Nursing Spirituality: History and Concepts

History of Spirituality in Nursing

• Focus includes religiosity, spirituality, healing arts and nursing care components

Spirituality Defined

• A continuous journey accumulating life experiences and understanding
• Searching meaning, value, and life purpose

Religion Defined

• A structured system of beliefs, practices, and conduct codes, like church, mosque, or synagogue
• Religion provides essential values and beliefs

Spirituality vs Religion Clarified

• Spirituality relates to the human spirit or soul, not physical matters.
• Religion involves worshiping a superhuman controlling power, like God.
• Faith is belief without proof.

Spiritual Dimension: A Unifying Approach

• Encompasses spiritual, sociological, physiological, and psychological factors
• Healing requires caring for mind, body, and spirit

Concepts of Spirituality

• Hope enables a positive outlook.
• Love connects people.
• Suffering is a state of distress that threatens personal integrity

Shelly & Fish's Three Spiritual Needs (1988)

• Meaning and purpose
• Love and relatedness
• Forgiveness

Spirituality Elements

• Unifying force of life
• Connection with nature, earth, environment, and cosmos
• Shapes self-awareness

Cures, Miracles and Spiritual Healing

• Miracles allow transcendence, commonly follow natural laws
• They can significantly impact expectations

Factors Influencing Spirituality

• Developmental stage
• Family
• Ethnic background
• Formal religion
• Life events

Spirituality and Health Beliefs

• Research suggests religion can positively influence physical and mental health
• However, it doesn't always explain how religion affects health

Major Religions in the United States

• Adventist
• American Muslim
• Baha’i International Community
• Buddhism
• Christian Scientist
• Church of Jesus Christ of Latter-Day Saints (Mormons)
• Confucianism
• Daoism (Taoism)
• Hinduism
• Islam
• Jehovah’s Witnesses
• Judaism
• Native American Religions
• Protestantism
• Roman Catholicism
• Sikhism
• Unitarian Universal Association of Churches and Fellowships

Practices in Judaism

• Torah
• The Sabbath observances are sunset Friday to sunset Saturday evening
• Dietary practices include kosher foods.
• Baby boy circumcision, contraception acceptable for women's health, organ transplants varying

Christianity Practices

• The Bible
• Baptism
• Moral cleansing/being born again
• No dietary restrictions.
• Variable views on artificial birth control methods

Christian Denominations

• Roman Catholics
• Orthodox
• Protestant denominations, including Jehovah’s Witnesses, Mormons, Christian Science

Islamic Practices

• Belief in Holy Quran and submission to Allah (God)
• No pork consumption allowed; halal meat is consumed.
• Ramadan fasting occurs between sunrise and sunset, but sick individuals are exempt
• Hygiene practices include washing hands before meals, eating with the right hand, and preferring free-flowing water for washing
• Modesty is preferred with female staff for women.
• Prayers whispered in newborn's ear are reproductive practices

Hinduism Practices

• Prefers washing in free-flowing water.
• Lifestyle & Health includes ayurvedic medicine.
• Modesty and Respect include women preferring female medical staff and avoiding touching feet/head as disrespect.
• Karma causes reincarnation in religious beliefs.
• Wear "sacred thread" around body or wrist, do not remove, or cut without permission.

Buddhism

• Core teachings state suffering ends with the eightfold path and Nirvana.
• Vegetarian diet, fasting customs, contraception accepted but abortion and euthanasia condemned,.
• They accept blood transfusions and organ transplantation.

Native American Spirituality

• Over 570 federally recognized tribes and nations
• They consider Earth a living organism and value land, meadows, rivers, and mountains.
• Professional note-taking during communication can be forbidden

Beliefs Related to Faith

• Agnostic: Unsure of higher power existence
• Atheist: Denies higher power existence

Essential Nursing Knowledge

• Nurses should gain self-knowledge, stay open-minded, welcome changes, and reflect

Meeting Spiritual Needs

• Offer compassionate presence.
• Assist in finding meaning.
• Foster relationships.
• Facilitate expressing beliefs.

Spiritual Care Barriers

• Lack of awareness, differences and fear
• Lack of knowledge

Spiritual Needs Nursing Process

• Assessment of Spiritual Needs and Practices

Tools For Assessment

• HOPE Model
• JAREL Spiritual Well-Being Scale
• SPIRIT Model
• Levels of Spiritual Assessments

HOPE Acronym

• H—sources of hope
• O—organized religion
• P—personal spirituality and practice
• E—effects on medical care and end-of-life issues
• Look for changes in spiritual practices

SPIRIT Model for Spiritual Needs

• S—Spiritual/religious belief system
• P—Personal spirituality
• I—Integration within a spiritual community
• R—Ritualized practices and restrictions
• I—Implications for medical care
• T—Terminal events planning

JAREL SPIRITUAL WELL-BEING MODEL

• 21 question tool assessing faith/belief, life/self-responsibility, and life-satisfaction/self-actualization.
• Use for clients 65+

Focused Assessment of Spiritual Aspects

• Assessing spiritual beliefs, practices, connection to daily life, distress, needs, meaning, love, forgiveness, and behaviors

Nursing Diagnosis

• Distinguishes Impaired Religiosity, Moral Distress, Risk for Spiritual Distress, Spiritual Distress*, Suffering, and Risk for Conflicting Religious Belief

Spiritual Distress Examples

• Pain from loss, alienation from community, and anxiety from challenged beliefs

Spiritual Issue

• May include guilt, anger, loss, and despair

Patient Goals for Spiritual Distress

• Exploring beliefs, identifying life challenges, exploring alternatives, finding supports and reporting decreased distress

Facilitating Religious Practice

• Respect privacy, assist with objects, arrange sacraments, and accommodate dietary needs

Prayer Guidelines

• Identify client's preference.
• Ask how to address.
• Respect client's choice to pray alone

Other Spiritual Interventions Include

• Active listening
• Presence
• Touch
• Meaning exploration
• Reminiscence
• Therapy
• Support
• Forgiveness
• Facilitation
• Hope inspiration
• Prayer

Assessing Spiritual Health

• Assess checklist to determine spirituality needs

Self-Care Behaviors

• Exploring beliefs, nurturing self, practices, demonstrating inner peace

Evaluating Expected Outcomes Include

• Identifying beliefs, acceptance, relationships, reconciliation, verbalizing satisfaction, expressing acceptance and forgiveness