Spiritual Care in Nursing
Spiritual support - finding value, meaning, trust,
By: Luth M. Mondano,RN,MAN
Principles in the study of spiritual care
1. Nursing diagnosis is intended to identify strengths
of the client as well as actual and potential
problems.
2. Our primary goal in spiritual care is to mobilise the
patient's spiritual resources.
3. Nursing staff should be aware that spiritual care is
not an attempt to 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.
4. 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.
5. Recognizing our own limitations and knowing when
to make a referral, or utilize other members of the
team is as important for spiritual care as it is for
other aspects of care.
6. The importance of documenting spiritual care in
nursing plans must be recognised, since this will
ensure that care is systematic, well thought out,
and consistent.
Acceptable diagnosis as identified by NANDA:
1. Risk for spiritual distress: At risk for altered sense
of harmonious connectedness with all of life and
the universe in which dimensions that transcend
and empower the self may be disrupted.
2. Spiritual distress: Impaired ability to experience
and integrate meaning and purpose in life through
the individual's connectedness with self, others,
art, music, literature, nature, or a power greater
than oneself
Signs of Spiritual Distress:
 Anger
 Fear
 Preoccupation with illness, suffering
 Loss of hope
 Change in beliefs
 Questioning beliefs
3. Readiness for enhanced spiritual well-being: Ability
to experience and integrate meaning and purpose
in life through connectedness with self, others, art,
music, literature, nature, or a power greater than
oneself.
Spiritual Care –the provision of interventions in the domain of
spirituality.
- a type of counselling that offers spiritual and
emotional support.
Four Specific Interventions for Spiritual Care as identified
by Nursing Intervention Classification:
a. Religious ritual enhancement
b.
and strength during difficult times.
c. Spiritual growth - helping to identify, connect
with, and call upon the source of meaning,
comfort, strength, and hope in his/her life.
d. Forgiveness facilitation - assisting
an individual to forgive and/or experience forgiven
ess in relationship with self, others
and higher power.
e. Religious addiction prevention –
prevention of a self -
imposed controlling religious lifestyle
Spirituality - the manner by which a person seeks meaning in
their lives.
(as personal concept) - individual’s attitudes and beliefs
related to transcendence (God) or to the non material forces
of life and of nature.
(as related to holistic nursing) - encompasses values, meaning
,and purpose as described by Dossey (1989)
- relationship with supreme being that directs one’s
beliefs and practises, Madeleine Leininger (1997,p.104)
Three Characteristics of Spirituality:
1. Unfolding mystery - related to one’s attempt to
understand the meaning and purpose of life
2. Harmonious interconnectedness - individual’s
relationship to other persons and/or God
3. Inner strength - relates to one’s personal spiritual
resources
Elements of Spirituality:
 Compassion
 Caring
 Transcendence
 Relationship with God
 Connection of body, mind, and spirit
The essence of good nursing is to help a person attain or
maintain wholeness in every dimension of their being.
Rogers, Parse, Newman and others, introduced holistic
view of persons into the nursing literature in 1980’s .
 The BIOPSYCHOSOCIAL MODEL is a general model
or approach stating that biological (physical health,
disability, genetic vulnerabilities), psychological
(which entails thoughts, emotions, and behaviors),
and social (socio-economical, socio-environmental,
and cultural) factors, all play a significant role in
human functioning in the context of disease or
illness.
Virtues Needed of a nurse:
 Truthfulness/honesty
 Integrity - personal choice to hold oneself to
consistent high moral and ethical standards.
 Sympathy/compassion - The essence of caring as a
nurse is torecognize the value and worth of those you
care for and that the patient and his or her experience
MATTERS to you.
 Humility- reflected as an attitude that finds joy and
satisfaction in serving others. The best nurses have a
 strong desire to serve their patients and putting their
needs ahead of their own
 Thankful-embracing an attitude of acceptance and
thankfulness for both the good and bad, accepting the
imperfections of yourself, others, and even the
nursing program you are a part of, can go a long way
to mitigate the stress that is inherent in academia.
Florence Nightingale (nursing brought to nursing her
traditional Christian and some very 'modern‘ values such
as autonomy and professionalism), claimed, "The needs of
the spirit are as critical to health as those individual organs
which make up the body".
The legitimate goal of nursing is restoring wholeness.
 the term 'holistic' came from the Greek 'Holos'
meaning whole or complete.
Holism has been defined as "concerned with the inter-
relationship of body, mind and spirit in an everchanging
environment" (Dossey 1995)
Wellness (health) - "a state of harmony between body, mind
and spirit" as defined by the American Holistic Nurses
Association.
What are patient strengths?
 the capacity to cope with difficulties, to maintain
functioning in the face of stress, to bounce back in
the face of significant trauma, to use external
challenges as a stimulus for growth, and to use
social supports as a source of resilience
Examples:
Cognitive and appraisal skills
 The ability to perceive, analyze, and accurately
comprehend a challenging situation. This includes
the ability to assess accurately one’s own capacities
or contributions to the situation and the ability to
perceive, analyze, and comprehend alternative
strategies for responding to it.
Defense and coping mechanisms
 Defense mechanisms are largely unconscious
mechanisms which are activated in times of
anxiety, stress and distress without any choice or
conscious intentionality.
 The characteristic mechanisms an individual uses
to deal with problematic internal and external
sources of stress.
 Coping, on the other hand, are conscious strategies
that are chosen in calm emotional states.
 Coping enables the individual to attain realistic
goals by using available resources and past
experiences while acting within society’s rules of
conduct.
Temperamental and dispositional factors:
 Dispositional Factors (also known as
Internal Factors) are individual characteristics that
influence behaviour and actions in a person. Things
like individual personality traits, temperament, and
genetics are all dispositional factors.
Interpersonal skills and supports:
 The ability to develop and maintain intimate and
supportive social networks.
External factors: For example, supportive social
institutions, financial resources.
Spiritual Resources - scheme/activities that a person can
do for the purpose of attaining inner peace and harmony.
Examples:
Community Resources
 consists of the spiritual support that a person can
receive from a relationship or from belonging to a
group of people who care for one another. Some
examples of community resources -religious
congregations; health care professionals; therapy
groups; volunteers belonging to social service
agencies.
Meditation Resources
 adherence to a particular belief system such as the
meditative practices found in Buddhism, Hinduism,
Sufism, and Christian mysticism.
 produces a feeling of inner peace, harmony and
healing.
 Meditation is a conscious effort to change how the
mind works.
 Some examples of meditative practices are focusing
attention on an object; focusing attention on one’s
breathing; the conscious relaxation of muscles and
stress points within the body; intense physical
exercise.
Prayer Resources
 Prayer is a resource for those who believe in the
existence of God (or higher power)
 Prayer can be communal, as in a worship service,
or it can be practiced individually.
SEVEN NURSING DIAGNOSES RELATED to “ALTERATIONS In
SPIRITUAL INTEGRITY", which were identified from
O’Brien’s research (1982a) on spirituality and life
threatening illness, include:
 “Spiritual Pain, as evidenced by expressions of
discomfort or suffering relative to one’s relationship
with God; verbalization of feelings of having a void
or lack of spiritual fulfilment, and/or a lack of peace
in terms of one’s relationship to one’s creator”. A
terminally ill patient, experiencing such “spiritual
pain,” may verbalize a fear that he or she has not
lived “according to God’s will”
 Spiritual Alienation, as evidenced by expressions of
loneliness, or the feeling that God seems very far
away and remote from one’s everyday life;
verbalization that one has to depend upon oneself in
times of trial or need; and/or a negative attitude
toward receiving any comfort or help from God”.
Often a chronically ill person expresses frustration in
terms of closeness to God during sickness; the
comment may be “Where is God when I need him
most?”