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Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 1 Chapter 35 Spiritual Health.
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Transcript of Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 1 Chapter 35 Spiritual Health.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 1
Chapter 35
Spiritual Health
2Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Scientific Knowledge Base
Mind, body, and spirit are interrelated.
Physical and psychological well-being results from beliefs and expectations.
Beliefs and convictions are powerful resources for healing.
3Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study
Victoria Timms is a 48-year-old African American college professor, diagnosed 3 months ago with breast cancer. She is married to Joe, an insurance salesman, and is the mother of two children: Valerie, 16 years, and Peter, 12 years.
Surgeons removed Victoria’s cancerous tumor and two involved lymph nodes. Because of the lymphatic involvement, Victoria is at increased risk for the cancer to spread.
4Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Spirituality
5Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Knowledge Base:Current Concepts in Spiritual Health
Spirituality: complex, unique to the individual Spiritual well-being: an interconnectedness
between God or a higher power and other people
Faith: several definitions Religion: associated with a specific system of
practice associated with a denomination, sect, or form of worship
Hope: gives an individual a motivation and the resources to achieve
6Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
Victoria has completed a course of radiation and now visits the cancer clinic with her husband three times a week for chemotherapy.
Victoria and Joe discuss their concern for their children. Valerie and Peter attend Sunday school weekly after going to church with their parents. Their Sunday school teacher informed Victoria and Joe that Valerie and Peter are very angry about their mother’s illness.
7Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Definitions
Atheist: one who does not believe in the existence of God
Agnostic: one who believes that there is no known ultimate reality
Self-transcendence: a sense of authentically connecting to one’s inner self
Transcendence: the belief that a force outside of and greater than the person exists beyond the material world
8Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
Jeff is a 36-year-old married student nurse assigned to the oncology clinic. He is in his last semester at school and hopes to get a position in the clinic after graduation. Jeff is assigned to follow Victoria during her visits.
Victoria’s experience is significant for Jeff because he has children who are the same age as Victoria’s, and he wonders how his children would react if his spouse became ill.
9Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Care: Religious versus Spiritual
Patients benefit from both types of care.Religious care: helping patients maintain faithfulness to their belief system and worship practices
Spiritual care: helping people identify meaning and purpose in life, look beyond the present, and maintain personal relations as well as a relationship with a higher being or life force
10Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Knowledge Base: Spiritual Health
Spiritual health represents a balance. Spiritual health matures with increasing awareness of
meaning, purpose, and life values. Spiritual beliefs change as patients grow and
develop. Spiritual distress: 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
11Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
During one of their clinic visits, Victoria and Joe appear very calm and relaxed when discussing the cancer therapy. Joe explains, “We both have a lot of faith in God.”
Victoria responds, “Even though I know I have cancer, I hope to be able to continue to go to church with my family and my children. My family is very supportive, and together, I know we will make it through this experience. But I am worried about my children. With God’s help, I can help them cope with my illness better.”
12Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Knowledge Base: Factors Influencing Spirituality
Acute illness Sudden, unexpected
Chronic illness Threatens a person’s independence
Terminal illness Uncertainty about death
Near-death experience (NDE) Psychological phenomenon close to clinical death
or recovered after declared death
13Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Critical Thinking
Apply knowledge, experience, standards, and attitudes.
Personal experience in caring for patients in spiritual distress is valuable when helping
patients select coping options.
Each person has a unique spirituality.
The Joint Commission requires health organizations to provide for pastoral care.
14Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
Jeff recognizes that Victoria shows acceptance of her disease because she is able to discuss cancer and the plan for treatment. Jeff knows that as patients begin to accept the fact of being diagnosed with a life-threatening disease, it is important to offer opportunities to share feelings and to begin to provide time to discuss future plans.
Jeff’s previous experiences with cancer patients have taught him that when patients express hope, they seem to be able to move forward and cope with the challenges of their disease.
15Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Quick Quiz!
1. When caring for patients, the nurse must understand the difference between religion and spirituality. Religious care helps individuals
A. Maintain their belief systems and worship practices.B. Develop a relationship with a higher being. C. Establish a cultural connectedness with the purpose
of life.D. Achieve the balance needed to maintain health and
well-being.
16Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process
Assessment Establish trust.
Diagnosis Use North American Nursing Diagnosis Association
International (NANDA-I)-approved list. Planning
Goals need to be realistic and individualized. Implementation
This is based on phase of care. Evaluation
This involves an increased or restored sense of connectedness.
17Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
Jeff discovers that spiritual needs are often associated with cultural beliefs. Spiritual and cultural beliefs affect how women of different cultures experience health and illness.
Spirituality often provides a source of healing, coping, and peace. Jeff uses this understanding to develop a culturally competent plan of care for Victoria and her family. Jeff learns that Victoria’s church has a parish nurse. What steps could Jeff take next?
18Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process: Assessment
Assessment expresses a level of caring and support.
Establish a trusting relationship. Assess patient’s viewpoints.
Ask direct questions. Utilize spiritual assessment tools:
• SWB (Spiritual Well-Being Scale)• BELIEF (belief, ethics, lifestyle, involvement, education,
future events)
19Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process: Assessment (cont’d)
Faith/Belief: ask about a religious source of guidance
Life and self-responsibility: ask about a patient’s understanding of illness limitations or threats and how the patient will adjust
Life satisfaction Connectedness: ask about the patient’s ability
to express a sense of relatedness to something greater than self
20Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Connectedness
21Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process: Assessment (cont’d)
Culture: ask about faith and belief systems to understand culture and spirituality relationships
Fellowship and community: ask about support networks
Ritual and practice: ask about life practices used to assist in structure and support during difficult times
Vocation: ask whether illness or hospitalization has altered spiritual expression
22Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process: Diagnosis
Potential diagnoses: anxiety, ineffective coping, fear, complicated grieving, hopelessness, powerlessness
NANDA-I accepted diagnoses: Readiness for enhanced spiritual well-being Spiritual distress Risk for spiritual distress
23Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
Jeff knows that current evidence shows many African American women use spirituality to cope with breast cancer, so he decides to assess Victoria’s spirituality in these areas: Victoria’s connections with herself Victoria’s connections with her family and
significant others Victoria’s connections with a power greater than
herself
24Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process: Planning
Goals and outcomesA spiritual care plan includes
realistic and individualized goals with relevant outcomes.
Setting prioritiesThe patient identifies what is most important.
Teamwork and collaborationIn a hospital setting, the pastoral care department
is a valuable resource.
25Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
Victoria had also expressed that her children, who were very close to their parents and shared their faith in God, now are not coping well with Victoria’s illness. What goals for the nursing diagnosis should Jeff
set for Victoria and Joe? What expected outcomes should Jeff establish?
26Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process: Implementation
Health promotion 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.
27Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process: Implementation (cont’d)
Acute care Support systems Diet therapies Supporting rituals
Restorative and continuing care Prayer Meditation Supportive grief work
28Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
Jeff knows that spiritual support is important. He uses therapeutic communication to establish
presence and trust, and to demonstrate empathy. He prays with Victoria and her family. He encourage their religious practices.
Jeff also tries to promote family integrity by identifying the family coping mechanisms and by encouraging Joe to communicate frequently and openly with Victoria.
29Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Process: Evaluation
Were expectations met? How can spiritual well-being be enhanced? Were patient outcomes achieved?
Include the patient in your evaluation of care. Successful outcomes reveal the patient
developing an increased or restored sense of connectedness with family; maintaining, renewing, or re-forming a sense of purpose in life; and for some, exhibiting confidence and trust in a Supreme Being or power.
30Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
What nursing actions should Jeff take to determine whether expectations have been met and whether patient outcomes were achieved?
If Victoria responded that she needed help working out a schedule to spend time with her children, what could Jeff suggest?
31Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Quick Quiz!
2. To assess, evaluate, and support a patient’s spirituality, the best action a nurse can take is to
A. Assist the patient to use faith to get well.B. Refer the patient to the health care facility
chaplain.C. Provide the patient with a variety of religious
literature.D. Determine the patient’s perceptions and
belief system.
32Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Case Study (cont’d)
In an effort to evaluate whether the clinic has met Victoria’s expectations, Jeff asks, “Your faith is strong, and it is my hope that you have felt comfortable in talking about your worries. Do you believe we have helped you so far with your concerns?”
Victoria replies, “The best thing you have done is listen and recognize how important my family is to me. Your suggestions have helped. I am truly blessed to have met all of you nice people at the clinic.”
33Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Conclusion
Spirituality ensures a holistic focus. Spirituality is much broader and unifying than
religion. Spirituality requires open communication and
establishment of trust between nurse and patient.
Spirituality involves faith, support systems, and hope.