Spiritual Assessment.pdf

The Nurse’s Role in Spiritual Assessment by Kim Stiles, PhD, RN, AHN-BC, CNE Why Conduct a Spiritual Assessment?  “Illness is both soul-shaking and soul-evoking for the patient and for all others for whom the patient matters. We lose innocence, we know vulnerability, we are no longer who we were be...

The Nurse’s Role in Spiritual Assessment by Kim Stiles, PhD, RN, AHN-BC, CNE Why Conduct a Spiritual Assessment?  “Illness is both soul-shaking and soul-evoking for the patient and for all others for whom the patient matters. We lose innocence, we know vulnerability, we are no longer who we were before this event, and we will never be the same.” Bolen, J.S. Close to the bone: Life-Threatening illness and the search for meaning. TJC and Spirituality  Requires that organizations include a spiritual assessment to determine how the person’s spiritual outcome can affect care, treatment, and service.  Main goal:  “identify the patient’s needs, hopes, resources, and possible outcome regarding spirituality” and  “determine appropriate actions necessary to address those issues.”  Each organization acts independently but,  “at a minimum, determines the patient’s religious affiliation (if any), as well as any beliefs or spiritual practices that are important to the patient. Watson’s 4 Tasks of Humanity  Healing our relationship with self and others.  Finding meaning for our own life.  Understanding and transforming our own and others’ suffering.  Deepening our understanding and acceptance of all of life’s cycles and preparing for our own death. Hey, these tasks sound spiritual! Religion: Organized system of beliefs, practices, rituals, and symbols to facilitate closeness to the sacred or transcendent and to foster an understanding of one’s relationship and responsibility to others. Image by: Daniel Mazola, Pittsburgh Post Gazette, 8-28-07 Comparing Religion and Spirituality Religion Spirituality  Community focused  Individualistic, personal  Religare, “to bind together”  Spiritualitas, “breath”  Formal, organized structure  Less formal, less structured  Behavior oriented, outward practices  Emotionally oriented, inward directed  Observable, measurable  More subjective, less visible  Doctrine  Unifying  Can be authoritarian or prescriptive in terms of behavior  Non authoritarian, little accountability Why Conduct a Spiritual Assessment?  To understand a person’s beliefs.  To determine if a person has a faith practice.  To assess whether a person has resources for hope and strength.  To assess whether a person would like access to a spiritual resource.  To identify “spiritual distress.” Nurse’s Role in Spiritual Assessment  Help people talk about how their physical, emotional, and spiritual needs relate to health, healing, and hope.  Process is conversational, active and ongoing.  Respectful, nonjudgmental, non-biased.  Non-confrontational.  Requires self-reflection and identification of one’s own beliefs to do well. The nurse does NOT:  Try to become a spiritual or religious leader, i.e. it’s OK to not have the answers to life’s hard questions!  Promote your own faith beliefs or values.  Impose an agenda on the patient: i.e, get someone to confess “sins”, deathbed conversion, etc.  Work in isolation from the interdisciplinary medical care team. Communication Tips  Use open-ended questions.  Ask patient to say more. “Tell me more about that.”  Ask about the patient’s emotions, “How do you feel about…?”  Use empathetic comments, “That sounds like it was a painful situation.”  Acknowledge and normalize patient’s concerns. Great assessment questions  What is most important to you right now?  What gives your life meaning?  What gives you energy during tough times?  To what or whom do you look to as a source of strength, hope, or faith during difficult times?  What can I do to support you?  See box 36-2, p. 738 Potter and Perry. Spiritual Distress Defined  Impaired ability to experience and integrate meaning and purpose in life through a person’s connectedness with self, others, art, music, literature, nature, or a power greater than oneself.” (NANDA: North American Nursing Diagnosis Association, 2009)  The disruption of healthy relationships with self and others resulting in emotional disquiet focused on matters of faith, meaning, and the purpose of life. (Pastoral care, Baylor Medical Health Care System) Identifying Spiritual Distress  Questions meaning/purpose of illness, pain, life (Why me?)  Expresses loss of hope.  Withdraws from relationships.  Angry feelings of abandonment by religious group/God.  Feels guilty/deserving of punishment.  Expresses self-loathing or unworthiness. Other Spirituality Nursing Diagnoses  Moral Distress: Person cannot carry out an ethical decision they made.  Impaired Religiosity: Difficulty in participating in rituals or beliefs of a faith tradition (religion).  Readiness for Enhanced Religiosity  Readiness for Enhanced Spiritual Well-Being  Risk for Impaired Religiosity  Risk for Spiritual Distress  Spiritual Distress Standardized (NIC) Spirituality Interventions  Active Listening  Presence  Touch  Reminiscence Therapy  Forgiveness Facilitation  Hope Inspiration  Exploring Meaning (non-NIC)  Prayer (non-NIC)  Referrals  Encourage expression of feelings  Help patient identify feelings of guilt  Respect patient’s dress/food requirements as determined by their religion.  ETC! Sample Outcomes/Goals  For Risk for Spiritual Distress: Exhibits no s/s of spiritual distress (e.g. finds meaning in life, expresses hope & faith, follows usual religious practices).  For Spiritual Distress: Returns to previous state of spiritual well-being and comfort. (e.g. expresses sense of peace, asks to see religious advisor).  For Readiness for Enhanced Spiritual Well-Being: Experienced a higher level of connectedness with self, others, higher power, and/or nature. Role of the Hospital Chaplain  https://www.youtube.com/watch?v=l6n6chrQX0A  Provide emotional/spiritual support to patients, families, and staff.  May coordinate volunteer programs/staff.  Typically serve on bioethics committees.  May respond to medical emergencies as support to families to free up medical team for patient care.