Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 TY, Ralph Christian VITUG, Fria Franchesca WANG, Yishan WONG, Jenina

YEPES, Justin Paul YU, Justine Renelee YU, Tracy Ezabel YUMENA, Marc Jusenn ZABAT, Michelle ZAMORA, Hyacinth Elaine ZAPANTA, Patrizia Anne ZERRUDO, Ma. Rhea Dell

2.1. Fowler's Stages of Spiritual Development:

Undifferentiated Faith (infancy) a "prestage" seeds of trust, courage, hope, and love are joined to combat such issues possible trust or mistrust to the one providing care is developed the future faith of an individual lies on what kind of faith was developed on this stage when thought and language developed and begin to influence the child to the use of symbols in speech and ritual play (concrete operational thinking), the child moves on to the next stage reality is not well-differentiated from fantasy o the infant begins to grasp that objects continue exist outside of his or her immediate awareness o "pre-images are largely formed prior to language, prior to concepts and coincident with the emergence of consciousness o adults preaching about the negative aspects of religion - the devil and the evils of sin - can cause great harm to a child of this age, leading him toward a very rigid, brittle and authoritarian personality as an adult has particular relevance for the maternal-infant nurse concerned with issues of parental-infant bonding "the quality of mutuality and the strength of trust, autonomy, hope and courage (or their opposites) developed in this phase underlie (or threaten to undermine) all that comes later in faith development"

Intuitive - Projective Faith (3-7 years old) The fantasy-filled, imitative phase in which the child can be powerfully and permanently influenced by examples, moods, actions and stories of the visible faith of primarily related adults. The gift or emergent strength of this stage is the birth of imagination, the ability to unify and grasp the experience-world in powerful images and as presented in stories that register the child's intuitive understandings and feelings toward the ultimate conditions of existence. The dangers in this stage arise from the possible "possession" of the child's imagination by unrestrained images of terror and destructiveness, or from the witting or unwitting exploitation of her or his imagination in the reinforcement of taboos and moral or doctrinal expectations. The main factor precipitating transition to the next stage is the emergence of concrete operational thinking.

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 Affectively, the resolution of Oedipal issues or their submersion in latency are important accompanying factors. At the heart of the transition is the child's growing concern to know how things are and to clarify for him- or herself the bases of distinctions between what is real and what only seems to be

Mythic-Literal faith (7-12 years old) Is the stage in which the person begins to take on for him- or herself the stories, beliefs and observances that symbolize belonging to his or her community. The rise of concrete operations leads to the curbing and ordering of the previous stage's imaginative composing of the world. They can be affected deeply and powerfully by symbolic and dramatic materials and can describe in endlessly detailed narrative what has occurred. They do not, however, step back from the flow of stories to formulate reflective, conceptual meanings. For this stage the meaning is both carried and "trapped" in the narrative. The new capacity or strength in this stage is the rise of narrative and the emergence of story, drama and myth as ways of finding and giving coherence to experience. This is the faith stage of the school child (though we sometimes find the structures dominant in adolescents and in adults). Marked by increased accuracy in taking the perspective of other persons, those in Stage 2 compose a world based on reciprocal fairness and an imminent justice based on reciprocity. The actors in their cosmic stories are anthropomorphic. They can be affected deeply and powerfully by symbolic and dramatic materials and can describe in endlessly detailed narrative what has occurred. They do not, however, step back from the flow of stories to formulate reflective, conceptual meanings. For this stage the meaning is both carried and "trapped" in the narrative The new capacity or strength in this stage is the rise of narrative and the emergence of story, drama and myth as ways of finding and giving coherence to experience. The limitations of literalness and an excessive reliance upon reciprocity as a principle for constructing an ultimate environment can result either in an over controlling, stilted perfectionism or "works righteousness" or in their opposite, an abasing sense of badness embraced because of mistreatment, neglect or the apparent disfavor of significant others

Synthetic-Conventional Faith (13-20 years old; middle adolescence) Differences in outlook are seen as differences in people Authority is vested in established leaders; a person can accept external authority without question A conformist stage - individuals tend to have conformist acceptance of a belief with little self-reflection on examination of these beliefs, very sensitive to other people's expectations

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 Has increased ability for abstract and hypothetical thinking makes people at this stage enables them to form hypothetical views of how others see them, and understand that others also envision how they can be seen by other people. Dependence upon significant others for confirmation and clarity about their identity and meaning to them Beliefs and values are deeply felt, even though the people in this stage may not be sure why they hold them. A behavior of a human leader may cast doubt on their credibility as moral authority. "the experience of leaving home" - transitory to the next stage; precipitates examination of self, background, and life-guiding values.

Individuating-Reflective Faith (21-30 years old; mid-twenties to late thirties) The individual takes personal responsibility for his or her beliefs and feelings Executive ego - the person is more able to govern himself without the need for rules from the outside. The person may put excess confidence in the rational, conscious mind One begins to critically examine own beliefs and often become disillusioned with former faith. This stage ends up being very non-religious and some people stay in it permanently This stage is marked by a double development. The self, previously sustained in its identity and faith compositions by an interpersonal circle of significant others, now claims an identity no longer defined by the composite of one's roles or meanings to others. To sustain that new identity it composes a meaning frame conscious of its own boundaries and inner connections and aware of itself as a "world view." - This is a "demythologizing" stage. It is likely to attend minimally to unconscious factors influencing its judgments and behavior. - Loss or demytholization of the symbols can result in grief and guilt in some cases, and the process can take up to seven years to complete. But in the place of the literal symbol, the person gains the ability to make comparisons and whatever meanings they retain are explicitly held and thus more authentic in that they are personal. - The strengths of this stage lie in the capacity for critical reflection and the willingness to face truths that may cause distancing from comfortable thought patterns. - The weakness of this stage is that the person may put excess confidence in the rational, conscious mind, thus ignoring unconscious forces that become more prominent in the next stage.

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 Paradoxical-Consolidative Faith (31-40 years old; A.K.A. conjunctive) time of opening to the voices of one's "deeper self" and the development of one's social conscience. Nurses caring for patients in this faith stage must be sensitive to the adults more mature spirituality, especially in relation to finding meaning in his or her illness. In this stage, one begins to realize that the clear boundaries of identity and worldview constructed in Stage four overlook much of life's complexity in an effort to adapt successfully to reality. Here, Fowler says the firm boundaries of the previous stage begin to become porous and permeable After first calling it "paradoxical-consolidative faith," Fowler decided to use this single word, CONJUNCTIVE, which of course implies a "joining together" -- in this case a conjoining of all those elements into that unique combination that constitutes this or that individual person. Accordingly, in his later book, Fowler describes this conjunctive faith: o " ... the stage of faith that emerges with mid-life or beyond involves the integration of elements in ourselves, in society, and in our experience of ultimate reality that have the character of apparent contradictions, polarities, or at least paradoxical elements. (Fowler, 1984 p. 64) In describing people of conjunctive faith, Fowler has, stated that these individuals are not likely to be `true-believers, in the sense of an undialectical, single-minded, uncritical devotion to a cause or ideology.......such people know that the line between the righteous and the sinners goes through the heart of each of us and our communities, rather than between us and them (Fowler:1984; p67). involves the integration into self and outlook of much that was suppressed or unrecognized in the interest of Stage 4's self-certainty and conscious cognitive and affective adaptation to reality. People at this stage recognize the validity of others beliefs yet clearly internalize their own. o Their own faith is clearly and consciously held together with the recognition that all truth is Gods truth. A person at this stage goes beyond the clearly defined theological formulas and continues to probe deeper, higher and broader to discover more of Gods revelation. o They live in the tension of having accepted clearly defined truth for oneself and yet recognizing that one has glimpsed only a small part of the ocean of Gods truth. o There is more to be known of God than the creeds and church can teach us. We are responsible to search more to know the God of our own faith. This stage is about embracing paradox and truly believing that not all things can be resolved intellectually. You learn to live in the questions rather than demand answers for everything.

Universalizing Faith (40 years and above) a culmination of the work of all of the previous faith stage a time of relating to the imperatives of absolute love and justice toward all humankind

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 Nurses need to be aware that patients may vary significantly in terms of degree of accomplishing the imperatives of this final stage. Assessing approximately where the nature adult patient is, related to such faith, will help in understanding both the patients response to an illness condition and his or her need for external support in coping with the crisis.

2.2 Westerhoffs Four Stages of Faith

Experienced Faith Occurs during pre-school & early childhood Children observe love and faith in their interaction with adults and react to what they experience At this stage, they are too young to consciously think about faith, but they demonstrate unwavering faith. at this stage are to experience trust, love, and acceptance. Little children need a few trusted and loving adults in their lives. (Example: Sometimes pets provide the love and acceptance adults are too busy to give) This is what we do. This is how we act. It is a time of imitation (ex: a child prays the Lords Prayer with out understanding the meaning of all the words) First to developed in young children by observing, exploring, trusting parents grows by participating in the customs and rituals of our faith tradition with other Christians It is the lifelong foundation of our faith also the faith of our senses Young children do not fully understand the meaning behind the rituals by participating in them they come to believe they are meaningful and important The rituals point to the experience and love of God When children experience warm and loving feelings in church, they are more likely to value church and, most importantly, associate God and church with love and warmth

Affiliative Faith - Ages 7 to 11 - Child goes through the motions of the faith without fully understanding but does them because it makes them feel like they belong - Child develops a sense of we and wants to be a part of religious expression of their faith through the symbols and rituals of their religions - Known as the religion of the heart - As one person gradually displays the beliefs, values, and practices of ones family, group, or church, there is another ring formed - The individual takes on the characteristics of the nurturing persons and becomes identified as an accepted partner, one who is part of the faith tradition

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 Such participation may be formalized as in membership, a rite of baptism or confirmation, or may simply be understood, as might be the case with regular participants who do not join a church This phase of a person's growth is recognized as a time of testing It is a matching of the person with peer expectations. Where traditions, values, and practices are similar, there usually is a good match and the individual merges his or her identity with that of the body There is little room for personal differences dud to a strong emphasis on unity and conformity in belief and practice The concerns for belonging, for security, and for a sense of power (and identity) that come from group membership are the key drives in forming one's faith concept during this period This level of faith is expressed, at the earliest, during adolescent years Examples: child singing loudly at mass to be part of a group, child signing him/herself during Gospel reading, Child reading along in the prayer book because it makes them feel big

Searching Faith Occurs at adolescence Is this what I believe? individual begins to question and doubt some aspect of their faith or religion marks the beginning/transition from believing in the faith of others to making faith their own/personal experimentation may be part of searching faith: exploring other religious communities, resisting common practices of roots of your faith assesses personal life experience against faith precepts learned through experienced and affiliative faith development a time of asking questionsnot blindly accepting what others have said adding the head to the heart of the earlier states Faith nurturers often have difficulties with people in this stage. Often they feel a loss of faith for the individual. This fear is rooted in love and their desire to pass on their faith which the nurturers consider important Examples: not wanting to go to Church, beginning to question about other faiths or become intrigued with other faith expressions

Owned Faith Occurs at early adulthood This is what I believe Comes through the searching stage The strong, personal faith that one witnesses to and one is willing to die for Because of the serious struggle with doubt that precedes it, owned faith may appear as a great illumination or enlightenment because of the serious struggle with doubts that precedes it It's now our own faith and no longer merely the faith of our parents, family, etc

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 has developed a firm set of convictions, values, and actions that direct and motivate his/her life faith becomes a part of the person and impacts the decisions, choices, and actions of the individual person is sure about his/her faith often entrace into this stage is called conversion - marks a new way of thinking, living, and acting a person with newly owned faith knows that something has occurred that has made a lifechanging difference note: a person may have life experiences that could cause a stepping back to searching faith for a further refining. some people never get to this stage amidst doubts and questions, those that remain in their own faith want to witness it by personal and social action, and are willing and able to stand up for what they believe in as mature disciples of Jesus Christ It is God's intention for everyone Importance of churches to provide opportunities that address the needs in each and every stage of faith development to reach their full faith potential Examples: commitment, making ones own faith a statement. I will go to church with my own freewill, body, mind and spirit.

2.3 Spirituality in Nursing Theory

THEORY OF NURSING AND SPIRITUALITY: JEAN WATSON Central theme: - Human Science & Care -Transpersonal Nursing Theory Nursing Paradigms Human being - a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts. Health - a high level of overall physical, mental and social functioning - a general adaptive-maintenance level of daily functioning - the absence of illness (or the presence of efforts that leads its absence) Environment/society - Caring (and nursing) has existed in every society. - A caring attitude is not transmitted from generation to generation. - It is transmitted by the culture of the profession as a unique way of coping

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 with its environment. Nursing - Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health. - a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions. Transpersonal Caring Relationship - human to human connectedness occurring in a nurse-patient encounter - entails first and foremost a belief in the value and dignity of each human being 10 Carative Factors 1. Formation of a humanistic- altruistic system of values 2. Installation of faith-hope 3. Cultivation of sensitivity to ones self and to others 4. Development of a helping-trust relationship 5. Promotion and acceptance of the expression of positive and negative feelings 6. Systematic use of the scientific problem-solving method for decision making 7. Promotion of interpersonal teaching-learning 8. Provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment 9. Assistance with the gratification of human needs 10. Allowance for existential-phenomenological forces

HEALTH AS EXPANDING CONSCIOUSNESS THEORY: MARGARET NEWMAN The theory stems from Martha Rogers Theory of Unitary Human beings Includes the health of all persons regardless of the presence or absence of disease Asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world Nurses practicing within this perspective experience joy of practicing in the expanding process of others and find that their own lives are enhanced and transformed.

Nursing Paradigms Health Nursing Health and illness are synthesized as health - the fusion on one state of being (disease) with its opposite (non-disease) results in what can be regarded as health.

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 Human The human is unitary, that is cannot be divided into parts, and is inseparable from the larger unitary field - Persons as individuals, and human beings as a species are identified by their patterns of consciousness - The person does not possess consciousness-the person is consciousness. - Persons are centers of consciousness within an overall pattern of expanding consciousness Environment - Environment is described as a universe of open systems HUMAN-TO-HUMAN RELATIONSHIP: JOYCE TRAVELBEE Central focus: the concept of finding meaning in an illness experience : human-to-human relationship Nursing Paradigms Person unique, irreplaceable individual who is in a continuous process of becoming, evolving, and changing Nursing is caring in the human health experience. Nursing is seen as a partnership between the nurse and client, with both grow in the sense of higher levels of consciousness

Health Nursing critical work of psychiatric nursing is to help people develop a sense of self through a healing interpersonal relationship Instrument for the delivery of interpersonal nursing is the therapeutic use of self o ability to use ones personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions includes the individuals perception of health and the absence of disease

Nurses Role - assisting the ill patient to experience hope as a means of coping with illness and suffering; assist individuals and families to not just cope with illness and suffering but to find meaning in these experiences Illness - spiritual, emotional, and physical experience that might be defined both subjectively and objectively

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 "the spiritual values a person holds will determine to a great extent his perception of illness" one's definition of illness and suffering depended very much on the "symbolic meaning attached to these concepts by the individual" "a person's attitude towards suffering ultimately determines how effectively he copes with illness"

MODELS OF PARSE (1981) AND PATERSON AND ZDERAD (1976) indirectly address the concept of the patient's spiritual nature in terms of phenomenological and humanistic approaches Parse accepted the transcendent nature of humanity Nursing is unfolding in simultaneous mutual interchange with the world transcending with greater diversity and complexity Paterson and Zderad viewed the human person as an incarnate being, always becoming, in relation with men and things in a world of time and space. Humanistic nursing embraces more than a benevolent technically competent subject-object one-way relationship guided by a nurse in behalf of another. Rather it dictates that nursing is a responsible searching, transactional relationship whose meaning fullness demands conceptualization founded on a nurse's existential awareness of self and of the other

5 phases: 1. Preparation of the nurse to know whats coming Understanding own viewpoint/angle helps to make sense and aid in acquiring meaning of experience By identifying own views they can be withheld, so that they do not interfere with ones attempts to describe the experiences of another Being open to new and different ideas/understandings is a necessary position in being able to get to know the other intuitively 2. Nurse knowing the other intuitively Moving back and forth between the impressions the nurse becomes aware of herself and the recollected real experience of the other Dialogue back and forth between patient and nurse allows for clearer understanding further generalization in developing process 3. Nurse knowing the other scientifically Implies need for objectivity in coming to know the other scientifically Reflective practice validates patterns and themes This is the time when the nurse mulls over, analyses, sorts out, compares, contrasts, relates, interprets, gives names to and categorizes 4. Nurse complimentarily synthesizing known others

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 The ability of the nurse to develop or see themselves as a source of knowledge, to continually develop the nursing community through education, and increased understanding of their owned learned experiences

5. Succession with the nurse from the many to the paradoxical one Nurse comes up with a conception or abstraction that is inclusive of and beyond the multiplicities and contradictions Process that allows for reflection, correction and expansion of own angular interpretation Implies universal understanding from the simplest to most complex dialogue and interactions between the nurse and assimilates patient experiences No member of this interaction or experience is the same as before Coming together of patient and nurse ADAPTATION MODEL: SISTER CALLISTA ROY Central Theme: person in constant interaction with the changing environment Nursing Paradigms Health - State of process of being of being or becoming an integrated and whole person Person - Human as an adaptive system - Conceptualizes human in a holistic perspective - As living system, persons are in constant interaction with their environment Nursing - Theoretical system of knowledge that prescribes a process of analysis and actions related to the care of the ill or potentially ill persons Environment - All conditions, circumstances, and influences affect the development and behavior of humans as adaptive system 4 Adaptive Models - Self-concept-Group Identity Mode (one of the Four Models of Adaptation) focuses on psychological and spiritual integrity and sense of unity, meaning, and purposefulness in the universe. 1. Physiological-physical mode i. Physical responses and interactions with the environment ii. Physiologic integrity

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4 2. Self-concept-group identity mode i. Relates to the basic need for psychic and spiritual integrity or a need to know self with a sense of unity ii. Self-concept i. Central to persons behavior ii. Consists of a persons beliefs or feelings about himself at any given time 3. Role function mode i. Ste of expectations of how a person in a particular position will behave ii. The need underlying this mode is social integrity 4. Interdependence i. Underlying need is relational integrity or security in nurturing relationship ii. Focuses on the giving and receiving love, respect, and value with significant others and support system Other Concept: - Persons have mutual relationships with the world and God - Human meaning is rooted in the omega point convergence of the universe. - God is intimately revealed in the diversity of creation and is the common destiny of creation. - Persons use human creative abilities of awareness, enlightenment, and faith. - Persons are accountable for the processes of deriving, sustaining and transforming the universe (Roy & Andrew, 1999, p. 35).

Topic 2: SPIRITUAL THEORIES 3NUR10 RLE 4