1 Chapter 35 Spiritual Health

Mind, body, and spirit are interrelated. Physical and psychological well-being results from beliefs and expectations. Beliefs and convictions are powerful resources for healing.

 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

 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

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

 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

 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

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.

 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.

 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)

 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

 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

 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

Goals and outcomes A spiritual care plan includes realistic and individualized goals with relevant outcomes. Setting priorities The patient identifies what is most important. Teamwork and collaboration In a hospital setting, the pastoral care department is a valuable resource.

 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.

 Acute care  Support systems  Diet therapies  Supporting rituals  Restorative and continuing care  Prayer  Meditation  Supportive grief work

 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.

 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.