Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 1 Chapter 35 Spiritual Health.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 1

Chapter 35

Spiritual Health

2Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Scientific Knowledge Base

Mind, body, and spirit are interrelated.

Physical and psychological well-being results from beliefs and expectations.

Beliefs and convictions are powerful resources for healing.


Case Study

Victoria Timms is a 48-year-old African American college professor, diagnosed 3 months ago with breast cancer. She is married to Joe, an insurance salesman, and is the mother of two children: Valerie, 16 years, and Peter, 12 years.

Surgeons removed Victoria’s cancerous tumor and two involved lymph nodes. Because of the lymphatic involvement, Victoria is at increased risk for the cancer to spread.


Spirituality


Nursing Knowledge Base:Current Concepts in Spiritual Health

Spirituality: complex, unique to the individual Spiritual well-being: an interconnectedness

between God or a higher power and other people

Faith: several definitions Religion: associated with a specific system of

practice associated with a denomination, sect, or form of worship

Hope: gives an individual a motivation and the resources to achieve


Case Study (cont’d)

Victoria has completed a course of radiation and now visits the cancer clinic with her husband three times a week for chemotherapy.

Victoria and Joe discuss their concern for their children. Valerie and Peter attend Sunday school weekly after going to church with their parents. Their Sunday school teacher informed Victoria and Joe that Valerie and Peter are very angry about their mother’s illness.


Definitions

Atheist: one who does not believe in the existence of God

Agnostic: one who believes that there is no known ultimate reality

Self-transcendence: a sense of authentically connecting to one’s inner self

Transcendence: the belief that a force outside of and greater than the person exists beyond the material world



Jeff is a 36-year-old married student nurse assigned to the oncology clinic. He is in his last semester at school and hopes to get a position in the clinic after graduation. Jeff is assigned to follow Victoria during her visits.

Victoria’s experience is significant for Jeff because he has children who are the same age as Victoria’s, and he wonders how his children would react if his spouse became ill.


Care: Religious versus Spiritual

Patients benefit from both types of care.Religious care: helping patients maintain faithfulness to their belief system and worship practices

Spiritual care: helping people identify meaning and purpose in life, look beyond the present, and maintain personal relations as well as a relationship with a higher being or life force


Nursing Knowledge Base: Spiritual Health

Spiritual health represents a balance. Spiritual health matures with increasing awareness of

meaning, purpose, and life values. Spiritual beliefs change as patients grow and

develop. Spiritual distress: impaired ability to experience and

integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself



During one of their clinic visits, Victoria and Joe appear very calm and relaxed when discussing the cancer therapy. Joe explains, “We both have a lot of faith in God.”

Victoria responds, “Even though I know I have cancer, I hope to be able to continue to go to church with my family and my children. My family is very supportive, and together, I know we will make it through this experience. But I am worried about my children. With God’s help, I can help them cope with my illness better.”


Nursing Knowledge Base: Factors Influencing Spirituality

Acute illness Sudden, unexpected

Chronic illness Threatens a person’s independence

Terminal illness Uncertainty about death

Near-death experience (NDE) Psychological phenomenon close to clinical death

or recovered after declared death


Critical Thinking

Apply knowledge, experience, standards, and attitudes.

Personal experience in caring for patients in spiritual distress is valuable when helping

patients select coping options.

Each person has a unique spirituality.

The Joint Commission requires health organizations to provide for pastoral care.



Jeff recognizes that Victoria shows acceptance of her disease because she is able to discuss cancer and the plan for treatment. Jeff knows that as patients begin to accept the fact of being diagnosed with a life-threatening disease, it is important to offer opportunities to share feelings and to begin to provide time to discuss future plans.

Jeff’s previous experiences with cancer patients have taught him that when patients express hope, they seem to be able to move forward and cope with the challenges of their disease.


Quick Quiz!

1. When caring for patients, the nurse must understand the difference between religion and spirituality. Religious care helps individuals

A. Maintain their belief systems and worship practices.B. Develop a relationship with a higher being. C. Establish a cultural connectedness with the purpose

of life.D. Achieve the balance needed to maintain health and

well-being.


Nursing Process

Assessment Establish trust.

Diagnosis Use North American Nursing Diagnosis Association

International (NANDA-I)-approved list. Planning

Goals need to be realistic and individualized. Implementation

This is based on phase of care. Evaluation

This involves an increased or restored sense of connectedness.



Jeff discovers that spiritual needs are often associated with cultural beliefs. Spiritual and cultural beliefs affect how women of different cultures experience health and illness.

Spirituality often provides a source of healing, coping, and peace. Jeff uses this understanding to develop a culturally competent plan of care for Victoria and her family. Jeff learns that Victoria’s church has a parish nurse. What steps could Jeff take next?


Nursing Process: Assessment

Assessment expresses a level of caring and support.

Establish a trusting relationship. Assess patient’s viewpoints.

Ask direct questions. Utilize spiritual assessment tools:

• SWB (Spiritual Well-Being Scale)• BELIEF (belief, ethics, lifestyle, involvement, education,

future events)


Nursing Process: Assessment (cont’d)

Faith/Belief: ask about a religious source of guidance

Life and self-responsibility: ask about a patient’s understanding of illness limitations or threats and how the patient will adjust

Life satisfaction Connectedness: ask about the patient’s ability

to express a sense of relatedness to something greater than self


Connectedness


Nursing Process: Assessment (cont’d)

Culture: ask about faith and belief systems to understand culture and spirituality relationships

Fellowship and community: ask about support networks

Ritual and practice: ask about life practices used to assist in structure and support during difficult times

Vocation: ask whether illness or hospitalization has altered spiritual expression


Nursing Process: Diagnosis

Potential diagnoses: anxiety, ineffective coping, fear, complicated grieving, hopelessness, powerlessness

NANDA-I accepted diagnoses: Readiness for enhanced spiritual well-being Spiritual distress Risk for spiritual distress



Jeff knows that current evidence shows many African American women use spirituality to cope with breast cancer, so he decides to assess Victoria’s spirituality in these areas: Victoria’s connections with herself Victoria’s connections with her family and

significant others Victoria’s connections with a power greater than

herself


Nursing Process: Planning

Goals and outcomesA spiritual care plan includes

realistic and individualized goals with relevant outcomes.

Setting prioritiesThe patient identifies what is most important.

Teamwork and collaborationIn a hospital setting, the pastoral care department

is a valuable resource.



Victoria had also expressed that her children, who were very close to their parents and shared their faith in God, now are not coping well with Victoria’s illness. What goals for the nursing diagnosis should Jeff

set for Victoria and Joe? What expected outcomes should Jeff establish?


Nursing Process: Implementation

Health promotion Establishing presence—involves giving attention,

answering questions, having an encouraging attitude, and expressing a sense of trust; “being with” rather than “doing for”

Supportive healing relationship• Mobilize hope.• Provide interpretation of suffering that is acceptable to

patient.• Help patient use resources.


Nursing Process: Implementation (cont’d)

Acute care Support systems Diet therapies Supporting rituals

Restorative and continuing care Prayer Meditation Supportive grief work



Jeff knows that spiritual support is important. He uses therapeutic communication to establish

presence and trust, and to demonstrate empathy. He prays with Victoria and her family. He encourage their religious practices.

Jeff also tries to promote family integrity by identifying the family coping mechanisms and by encouraging Joe to communicate frequently and openly with Victoria.


Nursing Process: Evaluation

Were expectations met? How can spiritual well-being be enhanced? Were patient outcomes achieved?

Include the patient in your evaluation of care. Successful outcomes reveal the patient

developing an increased or restored sense of connectedness with family; maintaining, renewing, or re-forming a sense of purpose in life; and for some, exhibiting confidence and trust in a Supreme Being or power.



What nursing actions should Jeff take to determine whether expectations have been met and whether patient outcomes were achieved?

If Victoria responded that she needed help working out a schedule to spend time with her children, what could Jeff suggest?


Quick Quiz!

2. To assess, evaluate, and support a patient’s spirituality, the best action a nurse can take is to

A. Assist the patient to use faith to get well.B. Refer the patient to the health care facility

chaplain.C. Provide the patient with a variety of religious

literature.D. Determine the patient’s perceptions and

belief system.



In an effort to evaluate whether the clinic has met Victoria’s expectations, Jeff asks, “Your faith is strong, and it is my hope that you have felt comfortable in talking about your worries. Do you believe we have helped you so far with your concerns?”

Victoria replies, “The best thing you have done is listen and recognize how important my family is to me. Your suggestions have helped. I am truly blessed to have met all of you nice people at the clinic.”


Conclusion

Spirituality ensures a holistic focus. Spirituality is much broader and unifying than

religion. Spirituality requires open communication and

establishment of trust between nurse and patient.

Spirituality involves faith, support systems, and hope.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 1 Chapter 35 Spiritual Health.

Documents

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case study victoria

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