1. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Professional Nursing Practice Concepts and Perspectives Seventh Edition Chapter 22 Nursing in a Spiritually Diverse World

2. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved 22.1 Analyze concepts related to spirituality and religion in nursing and health care. 22.2 Differentiate between spirituality, religion, and faith. 22.3 Differentiate between atheism and agnosticism. 22.4 Describe the spiritual development of the individual across the life span. 22.5 Describe the relationship between spirituality, prayer, and meditation. 22.6 Discuss the influence of spiritual beliefs about diet, dress, birth, pain, and death on health and healing practices. 22.7 Assess clients from a spiritual perspective. 22.8 Plan and implement spiritually competent care. Learning Objectives

3. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Hallmark Features A focus on foundational knowledge related to professional nursing –Includes nursing history, nursing theory, ethics, and legal aspects, etc. An overview of professional nursing roles, issues, and changes in the profession –Discusses nurses as healthcare providers, learners and teachers, and leaders

4. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Challenges and Opportunities Be open to differences in beliefs about health and illness Establish trust and acceptance of different beliefs of clients Understand how spiritual beliefs may influence clients’ belief about the cause of illness and acceptance of treatment Faith-based healing is shown to have positive effects

5. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 22.1 Analyze concepts related to spirituality and religion in nursing and health care.

6. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Spiritual beliefs and religious traditions integral part of person’s belief and value system Nurse must be aware clients’ beliefs Stressful events can cause individuals to seek comfort in religious or spiritual practice or can push people away from religion and spirituality

7. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 22.2 Differentiate between spirituality, religion, and faith.

8. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Spirituality –That which gives life or essence to the soul –Most human experiences that seek to transcend the self and find meaning through connectedness with others, nature, and/or Supreme Being –May or may not involve religion

9. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Burkhardt tells us that spirituality helps one –Deal with the unknown or uncertainties in life –Find meaning and purpose in life –Be aware of and able to use inner resources and strength –Have feeling of connectedness with oneself, others, the environment, and a Supreme Being

10. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Religion –Organized collection or set of beliefs concerning cause, nature, and purpose of the universe –May worship Supreme Being or multiple gods –Provides a way of spiritual expression that guides people in responding to life’s questions and crises

11. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Organized religious systems provide –Sense of community –Collective study of scripture –Performance of ritual –Use of disciplines, practices, commandments, and sacraments –Ways of taking care of the person’s soul

12. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Religious practices and rituals relate to life events Religious rules of conduct apply to daily life Religious development may or may not parallel spiritual development

13. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Faith –Belief in something that cannot be directly observed –Deeper and more personal than organized religion –About expectation or hope, conviction, and devotion

14. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 22.3 Differentiate between atheism and agnosticism.

15. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Atheism and agnosticism –Atheists and agnostics may believe in connectedness with one’s inner self, with others, and/or with nature –Care must be provided within context of person’s inner spirit

16. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Concepts Related to Spirituality Atheist –One who believes there is no Supreme Being –Believes that the concept of a god or many gods was created by humans Agnostic –One who believes there is no evidence or proof of existence of a Supreme Being –Doubts if Supreme Being exists

17. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 22.4 Describe the spiritual development of the individual across the life span.

18. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Spiritual Development Occurs in a linear fashion Person can be in more than one stage at a time Westerhoff’s four stages of faith –Experienced faith –Affiliative faith –Searching faith –Owned faith Fowler’s seven stages of faith –Parallel the developmental stages described by Piaget

19. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 22.5 Describe the relationship between spirituality, prayer, and meditation.

20. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Prayer and Meditation Prayer and meditation are part of most religions Prayer is a communication with or petition to a Supreme Being in word or thought Prayers may be –Petition –Request –Thanksgiving –Spiritual communion

21. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Prayer and Meditation Formal prayers are printed in prayer books Daily prayer is prescribed by some religions Meditation is focusing of one’s thoughts, internal reflection, or contemplation Meditation can provide relaxation from stress and renew energy

22. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Prayer and Meditation Clients may –Increase prayer and meditation practices in response to illness –Need uninterrupted quiet time –Want to have sacred writings, books, sacred symbols readily available –Want their minister, priest, rabbi, imam, or other spiritual adviser with them

23. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 22.6 Discuss the influence of spiritual beliefs about diet, dress, birth, pain, and death on health and healing practices.

24. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Holy days –Days of special religious observance –Most religions have a weekly day set for rest, prayer, readings –Special days of celebration and feasting –Many holy days require fasting, extended prayer, and reflection or ritual observances –Hospitals and health organizations facilitate ritual observances for patients, clients, and staff

25. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Sacred writings –Believed to be the thought or word of the Supreme Being –Tell the stories of the religion’s leaders, kings, heroes –Contain rules or commandments or other guidelines for living –Interpretations of these laws provide the foundation for ethical debates

26. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Sacred symbols –Jewelry, medals, amulets, icons, totems, body ornamentation may carry religious significance –People may wear religious symbols at all times and they may wish to wear them when undergoing treatment –Pictures or statues

27. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Dress –Many religions have laws and traditions that dictate dress –Clients who are trying to comply with religious rules about dress may refuse to wear hospital gowns

28. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Health beliefs and practices –In magicoreligious health belief system health and illness are controlled by supernatural forces  Some patients may require magical treatments in addition to scientific treatments in order for healing to occur –Holistic health holds that the forces of nature must be maintained in balance and harmony

29. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Health beliefs and practices –Four types of healing that involve spiritual and/or religious belief  Spiritual healing  Inner healing  Physical healing  Deliverance

30. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Dietary beliefs –Important for nurses to determine dietary requirements of patients and to ensure nutritional needs are met within that context –Orthodox Jewish diet  Kosher means food is considered clean according to Jewish law  Meat and dairy products not eaten at same time  Some meats forbidden

31. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Dietary beliefs –Islamic dietary practices  Forbid eating any meat of the pig  Animals must be slaughtered according to religious law  Alcohol is strictly forbidden  Fasting

32. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Dietary beliefs –Hinduism, Buddhism, Jainism  Predominantly vegetarians –Christian  Varies widely  Avoid meat on certain days  Discourages alcohol, caffeine, meat

33. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selected Spiritual and Religious Beliefs Influencing Nursing Care Childbirth and perinatal care –Christian sects that practice baptism during infancy may wish for infant in danger of dying to be baptized shortly after birth –Jewish law calls for circumcision as a religious rite performed on male child eight days after birth –Muslims may wish for the call to prayer to be the first sound a newborn baby hears; complete religious circumcision between 7 days and 12 years of age

34. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Pain, Suffering, and Their Spiritual Meaning Pain and suffering –May be seen as punishment for bad deeds –Some manage pain through prayer and meditation –Spiritual or religious practices that relieve pain and suffering should be supported and encouraged, in conjunction with medication and other nonpharmacological remedies

35. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Pain, Suffering, and Their Spiritual Meaning Death and dying –Prescribed care immediately before death, at death, after death –Preparation of body –Autopsy –Cremation –Organ donation –Prolonging life –Death-related rituals

36. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Spiritual Distress Spiritual distress –Impaired ability to experience meaning and purpose in life –May be cause of illness or result of illness –May ask question “Why is God allowing this to happen to me?” Spiritual distress may be result of –Physiological problems –Treatment concerns –Situational issues

37. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Spiritual Distress Impaired religiosity –Inability to practice one’s religious rituals –May result in spiritual distress Nurse’s responsibility to provide supportive environment for client to carry out religious and spiritual practices

38. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 22.7 Assess clients from a spiritual perspective.

39. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Providing Spiritually Competent Care All phases of nursing process affected by client’s and nurse’s spiritual beliefs and practices Spiritual assessment –Use broad statements and open-ended questions that encourage full expression –Collect enough basic data to identify spiritual practices that are important to client, especially during illness or crisis

40. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Providing Spiritually Competent Care Spiritual assessment method, SPIRIT –Spiritual belief system –Personal spirituality –Integration and involvement in a spiritual community –Ritualized practices and restrictions –Implications for health and medical care –Terminal events planning

41. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 22.8 Plan and implement spiritually competent care.

42. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Providing Spiritually Competent Care Diagnosing, planning and implementing spiritually competent care –Six nursing diagnoses related to spirituality  Spiritual distress  Risk for spiritual distress  Readiness for enhanced spiritual well-being  Impaired religiosity  Risk for impaired religiosity  Readiness for enhanced religiosity

43. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Providing Spiritually Competent Care Nurses can help clients meet spiritual and religious needs by –Providing presence –Supporting religious practices –Assisting clients with prayer and meditation –Referring clients for spiritual counseling