Spirituality

SPIRITUALITY spiritual distress – spiritual pain, alienation, anxiety, guilt, anger, loss, and despair spiritual needs – underlying all religious traditions and common to all people are • need for meaning and purpose - offer compassionate presence - assist in struggle to find meaning and purpose in face of suffering, illness, and death • need for love and relatedness - foster relationships (with God/humans) that nurture spirit • need for forgiveness - facilitate pt’s expression of religious or spiritual beliefs and practices spirituality – anything that pertains to person’s relationship with a nonmaterial life force or higher power - not something that runs parallel to rest of human life - ultimate depth of everything spiritual creatures do when they realize themselves (laugh, cry, accept responsibilities, love, live, die, stand up for truth, break out of preoccupation, hope, refuse to be embittered by stupidity) - live as if in opposition to selfishness and to the despair that always assails - elements include * experienced as unifying force, essence of being * expressed and experienced in and through connectedness w/nature and other people * shapes self-becoming and reflected in one’s being, knowing, and doing * permeates life, providing purpose, meaning, strength, and guidance and shaping the journey faith – confident belief in something for which there is no proof or material evidence - involves a person, idea, or thing, and usually followed by action related to the ideals or values of that belief - religions share * conviction of fundamental unity of human family, quality and dignity of all human beings * sense of sacredness of individual and conscience * sense of value of human community * belief that love, compassion, unselfishness, and force of inner truthfulness and of spirit have greater power than hate, enmity, and self-interest * sense of obligation to stand on side of poor and oppressed * profound hope that good will finally prevail atheist – person who denies existence of a God agnostic – one who holds that nothing can be known about the existence of a God

hope – ingredient in life responsible for positive outlook in even life’s bleakest moments - enables ability to consider a future and to actively bring that future into being - originates in imagination but must become a values and realistic possibility in order to energize action - unique to each person love – develops from basic human need to love and be loved, cannot be spiritually whole, spiritually healthy, unless this need is met religion – organized system of beliefs about a higher power - set forms of worship, spiritual practices, and codes of conduct - can directly influence pt’s response to illness and suffering, self-care practices, birth and death rituals, gender roles, spiritual practices, and moral codes - never presume to know what a pt’s religious beliefs are upon learning pt’s faith - do not interpret the fact that a pt does not belong to an organized religion to mean that pt has no spiritual needs; person may be deeply spiritual yet not profess a religion

I.

SPIRITUALITY, HEALTH

A. pt

GUIDE

TO

AND

ILLNESS

DAILY LIVING HABITS- certain practices may have religious significance for

- ex. dietary requirements and restrictions; acceptable birth-control practices B.

SOURCE OF SUPPORT- many seek support during times of stress - support is vital to acceptance of illness, especially if it is a prolonged period of convalescence or a questionable outcome - prayer, devotional reading, and other religious practices often do spiritually what protective exercises do physically C.

SOURCE OF STRENGTH AND HEALING - values derived from religious faith cannot be enumerated or evaluated easily - effects are constantly in evidence - endure extreme physical distress because of strong faith - taken on almost unbelievable rehabilitative tasks because of faith in eventual positive results D. SOURCE OF CONFLICT - sometimes religious beliefs conflict with prevalent healthcare practices - ex. Jehovah’s Witnesses prohibits blood transfusions; some view illness as punishment for sin and is therefore inevitable - acknowledgment of pt’s religious convictions and efforts by health practitioners to accommodate pt’s

beliefs can result in quality healthcare without violating person’s religious practices - ea. person is unique and has a right to pursue their own convictions, even though they may differ from those of the healthcare provider - major questions that religious beliefs, attitudes, and values can color include * meaning of suffering * how the physical body is regarded and its functions * meaning and role of gender differences, sexuality, and reproduction * how birth, aging, and death are understood and responded to * what constitutes the self, and how selfhood is to be assessed * how sin and moral culpability are understood (what makes something sinful, how sin is relieved or absolved) * tradition’s specific bioethical teachings

II.

FACTORS AFFECTING SPIRITUALITY

A.

DEVELOPMENTAL CONSIDERATIONS - child must have some capacity for abstract thought before beginning to understand the spiritual self - not to say spirituality is meaningless to children - common themes in all children * notion of God who works through human intimacy and interconnectedness of lives * belief that God is involved in self-change, growth, and transformations that make the world fresh, alive and meaningful * attributing to God tremendous and expansive power and showing considerable anxiety in face of this power * image of light - life experiences usually influence and mature spiritual beliefs - with advancing years, people have a tendency to think about life after death prompting some to reexamine and reaffirm their spiritual beliefs B.

FAMILY - parents play key role in development of child’s spirituality - what is important is what child learns about God, life, and self from parents’ behavior C.

ETHNIC BACKGROUND - clear distinctions between Eastern and Western spiritual traditions as well as individual ethnic groups - culture and formal religion have much to do with whether basic approach to religion is doing something, being someone, or continually striving for harmony D.

FORMAL RELIGION- common characteristics of major religious groups include

* * * * * *

basis of authority or source of power scripture or sacred word ethical code that defines right and wrong psychology and identity aspirations or expectations ideas about what follows death

E. LIFE EVENTS - both positive and negative life experiences are influenced by the meaning a person’s spiritual beliefs attribute to them - ex. two women who believe in a loving God ea. lose a child in a car accident, one bitterly denies God’s existence and the other spends more time in prayer asking God to help her - ex. chain of successful life experiences (marriage, promotion) may cause one person to assume success and experience no need for God; another finds cause for deep gratitude and rejoicing

III.

RELIGIOUS FAITHS

- major wisdom traditions address the invisible Spirit by creating principles and practices that * cultivate love of ourselves, neighbors, God and nature * cultivate wisdom that helps find meaning in life, in relationships with others, in being true to ourselves, living in uncertainty and mystery, dealing with suffering, sickness, and death, and honoring life’s transitions * cultivate awareness of sacred dimension of life through worship, prayer, meditation, singing * respect connectedness while acknowledging differences * helps us be generous in service to others - life affirming influences enhance life, give meaning and purpose to existence, strengthen one’s feelings of self-worth, encourage self-actualization, and are health giving and life sustaining - life denying influences restrict or enclose life patterns, limit experiences and associations, place burdens of guilt on individuals, encourage feelings of unworthiness, and are health denying and life inhibiting A. ADVENTIST – believe in individual’s choice and God’s sovereignty; body is believed to be temple of Holy Spirit - many regard Saturday as Sabbath - all narcotics and stimulants is prohibited B.

AMERICAN MUSLIM MISSION – Koran is sacred scripture - stresses importance of cooperation among blacks in business and education - encourage healthcare provided by black community

- tenets involve prayer rituals, dietary restrictions, hygiene, lifestyle modifications, and marital faithfulness C.

BUDDHISM – believe that the real cause of human suffering is ignorant craving - Noble Eightfold Path - - consists of right views, aspirations, speech, conduct, mode of livelihood, effort, mindfulness, and concentration - accepts modern science with avoidance of extremes applied to use of drugs, blood, vaccines - check on any special diet restrictions and observance of holy days D. CHRISTIAN SCIENCE – believe sickness and sin are errors of human mind and can be overcome by altering thoughts, not by using drugs or medicines - will use orthopedic services to set a bone but decline drugs and other medical or surgical procedures - alcohol and tobacco are not used E. LATTER DAY SAINTS (MORMONS) – believe in divine healing through the “laying on of hands”, though many do not prohibit medical therapy - disapprove of alcohol, tobacco, and caffeinated beverages - special undergarment worn by some that should be removed only in an emergency F. HINDUISM – moral factors, linked with doctrine of “karma”, believed to be significant in promoting health or causing disease - surprising openness to new ideas, at least with respect to practical treatment - dietary restrictions conform to individual sect doctrine - medical personnel should avoid touching patient’s lips when administering medications - prescribed rites are followed after death; disposal of body is by cremation G. JEHOVAH’S WITNESSES – oppose “false teachings”, often extends to modern science, including medicine - blood transfusions violate God’s laws and are not allowed - courts have not supported the right of parents to refuse life-saving treatment for children H.

JUDAISM – Hebrew Bible is authority, guide, and inspiration of the Jews - special needs in diet, birth rituals, male and female contact, and death - treatment and procedures should not be scheduled on the Sabbath

I. ISLAM – Allah, on God, who is only one, all seeing, hearing, knowing, willing and powerful - may have fatalistic view of health

- obligatory prayers, holy days, and fasting, and almsgiving - Koranic law and customs that influence birth, diet, care of women, death, and prayer rituals - women are not allowed to make independent decisions J. PROTESTANTISM – worship of one God revealed to world through Jesus Christ with most accepting modern medial science - sacraments: baptism, communion, confirmation K.

ROMAN CATHOLICISM – worship of one God revealed to world through Jesus Christ - many take an antiabortion stance, most accept modern medical science - seven sacraments (baptism, eucharist, penanace, anointing of the sick) - only natural means of birth control; abortion, euthanasia, sterilization are forbidden L. UNIFICATION CHURCH – goal is to unite Christians everywhere as one family under God - little information available on interactions with healthcare M. UNITARIAN UNIVERSAL ASSOCIATION – no member is required to adhere to given creed or set of religious beliefs - free to accept what they take to be best for their health

IV.

NURSING PROCESS

A. NURSING HISTORY - data are gathered about pt’s spiritual beliefs and practices, effect of these beliefs on everyday living, spiritual distress, and spiritual needs - categories of assessment: * spiritual pain * spiritual alienation * spiritual anger * spiritual anxiety * spiritual guilt * spiritual loss * spiritual despair NURSING OBSERVATION - pts find it difficult to talk about their spiritual beliefs and problems, observe pt’s behavior for signs of spiritual distress - include sudden changes in spiritual practices (rejection, neglect), mood changes (frequent crying, depression, apathy, anger), sudden interest in spiritual matters (reading religious material, watching religious programs, visits to clergy), and disturbed sleep B.

ANALYSIS / DIAGNOSIS 1. POTENTIAL FOR ENHANCED SPIRITUAL WELL-BEING – process of individual’s developing/unfolding of mystery through harmonious interconnectedness that springs from inner strengths 2. SPIRITUAL DISTRESS – disruption in life principle that pervades a person’s entire being and integrates and transcends one’s biologic and psychosocial nature

- further specified as spiritual pain, alienation, anxiety, guilt, anger, loss or despair - common etiologies include inability to reconcile current life situation (illness, death of loved one, divorce) with spiritual beliefs or separation from religious community or supports C.

PLANNING 1. ENHANCING SPIRITUAL HEALTH – patient will: * identify spiritual beliefs that meet needs for meaning and purpose, love and relatedness, and forgiveness * derive from these beliefs strength, hope, and comfort when facing challenges of illness, injury, or other life crisis * develop spiritual practices that nurture communion w/inner self, God, and the world * express satisfaction w/compatibility of spiritual beliefs and everyday living 2.

ADDRESSING SPIRITUAL DISTRESS – patient will: * explore origin of spiritual beliefs and practices * identify factors in life that challenge spiritual beliefs * explore alternatives given challenges (deny, modify, reaffirm beliefs) * identify spiritual supports * report or demonstrate decrease in spiritual distress after successful intervention D.

IMPLEMENTING - interventions can be used in the home, hospital, or care center 1.

OFFERING SUPPORTIVE PRESENCE – must underlie all other types of intervention - aim is to create hospitable and sacred space (“holy ground”) in which patients can share vulnerabilities without fear 2. FACILITATING PRACTICE OF RELIGION – familiarize pt w/religious services and materials available - respect pt’s need for privacy or quiet during prayer - assist to obtain devotional objects and protect them - arrange sacraments - arrange minister, priest, or rabbi’s visits - attempt to meet dietary restrictions - if there is a conflict between spiritual beliefs and proposed medical therapy, discuss this with the physician 3.

NURTURING SPIRITUALITY a. Relationship with One’s Inner World – prayer; reflection or “quiet listening to one’s essence”; communion w/nature; enjoyment of music, drama, art, dance; inner dialogues; dream

analysis b. Spiritual Energy to One’s Outer World – loving relationships; service to others in need; forgiveness of others; empathy, compassion, and hope; laughter, joyous expressions; participation in church 4. PRAYING WITH PATIENTS – many forms of prayer - - quiet reflection, silent communion w/God or higher power, reading or recitation of formal prayers, silent or loud calling on God or conversation w/God, or reading religious materials - prayer may also be a simple expression aloud of pt’s needs and hopes - prayer should not block communication w/pt - praying before pt feels ready may communicate lack of interest in pt’s feelings - be prepared to spend time w/pt after sharing prayer to respond to feelings 5. COUNSELING PATIENTS SPIRITUALLY – articulate spiritual beliefs; explore origin of pt’s spiritual beliefs; identify life factors that challenge pt’s beliefs; explore alternatives given these challenges; develop spiritual beliefs the meet needs - be open to different spiritual beliefs and forms of spiritual expression and supportive of pt’s efforts to nurture spiritual growth 6.

SPIRITUAL COUNSELOR REFERRAL – offer to contact pt’s own spiritual adviser - contact healthcare facility’s pastoral ministry department or use referral list of clergy in community - suggest a visit from a member of clergy from another faith - make counselor feel welcome, answering questions about pt, directing counselor to pt, and ensuring pt is ready to receive counselor - room should be orderly and free of unnecessary equipment - should be a seat for religious counselor at bedside or near pt - top of bedside table should be free of items and possibly covered, if so desired - bed curtains should be drawn to provide privacy 7. RESOLVING CONFLICTS BETWEEN SPIRITUAL BELIEFS AND TREATMENTS – nurse’s role is to assist pt in obtaining information needed to make an informed decision and to support pt’s decision making

- what the nurse says and the way it is said may powerfully influence pt’s decision, it is important to maintain objectivity