University of Cebu Banilad College of Nursing _____________________________________________________ A Resource Unit On Spiritual Care Nursing _____________________________________________________ Submitted to: Ms.Ma.

. Charisma M. Elep Clinical Instructor Elective Submitted by: Carulasan, Alvin Jay Castillo, Renette Thelma Dongallo, Ma. Roxanne Dorog, Odette Tashana Dumagat, Apple Glaize Endino, Noreen Fernan, Sean Red Gabales, Achim Juba, Sheila Marie Jumao-as, Rheyna Lamban, Zari Angelique Louise Luib, Estela-Berna BSN 3 A GROUP 2 ______________________________________________________ February 10, 2011 DATE

CRITERIA RESOURCE UNIT: Content Format and Mechanics Acknowledgment of Sources Organization Creativity Punctuality PRESENTATION: Content Mastery and Delivery Acknowledgment of Sources Stage Deportment and Teamwork Organization Classroom and Time Management 50 % 20 % 10 % 10 % 5% 5% 100 % 50 % 10% 15% 10 % 10% 5% 100 %

General Objective: After 45 minutes of lecture-discussion, the BSN III students will be able to render basic knowledge, beginning skills & positive attitude towards spiritual care in nursing.

Specifically, we will be able to:

1. Define related terms: a. Ethics b. Spiritual care c. Spiritual need d. Spirituality e. Religion f. Culture 2. Determine the ethics attributed in spiritual care nursing. 3. Enumerate the nurses role in spiritual care 4. Explain the significance of understanding own (nurses) spirituality and the degree to which one's spiritual needs are being met. 5. Recognize nurses own limitations in spiritual care nursing. 6. Identify ways in mobilizing the patients spiritual resources and patients expressed needs. 7. Present the importance of developing a relationship of trust between a nurse and a patient. 8. Develop awareness and respect of the patient's culture, social and spiritual preferences. 9. Site the implications of referral or utilization of team members in spiritual care and in other aspects of care. 10. List ways on documenting spiritual care

GENERAL OBJECTIVE: After 45 minutes of lecture-discussion, the BSN III students will be able to render basic knowledge, beginning skills & positive attitude towards spiritual care in nursing. SPECIFIC OBJECTIVE Specifically, we will be able to: CONTENT TIME ALLOTMENT METHODOLOGY RESOURCES Materials: For lecturediscussion a. Ethics pertain to the beliefs we hold about what constitutes right 3 minutes conduct. Ethics are moral principles adopted by an individual or group to provide rules for right conduct. b. Spiritual care - Spiritual care is an essential component of nursing practice and often the arbiter of how someone responds to his or her illness and associated life experiences. It would appear that when people encounter certain life events like serious trauma and illness, fundamental spiritual issues emerge that question their very existence. c. Spiritual need - Any factor that is necessary (requisite, indispensable) to support the spiritual strengths of a person or to diminish the spiritual deficits." (Simsen 1985, p.10). "The lack of any factor or factors necessary to maintain a person's dynamic relationship with God/Deity (as defined by that person)." (Stallwood, 1975, p.1088). "That requirement which touches the core of one's being where the search for personal meaning takes place." (Colliton, 1981, p.492). d. Spirituality-the spirit is that part of man which is concerned with the ultimate meaning of things and with a person's relationship to that which transcends the material." (Simsen, 1985:10) e. Religion - a framework of spiritual beliefs, a code of ethics and a philosophy that governs a person's activity in pursuit of that which he holds as supreme, his God. Lecture Discussion -projector/DLP -white marker board EVALUATION Post test to be given by the instructor

1. Define related terms: a. Ethics

b. Spiritual care

-board eraser -cartolina -permanent markers -scotch tape Human Resources: Time and effort of the clinical instructors and

c. Spiritual need

d. Spirituality

e. Religion

f. Culture

f. Culture a way of life , which provides a worldview, fundamental in defining and creating a persons reality, determining his/her meaning and purpose in life, and providing guidelines for living(Ersek et al., 1998).

the students.

2. Determine the ethics attributed in spiritual care nursing.

The Code strongly exhibits all the principles used in deontological 5 minutes thinking. Although the Code is best known as an ethical document, it relates to spirituality in that it requires nurses, as ethical practitioners, to value and show consideration for every facet and dimension of all patients entrusted to their care. The Code articulates the ethical relationship of patients and nurses and clarifies their collective position. A very careful reading of the Code is not necessary to realize how strongly grounded it is in autonomy. The first provision is "The nurse, in all professional relationships, practices with compassion and respect for inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or nature of health problems" (American Nurses Association, 2001). In that one statement, The Code demands that the nurse attend to every aspect, facet, and characteristic of every patient, which includes spiritual beliefs and practices. Complexity in the provision of spiritual care occurs partially because people have highly individual views of spirituality and spiritual practices that arise from different sources of authority. People are all different in many ways, but the greatest and hardest-to-grasp differences among us probably occur in individual concepts of own spirituality. As the essence of the individual, spirituality is so highly personal and intangible that it can be difficult or impossible to articulate. Religion is probably the most common and likely source. Because spirituality tends to be related to a higher power, and definitions of religion include some notion of a belief in and reverence for a supernatural

LectureDiscussion

power or powers, it follows that the two are often related and may even be lumped together. However, as already stated, religious beliefs are only one source of the spiritual. The person whose sense of spirit is related to energy fields, rainbows, or rocks has spiritually as real as the person who derives spirituality from Christianity or Buddhism. The code informs nurses that they must attend to every aspect, facet, and characteristic of every patient. It demands that they do no harm and not abandon the patient. They must treat every patient holistically; nurses must work within those parameters. They must attempt to not do harm, although this principle poses difficulty in practice, frequently in the form of cost benefits. Most importantly, they cannot abandon patient, physically, emotionally, or psychologically. if their own religion, ethic or sense of spirit will not allow them to sit with a patient who is meditating on an ancestor or an unfamiliar god, nurses mist find alternatives to accommodate the patient's needs. The nurses role in spiritual care are as follows: 5 minutes Nursing diagnosis is intended to identify strengths of the client as well as actual and potential problems. Our primary goal in spiritual care is to mobilize the patient's spiritual resources. Nursing staff should be aware that spiritual care is not an attempt to proselytize or win converts to a particular point of view. Rather, it is responding to a client's expressed needs. Interventions are by their request or permission. Spiritual assessment and care should be sensitive and based on a relationship of trust between client and nurse. It will involve awareness of the person's culture, social and spiritual preferences, as well as a respect for their beliefs and religious practices. Recognizing our own limitations and knowing when to make a referral, or utilize other members of the team is as important for Lecture Discussion

3. Enumerate the nurses role in spiritual care

spiritual care as it is for other aspects of care. The importance of documenting spiritual care in nursing plans must be recognized, since this will ensure that care is systematic, well thought out, and consistent. 4. Explain the significance of understanding own (nurses) spirituality and the degree to which one's spiritual needs are being met. Healing relationships can be mutually beneficial. The experience of 5 minutes working this closely with other human beings helps nurses to discover more about themselves and moves toward deeper understanding of their own spirituality (Olson 1997; Watkins 2000; Ronaldson & Potter 2004). Intervention in spiritual matters is easier for nurses who have an awareness of their own spirituality, whether it is based on religious convictions or not. It is acknowledged that nurses who reflect their own personal spirituality and who continually monitor the meeting of their own spiritual needs are best able to understand the meaning of spiritual health. Such nurses are more comfortable in helping relationships and in dealing with clients spiritual issues (Ronaldson 1997; Ronaldson & Potter 2004). Nurses who do not have personal awareness of their own spiritual nature are advised to take steps along the path of spiritual development. One way to start this process is for nurses to ask themselves questions they ask of clients when undertaking spiritual assessment. Personal spiritual awareness enables nurses to provide care that is truly holistic (Ronaldson & Potter 2004; Watkins 2000). All nurses need to be aware of their personal values and beliefs and be sensitive to the fact that they may inadvertently lead to assumptions about a clients wishes or needs. False assumptions can be a source of concern and may damage the spiritual well-being of clients. Confidence and competence in providing spiritual care include an understanding of our own beliefs and values, and the degree to which our own spiritual needs are being met. It is difficult to respond to spiritual needs of others if we ourselves are experiencing unresolved spiritual concerns or distress. Sometimes we will need to seek out help and support for ourselves so that we are more able to help others. LectureDiscussion

Narayanasamay (1993: 196) supports Conrad's claim and posits there is concern within nursing that spiritual care of the patients is inadequate and suggests this is due to the lack of sufficient educational preparation of nurses in the provision of holistic nursing care. Jacik (1989: 276) agrees and adds that nurses can only adequately provide the spiritual care if they have examined their own beliefs and discovered how the truths and religious principles have guided their own lives. Fitzgerald (1987: 15) offers the motto 'know thyself' to any nurse who wishes to be more comfortable with spiritual matters. The challenge adds Jacik (1987: 15), is to listen for the call for wholeness and embrace holism and a holistic view of life and self and then convey this into caring for others. One must be able to face the reality of one's own mortality, believe that they can help another die well by realizing human life is temporary and human beings are mortal, and accept life as transient. If the spiritual care is inept, the patient is left on their own to struggle with their spiritual needs. 5. Recognize nurses own limitations in spiritual care nursing. Nurses may be aware that patients have spiritual needs, but in many cases 4 minutes are unable to respond to these needs. This may result from an inadequacy in nurse education that does not prepare nurses to provide spiritual care. In addition, spiritual care is seen as part of the psychosocial assessment or in the domain of the pastoral care workers. In reality though, nurses are in the best position to deliver this important aspect of nursing care, particularly when caring for the patient with a life-threatening illness. Nurses learn early to become good listeners and communicators. By helping patients express their beliefs and by staying with them during the events of their illness, they are providing spiritual care. The challenge for nurses is to embrace holism and a holistic view of life and self and then convey this into caring for others. Nurses strive to incorporate holistic care that includes spiritual care into their nursing practice. The concept of providing spiritual care is derived from nursing theory, which states humans are biological-psychologicalspiritual beings. Although nursing has recognized that patients have spiritual needs, the practice of spiritual care by nurses is often infrequent Lecture Discussion

and an underutilized facet of care. This may be due to the assumption by many nurses that this domain should be dealt with by pastoral care workers. In reality, however, it is the nurse who is ideally placed to comfort and support the patient in spiritual distress, particularly those suffering a life-threatening illness. These patients are often more concerned with issues of a spiritual, rather than a physical nature. Thomas (1993: 12) believes these patients are not so afraid of death, as they are of being left alone, and describes the very act of maintaining a bond with the patient in distress as an extension of 'unconditional love'. As nurses we cannot prevent death from occurring, but we can accompany the patient some of the way just by staying, watching and being there. Ways in mobilizing the patients spiritual resources and patients 5 minutes expressed needs: Listening to the patient express key concerns Praying with the patient Reading to the patient favorite portion of religious readings Spending time with the patient Making referral to the chaplain Assess patients spiritual needs and the provision of spiritual care Counseling a patient about spiritual concerns Be aware and sensitive to patients spiritual needs Empathizing and responding is therapeutic when it comes to meeting the needs of the human spirit: the need for love and relatedness, meaning and purpose, and hope Perform meditation, guided imagery, art and music or calling a long-lost friend as important aspects of spiritual care. Nurses Spirituality understanding own and the degree t which ones 5 minutes spiritual needs are being met The client in spiritual distress, possibly more than any other, needs a healing relationship. The nurse, in having the closest contact with clients, is in a privileged position - Ideally placed to form healing relationship. Lecture Discussion

6. Identify ways in mobilizing the patients spiritual resources and patients expressed needs

7. Present the importance of developing a relationship of trust

LectureDiscussion

between a nurse and a patient.

Some of the attributes that help the nurse in developing such relationships are: Ability to accept the client unconditionally as a worthy person Genuineness Non-judgmental attitude Strong communication skills Ability to convey the sense of being fully focused on the client during times together Humility Commitment Ability to recognize ones own personal spirituality Healing relationships involve being there when a client needs support, even when it is emotionally difficult to do so, such as being with a client after the baby has died. Healing relationships involve being there and giving oneself in a rich way that is very much more than merely doing for a client. By actively sharing in the loneliness, anxiety and suffering of the client, the nurse in a healing relationship does much more than merely provides physical comfort and treatment. The nurses presence itself touches the clients spirit by communicating personal spiritual strength, a willingness to care, to listen and to be available (Hood & Leddy 2005; OBrien 2007; Stein-Parbury 2005).

8. Develop awareness and respect of the patient's culture, social and spiritual preferences.

Awareness and respect of the pt's culture, social and spiritual preferences: 5 minutes 1. Knowledge Defining spirituality, including these phenomenological aspects: experiences/attitudes/practices/beliefs (from here on these items are called simply experiences). Understanding the unique impact of spiritual/cultural experiences on human development and health in infancy, childhood, adolescence, and adulthood. Understanding a differential diagnosis for spiritual/cultural

LectureDiscussion

2.

phenomena at the individual and spiritual/cultural system levels. Understanding the impact of spiritual/cultural experiences on the relationship between the physician and patient, including transference and counter-transference. Understanding of spiritual/cultural issues and treatment preferences surrounding the end-of-life affect medical ethics as applied to family practice and internal medicine. Understanding of the variety of spiritual experiences and traditions, with unique perspectives on transpersonal issues. Understanding of the research data on the impact of patients cultural identity, beliefs and practices on their health and access to and interaction with health care providers. Understand that differences in cultural identity between physicians and patients can impact delivery of health care. Understanding of their own spirituality and how truly compassionate care giving can come from knowing and respecting the role spirituality has in their own life. Understanding of the role of culturally based healers and care providers. Understanding how physicians role encompasses patient care and the care of their family during the entire transition between life and death. Understanding the dimensions of palliative care (physical, emotional, social and spiritual) at the end-of-life of a patient.

Skills Interviewing patients with sensitivity to communication styles, vulnerabilities, and strengths as well as their cultural identity, beliefs and practices. Listening for, eliciting, and understanding accurate

3.

histories, including the importance of spiritual issues, cultural identity and beliefs/rituals and their impact on the patients life. Identifying and eliciting patients values, beliefs, and preferences for treatment during the course of illness. Identifying how, as influential caregivers, cultural identity, beliefs and practices might affect their relationship with patients, as well as their case formulation, diagnosis and management plans. Recognizing when a patients spiritual views or cultural beliefs/rituals are harmful to the patient and making appropriate interventions and referrals (for example to chaplain, spiritual directors or culturally-based healers). Diagnosing, assessing and formulating treatment plans for patients, with an understanding of spiritual and cultural realm of experiences. Recognizing and using specific transference and counter transference reactions. Recognizing possible biases against the spiritual/cultural issues found in the medical literature and understanding their origins. Demonstrating the ability to deliver difficult news to patients and their families in a caring and compassionate manner. Learning to work with a multi-disciplinary team delivering end-of-life care and appreciate each members contribution. Effectively listening to and responding to patients about their suffering.

Attitudes Awareness of their spiritual and cultural experiences and the impact of these experiences on their identity and world

9. Site the implications of referral or utilization of team members in spiritual care and in other aspects of care.

view. Avoidance of stereotyping and over-generalization and an appreciation for diversity of spiritual and cultural identities, belief, ritual and practices. Awareness of their own attitudes toward various spiritual and cultural experiences and the possible biases that could influence their treatment of patients. Respect for patients from a variety of spiritual and cultural backgrounds. Non-judgmental attitude when eliciting a spiritual history and preferences for treatment during the course of illness. An appreciation for the systems and venues for health care delivery at the end-of-life (hospice, home nursing, institutional care). The hospice team functions as an interdisciplinary team with a coordinated 4 minutes plan of care. The patient and family are integral members of the interdisciplinary team. Regular team meetings and frequent communications among clinical staff and with the patients primary physician ensure that patient and family needs and goals are met and constantly reassessed. Members of the hospice team involved directly in interdisciplinary care to the patient and family include the primary physician, hospice physician, nurse, social worker, chaplain, home health aide, and volunteers. Additional team members may include occupational or physical therapist, psychologist, art and music therapist, pharmacist, and nutritionist. Primary Physician Provides the hospice team with medical history Oversees medical care through regular communication with the hospice team Provides orders for medications and tests, signs death certificate, etc. Determines his or her level of involvement on a case-by-case basis with the hospice medical director

Lecture Discussion

Hospice Physician Provides expertise in pain and symptom control at the end of life Works closely with the hospice team and primary physician to determine appropriate medical interventions Makes home visits on as needed basis May oversee the plan of care, write orders, and consult with patient and family regarding disease progression and appropriate medical interventions on a case-by-case basis Nurse Visits patient and family in the home or nursing home on regular basis (biweekly to 3-4x per week, depending on needs of patient) May provide on-call services (24 hours a day, 7 days a week for emergencies) Assesses pain, symptoms, nutritional status, bowel functions, safety, and psychosocial-spiritual concerns Educates patient and family about disease progression, use of medications, daily care needs, and other aspects of the overall plan of care Educates and supervises nursing assistants Provides emotional and spiritual support to patient and family to cope with functional limitations, caregiver stress, and grief Home Health Aide Assists patient with activities of daily living such as bathing and dressing Provides a variety of other services depending on assessment of need Social Worker Attends to both practical needs and counseling needs of patient and family based on initial and ongoing assessment Arranges for durable medical equipment, discharge planning (from hospital to home), funeral/burial arrangements Serves as liaison with community agencies (such as Department of Human Services, Department of Aging, Public Aid office) Assist family in finding services to address financial needs and legal matters (Power of Attorney, Wills) Provides counseling related to family communication

10. List ways on documenting spiritual care

Assesses patient and family anxiety, depression, role changes, caregiver stress Provides general grief counseling Chaplain Provides patient and family with spiritual counseling to address questions of hope, meaning, despair, fear of death, relationship with divine, need for forgiveness, loss of life purpose Assists patient and family in sustaining their religious practice and in drawing upon religious/spiritual beliefs to cope with illness, dying, and grief Ensures that patient and family religious or spiritual beliefs and practices are respected by the hospice team (e.g. dietary restrictions, rituals to be observed at the time of death, disposition of the body) Serves as a liaison with the patient/family faith community and clergy May conduct funeral and memorial services for patients and families as requested Provides hospice staff with spiritual care and counseling Volunteer Provides respite care to family members May assist with light housekeeping or grocery shopping Helps patients stay connected with community groups and activities Facilitates special projects such as memoirs/legacy work, letters to family, and massage therapy May provide community education and outreach May assist with office work 4 minutes Documenting spiritual care: As with all nursing care, documentation of spiritual care is critical for providing quality patient care, addressing economic issues, and maintaining a legal document. Because documentation can be overwhelming, nurses may tend to overlook the documented care is effective. Furthermore, providing spiritual care takes time and effort by the Lecture Discussion

nurse. If only 25% of the work nurses perform is indicated in the patient records, it is difficult for administrators and managers to make claims about needing resources to provide more staff so that spiritual care can be provided. Changes in reimbursement occur only if documentation data indicate that providing spiritual care is cost effective. Tips for quality charting of spiritual care: Document patient spiritual beliefs accurately. Proper documentation of spiritual beliefs reflects respect for the patient and facilities implementation of appropriate interventions and avoidance of disrespectful interventions. Example: Patient is a vegetarian and does not eat meat based on religious beliefs. Patient eats beans with lunch and dinner. Mean what you say and say what you mean. Avoid generalizations or vague notes, such as patient is spiritually distressed. Be clear about what it is that you want others to know. Example: Patient expressed anger toward God because of illness but also described feeling guilty because I shouldnt be angry at God. Encouraged patient to discuss feelings about this, and patient indicated would like to speak to rabbi. Contacted Rabbi Goldberg, Star of David Synagogue, who stated will visit this evening. Follow professional standards for nursing care. When care deviates from legal, professional, or organizational standards, provide a valid reason for the alteration. Example: The patient had indicated that she missed her pet cat and wished she could see him. Bringing pet to hospital visit could have therapeutic effect on patients spirit. After discussion with Barbara Brown, nursing supervisor, arrangements were made to have daughter, Beth, bring pet into hospital for visit. Name anyone who becomes involved in the patients care. Because providing quality spiritual care for patients is interdisciplinary, be sure to include anyone who becomes involved. This could include organizational chaplains or clergy, parish nurses or lay visitors

from the patients faith community. Example: Discussed discharge plans with Elaine Sculley, RN, parish nurse from Christian Community Church, who will be following up with patient at home. Use approved abbreviations. Use the abbreviations approved at your organization because using unapproved abbreviations can lead to confusion. For instance does sc stand for spiritual care or sickle cell? The same goes for flow sheets. If the size of the box cannot accommodate the information needed to be documented, make a narrative note. Write legibly. Writing so others can read your notes minimizes the risk of errors, thereby contributing to quality spiritual care.

BIBLIOGRAPHY

BOOKS Delaune, Sue C. and Patricia K. Ladner. (2006). Fundamentals of Nursing: Standards and Practice. 3rd edition. Philippines. Delmar Learning Fortinash, K. and P.Holoday Worret (2008) Psychiatric Mental Health in Nursing. 4th Edition. Singapore. Mosby Elsevier

Hutchison, Marge (2008) Spirituality in Nursing Care. Philadelphia. Williams and Wilkins Lippincott Company

ELECTRONIC SOURCES Scribd (2009) Spiritual Care in Nursing and Ethics. Retrieved from http://scribd.com/marg_hutchison/nurse-4.html. Retrieved on 02-05-2011 Smeltzer, C. (2007) Nurses Role in Spiritual Care. Retrieved from http://books.google.com.ph/books?id=asjKsQ1stEsC&pg= PA129&lpg=PA12 9&dq=nurs e's+ role+in+spiritual+care&source=bl&ots=a6cS9vRrEr&sig=ydcEKOD4nrJROm6Z_IXhjS06yPU&hl=tl&ei=tIZOTcjIIMaHcd24vIEM&sa=X&oi=book_result &ct=result&resnum=9&ved=0CGsQ6AEwCA#v=onepage&q=nurse's%20role%20in%20spiritual%20care&f=false. Retrieved on 02-04-2011

Wikipedia (2009) Holistic Care in Nursing. Retrieved from http://wiki_holistic_nursing.com.html. Retrieved on 02-04-2011