SPIRITUALITY

spiritual distress – spiritual pain, alienation, anxiety, guilt, anger, loss, and despair

spiritual needs – underlying all religious traditions and common to all people are
• need for meaning and purpose - offer compassionate presence
- assist in struggle to find meaning and purpose in face of suffering,
illness, and death
• need for love and relatedness - foster relationships (with God/humans) that
nurture spirit
• need for forgiveness - facilitate pt’s expression of religious or spiritual beliefs
and practices

spirituality – anything that pertains to person’s relationship with a nonmaterial life

force or higher power
- not something that runs parallel to rest of human life
- ultimate depth of everything spiritual creatures do when they realize
themselves (laugh, cry, accept
responsibilities, love, live, die, stand up for truth, break out of
preoccupation, hope, refuse to be
embittered by stupidity)
- live as if in opposition to selfishness and to the despair that always
assails
- elements include
* experienced as unifying force, essence of being
* expressed and experienced in and through connectedness w/nature and
other people
* shapes self-becoming and reflected in one’s being, knowing, and doing
* permeates life, providing purpose, meaning, strength, and guidance
and shaping the journey

faith – confident belief in something for which there is no proof or material evidence
- involves a person, idea, or thing, and usually followed by action related to the
ideals or values of that belief
- religions share
* conviction of fundamental unity of human family, quality and dignity of
all human beings
* sense of sacredness of individual and conscience
* sense of value of human community
* belief that love, compassion, unselfishness, and force of inner
truthfulness and of spirit have greater
power than hate, enmity, and self-interest
* sense of obligation to stand on side of poor and oppressed
* profound hope that good will finally prevail

atheist – person who denies existence of a God

agnostic – one who holds that nothing can be known about the existence of a
God
hope – ingredient in life responsible for positive outlook in even life’s bleakest
moments
- enables ability to consider a future and to actively bring that future into being
- originates in imagination but must become a values and realistic possibility in
order to energize action
- unique to each person

love – develops from basic human need to love and be loved, cannot be spiritually
whole, spiritually healthy, unless
this need is met

religion – organized system of beliefs about a higher power

- set forms of worship, spiritual practices, and codes of conduct
- can directly influence pt’s response to illness and suffering, self-care
practices, birth and death rituals, gender
roles, spiritual practices, and moral codes
- never presume to know what a pt’s religious beliefs are upon learning pt’s
faith
- do not interpret the fact that a pt does not belong to an organized
religion to mean that pt has no
spiritual needs; person may be deeply spiritual yet not profess a religion
I. SPIRITUALITY, HEALTH AND ILLNESS
A. GUIDE TO DAILY LIVING HABITS- certain practices may have religious significance for
pt
- ex. dietary requirements and restrictions; acceptable birth-control
practices

B. SOURCE OF SUPPORT- many seek support during times of stress

- support is vital to acceptance of illness, especially if it is a prolonged
period of convalescence or a
questionable outcome
- prayer, devotional reading, and other religious practices often do
spiritually what protective exercises
do physically

C. SOURCE OF STRENGTH AND HEALING

- values derived from religious faith cannot be enumerated or evaluated
easily
- effects are constantly in evidence
- endure extreme physical distress because of strong faith
- taken on almost unbelievable rehabilitative tasks because of faith
in eventual positive results

D. SOURCE OF CONFLICT - sometimes religious beliefs conflict with prevalent

healthcare practices
- ex. Jehovah’s Witnesses prohibits blood transfusions; some view
illness as punishment for
sin and is therefore inevitable
- acknowledgment of pt’s religious convictions and efforts by health
practitioners to accommodate pt’s
 beliefs can result in quality healthcare without violating person’s
religious practices
- ea. person is unique and has a right to pursue their own convictions,
even though they may differ
from those of the healthcare provider
- major questions that religious beliefs, attitudes, and values can color
include
* meaning of suffering
* how the physical body is regarded and its functions
* meaning and role of gender differences, sexuality, and
reproduction
* how birth, aging, and death are understood and responded to
* what constitutes the self, and how selfhood is to be assessed
* how sin and moral culpability are understood (what makes
something sinful, how sin is
relieved or absolved)
* tradition’s specific bioethical teachings

II. FACTORS AFFECTING SPIRITUALITY

A. DEVELOPMENTAL CONSIDERATIONS
- child must have some capacity for abstract thought before beginning to
understand the spiritual self
- not to say spirituality is meaningless to children
- common themes in all children
* notion of God who works through human intimacy and
interconnectedness of lives
* belief that God is involved in self-change, growth, and
transformations that make the
world fresh, alive and meaningful
* attributing to God tremendous and expansive power and
showing considerable
anxiety in face of this power
* image of light
- life experiences usually influence and mature spiritual beliefs
- with advancing years, people have a tendency to think about life after
death prompting some to re-
examine and reaffirm their spiritual beliefs

B. FAMILY - parents play key role in development of child’s spirituality

- what is important is what child learns about God, life, and self from
parents’ behavior

C. ETHNIC BACKGROUND
- clear distinctions between Eastern and Western spiritual traditions as
well as individual ethnic groups
- culture and formal religion have much to do with whether basic
approach to religion is doing
something, being someone, or continually striving for harmony

D. FORMAL RELIGION- common characteristics of major religious groups include

 * basis of authority or source of power
* scripture or sacred word
* ethical code that defines right and wrong
* psychology and identity
* aspirations or expectations
* ideas about what follows death

E. LIFE EVENTS - both positive and negative life experiences are influenced by the
meaning a person’s spiritual
beliefs attribute to them
- ex. two women who believe in a loving God ea. lose a child in a car
accident, one bitterly denies
God’s existence and the other spends more time in prayer asking
God to help her
- ex. chain of successful life experiences (marriage, promotion) may
cause one person to assume
success and experience no need for God; another finds cause for
deep gratitude and rejoicing

III. RELIGIOUS FAITHS

- major wisdom traditions address the invisible Spirit by creating principles and
practices that
* cultivate love of ourselves, neighbors, God and nature
* cultivate wisdom that helps find meaning in life, in relationships with
others, in being true to
ourselves, living in uncertainty and mystery, dealing with suffering,
sickness, and death, and
honoring life’s transitions
* cultivate awareness of sacred dimension of life through worship, prayer,
meditation, singing
* respect connectedness while acknowledging differences
* helps us be generous in service to others
- life affirming influences enhance life, give meaning and purpose to existence,
strengthen one’s feelings of
self-worth, encourage self-actualization, and are health giving and life
sustaining
- life denying influences restrict or enclose life patterns, limit experiences and
associations, place burdens of
guilt on individuals, encourage feelings of unworthiness, and are health
denying and life inhibiting

A. ADVENTIST – believe in individual’s choice and God’s sovereignty; body is

believed to be temple of Holy Spirit
- many regard Saturday as Sabbath
- all narcotics and stimulants is prohibited

B. AMERICAN MUSLIM MISSION – Koran is sacred scripture

- stresses importance of cooperation among blacks in business and
education
- encourage healthcare provided by black community
 - tenets involve prayer rituals, dietary restrictions, hygiene, lifestyle
modifications, and marital
faithfulness

C. BUDDHISM – believe that the real cause of human suffering is ignorant craving
- Noble Eightfold Path - - consists of right views, aspirations, speech,
conduct, mode of livelihood,
effort, mindfulness, and concentration
- accepts modern science with avoidance of extremes applied to use of
drugs, blood, vaccines
- check on any special diet restrictions and observance of holy days

D. CHRISTIAN SCIENCE – believe sickness and sin are errors of human mind and can
be overcome by altering
thoughts, not by using drugs or medicines
- will use orthopedic services to set a bone but decline drugs and other
medical or surgical procedures
- alcohol and tobacco are not used

E. LATTER DAY SAINTS (MORMONS) – believe in divine healing through the “laying on of
hands”, though many do
not prohibit medical therapy
- disapprove of alcohol, tobacco, and caffeinated beverages
- special undergarment worn by some that should be removed only in an
emergency

F. HINDUISM – moral factors, linked with doctrine of “karma”, believed to be

significant in promoting health or
causing disease
- surprising openness to new ideas, at least with respect to practical
treatment
- dietary restrictions conform to individual sect doctrine
- medical personnel should avoid touching patient’s lips when
administering medications
- prescribed rites are followed after death; disposal of body is by
cremation

G. JEHOVAH’S WITNESSES – oppose “false teachings”, often extends to modern

science, including medicine
- blood transfusions violate God’s laws and are not allowed
- courts have not supported the right of parents to refuse life-saving
treatment for children

H. JUDAISM – Hebrew Bible is authority, guide, and inspiration of the Jews

- special needs in diet, birth rituals, male and female contact, and death
- treatment and procedures should not be scheduled on the Sabbath

I. ISLAM – Allah, on God, who is only one, all seeing, hearing, knowing, willing and
powerful
- may have fatalistic view of health
 - obligatory prayers, holy days, and fasting, and almsgiving
- Koranic law and customs that influence birth, diet, care of women,
death, and prayer rituals
- women are not allowed to make independent decisions

J. PROTESTANTISM – worship of one God revealed to world through Jesus Christ with
most accepting modern
medial science
- sacraments: baptism, communion, confirmation

K. ROMAN CATHOLICISM – worship of one God revealed to world through Jesus Christ
- many take an antiabortion stance, most accept modern medical science
- seven sacraments (baptism, eucharist, penanace, anointing of the sick)
- only natural means of birth control; abortion, euthanasia, sterilization
are forbidden

L. UNIFICATION CHURCH – goal is to unite Christians everywhere as one family under

God
- little information available on interactions with healthcare

M. UNITARIAN UNIVERSAL ASSOCIATION – no member is required to adhere to given creed

or set of religious beliefs
- free to accept what they take to be best for their health

IV. NURSING PROCESS

A. NURSING HISTORY - data are gathered about pt’s spiritual beliefs and practices,
effect of these beliefs on
everyday living, spiritual distress, and spiritual needs
- categories of assessment: * spiritual pain * spiritual
alienation * spiritual anger
* spiritual anxiety * spiritual guilt * spiritual loss
* spiritual despair
NURSING OBSERVATION - pts find it difficult to talk about their spiritual beliefs and
problems, observe pt’s
behavior for signs of spiritual distress
- include sudden changes in spiritual practices (rejection, neglect), mood
changes (frequent crying,
depression, apathy, anger), sudden interest in spiritual matters
(reading religious material,
watching religious programs, visits to clergy), and disturbed sleep

B. ANALYSIS / DIAGNOSIS
1. POTENTIAL FOR ENHANCED SPIRITUAL WELL-BEING – process of individual’s
developing/unfolding of
mystery through harmonious interconnectedness that springs from
inner strengths

2. SPIRITUAL DISTRESS – disruption in life principle that pervades a person’s

entire being and integrates
and transcends one’s biologic and psychosocial nature
 - further specified as spiritual pain, alienation, anxiety, guilt, anger,
loss or despair
- common etiologies include inability to reconcile current life
situation (illness, death of loved
one, divorce) with spiritual beliefs or separation from religious
community or supports

C. PLANNING
1. ENHANCING SPIRITUAL HEALTH – patient will:
* identify spiritual beliefs that meet needs for meaning and purpose, love
and relatedness, and
forgiveness
* derive from these beliefs strength, hope, and comfort when facing
challenges of illness, injury, or
other life crisis
* develop spiritual practices that nurture communion w/inner self, God,
and the world
* express satisfaction w/compatibility of spiritual beliefs and everyday
living

2. ADDRESSING SPIRITUAL DISTRESS – patient will:

* explore origin of spiritual beliefs and practices
* identify factors in life that challenge spiritual beliefs
* explore alternatives given challenges (deny, modify, reaffirm beliefs)
* identify spiritual supports
* report or demonstrate decrease in spiritual distress after successful
intervention

D. IMPLEMENTING
- interventions can be used in the home, hospital, or care center

1. OFFERING SUPPORTIVE PRESENCE – must underlie all other types of intervention

- aim is to create hospitable and sacred space (“holy ground”) in
which patients can share
vulnerabilities without fear

2. FACILITATING PRACTICE OF RELIGION – familiarize pt w/religious services and

materials available
- respect pt’s need for privacy or quiet during prayer
- assist to obtain devotional objects and protect them
- arrange sacraments - arrange minister, priest, or rabbi’s visits
- attempt to meet dietary restrictions
- if there is a conflict between spiritual beliefs and proposed
medical therapy, discuss this with
the physician

3. NURTURING SPIRITUALITY
a. Relationship with One’s Inner World – prayer; reflection or “quiet
listening to one’s essence”;
communion w/nature; enjoyment of music, drama, art, dance;
inner dialogues; dream
 analysis

b. Spiritual Energy to One’s Outer World – loving relationships; service

to others in need;
forgiveness of others; empathy, compassion, and hope;
laughter, joyous expressions;
participation in church

4. PRAYING WITH PATIENTS – many forms of prayer - - quiet reflection, silent

communion w/God or higher
power, reading or recitation of formal prayers, silent or loud calling
on God or conversation
w/God, or reading religious materials
- prayer may also be a simple expression aloud of pt’s needs and
hopes
- prayer should not block communication w/pt
- praying before pt feels ready may communicate lack of interest in
pt’s feelings
- be prepared to spend time w/pt after sharing prayer to respond to
feelings

5. COUNSELING PATIENTS SPIRITUALLY – articulate spiritual beliefs; explore origin of

pt’s spiritual beliefs;
identify life factors that challenge pt’s beliefs; explore alternatives
given these challenges;
develop spiritual beliefs the meet needs
- be open to different spiritual beliefs and forms of spiritual
expression and supportive of pt’s
efforts to nurture spiritual growth

6. SPIRITUAL COUNSELOR REFERRAL – offer to contact pt’s own spiritual adviser

- contact healthcare facility’s pastoral ministry department or use
referral list of clergy in
community
- suggest a visit from a member of clergy from another faith
- make counselor feel welcome, answering questions about pt,
directing counselor to pt, and
ensuring pt is ready to receive counselor
- room should be orderly and free of unnecessary equipment
- should be a seat for religious counselor at bedside or near
pt
- top of bedside table should be free of items and possibly
covered, if so desired
- bed curtains should be drawn to provide privacy

7. RESOLVING CONFLICTS BETWEEN SPIRITUAL BELIEFS AND TREATMENTS – nurse’s role is

to assist pt in
obtaining information needed to make an informed decision and to
support pt’s decision
making
 - what the nurse says and the way it is said may powerfully
influence pt’s decision, it is
important to maintain objectivity