NCM 101

• Spirituality


  A search for meaning and purpose in life; it seeks to understand life's ultimate questions in relation to the sacred
• Religion


  The rituals, practices, and experiences shared within a group that involve a search for the sacred (i.e., God, Allah, etc.)

  
• For some faiths, the idea of religion encompasses the concept of spirituality and is a natural outflow of that idea
• Others may view spirituality as a separate concept, possibly disconnected from any religious institution
• Spiritual assessment


  • The healthcare professional should keep an objective perspective with the goal of meeting the client where she or he is
• Public opinion and health care research give credence to the importance of the relationship of religion, spirituality, and health
• A large number of patients use spiritual resources during times of high stress (i.e., hospitalizations)
• Religion and spirituality have been related to a person's greater well-being in the face of chronic disease management and assistance adhering to medical regimens
• Clients have also called for medical providers to address spiritual issues during client provider interactions
• Nurses generally have more opportunities to address spiritual concerns with clients because nurses are the primary points of contact for most clients
• Religion and spirituality can be powerful coping mechanisms when a person faces end-of-life issues
• Some religions encourage positive health behaviors, greater mental health, and provide a strong social support network
• Spirituality can be practiced through a wide variety of avenues
• A working knowledge of the majority faiths' ideals, beliefs, and practices in the nurse's community would provide a useful foundation for spiritual care
• When conducting any type of review of the denominations or faiths in a particular community, be aware that a client's spiritual dimension is subjective and may vary greatly between persons, even persons of the same denomination or faith
• A discussion with a hospital chaplain or clergy regarding the views of religious faiths in the nurse's community would also provide a greater understanding about the particular faith's views of health and give the nurse a resource for future referral or collaboration
• Collaboration and referral with pastoral chaplains or clergy are extremely important when dealing with religious issues in a health care setting
• Particular religious views may negatively impact health
• Failure to seek timely medical care and withholding "proper" medical care based on religious dogma are usually the most prominent ethical dilemmas faced by healthcare providers
• Christian Scientists frequently rely on prayer alone to heal illnesses, rarely seek mainstream medical care, and have higher rates of mortality than the general population
• Jehovah's Witnesses refuse blood transfusions due to their belief that the body cannot be sustained by another's blood and accepting a transfusion will bar the recipient from eternal salvation
• If a nurse is presented with a situation where religious or spiritual views have the potential to compromise adequate nursing care, the situation should be presented to a supervising staff member immediately
• For complex cases, the situation may also be presented to the ethics committee of the institution or organization to assure appropriate measures are followed
• Consistently nurses who are more aware of their spirituality are more comfortable discussing the potential spiritual needs of the client
• Introspective reflection on one's own beliefs and biases about the relationship between spirituality and health can be undertaken through journaling, meditation, or discussions with interested persons
• Spiritual assessment


  Similar to the many other assessments nurses perform on a daily basis. Gaining relevant information about the client's spirituality helps to identify related nursing diagnoses and needed interventions and can improve client care
• There is no absolute in the timing of a spiritual assessment. Some professionals recommend inclusion with the initial assessment, while others argue for a delayed assessment after the nurse-client relationship has been established
• Briefly addressing a client's spirituality will establish an open dialogue, and provide a foundation for any intervention or care that may be needed in the future
• The client is the focus of the spiritual assessment. The nurse does not have to be spiritual to take a spiritual assessment. Objectivity is a key component in a high quality spiritual assessment
• The questions in a spiritual assessment probe for beliefs that could affect client care. Divulged information is then utilized to support, encourage, or lead clients in harmonizing their personal relationships to spirituality and health
• Some clients may not be connected to any religious group or have any interest in spirituality. These clients should be encouraged in whatever provides them strength in dealing with health care issues (i.e., family, friends, nature, etc.)
• If a client responds negatively to any aspect of the discussion of religion or spirituality, the nurse may collaborate with the hospital clergy or pastoral care department to further assess the situation and patient responses
• Spirituality is multidimensional. It is also unique to each individual. These characteristics of spirituality can present difficulties in proper assessment
• The most useful spiritual assessment techniques should have general introductory questions and not be specific to any religious denomination that would guide precise questions related to the client's specific spiritual needs
• A client's spirituality often affects her health. There are numerous capacities in which this occurs and frequently will go unnoticed without assessment. Subjective and objective data will be collected during assessment. Noticeably the subjective data will be the primary source of information during a spiritual assessment, but the objective data can validate or call into question information presented to the nurse
• Equipment for assessing skin, hair and nails

  • Examination light
  • Penlight
  • Mirror (for client's self-examination of skin)
  • Magnifying glass
  • Centimeter ruler
  • Gloves
  • Wood's light
  • Examination gown or drape
  • Braden Scale for Predicting Pressure Sore Risk
  • Pressure Injury Scale for Healing (PUSH) tool to measure pressure injury healing
• Equipment for assessing head and neck

  • Small cup of water or water bottle with drinking straw
  • Stethoscope
  • Penlight
  • Gloves (in presence of drainage)
• Equipment for assessing eyes

  • Snellen or E chart
  • Hand-held Snellen chart or near-vision screener
  • Penlight
  • Opaque cards
  • Ophthalmoscope
  • Disposable gloves
  • Amsler grid
  • Tape measure
• Equipment for assessing ears


  • Watch with a second hand
  • Tuning fork (512 or 1 024 Hz)
  • Otoscope
• Equipment for assessing mouth, throat, nose, and sinuses


  • Non latex examination gloves
  • x 4-in. gauze pad
  • Penlight
  • Short, wide-tipped speculum attached to the head of an otoscope
  • Tongue depressor
  • Nasal speculum