Spiritual Needs, Spiritual Caring, and Religious Differences Chapter 13 Spiritual Needs, Spiritual Caring, and Religious Differences

Chapter 13 Lesson 13.1

Learning Objectives Differentiate between spirituality and religion. Identify the difference between the spiritual and emotional dimensions of individuals. Discuss the practical/vocational nurse’s role in providing spiritual care to the patient and the family. Discuss nursing interventions that can be used to meet the spiritual needs of patients. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Learning Objectives (cont’d) List members of the health care team who can help provide spiritual care for patients. Discuss personal religious and/or spiritual beliefs, or the absence of them, and how these beliefs will influence nursing practice. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Spirituality and Religion Spirituality has to do with experience. Religion has to do with giving form to that experience. Spirituality focuses on what happens in the heart. Religion tries to make rules and capture that experience in a system. What are some examples of religious rituals? Can a person be spiritual, but not religious? Religious, but not spiritual? How does one practice spirituality? (prayer, meditation, appreciating nature, etc.) Religion provides us with outward signs of what we believe. What are some examples? (rosaries, yarmulkes, hijabs) Spirituality focuses on what happens in the heart and mind; religion makes rules and captures the spiritual experience in a system. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Spiritual Dimension vs. Emotional Dimension Spiritual dimension—refers to the relationship of a person to a higher power and gives insight into the meaning of life, suffering, and death Emotional dimension—refers to how a person responds to and deals with feelings of joy, anger, sorrow, guilt, remorse, love, etc. How do people express their spirituality? (often in private; crying, praying, journaling, and meditating) Many people are unprepared for illness and the prospect of dying; this is why spiritual care is so important. In what ways can a person’s spiritual dimension affect his or her health? Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Importance of Spiritual Care Involves helping patients develop awareness of and maintain the following: Inner strength Self-awareness Life’s meaning and purpose Relationship to others Relationship to a higher power Avoid waiting for crisis situations to occur to be concerned about spiritual care. The Joint Commission requires spiritual assessments and interventions to support the spiritual needs of patients and families. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Who Needs Spiritual Care? Patient situations that may intensify the need for spiritual care Hospitalization Patients who are in pain Patients who have a chronic or incurable disease Patients who are dying Families who have experienced the death of a loved one Patients who are facing an undesirable outcome of illness, such as an amputation Patients who have lost control of themselves Parish nurses recognize the relationship between spirituality and health and encourage spiritual growth in their patients. What effect may patients’ beliefs and values have on their illness? Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Gathering Data for Spiritual Issues First Step Providing spiritual care for patients is to strive to be personally comfortable with spiritual matters. Second Step Become aware of your own spirituality and the spirit that is the essence of you. Gather data about your spiritual self. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

LPN/LVN’s Role in Providing Spiritual Care Ask questions. Show interest. Listen with an understanding attitude. Respond naturally to spiritual concerns. Help patients face reality with hope. Encourage patient’s active involvement. Allow families to participate in care. Avoid false assurances. Be supportive and empathetic with the dying. Caring for someone on a spiritual level is very powerful, as well as difficult. Why might some people find it difficult to talk about spiritual or religious issues with patients? What are some ways to overcome the difficulties? Sometimes a nursing intervention at the spiritual level is not a conscious act that is learned in class—it is also instinctual. How is patient care enhanced when his or her spiritual needs are considered? Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Spiritual Care Interventions Ask open-ended questions. Actively listen, make eye contact. Be nonjudgmental. Avoid giving advice or lectures. Avoid trying to change a person’s beliefs. Be aware of patient’s nonverbal messages. Understand the patient’s feelings. What would you do for or say to a woman whose baby was stillborn? Sometimes, rather than offering advice or making suggestions, offer the patient space and just listen. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Spiritual Care Interventions (cont’d) Expect to learn from patients. Stay with patient after unfavorable diagnosis. Pray with patient if asked. Read to patient if asked. Assist patient’s participation in religious/spiritual rituals. Protect patient’s religious/spiritual articles. What questions should a nurse ask a patient who is of a religion that is unfamiliar to the nurse? What religious practices or rituals are important to you? What dietary restrictions or inclusions do you follow? How does your religion view pain and suffering? Does your religion prohibit people of the opposite sex from giving care? Some areas to consider for nursing interventions include food (preferences and meal times), gender of patient and staff, special days of the week or holy days, religious articles in the room, and anything else a patient might share with the nurse. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Pastoral Care Team Made up of ministers, priests, rabbis, consecrated religious women, representatives of other religious organizations, and laypersons Educated to meet spiritual needs, in addition to religious needs, in a health care setting For what reasons might a patient request to see a member of the pastoral care team? If you were a patient, would you like to see a member of the pastoral care team? If so, under what conditions? Patients with spiritual needs are often scared or emotional and do not want to be left alone. If the nurse is unable to stay with a patient in need, another staff member should always be called. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Personal Religious and Spiritual Needs Spiritual Practices Religious Ritual and Practices Atheists and Agnostics Spiritual Distress What is the difference between an atheist and an agnostic? (Atheists believe that there is no God or supernatural; agnostics believe that God’s existence can be neither proved nor disproved.) Do atheists and agnostics have spiritual needs? How could a nurse provide spiritual care for these patients? Discuss how spiritual distress may be exhibited. How might the health care setting trigger spiritual distress in patients? (They cannot fulfill the rituals and practices of their faith, or there is conflict between the health regimen and their spiritual beliefs.) A pastoral care team member may need to be called for patients experiencing spiritual distress. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Patients’ Spiritual Practices Help individuals develop awareness of self, understanding of the meaning and purpose of life, and their relationship to a higher power. Examples Gardening Reading inspirational book Listening to music Meditating Watching select TV shows and movies Communing with nature What other spiritual practices may be used? Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Religion and the Patient The religious self refers to the specific beliefs held by an individual in regard to a higher power. Religious Denomination An organized group of people who share a philosophy that supports their particular concept of God or a higher power, as well as worship experiences Agnostics Hold the belief that the existence of God can be neither proved nor disproved Atheists Do not believe that the supernatural exists, so they do not believe in God Christians may find comfort and solace in their refuge in God, including passing into another life after death. How do some patients meet their spiritual needs? The nurse may feel unsuccessful in meeting the total needs of the patient who is an atheist because atheists do not believe in the supernatural. Encourage patients to express personal feelings about life, death, separation, and loss. Avoid imposing personal beliefs and values on the patient. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Value of Rituals and Practices Rituals are series of actions that have religious meaning. Bring the security of the past into a crisis situation. Concrete symbols such as pictures, icons, herb packets, rosaries, statues, jewelry, and other objects can affirm the patient’s connection with a higher power. The value of patients’ rituals and religious practices is determined by their faith. There have been studies that have shown that people who have faith can recover more quickly from illness, surgery, and addiction and are less likely to die prematurely from any cause. When patients are not allowed to practice their religious rituals, practices, and responsibilities, they may feel guilty and uneasy. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Patient and Prayer Prayer is a spiritual practice of some individuals whether or not they are members of an organized religion. Can put a patient in touch with a personal God Can decrease anxiety as effectively as a drug Helps some patients cope with their illness or situation Honor the request of the patient who wants to pray privately. If the patient requests prayer, the nurse needs to assist the patient or seek assistance in this matter. What should you do when a patient express an interest in praying? Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Chapter 13 Lesson 13.2

Learning Objectives Discuss the general beliefs and practices that account for the differences among various Western, Middle Eastern, and Eastern religions, philosophies, and groups in the United States and Canada. Describe nursing interventions and considerations of patients of various religions, philosophies, and groups. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Who Is the Religious American? Hindu Jew Buddhist Muslim Lutheran Catholic Eastern Orthodox Quaker Presbyterian Methodist Church of Christ Mennonite Seventh-Day Adventist Assembly of God Mormon Baptist Wiccan Jehovah’s Witness Episcopalian African Methodist Episcopalian Christian Science United Church of Christ Moravian, Evangelical Salvation Army Nondenominational What are the fundamental beliefs and practices of each of these religions? What are some other religions that nurses could encounter that are not listed here? What amendment of the U.S. Constitution allows the free exercise of religious choice? Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Religion in the United States 2000 Religious Congregations & Membership Study conducted All Protestant denominations accounted for 66 million members 2005 Yearbook of American and Canadian Churches Identified the Catholic Church as the largest single denomination in the United States with over 67 million members The World Christian Encyclopedia 5.6 million Jews comprise the largest non-Christian, organized religion World Christian Encyclopedia Identified 4.1 million Muslims Starting with the pilgrims, America has a long history of religious freedom and tolerance. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Avoiding False Assumptions and Stereotypes It is a false assumption to expect that all individuals of a specific religion or belief system will believe exactly the same just because they are members of that religion or belief system. Individual differences occur within every religious or belief systems group. Clarify with the patient the specific beliefs and practices that offer comfort to them, and are preferred by them. Develop awareness of health issues and decisions that may involve religious or philosophical beliefs. Avoid making generalizations about people of the same faith. There is much diversity in beliefs and practices, even among members of the same religious denomination. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Judaism The oldest of faiths that have a belief in one God The Holy Books of the Jews are the Torah and the Talmud. Jewish clergy are called rabbis. Worship in buildings called temples or synagogues Major Divisions Orthodox, Conservative, and Reform What are followers of Judaism called? In 1990 there were almost 18 million Jews worldwide. The prophet Abraham founded Judaism in approximately the twentieth century. What are some interventions to consider when caring for Jewish patients? (Time to rest Friday evening and Saturday; kosher diet.) Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Christianity General Beliefs of Christians The Bible is the sacred book of Christians. Baptism is the rite of admission to the Christian community. Communion is partaking of consecrated (blessed) elements of bread and wine. What are the two sections in the Bible? Many Christian patients will find comfort in reading or having someone read to them selected passages from the Bible. Although water is used for baptizing, the method differs among groups (pouring, sprinkling, immersion). Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Christianity Major Divisions of Christianity Catholicism Protestantism Western Catholics of Eastern Rites Orthodox Eastern Churches Protestantism What are some interventions to consider when caring for Catholic patients? Catholic: fast or refrain from meat on Fridays during Lent; receive anointing of sick if seriously ill; nurse may baptize if death is imminent Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Islam Followers of Islam are called Muslims. Muslims believe in one God, Allah. Qur’an (Koran) is the holy book, contains the words of Allah as he spoke to Muhammad Believe in paradise, hell, final judgment, prayer, fasting, and giving to the poor Two Main Divisions Sunni and Shi’ite sects Muslims comprise approximately 20% of the world’s population. Salvation depends on one’s commitment to Allah and his teachings in the Qur’an (Koran). What are the Five Pillars that are essential and obligatory practices for all Muslims? Many Muslim women are required to be covered from head to ankle at all times. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Hinduism Based on a vast body of scriptures, including the Vedas and the Bhagavad-Gita More a way of life than a religion Belief in reincarnation One is reborn to a higher or lower level of existence based on one’s moral behavior in the prior phase of existence. There is no common creed or doctrine in Hinduism; it is based on the accumulated treasury of spiritual laws discovered by different people in different times. Most Hindus venerate many gods and goddesses. Most Hindus are vegetarian. Check dietary restrictions and respect personal or spiritual objects of Buddhist and Hindu patients. Hinduism is based on the belief that people are reincarnated. Because the cow is a sacred symbol of reincarnation, eating beef is considered sacrilegious. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Buddhism A religion, a philosophy, and a way of life Much of Eastern beliefs have evolved from Buddhism Originated in India Spread to China, Japan, Korea, Tibet, Burma, Sri Lanka, Laos, Cambodia, and Vietnam As it spread, the core beliefs were adapted to the culture of the host country. Siddhartha Gautama (Buddha) founded Buddhism in the sixth century BCE in India. What two core beliefs of Buddhism remained constant? Buddhists believe that suffering is caused by a desire for material pleasures. Buddhism is characterized by meditation and chanting. Many Buddhists are also vegetarian. Explain all medications and their actions to Buddhist patients. If medications are refused, the refusal must be charted. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

Nursing Interventions for Eastern Religions/Philosophies Develop awareness that not everyone sees the world as you do. Avoid stereotyping individuals and considering them all the same. In patient care the practical/vocational nurse can come in contact with a Japanese Buddhist, Korean Buddhist, and Tibetan Buddhist, among others, as well as American/Canadian patients who have blended Buddhism with their chosen religion. Ask about dietary preferences and restrictions, respect religious items, and avoid removing religious items from the patient’s body. Include all patients and family members in plans for care of the body after the patient’s death and discuss facility policies. Always make sure appropriate consent forms are signed for procedures, surgeries, and blood transfusions. Which religions prohibits members from accepting blood transfusions? (Christian Scientist and Jehovah’s Witnesses) Which religions have times of fasting? (Islam, Catholic, Baha’i, Hindu) Herbal treatments and folk medicines should be discussed with Buddhist and Hindu patients. Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.