Spiritual Care

in Nursing
Paula Bechayda
Odesa Beluso
Kristian Dave Diva
 Spiritual care in nursing
 Is included in most nursing texts
 Is often over-looked or discouraged in
traditional nursing
 Is the foundation for parish nursing
(diaconal nursing)
 Spirituality
 Spirituality refers to a belief in a higher power,
an awareness of life and its meaning, the
centering of a person with purpose in life. It
involves relationships with a higher being, with
self, and with the world around the individual..
Spirituality implies living with moral standards.
“The spirit of a human is his essence, that part
of him or her that is not visible. The part that
does not die but is immortal. Webster defines
spirit as “ a life giving force” and as the “active
presence of God in human life.”
(National Center of Continuing Education, Inc. Death and Dying, pg. 23)
 Religion
 Religion is an organized and public belief
system of worship and practices that generally
has a focus on a god or supernatural power. It
generally offers an arrangement of symbols and
rituals that are meaningful and understood by it’s
followers.
“Religion is primarily a set of beliefs, a collection
of prayers, or rituals. Religion is first and
foremost a way of seeing. It can’t change the
facts about the world we live in, but it can
change the ways we see those facts, and that in
itself can often make a difference.” (Harold
Kushner)
 Major World Religions
 Christianity
 Catholic, Lutheran, Presbyterian,
Methodist,Nazarene, Episcopal
 Baptist (largest protestant denomination in US)
 Non-denominational
 Other Western faiths
 Judaism
 Reform, Conservative, and Orthodox
 Hinduism
 Buddhism
 Islam (Muslims)
St. Paul Lutheran Church (Rochelle, IL USA)
 Spiritual care defined

Spiritual care is recognizing and responding to

the multifaceted expressions of spirituality we
encounter in our patients and their families. The
purpose is to determine the nature of a person’s
relationship to God and other people, and to
give the person the opportunity to accept
spiritual support. Themes such as the search
for meaning, feelings of connection or isolation,
hope or hopelessness, and fear of dying are all
clues that a person is struggling with spiritual
issues.
 Spirituality
 Spirituality fulfills specific needs
 Meaning to life, illness, crises, and death
 Sense of security for present and future
 Guides daily habits
 Elicits acceptance or rejection of other
people
 Provides psychosocial support in a group
of like-minded people
 Strength when facing life’s crises
 Healing strength and support
 Spiritual Care
• Practice of compassionate presence
• Listening to patient’s fears, hopes, pain,
dreams
• Obtaining a spiritual history
• Attentiveness to all dimensions of the patient
and patient’s family: body, mind and spirit
• Incorporation of spiritual practices as
appropriate
• Involve chaplains as members of the
interdisciplinary healthcare team
 Spiritual Distress is
 “the state in which the individual
experiences or is at risk for experiencing a
disturbance in his belief system that is the
source of his strength and hope.”
(Carpenito)
 Defining characteristics
 Expresses concern with the meaning of
life, suffering, and/or death
 Expresses concern about belief system
 Expresses anger toward God
 Expresses concern about his/her
relationship with God
 Questions meaning of own existence
 Unable to participate in usual religious
practices
 Seeks spiritual assistance
 Demonstrates gallows humor
 Displaces anger toward religious
representatives
 Suffers from sleep disturbances
 Alterations in mood or behavior
 Separated from cultural or religious ties
 Feels hopeless and helpless
 Others…
A More Compassionate Model
of Care
Focus on The Whole Person
Physical
Emotional
Social
Spiritual
 Five basic spiritual needs of every
person:
 A meaningful philosophy of life (values, and
moral sense).
 A sense of the transcendent (outside of self,
view of God and something beyond the
immediate life, having hope.)
 A trusting relationship with God (faith).
 A relatedness to nature and people (friendship).
Experiencing love and forgiveness.
 A sense of life meaning.
 Where does spirituality fit?
 Patients may have
coping mechanisms
related to their belief
 May be supported by
a community of caring
others.
 May feel themselves
to be in the company
of God who gives
them peace and
comfort.
 Spiritual Needs

• May be dynamic in patient

understanding of illness
• Religious convictions / beliefs may
affect healthcare decision-making
• May be a patient need
• May be important in patient coping
• Integral to whole patient care
Christina Puchalski MD
 Five basic spiritual needs of every
person:
 A meaningful philosophy of life (values, and
moral sense).
 A sense of the transcendent (outside of self,
view of God and something beyond the
immediate life, having hope.)
 A trusting relationship with God (faith).
 A relatedness to nature and people (friendship).
Experiencing love and forgiveness.
 A sense of life meaning.
 Three kinds of love
 Eros -If you satisfy my needs then I will love you.
A physical love.
 Phileo - a brotherly love, a friendship live. I love
you because of what you have or who you are.
This may be conditional love also, because
things might change.
 Agape – God’s kind of love. I love you, in spite
of …, I love you no matter what. Not deserved,
not earned. Freely given. Unconditional.
 The nurse’s role in spirituality
 Define your own philosophy of life and death.
What do you believe? What does human life
mean to you? What does death mean? Is there
life beyond? Is there a God? Is there a Heaven
and a Hell?
 You must be comfortable and confident in what
you believe in order to help others. Or you will
be threatened and fearful when confronting
death and dying in your patients.
 Identify your emotional and physical limitations.
 Ethics & professional boundaries
 Spiritual History: patient-centered
 Recognition of pastoral care professionals as
experts
 More in-depth spiritual counseling should be under
the direction of chaplains and other spiritual
leaders
 Praying with patients:
You can, if the patient requests, or make a
referral to pastoral care for chaplain led prayer.
 9 dimensions
of patient assessment
1. Illness / treatment 6. Social
summary 7. Spiritual
2. Physical 8. Practical
3. Psychological 9. Anticipatory planning
4. Decision making for death
5. Communication
 Approach to
spiritual assessment
 Suspect spiritual pain
 Establish a conducive
atmosphere
 Express interest, ask specific
questions
 Listen for broader meanings
 Be aware of your own beliefs
and biases
 A Spiritual Inventory might
include questions about:
 The patient’s perception of what is going on.
 What gives meaning and purpose to life?
 How, or whether belief and faith enter in.
 Love: By whom do you feel loved-accepted?
 Forgiveness--need it? Do you need to grant it to
others?
 Prayer--What do you pray for?
 Quiet and meditation--What helps get you on
center?
 Spiritual assessment
 Meaning, value – personal, of the illness
 burden, control, independence, dignity
 Faith
 Religious life, spiritual life
 Identify areas of spiritual crises. Would
pastoral intervention be needed or desired
– their own pastor or the hospital or
hospice chaplain?
 Spiritual assessment
 Spiritual assessment should, at a
minimum, determine the patient’s
denomination, beliefs, and what spiritual
practices are important to the patient.
 This information assists in determining the
impact of spirituality, on the care and
services being provide, and will identify if
further assessment or services are
needed.
 Spiritual Assessment
 An integral part of a patient’s initial assessment
should include data about the patient’s spiritual
and religious beliefs.
 Several tools exist for spiritual assessment.
 Spiritual care needs to be individualized, with
the patient given the opportunity to participate
 Open ended questions that are specific
regarding beliefs can be helpful. A formal
assessment guide can provide a review of
the strength and meaning of person’s
religious practices that can open the door
to helping the person establish a
meaningful relationship with their higher
power.
 Spiritual History
• Taken at initial visit as part of the social
history, and at follow-up visits as appropriate
• Recognition of cases to refer to chaplains
• Opens the door to conversation about values
and beliefs
• Uncovers coping mechanism and support
systems
• Reveals positive and negative spiritual coping
• Opportunity for compassionate care
 Taking a spiritual history. . .
 S Spiritual Belief System
 P Personal Spirituality
 I Integration in a Spiritual Community
 R Ritualized Practices and Restrictions
 I Implications for Health Care
 T Terminal Events Planning (advance
directives, DNR wishes, DPOA etc..)
 Assess for spiritual activities
 Religious denomination (past or present)
Where do you go to church when you are
able?
 Activity level Do you go all the time?
 Prayer / scriptural resources Do you read
your Bible? Do you pray much?
 Assess for spiritual crises
 Search for meaning or purpose in one’s life.
 Loss of a sense of connection with people or
God.
 Feelings of guilt or unworthiness
 No relationship with God
 Anger, denial, and bitterness expressed toward
self, others, or God. Questioning of faith
 Desire for forgiveness
 Sense of abandonment by God
 Spiritual Assessment Tools

 SPIRIT
 FICA (Pulchalski 1999)
 LET GO (Storey and Knight 1997)
 Nurses and MDs should know the patient’s
personal values and wishes. The patients
religion is specified in the medical record.

“The secret in the care of the patient is in

caring for the patient.”
 FICA assessment tool

F Faith, Belief, Meaning

I Importance and Influence
C Community
A Address
 The HOPE Questions
 H: Sources of hope, meaning,
comfort, strength, peace, love
and connection
 O: Organized religion
 P: Personal spirituality and
practices
 E: Effects on medical care and
end-of-life issues
 LET GO

 Listening to the patient’s story

 Encouraging the search for meaning
 Telling of your concern and acknowledging the
pain of loss
 Generating hope whenever possible
 Owning your limitations
 Spiritual History
F Do you have a spiritual belief? Faith? Do
you have spiritual beliefs that help you cope
with stress? What gives your life meaning?
I Are these beliefs important to you? How
do they influence you in how you care for
yourself?
C Are you part of a spiritual or religious
community?
A How would you like your healthcare
provider to address these issues with you?
Christina Puchalski MD
 Stoll’s Spiritual Assessment
(Concept of Deity)
 Is religion or God significant to you? If so,
can you describe how?
 Is prayer helpful to you? What happens
when you pray?
 Does a God or deity function in your
personal life? If yes, can you describe
how?
 How would you describe your God or what
you worship?
 Stoll’s Spiritual Assessment
(Source of Hope and Strength)
 Who is the most important person to you?
 To whom do you turn when you need
help? Are they available?
 In what ways do they help?
 What is your source of strength and hope?
 What helps you the most when you feel
afraid or need special help?
 Stoll’s Spiritual Assessment
(Religious Practices)
 Do you feel your faith (or religion) is important to
you? If yes, would you tell me how?
 Are there religious practices that are important
to you?
 Has being sick made any difference in your
practice of praying? Your religious practices?
 What religious books or symbols are helpful to
you?
 Stoll’s Spiritual Assessment
(Relation Between Spiritual Beliefs and Health)
 What has bothered you the most about being
sick (or in what has happened to you)?
 What do you think is going to happen to you?
 Has being sick (or what has happened to you)
made any difference in your feelings about God
or the practice of your faith?
 Is there anything that is especially frightening or
meaningful to you now?
 Planning
 Short-term
 Long-term
 individualize
CIRCLE Model
 Implementation
 C aring
 I ntuition
 R espect for religious beliefs & practices
 C aution
 L istening
 E motional
 Caring
 Demonstrating care and compassion
 Possessing an attitude that cares
 Caring enough to take/use the available
time
 Intuition
 Making an effort to hear what the person
feels
 Encouraging the person to express
feelings
 Respect for Religious Beliefs
and Practices
 Making appropriate referrals
 Praying
 Encouraging devotional activities
 Providing for specific rites, sacraments,
and observations
 Offering religious conversation
 Caution
 Declining to proselytize
 Avoiding judgments
 Giving choices
 Listening
 Making an effort to hear what the person
feels
 Encouraging the person to express
feelings
 Emotional Support
 Working through feelings
 Showing love
 Touching
 Evaluation
 Relational
 Physical
 Emotional
 Intellectual
 Religious/Spiritual