Chapter 036 Spiritual Health

Chapter 36
Spiritual Health
Copyright © 2017, Elsevier Inc. All Rights
Reserved.

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Mind, body, and spirit are interrelated.
Physical and psychological well-being
results from beliefs and expectations.
Beliefs and convictions are powerful
resources for healing.

 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.
 Victoria describes her family as being very close and
supportive.
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 Constructs of
spirituality
 Self-transcendence
 Connectedness
 Faith
 Hope
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 Spiritual well-being
 Faith
 Religion
 Hope
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 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.
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 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.
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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

 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.
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 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
 Acute illness
 Chronic illness
 Terminal illness
 Near-death experience
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 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.”
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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.
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 Jeff recognizes that Joe usually comes to the
clinic, and Victoria describes him as a strong
source of support. However, Jeff does not
know enough about the couple’s relationship
and wants to explore this further. The role of
family members in providing support,
particularly with regard to decision making, is
important for Jeff to understand before he
develops a plan of care.
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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.
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 Jeff discovers that spiritual needs are often
associated with cultural beliefs. Spiritual and
cultural beliefs affect how patients 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.
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 Jeff is a Lutheran and does not know very much about
the Baptist faith, the couple’s religion. However, he
knows that the Baptist sense of community is very
strong and that it is important to learn more about how
the members of the Timms’ church play a role in
offering support to the family.
 Jeff recognizes that spiritual well-being is more
complex than religion. He encourages Victoria and her
family to strengthen their spiritual health as they
continue to cope with Victoria’s breast cancer diagnosis
and treatment.
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 Assessment expresses a level of caring and
support
 Taking a faith history reveals patient’s
beliefs about life, health, and a Supreme
Being
 Through the patient’s eyes
 Assessment tools
 Listening
 Ask direct questions
 FICA (Faith, Importance, Community, Address)
 Spiritual well-being (SWB) scaleCopyright © 2017, Elsevier Inc. All Rights
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 Faith/Belief
 Ask about a religious
source of guidance
 Understand the
patient’s philosophy
of life
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 Life and self-responsibility: ask about a
patient’s understanding of illness limitations
or threats and how the patient will adjust
 Connectedness: ask about the patient’s
ability to express a sense of relatedness to
something greater than self
 Life satisfaction
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 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
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 Potential diagnoses
 Anxiety
 Ineffective Coping
 Complicated Grieving
 Hopelessness
 Powerlessness
 Readiness for Enhanced Spiritual Well-Being
 Spiritual Distress
 Risk for Spiritual Distress
 Risk for Impaired Religiosity
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 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
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Goals and outcomes
A spiritual care plan includes
realistic and individualized goals
with relevant outcomes.
Setting priorities
The patient identifies what is most important.
Teamwork and collaboration
In a hospital setting, the pastoral care department is a
valuable resource.

 Victoria expresses that her children, who are
very close to their parents and share their faith
in God, are not coping well with Victoria’s
illness.
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 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.
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 Acute care
 Support systems
 Diet therapies
 Supporting rituals
 Restorative and continuing care
 Prayer
 Meditation
 Supporting grief work
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 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 encourages 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.
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 Through the patient’s eyes
 Include the patient in your evaluation of care.
 Outcomes established during the planning phase
serve as the standards to evaluate the patient’s
progress.
 Patient outcomes
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 Victoria shares with Jeff that the chemotherapy
is making her tired much of the time. This
makes it difficulty for her to make time to get
everything done and spend time with her
children. She is worried that this may be part of
why they are having difficulty coping. She asks
Jeff for advice.
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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.
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 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 here.”
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