Chapter 12

Chapter 12: Assessing Spirituality and Religious Practices  A dynamic and intrinsic aspect of humanity though which people seek ultimate meaning, purpose, transcendence and experience relationship to self, family, others, community society, nature and the significant or sacred.  Spirituality is expressed through beliefs, values, traditions and practices.  Spirituality and religious beliefs and practices influence health decisions, lifestyle practices, dietary practices, end-of-life decisions, and many other elements of health care. Conceptualization of the relationship of religion and spirituality:  Religion- Rituals, practices, and experiences involving a search for the sacred (e.g., God, Allah)a that are shared within a group. o Characteristics:  Formal  Organized  Group oriented  Ritualistic  Objective, as in easily measurable (e.g., church attendance)  Spirituality- A search for meaning and purpose in life that seeks to understand life’s ultimate questions in relation to the sacred. o Characteristics:  Informal  Nonorganized  Self-reflective  May involve spiritual experiences  Subjective, as in difficult to consistently measure (e.g., daily spiritual experiences, spiritual well- being)  Spiritual Assessment- Active and ongoing conversation that assesses the spiritual needs of the client. o Characteristics:  Formal or informal  Respectful  Nonbiased  Spiritual Care - Addressing the spiritual needs of the client as they unfold through spiritual assessment. o Characteristics:  Individualistic  Client oriented  Collaborative Scope:  Spiritual well-being- Spiritual practices have the potential to encourage greater mental and physical health.  Spiritual Activities = prayer, participation in church services, yoga, tai chi, meditation, dietary restrictions, pilgrimage, confessions, reflection, forgiveness.  Spiritual despair Attributes:  Spirituality is universal, informal ad self-reflective  Patients/families must have willingness to share and act of spiritual beliefs Relevance to Nursing Practice:  The quality of healthcare is enhanced by integrating spirituality into patient care  Conduct a spiritual assessment Examples of Spirituality:  Faith, hope, prayer, mindfulness, meditation, compassion  Practice of organized religion (Buddhism, Hinduism, Islam, Christianity, Judaism)  Religious articles (oils, rosaries) and texts (Bible, Torah, Qur’an)

 Jehovah’s Witnesses refuse blood transfusions because of their beliefs that the body cannot be sustained by another’s blood and accepting a transfusion will bar the recipient from eternal salvation.  Controversy has erupted when a child of a Jehovah’s Witness is in need of a blood transfusion and the parents wish to withhold a possible lifesaving therapy.  The U.S. Supreme Court has generally sided against parents withholding medical therapies for religious reasons. The hospital’s ethics committee should be consulted immediately to assist in this complex decision. Spiritual Assessment:  Spiritual care cannot be provided without a spiritual assessment.  Benefits of spiritual care to the client, include: o Support for healthy grieving o Support for improved self-esteem and confidence o Assistance with maximization of potential in the current circumstances o Support to improve relationships with self, others, and with an Absolute/God o Assistance in renewing a sense of meaning and hope o Enhancement of the client’s sense of belonging o Assistance in improving problem solving o Help with enduring problems that cannot be solved and with continuing distress and disability o Help in finding renewed hope. 1. Approach:  There is no absolute in the timing of a spiritual assessment.  Some professionals include it with the initial assessment, whereas others want to establish a relationship with the patient first.  Spiritual assessment should not be viewed as static but rather as an ongoing conversation between the nurse and the client.  Objectivity is a key component in a high-quality spiritual assessment.  The questions in a spiritual assessment probe for beliefs that could affect client care. 2. Techniques:  The most useful spiritual assessment techniques should begin with general introductory questions and not be specific to any religious denomination so that the nurse can avoid assumptions and ascertain the client’s specific spiritual needs.  Nonformal: o The use of open-ended questions allows the client to disclose pertinent information.  Formal: o “FICA”  F- Faith & Belief- “Do you consider yourself spiritual or religious?” or “Is spirituality something important to you?” or “Do you have spiritual beliefs that help you cope with stress/difficult times?”  I- Importance- “What importance does your spirituality have in your life? Has your spirituality influenced how you take care of yourself, your health? Does your spirituality influence you in your health care decision making?”  C- Community- “Are you part of a spiritual community?” Communities such as churches, temples, and mosques, or a group of like-minded friends, family, or yoga can serve as strong support systems for some patients.  A- Address in Care- “How would you like me, your health care provider, to address these issues in your health care?” Analyzing Data- Possible Conclusions the Nurse may make after the assessment:  Opportunity to improve health- Opportunity to improve spiritual health associated with client request for minister to pray with them  Risk for client concerns- Risk for poor spiritual health associated with feelings of guilt associated with lung cancer diagnosis after years of smoking and alcohol abuse