless of their cultural background. Increase self-awareness of cultural identity, cultural knowledge, and potential biases. Attempt to remain culturally neutral while treating clients of a different culture.

Increase self-awareness of cultural identity, cultural knowledge, and potential biases.

After determining that the nurses on the psychiatric unit are uncomfortable caring for clients who are from different cultures than their own, the nurse manager establishes a unit goal that by the next annual review the unit will have achieved what? Increased cultural sensitivity Decreased cultural imposition Decreased cultural dissonance Increased cultural competence

Increased cultural competence Cultural competence encompasses sensitivity as well as knowledge, desire, and skill in caring for those who are different from one's self. The nurses are already somewhat sensitive to those from different cultures and now must move forward in their ability to care for these clients. The nurses are not imposing their culture on the clients; they are avoiding them. There is no clashing of cultures in this situation.

Which internal variable influences health beliefs and practices? Family practices Cultural background Socioeconomic factors Intellectual background

Intellectual background

The nurse is caring for an African American client with renal failure. The client states that the illness is a punishment for sins. Which cultural health belief does the client communicate? Yin/Yang balance Biomedical belief Determinism belief Magicoreligious belief

Magicoreligious belief

A client who has a hemoglobin of 6 gm/dL (60 mmol/L) is refusing blood because of religious reasons. What is the most appropriate action by the nurse? Call the chaplain to convince the client to receive the blood transfusion. Discuss the case with coworkers. Notify the primary healthcare provider of the client's refusal of blood products. Explain to the client that they will die without the blood transfusion.

Notify the primary healthcare provider of the client's refusal of blood products.

A nurse working in a Catholic hospital discourages clients from using contraceptives per hospital policy. Which category of ethics is the nurse following? Societal ethics Research ethics Professional ethics Organizational ethics

Organizational ethics Organizational ethics help ensure smooth ethical operation of an organization. These ethical codes include sets of rules and regulations to guide the actions and behavior of the members of the organization. Societal ethics are norms that serve a large community and involve legal and regulatory mechanisms. Research ethics are applicable to those conducting research involving human and animal subjects. Professional ethics involve a set of ethical standards and expectations for members of that profession, but unlike organizational ethics, they may apply to many different companies.

A client has a "prayer cloth" pinned to the hospital gown. The cloth is soiled from being touched frequently. What should the nurse do when changing the client's gown? Make a new prayer cloth. Discard the soiled prayer cloth. Pin the prayer cloth to the clean gown. Wash the prayer cloth with a mild detergent.

Pin the prayer cloth to the clean gown.

A nurse manager works on a unit where the nursing staff members are uncomfortable taking care of clients from cultures that are different from their own. How should the nurse manager address this situation? Assign articles about various cultures so that they can become more knowledgeable. Relocate the nurses to units where they will not have to care for clients from a variety of cultures. Rotate the nurses' assignments so they have an equal opportunity to care for clients from other cultures. Plan a workshop that offers opportunities to learn about the cultures they might encounter while at work.

Plan a workshop that offers opportunities to learn about the cultures they might encounter while at work.

When caring for a client who adheres to a kosher diet, which important thing should the nurse make sure to exclude from the client's meals? Pork and shellfish Blood-containing food All meat, fish, and poultry Animal and dairy products during Lent

Pork and shellfish

Which carative factor is involved in creating a healing environment at all levels, physical and non-physical, according to Watson's Transpersonal Caring? Promoting transpersonal teaching-learning Promoting and expressing positive and negative feelings Developing a helping, trusting, human caring relationship Providing for a supportive, protective, and/or spiritual environment

Providing for a supportive, protective, and/or spiritual environment The carative factor providing for a supportive, protective, and/or spiritual environment is related to create a healing environment at all levels, physical and non-physical. The carative factor promoting transpersonal teaching-learning is related to learning together while educating the client to acquire self-care skills. The carative factor developing a helping, trusting, and human caring relationship is related to learning to develop and sustain helping, trusting, and authentic, caring relationships through effective communication with the clients.

A client proclaims that he is "the second son of God." What type of delusion does the nurse identify? Influence Religious Reference Persecutory

Religious

what is tradition?

Religious traditions are constellations of beliefs, practices, and institutions used to describe a common type of religiosity.

What concept of death should a nurse expect a 4-year-old child to have? Cessation of life Reversible separation Only affects old people Force takes one away from family

Reversible separation Preschoolers view death as a separation; they believe that the deceased will return to life. This is part of their fantasy world; they view death as possibly a kind of sleep rather than a cessation of life and expect the deceased to return or wake up. The preschooler does not yet have the understanding that older people are more likely to die. The preschooler believes that the separation was initiated by the deceased, not by another force.

A client says "Do not cut the thread on my wrist before sending me for surgery because the thread is a blessing from God." Which internal variable influences the client's health belief in this scenario? Spiritual factors Emotional factors Developmental stage factors Intellectual background factor

Spiritual factors

An elderly client states, "Disease occurs when supernatural elements enter the body." Which variable influences the client's health beliefs in this scenario? Spiritual factors Emotional factors Intellectual background Perception of functioning

Spiritual factors

A school nurse works with adolescents who recently immigrated to the U.S. and are adjusting to life in the public schools. What characteristics help the nurse differentiate students who are assimilating from students who are acculturating? Students who acculturate shun all aspects of their new culture. Students who assimilate are generally unhappy in their new culture. Students who acculturate tend to be more social in their new culture. Students who assimilate abandon all aspects of their original culture.

Students who assimilate abandon all aspects of their original culture. Assimilation is a cultural process by which a person gives up his or her original identity and develops a new cultural identity by becoming absorbed into the dominant cultural group. The nurse may recognize these students if they abandoned all aspects of their original culture. In the process of acculturation, on the other hand, students may pick and choose different parts of each culture to incorporate into their identity. Since every student is different, it would not be possible to assume all students who choose either method are happier or more social in their new culture.

What is action?

The nurse identifies a clients spiritual need (assessment) and implements a nursing activity to address the need.

A nurse notices that a client is in spiritual distress. Which nursing action establishes the nurse as a caregiver? The nurse provides therapeutic treatment to the client. The nurse teaches the client about signs of spiritual distress. The nurse communicates the wishes of the client to family members. The nurse collaborates with the agency chaplain to pursue the best treatment plan.

The nurse provides therapeutic treatment to the client.

An elderly adult suffered an injury after falling down in the washroom. The primary healthcare provider performed a surgical procedure on the client and orders a blood transfusion. A family member of the client mentions that blood transfusions are not permitted in their community. What should the nurse do in order to handle the situation? The nurse should wait for the court's order to give blood to the client. The nurse should proceed with the transfusion in order to save the client's life. The nurse should inform the primary healthcare provider and not give blood to the client. The nurse should explain to the family member that the client needs this transfusion.

The nurse should inform the primary healthcare provider and not give blood to the client.

A client has just been admitted to the psychiatric unit on involuntary admission status. During the admission assessment the client tells the nurse, "I am the second son of God and need to say a prayer." What is the best response by the nurse? Interrupting the client and continuing the assessment Joining the client in the prayer and then refocusing on the assessment Quietly leaving the client and coming back later to complete the assessment Waiting until the client finishes the prayer and then completing the assessment

Waiting until the client finishes the prayer and then completing the assessment

What are the guidelines in "Clinical Practice Guidelines for Quality Palliative Care?"

all patients that are experiencing a serious illness get spiritual assessments

What are examples of spirituality?

contemplation mindfulness nature art music volunteering gardening activism hobbies

What are the major signs of spiritual distress?

depression, illness

What are examples of BOTH religion and spirituality?

music art prayer worship fellowship volunteering learning

What are the guidelines stated in "American Nurses Association Code of Ethics?"

must incorporate spiritual domain in their plan of care

___ is part of the large construct of spirituality

religion

What are the guidelines stated in "The Joint Commission?"

requires spiritual assessment to be done in the hospital

Impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself

spiritual distress

___ is seen as the big umbrella

spirituality

What is the difference between spirituality and religion?

spirituality: -root word is spiritus (Latin) - the life force in us; what brings life force to this person; what gives them their will to live, their joy? -a sense of awe, a sense of wonder, a sense of oneself religion: -institution; belief system; rituals; place of worship; where is it that a person expresses their spirituality; group or community that feeds that community

What are examples of religion?

theology beliefs traditions organization offices leadership standards legal documents regulations conferences

what does "proselytize" mean?

to convert someone to a faith, belief, or cause we DO NOT do this as nurses