Spirituality is a complex concept that is unique to each individual; it depends on a person’s culture, development, life experiences, beliefs, and ideas about life (McSherry, 2007). Furthermore, spirituality is an inherent human characteristic that exists in all people, regardless of their religious beliefs. It gives individuals the energy needed to discover themselves, cope with difficult situations, and maintain health (Villagomeza, 2006). Energy generated by spirituality helps patients feel well and guides choices made throughout life. Spirituality enables a person to love, have faith and hope, seek meaning in life, and nurture relationships with others. Because it is subjective, multidimensional, and personal, researchers and scholars cannot agree on a universal definition of spirituality (Tanyi, McKenzie, and Chapek, 2009). However, five distinct but overlapping constructs are frequently found in definitions of spirituality (Fig. 35-1).

Self-transcendence is a sense of authentically connecting to one’s inner self (Vachon, Fillion, and Achille, 2009), whereas transcendence is the belief that a force outside of and greater than the person exists beyond the material world (Bailey et al., 2009). Individuals usually see this force as positive, and it allows people to have new experiences and develop new perspectives that are beyond ordinary physical boundaries. Examples of transcendent moments include the feeling of awe when holding a new baby or looking at a beautiful sunset. Spirituality offers a sense of connectedness intrapersonally (connected within oneself), interpersonally (connected with others and the environment), and transpersonally (connected with the unseen, God, or a higher power). Through connectedness patients are able to move beyond the stressors of everyday life and find comfort, faith, hope, peace, and empowerment (Nelson-Becker, Nakashima, and Canda, 2007). Faith allows people to have firm beliefs despite lack of physical evidence. It enables them to believe in and establish transpersonal connections. Although many people associate faith with religious beliefs, it exists without religious beliefs (Villagomeza, 2006). Hope has several meanings that vary on the basis of how it is being experienced; it usually refers to an energizing source that has an orientation to future goals and outcomes (Phillips-Salimi et al., 2007; Vachon, Fillion, and Achille, 2009).

Spirituality gives people the ability to find a dynamic and creative sense of inner strength that is often used when making difficult decisions. Inner strength is a source of energy that instills hope, provides motivation, and promotes a positive outlook on life (Lundman et al., 2010). Inner peace fosters calm, positive, and peaceful feelings despite life experiences of chaos, fear, and uncertainty. These feelings help people feel comforted even in times of great distress (Hanson et al., 2008). Spirituality also helps people find meaning and purpose in life in both positive and negative life events (Bailey et al., 2009; Vachon, Fillion, and Achille, 2009).

Some people do not believe in the existence of God (atheist) or they believe that there is no known ultimate reality (agnostic). This does not mean that spirituality is not an important concept for the atheist or agnostic (Smith-Stoner, 2007). Atheists search for meaning in life through their work and their relationships with others. Agnostics discover meaning in what they do or how they live because they find no ultimate meaning for the way things are. They believe that people bring meaning to what they do.

Spirituality is an integrating theme. A person’s concept of spirituality begins in childhood and continues to grow throughout adulthood (Narayanasamy et al., 2004; Smith and McSherry, 2004). It represents the totality of one’s being, serving as the overriding perspective that unifies the various aspects of an individual. It spreads through all dimensions of a person’s life, whether or not the person acknowledges or develops it.

The concept of spiritual well-being is often described as having two dimensions. The vertical dimension supports the transcendent relationship between a person and God or some other higher power. The horizontal dimension describes positive relationships and connections that people have with others (Gray, 2006; Smith, 2006). Spiritual well-being has a positive effect on health. Those who experience spiritual well-being feel connected to others and are able to find meaning or purpose in their lives. Spiritual well-being leads to spiritual health. Those who are spiritually healthy experience joy, are able to forgive themselves and others, accept hardship and mortality, report an enhanced quality of life, and have a positive sense of physical and emotional well-being (Whelan-Gales et al., 2009; Yampolsky et al., 2008).

In addition to being a part of the definition of spirituality, the concept of faith has other common definitions. Faith is a cultural or institutional religion such as Judaism, Buddhism, Islam, or Christianity. It is also a relationship with a divinity, higher power, authority, or spirit that incorporates a reasoning faith (belief) and a trusting faith (action). Reasoning faith provides confidence in something for which there is no proof. It is an acceptance of what reasoning cannot explain. Sometimes faith involves a belief in a higher power, spirit guide, God, or Allah. Faith is also the manner in which a person chooses to live. It gives purpose and meaning to an individual’s life, allowing for action. Many times patients who are ill have a positive outlook on life and continue to pursue daily activities rather than resign themselves to the symptoms of the disease. Their faith often becomes stronger because they view their illness as an opportunity for personal growth (Alcorn et al., 2010; Ford et al., 2010).

Religion is associated with the “state of doing,” or a specific system of practices associated with a particular denomination, sect, or form of worship. Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. Many people practice a faith or belief in the doctrines and expressions of a specific religion or sect such as the Lutheran church or Orthodox Judaism. People from different religions view spirituality differently. For example, a Buddhist believes in Four Noble Truths: life is suffering; suffering is caused by clinging; suffering can be eliminated by eliminating clinging; and to eliminate clinging and suffering, one follows an eightfold path. The path includes right understanding, intention, speech, action, livelihood, effort, mindfulness, and concentration. It promotes wisdom, moral behavior, and meditation (Wilkins, Mailoo, and Kularatne, 2010). A Buddhist turns inward, valuing self-control, whereas a Christian looks to the love of God to provide enlightenment and direction in life.

When providing spiritual care to a patient, it is important to understand the differences between religion and spirituality. Many people tend to use the terms spirituality and religion interchangeably. Although closely associated, these terms are not synonymous. Religious practices encompass spirituality, but spirituality does not need to include religious practice. Religious care helps patients maintain their faithfulness to their belief systems and worship practices. Spiritual care helps people identify meaning and purpose in life, look beyond the present, and maintain personal relationships and a relationship with a higher being or life force.

Spirituality and faith bring hope. When a person has the attitude of something to live for and look forward to, hope is present. It is a multidimensional concept that provides comfort while people endure life-threatening situations, hardships, and other personal challenges. It is closely associated with faith and is energizing, giving individuals a motivation to achieve and the resources to use toward that achievement. People express hope in all aspects of their lives to help them deal with life stressors. Hope is a valuable personal resource whenever someone is facing a loss (see Chapter 36) or a difficult challenge (Duggleby, Cooper, and Penz, 2009).

Sudden, unexpected illness frequently creates significant spiritual distress. For example, both the 50-year-old patient who has a heart attack and the 20-year-old patient who is in a motor vehicle accident face crises that threaten their spiritual health. The illness or injury creates an unanticipated scramble to integrate and cope with new realities (e.g., disability). People often look for ways to remain faithful to their beliefs and value systems. Some pray, attend religious services more often, or spend time reflecting on the positive aspects of their lives. Often conflicts develop around a person’s beliefs and the meaning of life. Anger is common; and patients sometimes express it against God, their families, themselves, or the nurse. The strength of a patient’s spirituality influences how he or she copes with sudden illness and how quickly he or she moves to recovery. Nurses use knowledge of a person’s spiritual well-being and implement spiritual interventions to maximize inner peace and healing (Yeager et al., 2010).

Many chronic illnesses threaten the person’s independence, causing fear, anxiety, and spiritual distress. Dependence on others for routine self-care needs often creates feelings of powerlessness. Powerlessness and the loss of a sense of purpose in life impair the ability to cope with alterations in functioning. Spirituality significantly helps patients and their family caregivers adapt to the changes that result from chronic illness (Box 35-1). Successful adaptation often provides spiritual growth. Patients who have a sense of spiritual well-being, feel connected with a higher power and others, and are able to find meaning and purpose in life are better able to cope with and accept their chronic illness (Daaleman and Dobbs, 2010; Ebadi et al., 2009).

Terminal illness commonly causes fears of physical pain, isolation, the unknown, and dying. It creates an uncertainty about what death means, making patients susceptible to spiritual distress. However, some patients have a spiritual sense of peace that enables them to face death without fear. Spirituality helps these patients find peace in themselves and their death. Individuals experiencing a terminal illness often find themselves reviewing their life and questioning its meaning. Common questions they ask include “Why is this happening to me?” or “What have I done?” Terminal illness often affects family and friends just as much as the patient. It causes members of the family to ask important questions about its meaning and how it will affect their relationship with the patient (see Chapter 36). In addition to managing patients’ physical and psychosocial symptoms experienced at the end of life, empower them to have a greater sense of control over their disease, regardless of whether they receive care in a hospital or at home. Providing holistic care is essential because dying is a part of life that encompasses the patient’s physical, social, psychological, and spiritual health (Wasserman, 2008).

Some nurses care for patients who have had a near-death experience (NDE). An NDE is a psychological phenomenon of people who either have been close to clinical death or have recovered after being declared dead. It is not associated with a mental disorder. Persons who experience an NDE often tell the same story of feeling themselves rising above their bodies and watching caregivers initiate lifesaving measures. Most individuals describe passing through a tunnel to a bright light, encountering people who had preceded them in death, and feeling an inner tranquility and peace. Instead of moving toward the light, they learn that it is not time for them to die, and they return to life (Rominger, 2010).

Patients who have an NDE are often reluctant to discuss it, thinking that others will not understand. However, individuals experiencing an NDE who discuss it with family or caregivers find acceptance and meaning from this powerful experience. They are often no longer afraid of death. After a patient has survived an NDE, it is important to remain open and give him or her a chance to explore what happened. Provide support if the patient decides to share the experience with significant others (Duffy, 2007).

You can assess a patient’s spiritual health in several different ways. One way is to ask direct questions (Box 35-2). This approach requires you to feel comfortable asking others about their spirituality. Several assessment tools are available to help nurses clarify values and assess spirituality. For example, the spiritual well-being (SWB) scale has 20 items that assess the individual’s view of life and relationship with a higher power (Gray, 2006). The B-E-L-I-E-F assessment tool helps nurses evaluate a child’s and family’s spiritual and religious needs (McEvoy, 2003). The acronym stands for the following:

Assess the source of authority and guidance that patients use in life to choose and act on their beliefs. Determine if the patient has a religious source of guidance that conflicts with medical treatment plans and affects the option that nurses and other health care providers are able to offer patients. For example, if a patient is a Jehovah’s Witness, blood products are not an acceptable form of treatment. Christian Scientists often refuse any medical intervention, believing that their faith heals them. It is also important to understand a patient’s philosophy of life. Assessment data reveal the basis of the patient’s belief system regarding meaning and purpose in life and the patient’s spiritual focus. This information often reflects the impact that illness, loss, or disability has on the person’s life. Considerable religious diversity exists in the United States. A patient’s religious faith and practices, views about health, and the response to illness often influence how nurses provide support (Table 35-1).

TABLE 35-1

Religious Beliefs About Health

RELIGIOUS OR CULTURAL GROUP	HEALTH CARE BELIEFS	RESPONSE TO ILLNESS	IMPLICATIONS FOR HEALTH AND NURSING
Hinduism	Accepts modern medical science Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Legal Implications in Nursing Practice Young and Middle Adults Nursing Diagnosis Stress and Coping Stay updated, free articles. Join our Telegram channel Join Tags: Fundamentals of Nursing Nov 17, 2016 | Posted by admin in NURSING | Comments Off on Spiritual Health Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access