Assessing Spirituality

and Religious Sherwyn U. Hatab RN

Practices
Spirituality and Religion

what is religion? What is spirituality?

Religion

• Religion is defined as the rituals, practices, and experiences

shared within a group that involve a search for the sacred.
• Defining Characteristics:
• Formal
• Organized
• Group-oriented
• Ritualistic
• Objective, as in easily measurable
Religion
• For some faiths, this idea of religion
encompasses the concept of spirituality and is
a natural outflow of that idea.
• Others may view spirituality as a separate
concept, possibly disconnected from any
religious institution.
• The number of persons describing themselves
as “spiritual but not religious” has risen
substantially over the past decade (Gallup,
2006).
Spirituality
• A search for meaning and purpose in life, which seeks to understand
life’s ultimate questions in relation to the sacred.
• Defining characteristics:
• Informal
• Non-organized
• Self-reflection
• Experience
• Subjective, as in difficult to consistently measure.
Spirituality and Religion

• Spirituality and religion are important factors in health and can

influence health decisions and outcomes.
• Spirituality and religion may vary immensely from one client to the
next.
• During a spiritual assessment, the healthcare professional should
keep an objective perspective with the goal of meeting the client
where she or he is.
• Knowing how spirituality can vary will help the nurse to identify
possible coping responses.
The Role of Religion and Spirituality
in Health and Health Care Choices
• Religion and spirituality have been related to lower levels of mortality,
less heart disease, lower blood pressure, less depression, lower levels
of stress, less alcohol and tobacco abuse, greater well-being and
optimism, and positive health habits (Koenig, McCullough, & Larson,
2001; Loustalot, Wyatt, May, et al., 2006)
• Some religions encourage positive health behaviors, greater mental
health, and provide a strong social support network.
The Role of Religion and Spirituality
in Health and Health Care Choices
• Religious views may negatively impact health.
• Christian Scientists frequently rely on prayer alone to heal illnesses,
rarely seek mainstream medical care, and have higher rates of
mortality than the general population.
• Jehovah’s Witnesses refuse blood transfusions due to their belief that
the body cannot be sustained by another’s blood and accepting a
transfusion will bar the recipient from eternal salvation.
• Faith Assembly of Indiana have a negative view of modern health care
and have an especially high rate of infant mortality due to limited
prenatal care
The Role of Religion and Spirituality
in Health and Health Care Choices
• Religion may lead to depression or anxiety over not meeting group
expectations, and certain spiritual practices or participation in
complementary and alternative medical practices may delay needed
medical care. (Koenig, McCullough, & Larson, 2001; Barrett, Kurlan, &
Johnson, 2001).
• If a nurse is presented with a situation where religious or spiritual
views have the potential to compromise adequate nursing care
• the situation should be presented to a supervising staff member
immediately.
 Major World Religions
and Common Health
Beliefs

• Buddhism
• Overview: Suffering is a part of human existence,
but the inward death of the self and senses leads to
a state beyond suffering and existence.
• Illness:
• Prayer and meditation are used for cleansing and
healing.
• Terminal illness may be seen as a unique
opportunity to reflect on life’s ultimate meaning and
the meaning of one’s relation with the world.
Therefore, it is important that medication does not
interfere with consciousness.
Major World • Buddhism
• End of life: Life is the opportunity to cultivate understanding,
Religions and compassion, and joy for self and others. Death is associated with
Common Health rebirth. Serene surroundings are important to the dignity of dying.
• Nutrition: Many are strict vegetarians. Some holy days include fasting
Beliefs from dawn to dusk but considerations are allowed for the frail and
elderly for whom fasting could create problems.
 Major World Religions and Common Health
Beliefs
• Hinduism
• Overview: Nirvana is the primary
purpose of the religion. Many have
an altar in their home for worship.
• Illness: Illness is the result of past
and current life actions (Karma).
The right hand is seen as holy, and
eating and intervention needs to
be with the right hand to promote
clean healing.
Major World Religions and Common Health
Beliefs
• Hindu
• End of life: Death marks a passage because the
soul has no beginning or end. At death the
soul may be reborn as another person and
one’s Karma is carried forward.
• It is important for Karma to leave this life with
as little negativity as possible to insure a better
life next birth. Holy water and basil leaves may
be placed on the body; sacred threads may be
tied around wrists or neck. The deceased arms
should be straightened.
• Nutrition: Many but not all are vegetarians.
Many holy days include fasting.
Major World Religions and Common Health
Beliefs
• Islam
• Overview:
• Mohammed (PBUH) is believed to be the greatest of all prophets. Worship
occurs in a mosque. Prayer occurs five times a day: dawn, sunrise, noon,
afternoon, sunset, and evening.
• Prayers are done facing the sacred place in Mecca and often occur on a
prayer rug with ritual washing of hands, face and feet prior to prayer.
• The Islamic faith is presently one of the fastest growing religious groups in
the United States
Major World Religions and
Common Health Beliefs
• Illness: Allah is in control of the
beginning and end of life, and
expressions of powerlessness are
rare. To question or ask questions of
healthcare providers is considered a
sign of mistrust so clients and family
are less likely to ask questions.
• End of life: All outcomes, whether
death or healing, are seen as
predetermined by Allah. It is
important for dying clients to face the
quibla and to die facing the quibla.
Prayer is offered but need not be
done by an Imam (religious leader).
 Major World Religions and
Common Health Beliefs
• Islam
• Nutrition: Consumption of pork or
alcohol is prohibited. Other meats
must meet ritual requirements.
During the holy days of Ramadan,
neither food nor drink is taken
between sunrise and sunset, though
frail, ill and young children are
exempt.
Major World Religions and
Common Health Beliefs
• Christianity
• Overview:
• Beliefs focus around the Old and New
Testaments of the Bible and view
Jesus Christ as the Savior. Prayers may
be directed to one or all of the Holy
Trinity (God, Holy Spirit, and Jesus
Christ). Beliefs usually culturally
developed vary within
denominations.
Major World Religions and Common Health
Beliefs
• Christianity
• Illness: Most view illness as a natural process for the body and even as a
testing of faith. Others may see illness as a curse brought on by living
outside the laws of God and, therefore, retribution for personal evil.
• End of life: There is belief in miracles, especially through prayer. Western
medicine is usually held in high regard. Memorial services rather than
funerals and cremation rather than burial are more common in Christian
religions than in other sects.
• Nutrition: No special or universal food beliefs are common to Christian
religions, although there may be regional or cultural beliefs.
Major World Religions and Common Health
Beliefs
• Judaism
• Overview: Judaism includes religious
beliefs and a philosophy for a code
of ethics with four major groupings
of Jewish beliefs: Reform,
Reconstructionist, Conservative, and
Orthodox. Prayer shawls are
common and are often passed
between generations of family. The
clergy are known as Rabbi.
Major World Religions and Common Health
Beliefs
• Judaism
• Illness: Restrictions related to work on holy
days are removed to save a life. However,
tests, signatures, and assessments for
medical needs that can be scheduled to
avoid holy days are appreciated.
• End of life: Psalms and the last prayer of
confession (vidui) are held at bedside. At
death, arms are not crossed; any clothing or
bandages with client’s blood should be
prepared for burial with the person. It is
important that the whole person be buried
together.
 Major World Religions and
Common Health Beliefs
• Judaism
• Nutrition: Orthodox or Kosher involves no
mixing of meat with dairy; separate cooking
and eating utensils are used for food
preparation and consumption. Kosher laws
include special slaughter and food handling.
“Keeping Kosher” is predominantly an
Orthodox practice. When food has passed
Kosher laws of preparation, a symbol (K)
appears on the label. Many holy days
include a fasting period.
Self-Understanding of Spirituality

• Consistently nurses who are more aware of their spirituality are more
comfortable discussing the potential spiritual needs of the client.
• What are my/your views on the interaction between spirituality and
health?
• How would I/you respond to someone in spiritual distress or to
someone requesting an intervention relating to spirituality?
• How can I/you provide spiritual care?
Why Assess Spirituality?

• Nursing has a long history of incorporating spirituality into client care.

Florence Nightingale wrote at length about a spiritual dimension that
provided an inner strength.
• More recently modern nursing theorists have used spirituality as a
major determinant in the grand theories that guide nursing practice.
• NANDA-approved nursing diagnoses have also been formulated to
assist nurses in identifying and addressing the client’s spiritual
dimension.
• These references underlie a primary idea in nursing.
Why Assess Spirituality?

• A large number of patients use

spiritual resources during times of high
stress.
• Religion and spirituality have been
related to a person’s greater well-being
in the face of chronic disease
management and assistance adhering
to medical regimens.
• Religion and spirituality can be
powerful coping mechanisms when a
person faces end-of-life issues.
Spiritual Assessment
• Spiritual Assessment is an active and
ongoing conversation that assesses the
spiritual needs of the client.
• Defining characteristics: Formal or
informal, respectful, non-biased.
• A spiritual assessment is similar to the
many other assessments' nurses perform
on a daily basis.
• Gaining relevant information about the
client’s spirituality helps to identify related
nursing diagnoses and needed
interventions and can improve client care.
 • Spiritual Distress
• Spiritual Distress, risk
NANDA Spiritual for
Nursing Diagnosis • Spiritual Well-Being,
readiness for
enhanced
 Spiritual assessment does not
begin at the bedside.

Spiritual
Assessment There is no absolute in the timing
of a spiritual assessment.

spiritual assessment should not be

viewed as static but rather an
ongoing conversation between the
nurse and client
Spiritual
Assessment
• The nurse’s knowledge of the spiritual temperament
of the community and his or her own spirituality will
lead to greater ease when discussing the client’s
spirituality
• Be aware that a client’s spiritual dimension is
subjective and may vary greatly between persons,
even persons of the same denomination or faith.
 • Many hospitals have staff pastoral chaplains, and
Spiritual community resources of different faiths are usually
Assessment available through social work professionals.
• While nurses can assess and support many clients’
spiritual needs, some situations are beyond the scope of
nursing practice and require someone with more
experience and knowledge about a particular faith.
 Spiritual
Assessment
• The questions in a spiritual assessment probe for beliefs that
could affect client care. Divulged information is then utilized
to support, encourage, or lead clients in harmonizing their
personal relationships to spirituality and health.
• Some clients may not be connected to any religious group or
have any interest in spirituality. These clients should be
encouraged in whatever provides them strength in dealing
with health care issues
 • Nonformal
• asking the client a guided open-
ended questions and allowing the
SPIRITUAL client to disclose pertinent
ASSESSMEN information
• systematic to the extent that the
T client’s responses guide future
choices of questions, and they may
TECHNIQUE cover numerous practices in which
S the client may or may not be
involved (e.g., prayer, organized
religion, etc.)
• Example: FICA–Assessment Tool
SPIRITUAL • Formal
• The client’s spirituality and religiosity can
ASSESSMEN also be assessed with formal instruments.
T • Completion of a self-response spiritual or
religious assessment instrument in
TECHNIQUE conjunction with other past medical
history could uncover strengths or
S deficiencies that may have initially gone
unnoticed
Spiritual
care
Addressing the spiritual needs
of the client as they unfold
through spiritual assessment.
 • Mrs. Dela Cruz is a 60-year-old hospitalized
homemaker who is recovering from a right
radical mastectomy. Her primary care
provider told her yesterday that due to
metastases of the cancer, her prognosis is
poor. This morning her nurse finds her
Case tearful, stating she slept poorly and has no
Scenario appetite. She asks the nurse, “Why has God
done this to me? Perhaps it’s because I have
sinned in my life. I’ve not gone to church or
spoken to a minister in several years. Is there
a chapel in the hospital where I could go and
pray? I’m terribly afraid of dying and what
awaits me.”
 • Subjective data: Client verbalized “Why has
God done this to me? Perhaps it’s because I
have sinned in my life. I’ve not gone to
church or spoken to a minister in several
years. Is there a chapel in the hospital where
I could go and pray? I’m terribly afraid of
Case dying and what awaits me.”
Scenario • Objective data: Temperature: 36.6ºC, Pulse:
98 BPM, Respirations: 22/minute, BP:
140/90 mm Hg. Large surgical dressing right
chest wall and axillary region dry and intact.
Slight edema right hand and arm.
 • NURSING DIAGNOSIS
• Spiritual Distress related to feelings of guilt
Case and alienation from God as evidenced by
Scenario questioning why “God has done this”;
inquiries about praying in a chapel;
insomnia; no appetite.
 • Desired Outcome
• Spiritual Health as evidenced by:
1. Interacts with spiritual leader of her
Case religion
Scenario 2. Uses a type of spiritual experience that
provides her comfort
3. Connects with others to share thoughts,
feelings, and beliefs
 • NURSING INTERVENTIONS/SELECTED ACTIVITIES
• Assist client to properly express and relieve
anger in appropriate ways.
• Observe and listen empathetically to her
communication.
Case • Encourage the use of spiritual resources, if
desired.
Scenario • Create an accepting, nonjudgmental
atmosphere.
• Encourage verbalization of feelings, perceptions,
and fears. Allow time for grieving.
• Encourage her to list values that guide behavior
in times of tragedy.
 • EVALUATION
• Outcome met. Mrs. Dela Cruz has been
Case visited on several occasions by her minister.
She reads scripture each day and has found
Scenario consolation in reading the Book of Psalms.
She states “God is merciful and will help me
bear my suffering.”