Sean Whitfield - NURS 3000 - Module 13 Loss and Grief; Spiritual Needs- Accessible Version - Completed.pdf

NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Loss and Grief: Spiritual Needs Harding University - Active Learning Guide, Module 13 Name: Sean Whitfield Instructions Complete the module active learning guide as you work through the module content. Take notes, answer the questions...

NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Loss and Grief: Spiritual Needs Harding University - Active Learning Guide, Module 13 Name: Sean Whitfield Instructions Complete the module active learning guide as you work through the module content. Take notes, answer the questions on the guide, and respond to any case studies and client scenarios. All of these activities will assist in your preparation for exams, help you plan and implement care in the clinical setting, and facilitate your development as a Christian nurse servant. You will submit your completed guide to the instructor at the end of the week. The completed learning guide will be worth a maximum of 10 points. If you have questions or are unsure about your answers; or you may email your instructor for clarification. Note: The Active Learning Guide provides a general outline of topics covered in this module; it is not all inclusive of all information needed for the exam. You are responsible for all content in readings and activities throughout the module. I. Loss and Grief: Chapter 43: Loss, Grieving, and Death 1. Define loss: is an actual or potential situation in which something that is valued is changed or no longer available. 2. Describe the sources of loss:  External Objects: Loss of external objects includes (a) loss of inanimate objects that have importance to the individual, such as losing money or the burning down of a family’s house; and (b) loss of animate (live) objects such as pets that provide love and companionship.  Familiar Environment: Separation from an environment and individuals who provide security can cause a sense of loss. The 6-year-old is likely to feel loss when first leaving the home environment to attend school. The university student who moves away from home for the first time also experiences a sense of loss.  Loved Ones: Losing a loved one or valued individual through illness, divorce, separation, or death can be very disturbing. In some illnesses (such as Alzheimer’s disease), an individual may undergo personality changes that make friends and family feel they have lost that individual.  Aspect of Self: Losing an aspect of self changes an individual’s body image, even though the loss may not be obvious. A face scarred from a burn is generally obvious; loss of part of the stomach or loss of the ability to feel emotion may not be as obvious. The degree to which these losses affect an individual largely depends on the integrity of the individual’s body image.  Life: Everyone experiences loss, grieving, and death during his or her life. Individuals may suffer the loss of valued relationships through life changes, such as moving from one city to another; separation or divorce; or the death of a parent, spouse, or friend. Individuals may grieve changing life roles as they watch grown children leave home or they retire from their lifelong work. Losing valued material objects through theft or natural disaster can evoke NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs feelings of grief and loss. When individuals’ lives are affected by civil or national violence, they may grieve the loss of valued ideals such as safety, freedom, or democracy. 3. Describe types of loss:  Actual: can be recognized by others.  Perceived: is experienced by an individual but cannot be verified by others.  Anticipatory: is experienced before the loss actually occurs.  Situational: Loss, especially loss of a loved one or a valued body part, can be viewed as either a situational or a developmental loss and as either an actual or a perceived loss (both of which can be anticipatory). Losing one’s job, the death of a child, and losing functional ability because of acute illness or injury are situational losses.  Developmental: Losses that occur in normal development—such as the departure of grown children from the home, retirement from a career, and the death of aged parents—are developmental losses that can, to some extent, be anticipated and prepared for. 4. Describe how grief, mourning, and bereavement differ. ◦ Grief is the total response to the emotional experience related to loss. Grief is manifested in thoughts, feelings, and behaviors associated with overwhelming distress or sorrow Definition: Grief is the internal feeling one experiences in response to loss. It is the personal and emotional reaction that includes a range of feelings from deep sadness to anger, and can also involve thoughts, physical symptoms like changes in sleep or appetite, and behaviors. Grief can vary greatly from person to person and can be influenced by the nature of the loss, the relationship to the deceased, personal beliefs, and cultural factors. ◦ Mourning is the behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom. Definition: Mourning is the external expression or the act of showing grief. It encompasses the cultural and social rituals and practices that people engage in to express their grief and commemorate the deceased. This could include wearing specific clothes (such as black attire), holding funeral ceremonies, or participating in certain religious or spiritual practices. Mourning is heavily influenced by cultural norms and societal expectations and serves as a way for individuals to process their grief and receive community support. ◦ Bereavement is the subjective response experienced by the surviving loved ones. Definition: Bereavement refers to the state of having lost a significant person in one's life through death. It is the objective situation of having experienced a loss. Bereavement is the period following a death during which grief and mourning occur. The duration and intensity of bereavement can vary greatly among different individuals and cultures. 5. Describe the different types of grief.  Abbreviated: nificantly important to the grieving individual or may have been replaced immediately by another, equally esteemed object.  Anticipatory: is experienced in advance of the event such as the wife who grieves before her ailing husband dies. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs      Disenfranchised: occurs when an individual is unable to acknowledge the loss to others. Situations in which this may occur often relate to a socially unacceptable loss that cannot be spoken about, such as suicide, abortion, or giving a child up for adoption. Other examples include losses of relationships that are socially unsanctioned and may not be known to others (such as with extramarital relationships). Unresolved/chronic: Inhibited: many of the normal symptoms of grief are suppressed and other effects, including physiologic, are experienced instead. Delayed: occurs when feelings are purposely or subconsciously suppressed until a much later time. Exaggerated: A survivor who appears to be using dangerous activities as a method to lessen the pain of grieving may experience exaggerated grief. 6. Table 43.1 Client Responses and Nursing Implications in Kübler-Ross’s Stages of Grieving  List and describe the five stages of grieving as described here. o Denial: Refuses to believe that loss is happening. Is unready to deal with practical problems, such as prosthesis after the loss of a leg. May assume artificial cheerfulness to prolong denial. o Anger: Client or family may direct anger at nurse or staff about matters that normally would not bother them. o Bargaining: Seeks to bargain to avoid loss (e.g., “let me just live until [a certain time] and then I will be ready to die”). o Depression: Grieves over what has happened and what cannot be. May talk freely (e.g., reviewing past losses such as money or job), or may withdraw. o Acceptance: Comes to terms with loss. May have decreased interest in surroundings and support people. May wish to begin making plans (e.g., will, prosthesis, altered living arrangements). 7. Factors Influencing the Loss and Grief Responses.  Age: Age affects an individual’s understanding of and reaction to loss. With familiarity, individuals usually increase their understanding and acceptance of life, loss, and death.  Significance: The significance of a loss depends on the perceptions of the individual experiencing the loss. One individual may experience a great sense of loss over a divorce; another may find it only mildly disrupting. Several factors affect the significance of the loss: Importance of the lost individual, object, or function Degree of change required because of the loss The individual’s beliefs and values.  Culture: Culture influences an individual’s reaction to loss. How grief is expressed is often determined by the customs of the culture. Unless an extended family structure exists, grief is handled by the nuclear family. The death of a family member in a typical nuclear family leaves a great void because the same few individuals fill most of the roles. In cultures where several generations and extended family members either reside in the same household or are physically close, the impact of a family member’s death may be softened because the roles of the deceased are quickly filled by other relatives. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs       Spiritual Beliefs: Spiritual beliefs and practices greatly influence both an individual’s reaction to loss and subsequent behavior. Most religious groups have practices related to dying, and these are often important to the client and support people. To provide support at a time of death, nurses need to understand the client’s particular beliefs and practices (see Chapter 41). Gender: The gender roles into which many individuals are socialized in the United States affect their reactions at times of loss. Males are frequently expected to “be strong” and show very little emotion during grief, whereas it is acceptable for females to show grief by crying. When a wife dies, the husband, who is the chief mourner, may be expected to repress his own emotions and to comfort sons and daughters in their grieving. Socioeconomic Status: The socioeconomic status of an individual often affects the support system available at the time of a loss. A pension plan or insurance, for example, can offer an individual who is widowed or disabled a choice of ways to deal with a loss; an individual who is confronted with both severe loss and economic hardship may not be able to cope with either. Support System: The individuals closest to the grieving individual are often the first to recognize and provide needed emotional, physical, and functional assistance. However, because many individuals are uncomfortable or inexperienced in dealing with losses, the usual support people may instead withdraw from the grieving individual. In addition, support may be available when the loss is first recognized, but as the support people return to their usual activities, the need for ongoing support may be unmet. Sometimes, the grieving individual is unable or unready to accept support when offered. Cause of Loss: Individual and societal views on the cause of a loss or death may significantly influence the grief response. Some diseases are considered “clean,” such as cardiovascular disorders, and engender compassion, whereas others may be viewed as repulsive and less unfortunate. A loss or death beyond the control of those involved may be more acceptable than one that is preventable, such as a drunk driving incident. Injuries or deaths that occur during respected activities, such as “in the line of duty,” are considered honorable, whereas those occurring during illicit activities may be considered the individual’s just rewards. Previous Losses: Determining how much and what type of home care follow-up is needed is based in great part on the nurse’s knowledge of how the client and family have coped with previous losses. 8. What are some of the responses the client may have when experiencing a loss? Refuses to accept loss, Anger may be directed at agency, nurses, or others, Conducts rituals of mourning, May accept more dependent relationship with support person, Represses all negative and hostile feelings toward lost object, importance of lost object as source of support. 9. Describe some of the religious and cultural practices r/t death. Why is it important for the nurse to be aware of the client’s beliefs? Culture influences an individual’s reaction to loss. How grief is expressed is often determined by the customs of the culture. Unless an extended family structure exists, grief is handled by the nuclear family. The death of a family member in a typical nuclear family leaves a great void because the same few individuals fill most of the roles. In cultures where several generations NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs and extended family members either reside in the same household or are physically close, the impact of a family member’s death may be softened because the roles of the deceased are quickly filled by other relatives. Some individuals believe that grief is a private matter to be endured internally. Therefore, feelings tend to be repressed and may remain unidentified. Individuals socialized to “be strong” and “make the best of the situation” may not express deep feelings or personal concerns when they experience a serious loss. Some cultural groups value social support and the expression of loss. In some groups, expressions of grief through wailing, crying, physical prostration, and other outward demonstrations are acceptable and encouraged. Other groups may frown on this demonstration as a loss of control, favoring a more quiet and stoic expression of grief. In cultural groups where strong kinship ties are maintained, physical and emotional support and assistance are provided by family members. 10. Box 43.1 Signs of Impending Clinical Death Describe these signs and note why the nurse needs to assess for these. Loss of Muscle Tone ◦ Relaxation of the facial muscles (e.g., the jaw may sag) ◦ Difficulty speaking ◦ Difficulty swallowing and gradual loss of the gag reflex ◦ Decreased activity of the gastrointestinal tract, with subsequent nausea, accumulation of flatus, abdominal distention, and retention of feces, especially if narcotics or tranquilizers are being administered ◦ Possible urinary and rectal incontinence due to decreased sphincter control ◦ Diminished body movement Slowing of the Circulation ◦ Diminished sensation ◦ Mottling and cyanosis of the extremities ◦ Cold skin, first in the feet and later in the hands, ears, and nose (the client, however, may feel warm if there is a fever) ◦ Slower and weaker pulse ◦ Decreased blood pressure Changes in Respirations NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs ◦ Rapid, shallow, irregular, or abnormally slow respirations ◦ Noisy breathing, referred to as the death rattle, due to collecting of mucus in the throat ◦ Mouth breathing, dry oral mucous membranes Sensory Impairment ◦ Blurred vision ◦ Impaired senses of taste and smell Assessing To gather a complete database that allows accurate analysis and identification of appropriate nursing diagnoses for dying clients and their families, the nurse first needs to recognize the states of awareness manifested by the client and family members. In cases of terminal illness, the state of awareness shared by the dying client and the family affects the nurse’s ability to communicate freely with clients and other healthcare team members and to assist in the grieving process. Three types of awareness that have been described are closed awareness, mutual pretense, and open awareness (Glaser & Strauss, 1965). 11. What are the major goals of nursing care for the dying client? Major goals for dying clients are (a) maintaining physiologic and psychologic comfort and (b) achieving a dignified and peaceful death, which includes maintaining personal control and accepting declining health status. Many clinical agencies and organizations have created documents that describe the dying client’s rights. When planning care for dying clients, these guides can be useful guides. 12. How can the nurse assist the client in dying with dignity? Helping Clients Die with Dignity Nurses need to ensure that the client is treated with dignity, that is, with honor and respect. Dying clients often feel they have lost control over their lives and over life itself. Helping clients die with dignity involves maintaining their humanity, consistent with their values, beliefs, and culture. By introducing options available to the client and significant others, nurses can restore and support feelings of control. Some choices that clients can make are the location of care (e.g., hospital, home, or hospice facility), times of appointments with health professionals, activity schedule, use of health resources, and times of visits from relatives and friends. Clients want to manage the events preceding death so they can die peacefully. Nurses can help clients to determine their own physical, psychologic, and social priorities. Dying individuals often strive for self-fulfillment more than for self-preservation, and may need to find meaning in continuing to live if suffering. Part of the nurse’s challenge is to support the client’s will and hope. 13. What is hospice care? NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Hospice care focuses on support and care of the dying client with a life expectancy of 6 months or less and the family, with the goal of facilitating a peaceful and dignified death. Hospice care is based on holistic concepts and emphasizes team-based care to improve quality of life rather than cure, support the client and family through the dying process, and support the family through bereavement. Assessing the needs of the client’s family is just as important as caring for the client who is receiving hospice care (Figure 43.3). 14. Describe palliative care. an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care: provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten nor postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patient’s illness and in their own bereavement; uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. (para. 1) Palliative care “attends to the physical, functional, psychologic, practical, and spiritual consequences of a serious illness. It is a person- and family-centered approach to care, providing seriously ill people relief from the symptoms and stress of an illness. Through early integration into the care plan of seriously ill people, palliative care improves quality of life for both the patient and the family” (National Consensus Project for Quality Palliative Care, 2018, p. i). This care may differ from hospice because the client is not necessarily believed to be imminently dying. Both hospice and palliative care can include end-of-life care, that is, the care provided in the final weeks before death. 15. Table 43.5 Physiologic Needs of Dying Clients. Discuss these. Airway clearance: Fowler position: conscious clients Throat suctioning: conscious clients Lateral position: unconscious clients Nasal oxygen for hypoxic clients Anticholinergic medications may be indicated to help dry secretions Air hunger NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Open windows or use a fan to circulate air Morphine may be indicated in an acute episode Bathing and hygiene Frequent baths and linen changes if diaphoretic Mouth care as needed for dry mouth Liberal use of moisturizing creams and lotions for dry skin Moisture-barrier skin preparations for incontinent clients Physical mobility Assist client out of bed periodically, if able Regularly change client’s position Support client’s position with pillows, blanket rolls, or towels as needed Elevate client’s legs when sitting up Implement pressure injury prevention program and use pressure-relieving surfaces as indicated Nutrition Antiemetics or a small amount of an alcoholic beverage to stimulate appetite Encourage liquid foods as tolerated Constipation Dietary fiber as tolerated Stool softeners or laxatives as needed Urinary elimination Skin care in response to incontinence of urine or feces Bedpan, urinal, or commode chair within easy reach Call light within reach for assistance onto bedpan or commode Absorbent pads placed under incontinent client; linen changed as often as needed Catheterization, if necessary Keep room as clean and odor free as possible Sensory and perceptual changes Check preference for light or dark room Hearing is not diminished; speak clearly and do not whisper Touch is diminished, but client will feel pressure of touch Implement pain management protocol if indicated 16. Discuss ways the nurse can provide spiritual support to the dying client. What do you believe the client might see in the care provided by a Christian nurse that the client might not see in the nurse who does not profess to be a Christian? The nurse has a responsibility to ensure that the client’s spiritual needs are attended to, either through direct intervention or by arranging access to individuals who can provide spiritual care. Nurses need to be aware of their own comfort with spiritual issues and be clear about their own NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs ability to interact supportively with the client. Nurses have an ethical and moral responsibility to not impose their own religious or spiritual beliefs on a client but to respond to the client in relation to the client’s own background and needs. Communication skills are most important in helping the client articulate needs and in developing a sense of caring and trust. Interventions may include facilitating expressions of feeling, prayer, meditation, reading, and discussion with clergy or a spiritual adviser. It is important for nurses to establish an effective interdisciplinary relationship with spiritual support specialists. 17. How can the nurse support the family of a client who is dying? The most important aspects of providing support to the family members of a dying client involve using therapeutic communication to facilitate their expression of feelings. When nothing can reverse the inevitable dying process, the nurse can provide an empathetic and caring presence. The nurse also serves as a teacher, explaining what is happening and what the family can expect. Due to the stress of moving through the grieving process, family members may not absorb what they are told and may need to have information provided repeatedly. The nurse must have a calm and patient demeanor. 18. What is essential in post-mortem care?  Body Positioning:  Eyes and Mouth:  Removing tape, etc.  Describe rigor mortis → is the stiffening of the body that occurs about 2 to 4 hours after death. Rigor mortis starts in the involuntary muscles (heart, bladder, and so on), then progresses to the head, neck, and trunk, and finally reaches the extremities. algor mortis → is the gradual decrease of the body’s temperature after death. When blood circulation terminates and the hypothalamus ceases to function, body temperature falls about 1°C (1.8°F) per hour until it reaches room temperature. Simultaneously, the skin loses its elasticity and can easily be broken when removing dressings and adhesive tape. livor mortis → After blood circulation has ceased, the red blood cells break down, releasing hemoglobin, which discolors the surrounding tissues. This discoloration, referred to as livor mortis, appears in the lowermost or dependent areas of the body. II. Spiritual Needs: Chapter 41: Spirituality 1. Define spirituality: is generally thought to refer to the human tendency to seek meaning and purpose in life, inner peace and acceptance, forgiveness and harmony, hope, beauty, and so forth. 2. Define religion: is usually applied to ritualistic practices and organized beliefs. Indeed, there has been a tendency in nursing—as in psychology and other fields—to separate these two concepts. Yet trying to make religion an opposite of spirituality (e.g., institutional versus personal, objective versus subjective, narrow versus broad, cerebral versus emotional, bad versus good) is unfair to both concepts. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs 3. What is the difference between an atheist and an agnostic? An atheist is one without belief in a deity. Atheists report that they often feel discriminated against (Brewster, Hammer, Sawyer, Eklund, & Palamar, 2016) or perceived as angry (Meier, Fetterman, Robinson, & Lappas, 2015) by those in our culture who experience and value spirituality or religion. An agnostic is an individual who doubts the existence of God or believes the existence of God has not been proved. Does a client professing to be an atheist or agnostic have spiritual needs? If so, describe them. Yes, clients who identify as atheist or agnostic can still have spiritual needs. Spirituality is a broad concept that encompasses more than just religious beliefs or practices; it can include any element relating to a person's sense of peace, purpose, ethics, values, and connection to oneself, others, and the world. Addressing Spiritual Needs in Care Settings For healthcare providers, counselors, and other professionals working with atheist or agnostic clients, recognizing that these clients may have spiritual needs is important. Addressing these needs involves: Asking Open-Ended Questions: Questions about what gives them meaning, joy, or comfort can help clarify where their spiritual needs lie. Respecting Their Beliefs: Clearly acknowledging and respecting their beliefs (or lack of religious beliefs) avoids alienating the client and creates a supportive environment. Providing Relevant Resources: This could include referrals to community groups, philosophical discussions, art therapy, or other non-religious forms of support that align with their values and interests. Encouraging Self-Expression: Facilitating avenues for self-expression, whether through art, writing, or conversation, can help meet spiritual needs related to understanding oneself and one’s place in the world. Understanding that spirituality is not confined to religious expression allows professionals to better support the holistic well-being of atheist and agnostic clients, respecting their unique perspectives and supporting their spiritual journeys in a broad and inclusive manner. 4. Box 41.1 Spiritual Needs. Review responses seen in clients who are experiencing an impairment in meeting their spiritual needs. Need for satisfying meaning to ascribe to illness, to life, to dying, to any loss or serious challenge “Why would this happen to me? Having cancer is a celestial crapshoot!” “This is so unfair.” “Why do bad things happen?” Need for purpose, vocation, mission NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs “Now that I can’t work anymore, what good is it for me to keep on living?” “What’s there for me to do now with my old body?” Need for believable beliefs, sensible worldview “I’ve been told God is in control and is loving, but that doesn’t make sense to me anymore.” Guilt, need to restore relationship “I wonder if I’m being punished for something I did when I was younger.” “I know I have to meet my Maker soon, so I’d better get things right with Him.” Shame, imperfection, unworthiness “I never was good enough for... , but now look how sick/disabled/scarred I am!” “I am going to do whatever my family wants me to do.” “I’m just using up society’s resources. I’m such a burden to my family.” Need to worship, transcend self “I am so tired/sick/befuddled/anxious, I’m beside myself.... I wish I could feel God was involved in this situation.” “I never get to go to church because I’m always taking care of my husband.” Need for peace, composure “I don’t feel comfortable being alone or in silence.” “I just wish I could make it all turn out the way I want it to.” Need to be grateful “I know I should count my blessings; things could be worse.” Need to express love “I keep my problems to myself, because I don’t want to trouble my family any more than necessary.” “You nurses do so much for me; I wish I could do nice things for you.” Isolation, abandonment, betrayal “Why don’t they come to visit anymore?” “It just seems like all my prayers bounce back to me without being heard.” 5. Components of the spiritual dimension: Considering these five needs, assess your own current spiritual health state.      Meaning/Purpose: To be helpful. Identity: Murse. Love: Yes. It is in my heart. Hope: I hope to be consistent. Forgiveness: Is the only way to move forward. 6. Interventions for spiritual health: Describe:  Providing Presence: Presencing is a term describing the art of being present, or just being with a client during his or her suffering. To be fully present to a client, a nurse must be purposefully attentive (Fahlberg & Roush, 2016). To be comfortable being fully present to NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs another individual, however, one must be comfortable being fully present to oneself (du Plessis, 2016).  Conversing about spirituality: Initiating conversation about spiritual or religious concerns with a healthcare professional is likely hard for clients; they presumably wait for an appropriate time with a “safe” clinician. Both physicians and nurses typically find it difficult to talk with clients about this intimate and sometimes socially taboo topic (Best, Butow, & Olver, 2016; Wittenburg, Ragan, & Ferrell, 2017). Sometimes clients do not want to talk about deep inner pain, spiritual or emotional. They may instead find comfort and help from the nurse who genuinely shows interest in their life, family, and hobbies. However, sometimes clients do want to have overtly spiritual discussions with their nurse.  Assisting with prayer or meditation: Many nurses pray with clients when they request it (Minton, Isaacson, & Banik, 2016; Taylor, Park, & Pfeiffer, 2014). Prayer allows individuals to connect with each other and with the divine. To pray for another is also a way for loving individuals to express care. While most clients may say that prayer makes them feel better, it is also possible that prayer could raise to awareness a spiritual struggle or a disappointment and questions about “unanswered prayers” (Taylor, 2012).  Referring to spiritual care experts: Referring Clients to Spiritual Care Experts There are times when spiritual care is best referred to other members of the healthcare team. Referrals can be made for hospitalized clients and their families through the hospital chaplain’s office if one is available. Nurses in home and community health settings can identify spiritual resources by checking directories of community service agencies, telephone directories, or religious directories that describe available spiritual counselors and the services provided through the religious community. Many religious counselors will assist members of their faith who are not members of their specific religious community. For example, a priest may attend a client in the hospital or at home even though the client is not a member of the priest’s parish. Be sure to obtain a client’s approval before initiating a referral. The client often will have a preferred spiritual care provider to contact.  Supporting religious practices: During the assessment of the client, the nurse will have obtained specific information about the client’s religious preference and practices. Nurses need to consider specific religious practices that will affect nursing care, such as the client’s beliefs about birth, death, dress, diet, prayer, sacred symbols, sacred writings, and holy days as discussed earlier in this chapter. See Practice Guidelines for ways the nurse can help clients to continue their usual spiritual practices. Box 41.2 provides health-related information about specific religions. 7. Religious Practices the Nurses Should Know pp. 1031-1034. Familiarize yourself with these ideas. Discuss something you learned from this section which enhanced your awareness of potential spiritual needs of clients. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Many traditional religious practices and rituals are related to life events such as birth, transition from childhood to adulthood, marriage, illness, and death. Religious rules of conduct, typically influenced concurrently by culture, may also apply to matters of daily life such as dress, food, social interaction, menstruation, childrearing, and sexual relationships. When individuals get sick, they frequently rely on prayer and other spiritual practices. Decisions about health and end-of-life care are guided by spiritual or religious beliefs. Given this deep connection between spiritual or religious practices and the circumstances in which nurses often provide care, it is fitting for nurses to have some awareness and understanding of these practices (Taylor, 2012). Holy Days Solemn religious observances and feast days throughout the year may be referred to as holy days and may include fasting or special foods, reflection, rituals, and prayer. Believers who are seriously ill are often exempted from such requirements. Clients may be used to spending such days with family and attending religious services. Examples of such holy days are Rosh Hashanah and Yom Kippur (Jewish); Good Friday and Christmas (Christian); Buddha’s birthday (Buddhists); Mahashivratri, a celebration of Lord Shiva (Hindu); and the month-long Ramadan (Islam). Because some religions follow calendars other than the Gregorian calendar, a multifaith calendar can be used to identify the holy days of the various religious groups. Sacred Texts Individuals often gain strength and hope from reading religious writings when they are ill or in crisis. Each religion has sacred and authoritative scriptures that provide guidance for its adherents’ beliefs and behaviors (Taylor, 2012). In addition, sacred writings frequently tell instructive stories of the religion’s leaders, kings, and heroes. In most religions, these scriptures are thought to be the word of the Supreme Being as written down by prophets or other human representatives. Christians rely on the Old and New Testaments of the Bible, Jews on the Hebrew Bible, and Muslims on the Koran; Hindus have several holy texts, or Vedas; Sikhs cherish the Adi Granth; and Buddhists value the teachings of the Tripitakas. Scriptures generally set forth religious law in the form of warnings and rules for living (e.g., the Ten Commandments). This religious law may be interpreted in various ways by subgroups of a religion’s followers and may affect a client’s willingness to accept treatment suggestions; for example, blood transfusions are in conflict with the biblical interpretations of Jehovah’s Witnesses. Sacred Symbols Sacred symbols include jewelry, medals, amulets, icons, totems, or body ornamentation (e.g., tattoos) that carry religious or spiritual significance. They may be worn to pronounce one’s faith, to remind the practitioner of the faith, to provide spiritual protection, or to be a source of comfort or strength (Taylor, 2012). Clients may wear religious symbols at all times, and they may wish to wear them when they are undergoing diagnostic studies, medical treatment, or surgery. For example, clients who are Roman Catholic may carry a rosary for prayer; a Muslim may carry a mala, or string of prayer beads (Figure 41.2). Prayer and Meditation NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Prayer involves humans experiencing the divine (however that is perceived). Some would describe prayer as an inner experience for gaining awareness of self (including Self—or the immanent manifestation of the divine). Others may view it as a conversation with the divine (e.g., to entreat or dialogue). These differing perspectives likely reflect the theological variations about how the divine relates to humanity. For example, some view the divine as transcendent (e.g., God in Heaven), while others experience the divine as immanent (e.g., the inner light or wisdom within individuals). A more complex perspective would accept that the divine engages with humanity in both—or many—ways (Borg, 1997; Taylor, 2012). Beliefs Affecting Diet Many religions have prescriptions regarding diet. It is important that healthcare providers prescribe diet plans with an awareness of the client’s dietary and fasting beliefs. There may be rules about which foods and beverages are allowed and which are prohibited. For example, Orthodox Jews are not to eat shellfish or pork, and Muslims are not to drink alcoholic beverages or eat pork. Members of the Church of Jesus Christ of Latter-Day Saints (Mormons) are not to drink caffeinated or alcoholic beverages. Older Catholics may choose not to eat meat on Fridays because this was prescribed in years past. Buddhists and Hindus are often vegetarian, not wanting to take life to support life. Religious prescriptions may also dictate how food is prepared; for example, many Jews require kosher food, which is food prepared according to Jewish rules. Beliefs About Illness and Healing Clients may have religious beliefs that attribute illness to a spiritual disease or sin. Some clients may think that disease is caused by the presence of sin and evil in this world, whereas others may believe the disease is a punishment for sin in their past. Indeed, how clients view the divine, interpret good and evil, and so forth, inevitably influences their thinking about illness and decision-making about treatment. Healing for such clients may appear to be unrelated to current treatment practices. When relevant, the nurse should assess the client’s beliefs related to health and, if possible, include aspects of healing that are part of the client’s belief system in the planning of care. For example, many religious traditions have rituals of healing such as anointing by a leader of the local religious community (Taylor, 2012). Beliefs About Dress and Modesty Many religions have traditions that dictate dress. For example, Orthodox and some conservative Jewish men believe that it is important to have their heads covered at all times and therefore wear yarmulkes. Orthodox Jewish women cover their hair with a wig or scarf as a sign of respect to God. Mormons may wear temple undergarments in compliance with religious dictates. For some individuals, it is imperative that they not shave certain hair (e.g., sideburns for Hasidic Jewish men, any hair for a Khalsa [dedicated] Sikh). Beliefs Related to Birth For all religions the birth of a child is an important event giving cause for celebration. Many religions have specific ritual ceremonies that consecrate the new child to God. For example, while a baby is being born, its Muslim mother may recite a prayer. As soon as it is born, its NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs father or someone else will recite a call to prayer into the infant’s ears. Likewise, Hindus will perform a number of religious rituals when a baby is born. Most Christian parents will have their babies christened or baptized at some point; however, for some, if their infant is dying, they may want a baptism as soon as possible. In such dire circumstances, Christian parents of seriously ill infants may want baptism performed at birth by a religious nurse or primary care provider if a chaplain or clergy member is not present. In the Jewish and Islamic traditions, male circumcision is obligatory, whereas Hindus never practice circumcision. When nurses are aware of the religious needs of families and their infants, they can support families in fulfilling their religious obligations (Taylor, 2012). Beliefs Related to Death Spiritual and religious beliefs play a significant role in the believer’s approach to death just as they do in other major life events. Many believe that the individual who dies transcends this life for a better place or state of being. Research findings suggest these religious beliefs may influence end-of-life care choices, such as whether to seek hospice care, have an advance care plan, or desire for resuscitation (Ohr, Jeong, & Saul, 2016; Van Norman, 2017). One intriguing aspect of nurses caring for patients of other religions is the importance of cultural competence and sensitivity in delivering holistic care. Nurses must be aware of and respect the religious beliefs, practices, and traditions of their patients to provide effective and patientcentered care. Statistics show that around 84% of Americans believe that healthcare providers should consider patients' religious beliefs when providing care. This underscores the significance of nurses being attuned to the religious needs of their patients. Furthermore, studies have shown that culturally competent care leads to better patient outcomes, increased patient satisfaction, and improved communication between healthcare providers and patients from diverse backgrounds.