Spiritual Needs, Spiritual Caring, and Religious Differences



Spiritual Needs, Spiritual Caring, and Religious Differences



Objectives


On completing this chapter, you will be able to do the following:


1. Differentiate between spirituality and religion.


2. Identify the difference between the spiritual and emotional dimensions of individuals.


3. Discuss the practical/vocational nurse’s role in providing spiritual care to the patient and the family.


4. Discuss nursing interventions that can be used to meet the spiritual needs of patients.


5. List members of the health care team who can help provide spiritual care for patients.


6. Discuss personal religious and/or spiritual beliefs, or the absence of them, and how these beliefs will influence nursing practice.


7. Discuss the general beliefs and practices that account for the differences among various Western, Middle Eastern, and Eastern religions, philosophies, and groups in the United States and Canada.


8. Describe nursing interventions/considerations of patients of various religions, philosophies, and groups.



Key Terms



image http://evolve.elsevier.com/Hill/success



image   Keep in Mind


If you were hospitalized, is it important to you that the staff be informed of your spiritual practices?



Jan, the evening nurse, found Thomas Bernes, age 32, sitting up in bed, crying and moaning with what she interpreted as pain after a testicular biopsy that was positive for cancer. After assessment, she volunteered to get Thomas some pain medication, but he refused. Thomas shouts, “Why did I have to get cancer? Why me?” Then he says, “Oh, I’ll be fine. Just leave me alone and I will get rid of the pain myself.” Jan quickly and quietly leaves the room so Thomas can be alone.


In its Nursing Diagnoses: 2009–2011 edition, the North American Nursing Diagnosis Association (NANDA) includes “spiritual distress” as a nursing diagnosis. In the foregoing patient situation, Thomas was in spiritual distress. A minister or priest might have been able to address Thomas’s problem, but Thomas needed immediate spiritual care. It would have been helpful to Thomas if his nurse had offered to spend time with him and encouraged him to talk about what he was thinking and feeling at that time. Nursing has always embraced a holistic approach to patient care: care of the body, mind, and spirit. Despite the NANDA-I diagnosis, some nurses are uncomfortable with matters of the spirit. Some have not had adequate education in how to deal with patients in this aspect of care.



Spirituality and religion


Spirituality is an essential part of being human. The word comes from the Latin word spiritus, which means “breath” or “air.” The spirit is the very essence of a person, the innermost part of a person that provides animation. The spirit is a life force that penetrates a person’s entire being. It includes the beliefs and value systems that give people strength and hope. The spirit gives meaning to life. It is hoped that the spiritual self grows and matures throughout one’s life.


The terms spirituality and religion are related, but they have different meanings. Religion may be a spiritual experience that contains specific beliefs and rituals. It can include spirituality, but spirituality, one’s life force, does not necessarily include religion. Participation in a religion may include spirituality, but spirituality does not necessarily include participation in a religion. According to LeGere (Carson, 1989), spirituality is not a religion. Spirituality is related to experience, but religion has to do with giving form to that experience. Spirituality focuses on what happens in the heart, and religion tries to make rules and capture that experience in a system.





Who needs spiritual care?


An individual’s spiritual dimension is a very private and personal area. Although all people have a spiritual dimension, needs that arise in this area depend on a variety of situations and the individual’s ability to cope with them. An example of nurses who routinely recognize spiritual needs are nurses who work with patients in various church settings in a health ministry. The goal of these parish nurses is to keep their groups happy and healthy by treating the whole person—body, mind, and spirit. Parish nurses recognize the relationship between spirituality and health and encourage spiritual growth in their patients.


Crisis situations occur in all health care situations, but they especially arise in acute health care. Patients’ beliefs and values can profoundly affect their response to these crises, their attitude toward treatment, and their rate of recovery. Be alert for the following patient situations that may intensify the need for spiritual care for patients and families:



In her article “Called to Care: Addressing the Spiritual Needs of Patients,” Schoenbeck (1994) said, “When the body and mind are battered by time and use, the spirit, the very essence of the patient, remains.”



Gathering data for spiritual issues


The first step to providing spiritual care for patients is to strive to become comfortable dealing with spiritual matters. The second step is to become aware of your own spirituality and the spirit that is the essence of you. Gather data about your spiritual self. The exercise in the Try This: Your Personal Spirituality box can help you increase awareness of your personal spirituality.



image   Try This


Your Personal Spirituality





image   Critical Thinking


My Spiritual Sensitivity


Have you ever said or heard others say, “My spirit is broken”? What does this remark mean to you?



Meeting the spiritual needs of patients and their families


Once you know your spiritual self, you will be better able to help others meet their spiritual needs. When you acknowledge that your beliefs are effective for you but not necessarily for others, you will be able to set your beliefs aside when helping patients and families meet their spiritual needs. The questions in the Your Personal Spirituality box can also be used to gather data for patients’ spiritual condition. Respect for the belief system of patients and families can give strength, hope, and meaning to their lives. When working with patients and families, try to do the following:



• Ask questions to help patients and families verbalize beliefs, fears, and concerns, such as “What do you think is going to happen to you (your father/mother)?” and “Who is your source of support?”


• Show interest through supportive statements (see Chapter 13).


• Listen with an understanding attitude. Be sure your body language and affective response reflect what you are saying.


• Respond as naturally to spiritual concerns as you do to physical needs.


• Help patients face the reality of a terminal illness without abandoning hope.


• Encourage the patient’s active involvement in self-care, which can help uphold hope.


• Allow families to participate in caregiving (e.g., offering fluids/ice chips, when allowed; wiping the patient’s brow).


• Avoid false assurances such as “Everything will be okay.”


• When a patient faces death, you can help to make the remaining days meaningful by attending to needs, respecting their beliefs and death practices, and approaching the patient in a supportive and empathetic manner. Feeling loved helps bring peace to the dying.


Box 17-1 lists spiritual care interventions that can be used by practical/vocational nurses.



Box 17-1   Spiritual Care Interventions




• Ask open-ended questions.


• Actively listen to the patient. Sit beside the patient. Make eye contact.


• Be nonjudgmental of patients and their responses.


• Avoid giving advice or a lecture to the patient.


• Avoid being a proselytizer (i.e., a person who tries to convert another person to one’s religion).


• Be aware of nonverbal messages from the patient.


• Understand the feelings of the patient, but avoid adopting those feelings for yourself. (See Chapter 13 for a discussion of sympathy versus empathy.)


• Expect to learn from patients.


• Stay with the patient after the person has received an unfavorable diagnosis.


• When patients request help with prayer, offer to pray with them.


• When a patient requests help with specific readings, offer to read to him or her.


• Assist the patient to participate in desired religious/spiritual rituals.


• Protect the patient’s religious/spiritual articles.



Pastoral care team


The pastoral care team is made up of ministers, priests, rabbis, consecrated religious women (i.e., nuns/sisters), representatives of other religious organizations, and laypersons. All are educated to meet spiritual needs, in addition to religious needs, in a health care setting. The members of this team are allies with nurses in providing spiritual care. You can notify this team if a patient requests a visit. When members of the pastoral care team come to the unit to fill the request, inform them of the patient’s background and condition. Describe the interventions you have incorporated into the patient’s care to provide spiritual care. Remember that the pastoral care team does not relieve you of your responsibility to provide spiritual care.


By visiting, talking, and listening, the pastoral care team explores the patients’ fears, hopes, and sources of strength. Because of federal privacy standards (see the Health Insurance Portability and Accountability Act [HIPAA] in Chapter 12), the health care facility may not make a patient’s name available to church representatives without the patient’s permission. Before being hospitalized/admitted, patients can personally notify their clergy regarding a planned hospitalization and desire for a visit. If an admitted patient requests a visit of personal clergy, follow the facility directive for arranging this request. Agency policies vary and are being tested nationwide.



How patients meet spiritual needs


Patients’ spiritual practices


Regardless of religious beliefs, or lack of them, all patients have a spiritual self. They also have spiritual needs and personal spiritual practices to meet those needs. Spiritual practices help individuals to develop an awareness of self, an understanding of the meaning and purpose of life, and an appreciation of their relationship to a higher power. Examples of personal spiritual practices may include gardening, reading inspirational books, listening to music, meditating, watching select TV shows and movies, communing with nature, walking a labyrinth, practicing breathing techniques, enjoying art, enjoying fresh flowers, volunteering, expressing gratitude, counting blessings, walking, talking with friends and relatives, and participating in crafts and hobbies.




image   Try This


My Spiritual Practices


Identify the spiritual practices that you use to meet spiritual needs.



Religion and the patient


The religious self refers to the specific beliefs an individual holds in regard to a higher power. Some patients help to meet their spiritual needs by belonging to a specific religious denomination. A religious denomination is an organized group of people who share a philosophy that supports their particular concept of God or a higher power, as well as worship experiences.


Agnostics hold the belief that the existence of God can be neither proved nor disproved. Atheists do not believe that the supernatural exists, so they do not believe in God. Christians may find comfort and solace in their refuge in God, including passing into another life after death. The atheist does not have this belief. It may be difficult for the nurse who believes in the supernatural to relate to a person with atheistic beliefs. The nurse may feel unsuccessful in meeting the total needs of the patient who is an atheist because atheists do not believe in the supernatural. The spiritual aspect, however, is present in all individuals. Spiritual assessment and interventions are appropriate for agnostic and atheist patients. Encourage these patients to express personal feelings about life, death, separation, and loss.



image   Professional Pointer


Avoid imposing your personal beliefs and values on the patient.



Value of rituals and practices


The different rituals and practices of a religion are stabilizing forces for the patient. Rituals are a series of actions that have religious meaning. They can bring the security of the past into a crisis situation. Concrete symbols such as pictures, icons, herb packets, rosaries, statues, jewelry, and other objects can affirm the patient’s connection with a higher power.


The value of patients’ rituals and religious practices is determined by their faith. Value is not determined by scientific proof of their benefit. Studies have shown that people who have faith recover more quickly from illness, surgery, and addiction and are less likely to die prematurely from any cause. When patients are not allowed to practice their religious rituals, practices, and responsibilities, they may feel guilty and uneasy. This can also affect their recovery. As a practical/vocational nurse, you need to develop an awareness of the general religious philosophy of the patient’s belief system. If membership is claimed in a specific denomination, question the patient about the rituals and exercises that the patient believes in and practices. Spiritual distress can be observed in patients who are unable to practice their religious rituals. It also can be observed in patients who experience a conflict between their religious and spiritual beliefs and the prescribed health regimen (e.g., a Catholic patient with continuous, severe psychiatric problems who is advised to avoid pregnancy).



The patient and prayer


Prayer is a spiritual practice of some individuals whether or not they are members of an organized religion. Prayer can put a patient in touch with a personal higher power. Sometimes prayer can decrease anxiety as effectively as a drug. Prayer helps some patients cope with their illness or situation. Honor the request of the patient who wants to pray privately. If the patient requests prayer, the nurse needs to assist the patient or seek assistance in this matter. When patients express an interest in praying, ask what prayer they would like to say. Try to accommodate the request.


In her book Spiritual Dimensions of Nursing Practice (1989), Carson comments on conversational prayer, one of the many forms that prayer can take. In this type of prayer, the specific concerns and needs of the patient are included in the prayer. Carson provides the following interaction between a patient awaiting a cesarean section and a nurse who noticed the patient had been crying. It is an excellent example of the simplicity and effectiveness of conversational prayer.




The religious american


Examples of the religious American include Hindu, Jew, Buddhist, Muslim, Lutheran (Evangelical Lutheran Church in America, Wisconsin Synod, Missouri Synod, and English Synod), Catholic (Roman Rite, Eastern Rite as Ukrainian Catholic, and Greek Catholic), Eastern Orthodox (Russian Orthodox and Greek Orthodox), Quaker, Presbyterian, Methodist, Church of Christ, Mennonite, Seventh-Day Adventist, Assembly of God, Mormon, Baptist (Independent and Southern Baptist Convention), Wiccan, Jehovah’s Witness, Episcopalian, African Methodist Episcopalian, Christian Science, United Church of Christ, Moravian, Evangelical, Salvation Army, and nondenominational.


The First Amendment of the U.S. Constitution allows the free exercise of religious choice. Starting with the Pilgrims, America has a long history of religious freedom and tolerance. As the preceding list shows, the United States is religiously diverse.



Religion in the united states


The U.S. Census Bureau does not ask about religion on the census questionnaire. The number of persons belonging to specific religious denominations and groups in the United States can be found at www.adherents.com. The approximate sizes of Protestant, Catholic, Jewish, and Islamic denominations in the United States follow:




Avoiding false assumptions and stereotypes


The suggestions presented in Chapter 16 regarding the avoidance of false assumptions and stereotyping when caring for culturally diverse patients also apply when caring for patients of different religions. Some nursing students may think there is also a guidebook that supplies nursing interventions when caring for patients who belong to different religions. As with different cultures, this type of approach can lead to false assumptions and stereotyping. Not only is there diversity among religious groups, but there is also diversity among members of a specific religion or group. It is a false assumption to expect that all individuals of a specific religion or belief system will believe exactly the same just because they are members of that religion or belief system. Avoid assuming that all Protestants, Catholics, Jews, Muslims, Buddhists, and Hindus, for example, believe in and follow all the aspects of their formal religion/belief system. Individual differences occur in every religious or belief systems group. Members may have modified the degree to which they observe the practices of their religion or belief system based on age, experience, education, social group, and so on. Avoid judging patients if their religious beliefs do not conform to the traditional ones for that religion. Data must be gathered about each patient’s specific beliefs and religious practices (Box 17-2).



Box 17-2   Gathering Data for Religious Beliefs and Practices of Patients




The nursing interventions provided in Boxes 17-3 to 17-8 and Tables 17-1 and 17-2 will serve as a reference to be used in meeting the religious needs of specific patients during your time as a student practical/vocational nurse. This information can also be used in your nursing career after you graduate. Each religion has specific beliefs and practices. Sometimes an individual will adapt them to fit his or her own circumstances. Clarify with the patient the specific beliefs and practices that offer comfort to them and that they prefer. Develop an awareness of health issues and decisions that may involve religious or philosophical beliefs. The references at the end of this book can be used to learn more about a specific religion when such information is needed. Also, check www.beliefnet.com.



Box 17-3   Beliefs, Practices, and Nursing Interventions for Jewish Patients


General







Dying jewish patient



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Mar 1, 2017 | Posted by in NURSING | Comments Off on Spiritual Needs, Spiritual Caring, and Religious Differences

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