1. Spiritual Care in Nursing Marcia Schnorr, RN, EdD Certified Lutheran Lay Minister- Parish Nurse

2. Sielunhoito Hoitotyossa

3. Spiritual care in nursing  Is included in most nursing texts  Is often over-looked or discouraged in traditional nursing  Is the foundation for parish nursing (diaconal nursing)

4. St. Paul Lutheran Church (Rochelle, IL USA)

5. Spiritual Distress is  “the state in which the individual experiences or is at risk for experiencing a disturbance in his belief system that is the source of his strength and hope.” (Carpenito)

6. Defining characteristics  Expresses concern with the meaning of life, suffering, and/or death  Expresses concern about belief system  Expresses anger toward God  Expresses concern about his/her relationship with God  Questions meaning of own existence

7. Characteristics continued  Unable to participate in usual religious practices  Seeks spiritual assistance  Demonstrates gallows humor  Displaces anger toward religious representatives  Suffers from sleep disturbances

8. Characteristics continued  Alterations in mood or behavior  Separated from cultural or religious ties  Feels hopeless and helpless  Others…

9. Assessments  Religious cues (verbal, literature, jewelry, behavior…)  Emotional cues  Assessment guides  Item on “intake history”  Other

10. Stoll’s Spiritual Assessment (Concept of Deity)  Is religion or God significant to you? If so, can you describe how?  Is prayer helpful to you? What happens when you pray?  Does a God or deity function in your personal life? If yes, can you describe how?  How would you describe your God or what you worship?

11. Stoll’s Spiritual Assessment (Source of Hope and Strength)  Who is the most important person to you?  To whom do you turn when you need help? Are they available?  In what ways do they help?  What is your source of strength and hope?  What helps you the most when you feel afraid or need special help?

12. Stoll’s Spiritual Assessment (Religious Practices)  Do you feel your faith (or religion) is important to you? If yes, would you tell me how?  Are there religious practices that are important to you?  Has being sick made any difference in your practice of praying? Your religious practices?  What religious books or symbols are helpful to you?

13. Stoll’s Spiritual Assessment (Relation Between Spiritual Beliefs and Health)  What has bothered you the most about being sick (or in what has happened to you)?  What do you think is going to happen to you?  Has being sick (or what has happened to you) made any difference in your feelings about God or the practice of your faith?  Is there anything that is especially frightening or meaningful to you now?

14. Other useful interview questions  What Bible character do you identify with? Why?  Do you have a favorite hymn? If so, what is it and why?  Is there a Bible verse that is especially meaningful to you? If so, what is it and why?

15. Planning  Short-term  Long-term  individualize

16. CIRCLE Model

17. Implementation  C aring  I ntuition  R espect for religious beliefs & practices  C aution  L istening  E motional

18. Caring  Demonstrating care and compassion  Possessing an attitude that cares  Caring enough to take/use the available time

19. Intuition  Making an effort to hear what the person feels  Encouraging the person to express feelings

20. Respect for Religious Beliefs and Practices  Making appropriate referrals  Praying  Encouraging devotional activities  Providing for specific rites, sacraments, and observations  Offering religious conversation

21. Caution  Declining to proselytize  Avoiding judgments  Giving choices

22. Listening  Making an effort to hear what the person feels  Encouraging the person to express feelings

23. Emotional Support  Working through feelings  Showing love  Touching

24. Evaluation  Relational  Physical  Emotional  Intellectual  Religious/Spiritual

25. Case studies  Jeff and Vicki  Les and Deb  Laura  Others

26. Jumalalle olkoon kunnia! To God be the glory!