<<Instructor: Please review each bulleted item while referring to the following notes.>>
Pre-Christian: Caring for the sick was an expression of the values of hospitality and charity. People prayed to the god(s) for healing and as an adjunct for primitive medical procedures.
Early Christian era: Nursing the sick was honored and respected because it was one of Jesus Christ’s primary teachings. Caring for the sick was a vital component of loving one’s neighbor. Gradually, religious communities of women and men in the 4th through 12th centuries provided models for combining the healing arts with religious care.
Post-Reformation: Nursing orders continued to flourish, among them the Daughters of Charity, the Sisters of Mercy, and the Kaiserswerth Deaconesses (Donahue, 1985). Florence Nightingale trained under Pastor Fliedner at his Deaconess School in Kaiserswerth, as well as under the Daughters of Charity of St. Vincent de Paul in France. For Nightingale, spirituality was at the very heart of human nature and thus was fundamental to healing.
Mid 20th century: Nursing in the United States had begun to see spiritual care as less important. As science continued to develop and expand, and as more nurses studied in university settings, nursing joined ranks with the scientific disciplines. Its spiritual underpinnings were replaced by what could be “seen and tested” by the scientific method.
<< Instructor: Review each bulleted item while referring to the following notes >>
The “map” of religion tells you what to believe and what values are essential. It provides codes of conduct that integrate beliefs and values into a way of living.
The map itself may be in the form of a religious tradition (e.g., Christianity) or denomination (e.g., Baptist), which provides an identity and a “lens” for reading the world.
The rituals, symbols, sacraments, and holy writings associated with religions serve as bases of authority and provide diverse ways to transcend the physical and access the divine (e.g., God).
<<Review each bulleted item while referring to the following notes.>>
Many life events that prompt spiritual growth are fulfilling and joyful, but growth often results from painful life events that cause great internal upheaval, struggle, and challenge.
Spirituality also allows various ways and means to access the divine in our daily lives, to transcend the physical world, or simply to be still and introspective.
For centuries, Eastern traditions have emphasized that spirituality is awareness, paying attention, and being “sensitive to reality” (Krishnamurti, 1989).
One Western model of spirituality asserts that we learn to “read” the spiritual in everyday events only when we attain a new “level of literacy.”
<<Instruct students to do the following: Select the most appropriate answer to this question using your clicker.>>
<<Instructor: The correct answer is A.>>
<<Instructor: Review each bulleted item while referring to the following notes.>>
Faith: Faith is an evolving pattern of believing that grounds and guides us and helps us make sense of the world and confront the challenges we face (Dyess, 2011). Faith represents a set of beliefs developed over time, through events that cause us to suffer and those that enable us to rejoice.
Hope: Hope is a dynamic process that reflects a positive orientation toward future outcomes. It includes our basic human needs to achieve, create, and shape something of our life that will endure. “Hope . . . is different from optimism or wishful thinking. When we have hope, we discover powers within ourselves we may have never known—the power to make sacrifices, to endure, to heal, and to love. Once we choose hope, everything is possible” (Reeve, 2002, p. 176).
Love: While active loving in human relationships opens us up to joy and can give life, meaning, and purpose; it also carries with it the certainty of heartbreak (e.g., when a loved one dies). We extend our love because we hope to find that love is returned in some way.
Miracle: This is anything that allows for the presence of the transcendent (e.g., God, a Higher Being, the experience of one’s angel, or any brush with the divine). It is an event that excites wonder and in which we see God at work in our ordinary day-to-day lives (Macquarrie, 1977), but it does not necessarily involve a physical cure. We typically think of miracles as events that break with the natural order of things (e.g., a blind person suddenly can see, with no treatment or explanation); however, miracles more commonly proceed according to natural law. What makes events miracles is the fact that they far exceed our expectations.
<<Instructor: Review each bulleted point and encourage student discussion on these items.>>
<<Instructor: Review each bulleted point and encourage student discussion.>>
<<Instructor: Introduce the concept of fatalism and fatalismo to address the second bullet point.>>
Fatalism: This is often seen in the Hispanic culture and rooted in Buddhism; it views fatal disease as predestined by nature and acceptance as a sign of wisdom and maturity.
Fatalismo: This is often seen in the Asian culture and is rooted in Christianity. Disease is viewed as predetermined with a predictable outcomes.
These beliefs negatively impact participation in preventative care activities.
<<Instructor: Review each bulleted point while referring to the following notes.>>
Judaism
Orthodox: Orthodox Jewish women prefer to have their bodies and limbs covered. They may also prefer to keep their hair covered with a scarf and often wear a wig. Orthodox men keep their head covered with a hat or skullcap (kappel). Some Orthodox Jewish sects forbid contraception unless the woman’s health is at risk. Nearly all Jewish boys are circumcised, usually 8 days after birth. Orthodox Judaism usually forbids organ transplants, but opinions vary and decisions may rest with the rabbinic authority.
Conservative: Conservative Jews observe strict dietary laws: Only kosher foods are accepted. Kosher foods have been prepared under strict guidelines for how animals are slaughtered and do not contain pork, certain types of seafood, or combinations of dairy and meat. If possible, consult a rabbi or dietitian who is knowledgeable about Jewish dietary laws for assistance in planning dietary and activity modifications.
Both Reconstructionist and Reform Judaism adhere to the basic tenets of the Jewish faith but incorporate modern Western societal values of democracy and equality.
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Christianity: Christians hold that Jesus’ death atoned for the sins of men and women, providing a way to experience the forgiveness of God and to gain eternal life.
Roman Catholicism: The sacraments are a means to obtain grace. A Roman Catholic who is seriously ill might wish to receive the sacrament of anointing the sick. This sacrament, once known as the last rites, can be repeated if the person recovers and then becomes ill at a later time. Only a priest can hear the sacrament of reconciliation (confession), during which God, through the agency of the priest, grants forgiveness for past sins. The Eucharist (communion bread), consecrated at the mass (a religious service), may be brought to hospitalized patients by a priest, deacon, or designated lay Eucharistic minister.
Christian Science teaches a reliance on God for healing rather than on medicine or surgery. Therefore, you might encounter followers as patients only after accidents or because of family or legal pressures. Christian Scientists do not use alcohol and tobacco; strict Christian Scientists may not drink tea or coffee. Adults will probably not accept a blood transfusion, but parents usually consent to transfusion and other medical care for their child if doctors consider it essential or the law requires them to do so. Adults will not usually consent to donate or receive organs.
Protestantism: Protestant denominations (e.g., Lutheran, Baptist, United Methodist)
<<Instructor: Review each bulleted item while referring to the following notes.>>
Islam: A Muslim is one who submits to Allah (God). The principal book of authority in Islam, the Koran (Qu’ran), is the result of a vision received by Muhammad, the founder of Islam, in the early 7th century A.D. Islam teaches that all faiths have essentially one common message: There is a Supreme Being whose sovereignty is acknowledged in worship and whose teaching and commandments must be obeyed. Women prefer to be treated by female staff. Some women may refuse vaginal examination by a male nurse or physician because they are forbidden to expose their bodies to or be touched by any man other than their husband.
Hinduism: Hindus practice ayurvedic medicine, which encompasses all aspects of life, including diet, sleep, elimination, and hygiene. Some believe in the medicinal properties of “hot” and “cold” foods—”hot” and “cold” having nothing to do with either temperature or spicy qualities. Women are modest and usually prefer to be treated by female medical staff. Jewelry often has a religious or cultural significance.
<<Instructor: Review each bulleted item while referring to the following notes.>>
Buddhism: A core teaching is that suffering can be ended by following the eightfold path of rights: understanding, intention, speech, action, livelihood, effort, mindfulness, and contemplation (Bodhi, 2007; Kneirim, 2008). Many Buddhists follow a vegetarian diet; in some cases, the diet may include both milk and eggs. Fasting customs vary by tradition. Buddhists accept contraception, blood transfusion, and organ transplantation, but may condemn abortion and active euthanasia.
American Indian: Health is a state of harmony with nature. Whenever disharmony exists, disease or illness can occur. The traditional healer is the medicine man or woman who is wise in the interrelationships of land, humankind, and the universe. Note-taking by the professional is forbidden so when you take a history or perform an exam, rely on your memory to record findings later. Native Americans tend to converse in a low tone of voice and may maintain long periods of silence.
Rastafarianism: The Rastafarian movement began in the 1930s in the West Indies. It emphasizes personal dignity and a deep love of God. Rastafarians use the Old and New Testaments of the Bible as their authoritative writings, but they do not consider themselves to be Christian. There are no churches, services, or official clergy.
Atheists: Athiests do not believe in the presence of God or supernatural deities. Rather than receiving directives on living from external sources, atheists have their own personal moral code that is derived from their value systems, beliefs, and life experiences. They can be spiritual and even religious, but focus on the humanistic, secular perspectives.
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<<Instructor: The correct answer is D.>>
<<Instructor: Review each bulleted item while referring to the following notes.>>
To work effectively with a diverse population, you must first obtain a greater degree of self-knowledge by
(1) being open to the many possibilities for diverse thinking, (2) welcoming challenging experiences that allow for personal growth, and (3) taking time to contemplate how your actions and biases might affect the care of others. The more you know about yourself, the more effectively you care for others.
<<Instructor: Encourage discussion with the students on ways to develop nonjudgmental attitudes and open thinking.>>
<<Instructor: Review each bulleted item while referring to the following notes.>>
Lack of awareness of spirituality in general: A greater awareness of spirituality in general will help you tune into the spiritual needs of patients and improve your comfort in communicating about spiritual matters.
Lack of awareness of your own spiritual belief system: Increase your knowledge about spirituality.
Develop your critical and reflective thinking abilities.
Explore your own spirituality (e.g., reflection, discussing with others). One technique is to write your own epitaph, one or two lines summing up how you would like to be remembered.
Reflect on your thoughts and feelings about end-of-life issues. Imagine you have only a few weeks to live; think how you would feel.
Differences in spirituality between nurse and client: When a patient’s spiritual beliefs are very different from your own, you must be careful not to impose your beliefs on the patient or discount the importance of the patient’s beliefs and rituals. When the patient’s views or beliefs are similar to yours, take care not to make false assumptions about the patient’s spiritual needs. Just because you agree on some things does not mean you will have the same views or needs in all areas of spirituality or religion.
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Fear that your knowledge base is insufficient: Nurses sometimes avoid giving spiritual care because they believe they lack knowledge of spirituality or of the patient’s religion.
Fear of where spiritual discussions may lead: You should realize that being open to the spiritual realm and assessing the patient’s need for spiritual intervention does not mean that you must be a chaplain or have the extraordinary ability to deal with all spiritual or religious questions or requests.
<<Instructor: Review each bulleted item while referring to the following notes.>>JAREL Spiritual Well-Being Scale: was developed and is commonly used by nurses (Hungelmann, Kenkel-Rossi, Klassen, et al., 1996). Cutting across religious and atheistic belief systems, it assesses three key dimensions: (1) faith/belief, (2) life/self-responsibility, and (3) life-satisfaction/self-actualization.
SPIRIT model: Highfield (2000) has proposed a comprehensive method of spiritual assessment. It involves an interview that is concerned with six key areas designated by the acronym SPIRIT:
SP—Spiritual/religious belief system
I—Integration within a spiritual community
R—Ritualized practices and restrictions
I—Implications for medical care
T—Terminal events planning
HOPE: HOPE is a mnemonic, as follows:
H—sources of Hope
O—Organized religion
P—Personal spirituality/Practices
E—Effects on medical care and end-of-life issues
Levels of spiritual assessment: Initial data are often limited to the patient’s church preference, name of clergy, whom to call in case of emergency, dietary requirements, and any religious implications for medical care (e.g., refusal of organ transplants or blood transfusion). Over time, as you have more contact with the patient and family, trust will develop, and you will be able to obtain more sensitive, complex, and meaningful information.
<<Instructor: Review with the students the bulleted items on this slide and encourage discussion about identifying how each of these can be a source of information about spirituality.>>
<<Instructor: Please review each bulleted item while referring to the following notes.>>
Moral distress: This is experienced when the person makes an ethical or moral decision but then is unable to carry out the chosen action. Defining characteristics include anguish, powerlessness, guilt, frustration, anxiety, self-doubt, and fear over the inability to act on the moral choice.
Spiritual distress: This is the “impaired ability to experience and integrate meaning and purpose in life through a person’s connectedness with self, others, art, music, literature, nature, or a power greater than oneself” (NANDA International, 2012, p. 410).
Risk for spiritual distress: This exists when the patient experiences energy-consuming anxiety, low self-esteem, mental illness, physical illness, blocks to self-love, poor relationships, physical or psychological stress, substance abuse, loss of loved one, natural disasters, situational losses, maturational losses, or inability to forgive. Illness creates countless risk factors for spiritual distress.
Readiness for enhanced spiritual well-being: NANDA-I (2012) defines it as the “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 that can be strengthened” (p. 394).
<<Instructor: Review each bulleted item while referring to the following notes.>>
Impaired Religiosity is difficulty in exercising or impaired ability to exercise reliance on beliefs or to participate in rituals of a faith tradition (e.g., go to church, take communion).
Risk for impaired Religiosity occurs when risk factors for Impaired Religiosity are present but symptoms are not. Risk factors may be categorized as developmental, environmental, physical, psychological, sociocultural, or spiritual. Specific examples include life transitions, lack of transportation, pain, depression, social isolation, and suffering.
Readiness for Enhanced Religiosity is the ability to increase reliance on religious beliefs and/or participate in rituals of a particular faith tradition. The patient is not experiencing a problem but wishes to make a satisfactory situation even better.
Spiritual Pain (non-NANDA) may occur when a person experiences a combination of awareness of death, loss of relationships, loss of self, loss of purpose, and loss of control. However, this combination of negative experiences can be balanced by having a life-affirming and transcending purpose and an internal sense of control. The presence and quality of Spiritual Pain is determined by the degree to which the person is experiencing each component, and by the relationship of the components to each other.
<<Instructor: Review each bulleted point while referring to the following notes.>>
NOC standardized outcomes: NOC standardized outcomes associated with spirituality diagnoses include, but are not limited to, the following: Anxiety Level, Comfortable Death, Comfort Status: Psychospiritual, Dignified Life Closure, Hope, Loneliness Severity, Personal Resiliency, Personal Well-Being, Quality of Life, Spiritual Health, and Will to Live (Moorhead, Johnson, Maas, et al., 2013).
NIC standardized interventions:
Active Listening
Presence
Touch
Exploring Meaning
Reminiscence Therapy
Spiritual Support
Forgiveness Facilitation
Hope Inspiration
Prayer
<<Review each bulleted item with the students and encourage discussion.>>
<<Instructor: Review each bulleted item while referring to the following notes.>>
Always feel free to pray or not to: if you feel at all uncomfortable about offering prayer, then you should state those feelings and offer to find someone who is comfortable with prayer.
<<Instructor: Review each bulleted item with the students and encourage discussion.>>
<<Instructor: Review each bulleted item while referring to the following notes.>>
For many people, prayer provides for periods of intimacy with God, reveals the presence and love of God, and serves as a powerful source of comfort and hope. For those who embrace the power and influence of prayer, it supports their spiritual journeys and may help them experience forgiveness, love, hope, trust, and meaning. Symbolically, a nurse engaged in prayer manifests the reality of God’s presence with that patient.
You can support patients’ prayer needs by offering to pray, meditate, or read spiritual text with them, or by providing literature, music, or other items the patient uses in prayer.
<<Instructor: Review each bulleted item and encourage discussion with the students.>>
<<Instructor: Review each bulleted item and encourage discussion with the students.>>
<<Instructor: Select the most appropriate answer to the question using your clicker.>>
<<Instructor: The correct answer is B.>>
<<Instructor: Encourage active discussion with the students while answering these questions.>>
