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Course: Fundamentals of Nursing

Topic: Spiritual Care

The Nurses International Community

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COPYRIGHT

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Module Goals

Learners will be able to:

Define the concept of Spiritual Care.
Discuss the significance of spiritual care and client wellness.
Provide examples of spiritual care among varied populations.
List the barriers to spiritual care.
Discuss the role of the nurse and nursing care in the care of the terminally ill client.

Contact info: info@nursesinternational.org

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Introduction

Ernstmeyer,& Christman, 2021

Spirituality includes a sense of connection to something bigger than oneself and typically involves a search for meaning and purpose in life.
Some people’s spiritual life is linked to a religious association with:

A church, temple, mosque, or synagogue
Pray and find comfort in a personal relationship with God or a higher power and
Find meaning through their connections to nature or art.

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Basic Concepts

Spiritual Distress: is defined by NANDA-I as, “A state of suffering related to the inability to experience meaning in life through connections with self, others, the world, or a superior being.”

Spirituality: Is defined by the Interprofessional Spiritual Care Education Curriculum (ISPEC) as, “A dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence and experience relationship to self, family, others, community, society, nature, and the significant or sacred.”

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Significance of Spiritual Care and Client Wellness

Daher, 2012

Many individuals rely on their spirituality and faith when coping with illness which has positive outcomes:

Less depression and longer survival.
Fewer post-surgical complications.
Delayed onset and slower progression of physical disability.
Influence serotonin pathways in the brain that regulate mood and possibly less pain.

Overall, spirituality improves quality of life.

Contact info: info@nursesinternational.org

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Common Religions Beliefs and Practices

Ernstmeyer,& Christman, 2021

Buddhist Patients:

Emphasis on "mindfulness," so may request peace and quiet for the purpose of meditation during crises.
Express strong, culturally-based concerns about modesty: regarding treatment by someone of the opposite sex.
Some are strictly vegetarian in refusing to consume any meat or animal by-product. (even medications that are produced using animals are likely to be problematic).

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Common Religious Beliefs and Practices

Christians:

Varying beliefs and practices depending on the denomination (Lutheran, Episcopailan, Baptist, Non-Denomination, Wesleyan etc).
Primary focus on Bible for direction and spiritual encouragement.
Emphasis on personal prayer and ‘devotions’.
May observe Sunday or Saturday as days of worship.
May request to have minister or priest visit client.
Observe religious holidays throughout the year (major holidays are Christmas and Easter).

Contact info: info@nursesinternational.org

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Common Religions Beliefs and Practices

Ernstmeyer,& Christman, 2021

Catholic Patients:

Sacraments and blessings by a Catholic priest can be viewed as highly important, especially before surgery or as a perceived risk of death.
If a clientis near death, there may be an urgent request for a Catholic priest to offer.
Baptism: All requests for the sacrament of baptism should be relayed to a Catholic priest.
Clients may request Holy Communion (Eucharist) prior to surgery.
Clientsmay request non-meat diets, especially during the late-winter time of Lent.

Contact info: info@nursesinternational.org

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Common Religious Beliefs and Practices

Pentecostal Patients:

Pentecostal Clients may pray exuberantly.
Noise concerns in a hospital can sometimes present a problem in this regard, but simply shutting the door to the patient’s room can usually provide an adequate solution.
Pentecostals may pray by “speaking in tongues,” expression of words that seem unintelligible to an individual hearer but holds very deep religious significance for worshippers.
Clients or families may request that relatively large numbers of people be allowed in the patient’s room for prayer.
Clients or families may express strong belief in miraculous healing.

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Common Religions Beliefs and Practices

Ernstmeyer,& Christman, 2021

Hindu:

Often strictly vegetarian and do not consume meat or animal by-products.
Beef is strictly not allowed.
May also refrain from eating onions or garlic.
Fasting is a common practice.
A client may have a strong desire to wash their hands after meals.
A cultural norm to use the right hand for “clean” tasks like eating.
Clients may wear jewelry or adornments that have strong cultural and religious meaning.

Contact info: info@nursesinternational.org

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Common Religions Beliefs and Practices

Jehovah’s Witness Patients:

The most defining tenant for Jehovah’s Witnesses in health care is the strict prohibition against receiving blood (i.e., red blood cells, white blood cells, platelets, or plasma) by transfusion (even the transfusion of a patient’s stored blood), in medication using blood products, or in food.

Some blood fractions (such as albumin, immunoglobulin, and hemophiliac preparations) are allowed, but clients are guided by their own conscience.
Organ donation and transplantation are allowed, but clients are guided by their own conscience.

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Common Religions Beliefs and Practices

Muslim Patients:

May express strong concerns about modesty, especially regarding treatment by someone of the opposite sex.
A Muslim woman may need to cover her body completely and should always be given time and opportunity to do so before anyone enters her room.
Some Muslims may avoid eye contact as a function of modesty
May specifically request a diet in accordance with religious laws for “Halal” food, though many Muslims opt for a vegetarian diet as a simple way to avoid religious prohibitions against such things as pork products or gelatin.

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Common Religions Beliefs and Practices

Jewish Patients:

May strictly observe a rule not to “work” on the Sabbath (from sundown on Friday until sundown on Saturday) or on religious holidays.
Often request a special Kosher diet in accordance with religious laws that govern the preparation of certain foods (e.g., beef), the prohibition of certain foods (e.g., pork and gelatin), or the combination of some food (e.g., beef served with dairy products).
May have culturally-based concerns about modesty, especially regarding treatment by someone of the opposite sex.

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Barrier to Spiritual Care

Barriers that affect nurses’ ability to provide Spiritual care can be divided into two groups:

Internal or intrapersonal barriers:

Include inability to communicate,
lack of information and knowledge about spirituality, and
Individual beliefs and values

The external factors or healthcare and environmental situations:

Include environmental limitations (providing a quiet environment for the patient)
Lack of personnel and time
Short period of the client staying in the hospital, and
Nurses’ high workload and tiredness

Atashzadeh-Shoorideh, Zakaryaee, & Fani, 2018

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Critical Thinking Question

You are a nurse providing care to a 65 years old muslim male patient. The client is very strict about their religious practice. Which of the following food is not allowed in his case?

Beef
Mutton
Pork
Chicken

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Nurses Role in Spiritual Care

Assessment:

Subjective Assessment: The FICA model

F–Faith or beliefs:

What are your spiritual beliefs? Do you consider yourself spiritual? What things do you believe in that give meaning to life?

I–Importance and influence:

Is faith/spirituality important to you? How has your illness and/or hospitalization affected your personal practices /beliefs?

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Nurses Role in Spiritual Care

Assessment:

Subjective Assessment: The FICA model

C–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 who supports/assists you in your spirituality?

A–Address:

What support can we provide to support your spiritual beliefs/practices?

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Nurses Role in Spiritual Care

Subjective Assessment:

The HOPE tool is also helpful for incorporating spiritual assessment questions into a medical interview.
HOPE stands for:

H: Sources of hope, meaning, comfort, strength, peace, love and connection
O: Organized religion
P: Personal spirituality and practices
E: Effects of spirituality on medical care and end-of-life issues

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Nurses Role in Spiritual Care

Objective Assessment:

Clientsexperiencing chronic or serious illness may make statements indicating spiritual distress that should cue the nurse that spiritual care is needed

Examples of these statements/concepts are as follows:

Lack of Meaning: “I am not the person I used to be.”
Hope: “I have nothing left to hope for.”
Mystery: “Why me?”
Isolation: “All my family and friends are gone.”
Helplessness: “I have no control over my life anymore.

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Nurses Role in Spiritual Care

Diagnosis: Common NANDA I nursing diagnosis associated with spiritual Health:

Readiness for Enhanced Spiritual Well-Being as evidenced by expressed desire to enhance time outdoors.
“Impaired Religiosity related to environmental barriers to practicing religion as evidenced by difficulty adhering to prescribed religious beliefs.”
“Spiritual Distress related to anxiety associated with illness as evidenced by crying, insomnia, and questioning the meaning of suffering.”

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Case Study

Mr. Hernandez is a 73-year-old client admitted with end stage congestive heart failure, COPD, and diabetes. He appears anxious and verbalizes “I think this is the end” when he is admitted to the medical surgical unit. As you complete the admission assessment, the client asks you if you believe in God? Utilizing the FICA model, what questions might you ask to gain insight into the patient’s personal spiritual beliefs?

Contact info: info@nursesinternational.org

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Nurses Role in Spiritual Care

Ernstmeyer,& Christman, 2021

Planning Interventions: Providing Spiritual Care:

Take cues from the client.
Ask the client how you can support them spiritually.
Support clients within their own faith tradition
Listen to a patient’s fears and concerns without adding your own stories
Pray with a client if requested (or provide someone who will)
Share an encouraging thought or word
Use presence and touch

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Nursing Interventions for Spiritual Support

Therapeutic communication to establish trust and empathetic care.
Actively listen to the individual’s feelings and express empathy.
Be open to the individual’s expressions of loneliness and powerlessness.
Encourage the individual to review their past and focus on events and relationships that provided spiritual strength and support.
Provide privacy and quiet time for spiritual activities.
Offer opportunities for the clientto practice their religion.
Encourage the client to engage in spiritual, meditative, or mind-body practices to promote spiritual healing.

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Nursing Interventions for Spiritual Support

Arrange visits with the chaplain, patient’s pastor, or other spiritual advisor.
Pray with the individual, as appropriate.
Provide spiritual music, literature, radio, television, or online programs as appropriate.
Promote hope however the individual defines it for their situation without providing false reassurance.
Encourage forgiveness.
Encourage participation in interactions with family members, friends, and others.
Encourage participation in support groups.

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Nurses Role in Spiritual Care

Implementing Interventions:

Support patients’ spiritual and religious preferences.
Respect and listen to the patient’s expression of beliefs and not impose their own beliefs on the patient.
If a client has a spiritual belief, value, or practice that conflicts with their treatment plan: The nurse should:

Explain the rationale for the intervention or treatment.
Attempt to negotiate the treatment plan with the client and/or health care provider.

Example: A nurse can advocate for rescheduling a procedure after the Sabbath or Modifying the dietary plan and medication administration times during Ramadan.

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Nurses Role in Spiritual Care

Evaluation:

When evaluating the effectiveness of interventions in promoting a patient’s spiritual health, refer to the overall goal,
“The client will demonstrate spiritual health as evidenced by the following indicators: feelings of faith, hope, meaning, and purpose in life with connectedness with self and others.”

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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Spiritual Care for Self

Associated with better health and well-being for everyone, including nurses and nursing students.
Can help nurses and nursing students overcome the emotional toil associated with caring for seriously ill and dying Clientsand prevent compassion fatigue and burnout.
Practices and other methods to build spiritual strength include:

Meditation
Yoga
Journaling
Prayer
Mindfulness

Ernstmeyer,& Christman, 2021

Contact info: info@nursesinternational.org

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What would the nurse do?

You are a newly appointed RN in a oncology ward taking care of terminally ill patients. How do you spiritually care for yourself?

Contact info: info@nursesinternational.org

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References:

Atashzadeh-Shoorideh, F., Zakaryaee, N. S., & Fani, M. (2018). The barriers and facilitators in providing spiritual care for parents who have children suffering from cancer. Journal of family medicine and primary care, 7(6), 1319–1326. https://doi.org/10.4103/jfmpc.jfmpc_76_18

Daher, M.,(2012). Cultural beliefs and values in cancer patients.Annals of Oncology,Volume 23, Supplement 3,ISSN 0923-7534.

https://doi.org/10.1093/annonc/mds091

Ernstmeyer, K., & Christman, E. (Eds.). (2021). Open RN N ursing Fundamentals by Chippewa Valley Technical College is licensed under CC BY 4.0.

Contact info: info@nursesinternational.org

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