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Doctoral Student in Public Health: Preventive Care, Loma Linda, California, USA
Correspondence:
Ruth A. Tanyi,
Family Nurse Practitioner,
Prevention, Lifestyle and
Wellness Services,
PO Box 1185,
Loma Linda,
CA 92354,
USA.
E-mail: rtanyi@yahoo.com
Introduction
In this paper, family spirituality is described as the search for
meaning and purpose in life, meaningful relationships,
individual family member spirituality, family values, beliefs,
and practices, which may or may not be religiously based,
and the ability to be transcendent (Sperry & Giblin 1996,
Tanyi 2002). Family spirituality can be much broader than
individual spirituality, as it encompasses individuals distinct
spirituality and that of the family unit. The broadness of this
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Background
Despite the lack of consensual definition of spirituality
(MacLaren 2004), its positive effect pervades health care
and is evident in the nursing literature. Therefore, providing
spiritual care will remain an invaluable part of nursing, as
nurses work with humans who are spiritual beings. Spirituality and religion are sometimes used interchangeably, but the
two concepts are different, thus warranting a distinction.
Religion involves an organized entity with established rules,
practices, beliefs, values, and boundaries about a Higher
Power or God to which individuals should adhere (Thoresen
1999). On the contrary, spirituality has been described as a
personal journey and defined as:
the personal search for meaning and purpose in life, which may or
may not be related to religion. It entails connection to self-chosen
and/or religious beliefs, values, and practices that give meaning to
life, thereby inspiring and motivating individuals to achieve their
optimal being. This connection brings faith, hope, peace, and
empowerment. The results are joy, forgiveness of oneself and others,
Spiritual assessment
The major goals of spiritual assessment are (1) to support and
enhance families spiritual well-being and development; (2) to
discern spiritual distress and its effect on overall family
health; and (3) to ascertain ways to incorporate family
spirituality when providing care. To capture the essential
elements of spirituality and organize the assessment, nurses
can utilize the guideline in Table 1 to categorize the data
according to: meaning and purpose, strengths, relationships,
beliefs, individual members spirituality, and familys preference for spiritual care.
The initial step of a thorough spiritual assessment and
intervention requires that nurses be comfortable with the
topic and develop a trusting relationship with the family
(Maugans 1996). One cannot precisely gauge when a nurse
should establish a trusting relationship with a family as this
depends on their interactions over a period of time. However,
nurses actions, such as displaying genuine caring and
concern, respecting families circumstances, and remaining
non-judgemental can foster a healthy environment and
expedite the development of a trusting relationship. In order
to maintain the ethical aspects of spiritual care, nurses must
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Spiritual interventions
The process of spiritual assessment is an effective intervention.
It allows the family to openly discuss their spiritual strengths
and legitimizes their abilities to manage lifes challenges
(Hodge 2000). Nurses can, therefore, encourage families to
draw upon this strength to manage other problems. Following
the assessment, nurses would formulate an appropriate interpretation to guide the interventions in Table 2.
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The desired outcome for spiritual assessment and intervention is spiritual well-being. In this state, family members
express satisfaction with their relationships, beliefs, circumstances, and display a strong sense of connectedness with
each other, their God/Higher Power, universe, environment,
and others (Wilkinson 2000). Evaluation criteria are verbalized comments from family members indicating (1) continuing spiritual growth; (2) feelings of connectedness and peace;
(3) satisfaction with family circumstances, and improved
sense of overall health and well-being.
Case examples
The ensuing fictitious case studies exemplify certain potential
components within a family unit to favour an interpretation
of spiritual support, wellbeing, or distress. While there are
many other potential spiritual interpretations, these cases
only underscore the major ones. As families circumstances
change over time, spiritual interpretations are not permanent;
they change to reflect a familys state at any given time. The
cases further illustrate how to integrate spiritual assessment,
interpret data and implement appropriate interventions.
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Conclusion
Use of this guideline would improve nurses understanding of
family functioning, thereby enhancing communication and
trust in nursesfamily relationship. Spiritual care is ongoing
with each family interaction, and spirituality is an important
component of many families: its impact cannot be underestimated on the overall family health.
By attending to families spiritual needs, nurses would be
promoting a comprehensive and holistic approach to healthcare delivery. Not examining the spiritual dimension of
families would be ignoring a vital aspect of their overall
health. In essence, one cannot truly assess a familys health
without examining its spirituality.
Acknowledgements
The author would like to thank Jennifer L. Feeken and Mary
Wittenbreer, librarians at Regions Hospital Medical Library,
St Paul MN, USA for their invaluable assistance during the
literature search process for this article. Special thanks to
Dr Werner, UWEC, WI and DeAnn Lancashire-Mabin, St
Paul, MN for their proofreading assistance.
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