1. Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 1 Chapter 35 Spiritual Health

2. 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.

3. 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.

4. 4Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Spirituality

5. 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

6. 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.

7. 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

8. 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.

9. 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

10. 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

11. 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.”

12. 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

13. 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.

14. 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.

15. 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.

16. 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.

17. 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?

18. 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)

19. 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

20. 20Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Connectedness

21. 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

22. 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

23. 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

24. 24Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Process: Planning 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.

25. 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?

26. 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.

27. 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

28. 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.

29. 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.

30. 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?

31. 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.

32. 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.”

33. 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.