Spirituality & The Nursing Process PDF

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NUR 302 Spirituality and the Nursing Process...

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Spirituality & The Nursing Process Thursday, October 29, 2020 9:35 PM

Overview of Spiritual Care in Nursing Mutual, purposeful, and interactive process between patient and nurse which may include family to promote the patient's spiritual health. Nursing care interventions may include referral to a chaplain or religious leader, baptizing an infant in an emergency situation, participation in prayer or meditation, providing a location and opportunity for faith-related rituals Individualized Spiritual Care Considerations Spiritual care differs according to age, gender, ethnicity, religion and disability Consider these differences: Life span: Fowler's Theory of faith Development (1981, 2002) describes developmental phases of faith:  Infant (primal faith): building trust and loving relationships is fundamental  Toddler/preschool (intuitive projective faith): with language development comes the ability to find meaning in stories and an understanding of good versus evil  School age (mythic-literal faith): spiritual growth happens as a result of finding meaning in social relationships and applying principles of ethical and moral reasoning  Adolescence (synthetic-conventional faith): beginning with abstract thinking and the development of self-identity, this is the time of rejecting concrete rules and finding personal meaning in one's own faith beliefs, which may not be thoroughly examined. Some people remain at this stage of faith development throughout adult life  Young adulthood (individuative-reflective faith): self-identity is established with a greater understanding of self and appreciation of different perspectives. At this level, decisions are based on a broader world view  Middle adulthood (conjunctive faith): The person has the ability to accept that multiple interpretations of reality exist. An openness to various religions and faith traditions is exhibited in a person who reaches this stage  Older adult (universalizing faith and God-grounded self): the person understands self as part of a universal "whole" of love and justice Gender:  

Women more want communication and reflection with others, along with personal spiritual and religious practices Men typically want facts and information to assist in decision making and participate less in daily spiritual practices than women

Culture, Ethnicity, and Religion:  Religious traditions differ in spiritual practices. People of various cultural backgrounds find spiritual care to be important to health  Life experiences affect the need for spiritual care. People with chronic illness require more spiritual care

Cultural practices surrounding illness and death vary depending on the faith tradition of patients and their families. Nurses must ask about preferences and try to accommodate requests as much as possible. Disability:  

Parents of chronically ill children report "having faith in God" as their most recent coping resource Intellectually and developmentally disabled people who participate in bereavement groups after the death of a friend have been found to experience lower rates of depression

Parish Nursing Parish nursing, where RNs provide counseling, referrals, and spiritual care, evolved in the mid 1980s and was designated as a specialty by the American Nurses Association in 1997. Parish nursing is another opportunity for nurses to provide spiritual nursing care. Parish nurses come from many faith traditions and seek to provide holistic care by focusing on the mind, body, and spirit, as well as community wellness. Parish nurses can be:  Health advisors  Health educators  Advocates  Liaisons to faith and community resources  Coordinators of volunteers  Developers of support groups Overview of Spiritual Assessment Individual spiritual needs is initiated early in the patient encounter by the admissions officer or the admitting care provider. Health assessment questions addressing spiritual health and spiritual assessment frameworks (FICA, SPIRIT, and HOPE) are frequently used tools in the health care setting. Spiritual Assessment Frameworks 

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Spiritual Health o Do you have any family in the area (assess for family importance, relationships and meaningful experiences)? o Is there anyone you would like to call? o How are you handling this hospitalization or illness? o What faith practices or beliefs will help you cope with this illness or hospitalization? o Do you belong to a faith community? o Do you want the community to be notified? o Would you like a chaplain to visit? FICA Framework o F: faith and belief o I: importance of faith o C: faith community involvement o A: address spirituality or spiritual practices in care

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SPIRIT Framework: o S: spiritual belief system o P: personal spirituality o I: integration and involvement in a spiritual community o R: ritualized practices and restrictions o I: implications for medical care o T: terminal-events planning (advanced directives) HOPE Framework: o H: sources of hope, meaning, comfort, strength, peace, love and connection o O: organized religion o P: personal spirituality and practice o E: effects on medical care and end-of-life issues

Legal and Ethical Considerations in Spiritual Care There are legal, ethical, and professional responsibilities associated with spiritual care. 

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Legal responsibility o Because of HIPPA requirements, HCP cannot contact a faith community w/o the consent of the patient. Therefore, most health care institutions ask, as part of the admission process, whether a faith community should be notified Ethical responsibility o Pettigrew maintains that nursing care that fails to recognize a patient's spiritual needs as a part of holistic care is unethical and defies the ethical concept of fidelity o The International Council of Nurses Code of Ethics for Nurses urges all nurses to promote environments in which the human rights, customs, spiritual beliefs, and values of individual patients, families, and communities are respected Professional responsibility o Refusing to provide spiritual care for patients because of a nurse's fear of spiritual vulnerability represents a violation of the nurse's commitment to nonmaleficence

Risk for Spiritual Distress Assessment of a patient's spiritual needs is an ongoing and dynamic process. When a patient receives a life-changing medical diagnosis or is undergoing a health crisis, there is a high risk of spiritual distress. Spiritual distress is defined as a belief or value disruption that threatens their sense of purpose in life. Nurses must be alert to patient's changing health situations and coping behaviors to determine the need for spiritual care interventions. Spiritual Assessment Cues and Potential Religious Needs Nurses must have an active presence and be active listeners, paying attention to non-verbal cues such as body language and facial expressions.

Verbal:        Nonverbal:    

Asks for prayer or chaplain Asks if the nurse has time to talk Talks about topics related to life, death or purpose Talks about faith Uses religious words in conversation Asks frequent questions about diagnosis; needs to talk Expresses concerns about family

Exhibits neediness (doesn't want to be alone, or has frequent requests for care or company) Is angry or noncompliant Seems depressed or withdrawn Has emotional outbursts and cries quietly

Environmental:  Has religious books, jewelry, or symbols and/or prayer objects  Displays family pictures Situational:   

Has life-threatening diagnosis or life-changing condition Is facing death Faces treatment decisions

Nursing Diagnoses Related to Spirituality After a thorough spiritual assessment is completed, nurses can select and individualize nursing diagnoses to address patient's concerns related to spirituality. Multiple nursing diagnoses are often appropriate. Risk Nursing Diagnosis: diagnosis labels related to spirituality include:  Risk for spiritual distress  Risk for impaired religiosity Applied when there is an increased potential or vulnerability for a patient to develop a problem or complication, such as the risk for a patient to feel disconnected from their religious community and traditions while hospitalized in isolation for an extended period of time Recall that risk nursing diagnoses use this format: Risk nursing diagnosis = diagnosis label + risk factors Ex: Risk for impaired religiosity related to decreased ease of access to usual religious entities Actual Nursing Diagnosis:  Spiritual distress  Impaired religiosity  Decisional conflict  Moral distress

Applied when there is an actual problem, such as hopelessness or challenging of personal beliefs Recall that actual nursing diagnoses use this format: Actual nursing diagnosis = diagnosis label + related factors + defining characteristics Ex: Spiritual Distress related to chronic illness as evidenced by expressions of hopelessness Impaired Religiosity related to illness as evidenced by difficulty adhering to religious dietary customs and expressions of emotional distress over special diet restrictions Moral distress related to cultural conflicts b/t medical treatment and religious beliefs as evidenced by expressions of concern about rejection by religious community and hesitation in accepting blood transfusion Decisional conflict related to unclear personal beliefs as evidenced by questioning of personal beliefs while making decisions and delayed decision-making Health-Promotion Nursing Diagnosis:  Readiness for enhanced spiritual well-being  Readiness for enhanced religiosity Used in situations in which the patient expresses interest in improving their health status through a positive change in behavior, such as desire to change a harmful behavior or custom Recall that health-promotion nursing diagnoses use this format: Health-promotion nursing diagnosis = diagnosis label + defining characteristics Ex: Readiness for enhanced religiosity as evidenced decreased isolation and seeking reconciliation with previously estranged family members Measurable Patient-Centered Goals Patient outcomes are improved when nurses address spiritual concerns, identify patient specific nursing diagnoses, set patient-centered goals, and individualize and prioritize care. Nursing care plans addressing spiritual needs must include a patient-centered goal or outcome statement that is specific, accurate and achievable that will lead to better patient outcomes. Risk for Impaired Religiosity Diagnostic Statement: risk for impaired religiosity with risk factor of decreased ease of access to usual religious entities. Goal: the patient will report an opportunity to say her prayers after her family brings her rosary to the hospital.

Spiritual Distress:

Diagnostic Statement: spiritual distress related to chronic illness as evidenced by expressions of hopelessness. Goal: the patient will express optimism about her future after receiving information about medical and lifestyle therapies to treat her heart failure by the end of her discussion with her physician. Impaired Religiosity: Diagnostic Statement: impaired religiosity related to illness as evidenced by difficulty adhering to religious dietary customs and expressions of emotional distress over special diet restrictions. Goal: the patient will consult with a dietician and agrees to begin a diet that is within his religious customs by time of discharge Moral Distress: Diagnostic Statement: moral distress related to cultural conflict between medical treatment and religious beliefs as evidenced by expressions of concern about rejection by religious community and hesitation in accepting blood transfusion Goal: the patient will meet with her religious community today to discuss other treatment options other than a blood transfusion to treat her medical condition Decisional Conflict: Diagnostic Statement: decisional conflict related to unclear personal beliefs as evidenced by questioning of personal beliefs while making decisions and delayed decision making Goal: after deep reflection the patient will make a decision about his life saving medical treatment and lifelong commitment to medication by the end of the day Readiness for Enhanced Religiosity: Diagnostic Statement: readiness for enhanced religiosity as evidenced by rejecting harmful customs and seeking reconciliation with previously estranged family members Goal: the patient will confer with family and spiritual advisor and agree to enter an alcohol rehabilitation center at the conclusion of the family conference Planning Collaborative Care Nurses should make referrals to the chaplain when a patient demonstrates or verbalizes a need for spiritual care, then follow-up to assure these patient's spiritual needs have been met. Research of Vanderwerker and colleagues found that the most common source of referrals to hospital chaplains was nurses (28%).

Patient: patient is the most important collaborator and contributor when addressing and planning spiritual care. Patients often make a personal request for a hospital chaplain (23%). Chaplain: should be included in care conferences when they can provide spiritual insight and participate in planning holistic health care. They are also an excellent resource for providing spiritual counseling for nurses who work on units where the patient's spiritual needs are intense. Social Worker: involved in the process of making referrals to link a patient/family to needed resources, including spiritual resources. Case Manager: identifies which services are available to the patient, and helps the patient access them. Case managers assist with discharge by helping the patient obtain necessary equipment and services, such as home health care or nursing home care. Overview: Interventions Related to Spirituality Spiritual care interventions aim at promoting spirituality. It is important to recognize patient's cues and select the appropriate interventions to promote:  Reflection  Connections with others  Faith rituals Interventions to Promote Reflection Reflection is another component of spiritual interaction and expression. Discussion and questions initiated by the nurse may explore and search for meaningful aspects of a health care crisis and the subsequent effects of family and loved ones. Examples of probing questions include: "This must be a difficult time for you", and "What are you thinking?" Other sensitive topics worth investigation are life plans or health care decision-making. Specific interventions to promote reflection include:  Allow time and opportunity for self-disclosure by the patient  Have an active presence and be an active listener Interventions to Promote Connectedness with Others The nurse's role in promoting connectedness with others is in creating an environment where family and friends can contribute to spiritual care. This may include looking into policies related to visitation, rescheduling medical procedures with the approval of the health care provider, eliminating or reducing noises created by medical equipment or the paging system, and by assigning a private room. Nurses may initiate conversations with patients and family or friends by asking "Is there anything I can do?" or "can I get more information for you?" or "I will give you some privacy" Nursing interventions to promote connectedness with family and friends include:  Monitor and promote supportive social contacts

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Integrate the family into supportive practice Refer the patient to, or arrange for the patient to engage in, a support group or community

Interventions to Promote Faith Rituals Promoting faith rituals depends on the patient's religious beliefs and practices, and the nurse's own comfort level in participating. This may include leading a prayer or being silent while participating in a prayer session. A referral to the chaplain may be preferred, or necessary, to help facilitate an individual's religious expression, such as receiving communion or getting the blessings of the sick. Specific interventions to promote faith rituals include:  Arrange for regular visits from religious advisers as desired by the patient  Support avenues to spiritual growth that are meaningful to the patient, such as praying, meditating, listening to music, viewing or creating art, or reading or writing poetry...