SPIRITUALITY

• Spirituality


  The human tendency to seek meaning and purpose in life, inner peace and acceptance, forgiveness and harmony, hope, beauty, and so forth
• Religion


  Ritualistic practices and organized beliefs
• Agnostic


  A person who doubts the existence of God or a Supreme Being or believes the existence of God has not been proved
• Atheist


  One without belief in a deity
• Spiritual nursing care


  • Intuitive, interpersonal, altruistic, and integrative expression that is contingent on the nurse's awareness of the transcendent dimension of life but that reflects the client's reality
  • At its foundational level, spiritual nursing care is an expression of self
• Spiritual distress


  A disturbance in the belief or value system that provides strength, hope, and meaning to life
• Defining characteristics of spiritual distress

  • Expresses lack of hope, meaning of life, inadequate acceptance of self
  • Expresses feeling abandoned or anger toward power greater than self
  • Refuse interaction with significant others
  • Exhibits sudden changes in spiritual practices
  • Requests (or refused) to interact with a spiritual leader
  • Has no interest in nature or in reading spiritual literature
• Spiritual health/wellbeing


  The opposite of spiritual distress, thought to not occur by chance, but by choice
• Spiritual/religious coping


  The spiritual beliefs or ways of thinking that help people cope with their challenges
• Theories about human development include not just theories about physical, cognitive, and moral development, but also spiritual development
• A normal part of this development for teens and young adults involves evaluating the beliefs and religiosity of authority figures to form beliefs and practices that are meaningful for them
• It is not unusual, however, to find adults who have failed to complete this developmental task
• Guidelines for nurses in spiritual caregiving

  • First seek a basic understanding of clients' spiritual needs, resources, and preferences (i.e., assess)
  • Follow the client's expressed wishes regarding spiritual care
  • Do not prescribe or urge clients to adopt certain spiritual beliefs or practices, and do not pressure them to relinquish such beliefs or practices
  • Strive to understand personal spirituality and how it influences caregiving
  • Provide spiritual care in a way that is consistent with personal beliefs
• Clients often confuse religiosity with spirituality; this may contribute to their uncertainty about receiving spiritual care from nurses
• Observing and using the client's language for spirituality (e.g., "being at peace" or "faith") and exhibiting large measures of sensitivity and respect will help nurses to converse therapeutically with clients to provide spiritual care
• Examples of holy days

  • Rosh Hashanah and Yom Kippur (Jewish)
  • Good Friday and Christmas (Christian)
  • Buddha's birthday (Buddhists)
  • Mahashivarathri—a celebration of Lord Shiva (Hindu)
  • The month-long Ramadan (Islam)
• Sabbath


  The biblical commandment "Remember the Sabbath day to keep it holy"
• Sabbath observance


  • Most Christians observe the "Lord's Day" on Sunday
  • Jews and Sabbatarian Christians (e.g., Seventh- Day Adventists) observe Saturday as their Sabbath
  • Muslims traditionally gather on Friday at noon to worship and learn about their faith
• Sacred symbols


  Jewelry, medals, amulets, icons, totems, or body ornamentation (e.g., tattoos) that carry religious or spiritual significance
• Prayer


  Humans pleading or experiencing the divine (however that is perceived)
• Types of prayer


  • Ritual (e.g., Hail Mary, memorized prayers that can be repeated)
  • Petitionary (e.g., "God, cure me!" or intercessory prayers when one is requesting something of the divine)
  • Colloquial (i.e., conversational prayers)
  • Meditational (e.g., moments of silence focused on nothing, a meaningful phrase, or a certain aspect of the divine)
• Meditation


  The act of focusing one's thoughts or engaging in self-reflection or contemplation
• Dietary beliefs affecting diet

  • Orthodox Jews are not to eat shellfish or pork
  • Muslims are not to drink alcoholic beverages or eat pork
  • Members of the Church of Jesus Christ of Latter-Day Saints (Mormons) are not to drink caffeinated or alcoholic beverages
  • Older Catholics may choose not to eat meat on Fridays
  • Buddhists and Hindus are often vegetarian, not wanting to take life to support life
  • Many Jewish people require kosher food, which is food prepared according to Jewish law
• Beliefs about illness and healing

  • Clients may have religious beliefs that attribute illness to a spiritual disease or sin
  • Some clients may ascribe disease to the innate presence of sin and evil in this world, whereas others may believe the disease is a punishment for sin in their past
• Beliefs about dress and modesty

  • Orthodox and some Conservative Jewish men believe that it is important to have their heads covered at all times and therefore wear yarmulkes
  • Orthodox Jewish women cover their hair with a wig or scarf as a sign of respect to God
  • Mormons may wear temple undergarments in compliance with religious dictates
  • For some, it is imperative that they not shave certain hair (e.g., sideburns for Hasidic Jewish men, any hair for a Khalsa
• Beliefs related to birth

  • Muslim mother may recite a prayer while a baby is being born, and its father or someone else will recite a call to prayer into the infant's ears
  • Hindus will perform a number of religious rituals when a baby is born
  • Most Christian parents will have their babies christened or baptized at some point
  • Christian parents of seriously ill infants may want baptism performed at birth by a religious nurse or primary care provider if a chaplain or clergy person is not present
  • In the Jewish and Islamic traditions, male circumcision is obligatory, whereas Hindus never practice circumcision
• Beliefs related to death


  • Roman Catholic priests perform the Sacrament of the Sick (previously referred to as the Last Rites) when clients are very ill or near death
  • Muslims who are dying want their body or head turned toward Mecca, whereas Hindus may want to face south
  • In the Muslim, Hindu, and Jewish traditions, a ritual bath and body preparation for burial may be done by a family member or by a ritual burial society
  • Jews and Muslims have a tradition of burial within 24 hours following death
  • Hindus cremate the body within 24 hours. Then the bereaved family observes a period of isolation given their defilement from living with the deceased
  • Jews "sit Shiva" (gather to pay respects) for several days in the home of the deceased
  • Buddhists perform prayers and rituals to aid the deceased to a better next life
• The Joint Commission mandates that each client admitted to one of its accredited institutions must be assessed for spiritual beliefs and practices
• Nurse-conducted spiritual assessment should limit itself to client spirituality as it relates to health. That is, it is not the privilege of clinicians to investigate a client's spirituality unless it has a purpose
• Religious practices after death

  • Hindus cremate the body within 24 hours, then bereaved family observes a period of isolation
  • Jews "sit Shiva" (gather to pay respects) for several days in the home of the deceased
  • Buddhists perform prayers and rituals to aid the deceased to a better next life
• Spiritual assessment by nurses

  • It is assumed that spirituality can be assessed, and that nurses are appropriate clinicians for conducting an initial or relatively superficial level of assessment. Both of these assumptions, however, may be debated
  • Nurse-conducted spiritual assessment should limit itself to client spirituality as it relates to health. It is not the privilege of clinicians to investigate a client's spirituality unless it has a purpose related to providing health care
  • Nurses should never assume that a client follows all of the practices of the client's stated religion
• FICA


  F = Faith or beliefs

  I = Implications or influence

  C = Community

  A = Address
• Nurses, as spiritual care generalists, must be extremely cautious when judging a client's spiritual health and applying a diagnosis that could be inappropriate
• Spiritual diagnoses recognised by NANDA International

  • Spiritual Distress
  • Readiness for Enhanced Spiritual Well-Being
  • Risk for Spiritual Distress
• Religious diagnoses recognised by NANDA International

  • Impaired Religiosity
  • Risk for Impaired Religiosity
  • Readiness for Enhanced Religiosity
• Spiritual distress


  May affect other areas of functioning and indicate other diagnoses
• Examples of spiritual distress as etiology

  • Fear related to apprehension about soul's future after death and unpreparedness for death
  • Chronic Low or Situational Low Self-Esteem related to failure to live within the precepts of one's faith
  • Insomnia related to spiritual distress
  • Ineffective Coping related to feelings of abandonment by God and loss of religious faith
  • Decisional Conflict related to conflict between treatment plan and religious beliefs
• Planning for spiritual needs

  • Helping clients to practice their religious rituals
  • Supporting clients to recognize and incorporate spiritual beliefs in health care decision making
  • Encouraging clients to recognize positive meanings for health challenges
  • Promoting a sense of hope and peace
  • Providing spiritual resources when requested
• Presencing


  The art of being present, or just being with a client during an "existential moment"
• Levels of presencing


  • Presence (when a nurse is physically present but not focused on the client)
  • Partial presence (when a nurse is physically present and attending to some task on the client's behalf but not relating to the client on any but the most superficial level)
  • Full presence (when a nurse is mentally, emotionally, and physically present; intentionally focusing on the client)
  • Transcendent presence (when a nurse is physically, mentally, emotionally, and spiritually present for a client; involves a transpersonal and transforming experience)