Initial spiritual assessment and understanding of patients spirituality through observing and listening to the patient Spirituality is a core

component of our lives, it is the bridge connecting our own self with God, the nature, the others, the past and the future, enabling us to find the meaning and purpose of life and giving us the ability to cope with challenges we face (Cloninger, 2006; Gebhardt, 2008; Speck, 2005). Spiritual care is an important integral part in planning and providing holistic nursing care for patients, their families and significant others (Glass, Meyer, & Morely, 2007; MacKinlay, 2006; Tanyi, 2006). Patients own world view and their spirituality, which does not have to have a religious component, are the foundation of planning patients spiritual care (Boswell, Glacoff, Hammer, McChesney, & Knight, 2007; Lynne, 2009). Successful spiritual care is based on spiritual needs assessment of the patients, their families and significant others as well on the personal life experience and spirituality of a nurse and other members of an interdisciplinary team providing the care (Gebhardt, Speck). Geoff (not his real name), 57 years of age, was brought in by an ambulance to emergency department with bradycardia-triggered arrhythmia secondary to cervical spinal cord injury at C3-C4, which he sustained in an accident almost 4 years ago. Geoff is a wheelchair bound with quadriplegia and requires permanent mechanical ventilation. At home Geoff is cared for by personal care assistants provided by a community healthcare agency. However, Geoffs present condition, which is frequently associated complication of cervical spinal cord injury, requires treatment and monitoring in intensive care unit (Franga, Hawkins, Medeiros, & Adewumi, 2006; Schulz-Stubner, 2005). Geoff is married and he lives with Gabriella, his wife for over 30 years; their two children (26 and 24 years of age) moved out a few years ago and now live overseas. Gabriella runs a successful marketing business in partnership with Geoffs sister. Geoff and Gabriella have an extensive network of friends who often come to visit them. Geoff uses his laptop and internet (Skype) to stay in touch with their two children and the friends as well as with his parents who live interstate. Recently Geoff and Gabriella purchased a custom vehicle van which will enable them to go for longer trips outside the City. During Geoffs treatment in the intensive care unit, Geoff used to keep his eyes closed at the times when nurses were attending to his personal hygiene needs, which Geoff explained as that was his way of concentrating and keeping himself calm and in his peaceful place. By separating his mind from his body and from whatever was happening around him during the procedures, Geoff focused on achieving his inner peace by accepting there are things that have to be done in order to achieve his most important goal, i.e. improving quality of his life (DeGraff, 2006; OConnell & Skevington, 2005; Parker, 2007). As Geoffs condition was improving he spent more time listening to his music and talking about the two subjects he likes the most: urban architecture and wine. When he Page 1 of Zarko Djekic, BN RN

was a young man Geoff studied urban architecture at Cambridge University and his most treasured memories from that period were the times spent in the Cathedral on his way from the University library and his home. Geoff said that he never felt so close to God as when he prayed at that Cathedral and the reflecting on these memories always gives him new strength and hope. Cloninger (2006) put spirituality at the foundation of human ability to cope with challenges and gave it an essential role in patients recovery; Boswell et al. (2007) viewed spirituality as ones quest for finding and understanding the purpose and meaning of life determined by ones culture; Rolley, Chang, and Johnson (2008) saw spirituality as the process of forming the bridge between oneself and the world and everything that transcendent oneself, while Lynne (2009) stated that each of us has our individual definition and expression of spirituality. In his own way Geoff was expressing his spirituality by searching and finding the meaning in life through his faith and belief in God (DeGraff, 2006; Lanzetta, 2010; OConnell & Skevington, 2005). After the accident Geoff sold his vineyard and he does not work in his profession any more, but Geoff still keeps urban architecture and wine production very close to his heart. With Gabriellas help and the help of his personal assistants, Geoff does literature research and uses his laptop and voice recognition software to write articles for different periodicals on both subjects. Without my music and without my writing, Geoff said, My mind would go crazytrapped like this inside my body. Music and creativity were another way Geoff expressed his spirituality and ongoing search for new purpose and meaning in life (DeGraff, 2006; Lanzetta, 2010). On the day before his discharge from the hospital Geoff made a short visit to a coffee shop in the hospital park. Geoff enjoyed the breeze on his face and the full body flavour of Italian espresso in his mouth, but he was missing being able to smell the aroma of the coffee. Geoff talked about small and simple pleasures in life and about the beauty of Gods creation surrounding us when a subtle change in his feelings started to emerge. At that moment Geoff asked himself: What have I done in my life that God punished me with this accident? Geoffs voice and the gaps in his story were telling the meaning Geoffs disability had for him as well as how Geoff moves through stages and changes in his spiritual live (DeGraff, 2006; Lanzetta, 2010; Telos, 2005). The next day as Geoff was getting ready for the discharge from the hospital and while he was waiting for Gabriella and a personal care assistant from the agency to come and accompany him home, Geoff said: You know, I am a very lucky manGabriellashes been with me through everything more than 30 yearsyeah, I am a very lucky man and he smiled. The time Geoff spent recovering in the hospital was a good opportunity to assess Geoffs spirituality and spiritual needs. Geoff showed very strong resilience founded on his spiritual strength and his religious believes. Geoff accepted his disability and he has found ways which give him ongoing purpose and hope in life- love of his family, faith in God, music and writing, and a chance to get out of the City in his new van, as Geoff once said: to go to where were the clouds going to. Geoff does not see a new day as a new struggle but as an opportunity to do something new or just to finish writing this

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page... as it was Geoffs usual request before something else has been commenced. It is important for Geoff and his family to harbour Geoffs spirituality and the strength he gets from it by encouraging and supporting him in the creative work he does as the same as it is important to monitor his medical condition (Franga et al. 2006; Lanzetta, 2010; SchulzStubner, 2005). Spirituality facilitates healthy functioning of marital, family and social life and it intertwines with all aspect of nursing, making spirituality, spiritual needs assessment and spiritual care a core component of holistic care (Boswell et al. 2007; Parker, 2007; Power, 2006; Speck, 2005). Initial spiritual assessment shows very strong connectedness between Geoff, Gabriella and their children while at the same time each of them needs definite personal time for themselves. There is a need to obtain Geoffs and Gabriellas consent for detailed individual and family spiritual assessment and implementation of spiritual care plan (Lynne, 2009; Tanyi, 2006). A nurses ability to perform spiritual needs assessment, to plan and to provide spiritual care to patients, their families and significant others depends on a nurses awareness of their own spirituality and their cultural competence in cultural diverse society as well as knowing that individual family members might have different ways of expressing and understanding their own spirituality (Lanzetta, 2010; OConnell & Skevington, 2005; Rolley et al. 2008; Tanyi, 2006). Some of the attributes that every nurse should have or needs to develop in order to provide effective spiritual care are: active listening, therapeutic use of self, willingness to create therapeutic conditions for spiritual growth, empathy, and recognising unmet spiritual and religious needs of others (Glass et al. 2007; MacKinlay, 2006). Although every person might have their unique perception, understanding and expression of spirituality, and whether it is in a secular or in a religious form, spirituality is a core component of our lives. Nurses awareness of their own spirituality is essential for a nurse to be able to assess and understand patients spirituality and to plan and provide spiritual care as an integral part of holistic nursing care (Cloninger, 2006; Gebhardt, 2008; Lanzetta, 2010; OConnell & Skevington, 2005; Rolley et al. 2008; Speck, 2005; Tanyi, 2006).

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Reference: Boswell, B., Glacoff, M., Hammer, M., McChesney, J., & Knight, S. (2007). Dance of disability and spirituality. Journal of Rehabilitation, 7(4), 33-40. Cloninger, C. R. (2006). Fostering spirituality and well-being in clinical practice. Psychiatric Annals, 36(3), 156-162. DeGraff, A. H. (2006). Religion and spirituality related to ability to cope for people living with spinal cord injury. Unpublished doctoral dissertation, University of Northern Colorado, Colorado. Franga, D.L., Hawkins, M.L., Medeiros, R.S., & Adewumi, D. (2006). Recurrent asystole resulting from high cervical spinal cord injuries. The American Surgeon, 72(6), 525-529. Gebhardt, M. C. (2008). Rehabilitation nurses experiences providing spiritual care. Spirituality and Health International, 9, 230-240. Glass, E., Meyer, B., & Morely, D. (2007). Spiritual care. Journal of Hospice and Palliative Nursing, 9(1), 15-16. Lanzetta, B. (2010). Spirituality. Alternative Therapies in Health and Medicine, 16(1), 20-25. Lynne, P. (2009). Delivering spiritual care. Nursing Standard, 23(28), 22-23. MacKinlay, E. (2006). Spiritual care: recognizing spiritual needs of older adults. Journal of Religion, Spirituality & Aging, 18(2/3), 59-71. OConnell, K. A. & Skevington, S. M. (2005). The relevance of spirituality, religion and personal beliefs to health-related quality of life: themes from focus groups in Britain. British Journal of Health Psychology, 10, 379-398. Parker, J. (2007). Spirituality and well-being. Working with Older People, 11(3), 13-16. Power, J. (2006). Religious and spiritual care. Nursing Older People, 18(7), 24-27. Rolley, J., Chang, E. & Johnson, A. (2008). Spirituality and the nurse: engaging in human suffering, hope and meaning. In E. Chang & A. Johnson (Eds.), Chronic illness and disability. Principles for nursing practice (pp.33-49). Chatswood: Elsevier. Schulz-Stubner, S. (2005).The use of small-dose theophylline for the treatment of bradycardia in patients with spinal cord injury. Anesthesia & Analgesia, 101,

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1809-1811. Speck, P. (2005). The evidence base for spiritual care. Nursing Management, 12(6), 2831. Tanyi, R.A. (2006). Spirituality and family nursing: spiritual assessment and interventions for families. Journal of Advanced Nursing, 53(3), 287-294. Telos, N. (2005). Proactive: spiritual care for terminal restlessness. Palliative and Supportive Care, 3, 245-246.

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