SPIRITUALITY IN HEALTH CARE

SUBMITTED TO:
Mr. Lawrence M. Manuel RN

SUBMITTED BY:
Annabel P. Dela Cruz WB601A

Spirituality in health: the role of spirituality in critical care.

by: Peter Emerson

Caring for critically ill patients requires that physicians and other health care professionals recognize the potential importance of spirituality in the lives of patients, families, and loved ones and in their own lives. Patients and loved ones undergo tremendous stress and suffering in facing critical illness. Professional caregivers also face similar stress and sadness. Spirituality offers people away to understand suffering and illness. Spiritual beliefs can also impact how people cope with illness. By addressing spiritual issues of patients, loved ones, and ourselves, we can create more holistic and compassionate systems of care.

Spirituality in end-of-life care: attending the person on their journey.

Spirituality is a fundamental element to the human experience of health and healing, illness and dying. Spiritual care is an essential component of palliative and end-of-life care provision and is the responsibility of all staff and carers involved in the care of patients and families. As end-oflife care is a significant element of community nursing, this article explores the relevancy of spirituality to end-of-life practice, the challenge of defining spirituality and the attributes and skills required for the practice of spiritual care. The aim of is to encourage self reflection and open dialogue about the subject, thus enhancing community nurses' understanding of spiritual care practice. By reflecting and generating talk about the practice of spiritual care, it may become more normalized, recognized, and practically meaningful, thereby retaining its significance in holistic nursing.

T.R.U.S.T.: an affirming model for inclusive spiritual care.

Literature across health care disciplines has come to acknowledge spiritual care as integral to holistic health promotion. However, caregivers often continue to be reluctant to explore the spiritual dimension of health with their clients. In order to help caregivers feel more prepared to offer spiritual care, the author has drawn upon the interdisciplinary literature to develop the T.R.U.S.T. Model for Inclusive Spiritual Care. This article introduces the T.R.U.S.T. Model and its foundational concept of 'inclusive spiritual care': relevant, non-intrusive care which tends to the spiritual dimension of health by addressing universal spiritual needs, honoring unique spiritual worldviews, and helping individuals to explore and mobilize factors that can help them gain/regain a sense of trust in order to promote optimum healing. The article also describes the T.R.U.S.T. Model's origins, underlying assumptions, and its non-prescriptive outline for exploring five topics: 'Traditions', 'Reconciliation', 'Understandings', 'Searching', and 'Teachers'. Guidelines are included for using T.R.U.S.T. to enhance holistic health care, with an emphasis on its use in holistic nursing practice.Nursing: a spiritual perspective.

This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue. To be spiritual is to become fully human, the article argues, and the reverse is also true. Spirituality in health is inextricable in each person's search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole. The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness. Abstract themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving. Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse.

The spiritual dimension: its importance to patients' health, well-being and quality of life and its implications for nursing practice.
The spiritual dimension is described and is interpreted as the need for: meaning, purpose and fulfillment in life; hope/will to live; belief and faith. As the spiritual dimension is important for the attainment of an overall sense of health, well-being and quality of life (referred to as the health potential) and as illness and hospitalisation can precipitate spiritual distress, patients' spiritual needs should be addressed. The nurse's role in spiritual care is discussed with reference to the nursing literature.

Attributes of spiritual care in nursing practice.

Nurses are increasingly being called on to engage in spiritual care with their patients. A diverse body of theoretical and empirical literature addresses spirituality as it relates to nursing practice, yet there is little consensus about what spiritual nursing care entails. The purpose of this article is to conceptualize spiritual care in relation to nursing practice. A brief historical review indicates that our current understandings of spiritual nursing care have been shaped by three eras characterized by particular approaches: the religious approach, the scientific

approach, and the existential approach. We draw elements from each of these approaches to propose attributes of spiritual care in the context of nursing practice. We propose that spiritual nursing care is an intuitive, interpersonal, altruistic, and integrative expression that is contingent on the nurse's awareness of the transcendent dimension of life but that reflects the patient's reality.

Spiritual interventions provided by mental health nurses. Western Journal of Nursing Research
| June 01, 1997 | Tuck, Inez; Pullen, Lisa; Lynn, Cynthia | Copyright This descriptive qualitative study explored the spiritual nursing interventions provided by mental health nurses. Fifty mental health nurses responded to open-ended interrogative statements to report on nursing interventions in three situations that supported the spiritual needs of patients and families. Their responses were grouped into four categories, nurses being with the client, doing for the client, encouraging the client to look inward, and encouraging the client to look outward. Being with was demonstrated through the presence of the nurse. Doing for included interventions performed on the client's behalf and included the nurse using fume, people, and space to provide care. Clients were encouraged to look inward for strength and look outward for people and objects that could be resources for them A serendipitous finding was that mental health nurses were able to describe the ideal spiritual interventions but reported fewer instances of actually having intervened. In the early years of nursing practice, spirituality was central to nursing due to the fact that the profession's origin was in religious orders (Dolan, Fitzpatrick, & Herrmann, 1983; Stuart, Deckro, & Mandle, 1989). Florence Nightingale (1859/1969) viewed nursing through the spiritual perspective and referred to nursing as a profession called by God. This view allowed her to combine clinical principles with a deep spiritual commitment to caring for the ill. Nightingale recognized herself as a spiritual being, valued individuals as such, and saw them as worthy of time and presence. The meaning of spirituality has changed from being only associated with religion to a much broader perspective (Grove, 1986). The concept of spirituality includes awareness of selftranscendence, personal relationships, interpersonal communication, and religion (Emblen, 1992; Emblen & Halstead, 1993; Reed, 1991). The definition of spirituality goes beyond the boundaries of religious affiliations, rituals, or the Judeo-Christian culture. Goddard (1995) viewed spirituality as the energy producing harmony of mind, body, and spirit, a holistic perspective. According to Reed (1991), the expression of spiritual needs varies across cultures and the life span. Reed further implies that spirituality embodies a much deeper meaning, which interrelates the physical, emotional, and psychosocial fabric of every human being. In 1963, Hubert recognized that spirituality in modern nursing practice had been largely ignored. This decline in emphasis in research and practice is related to a lack of education regarding spiritual issues and to a discomfort felt by nurses in dealing with spiritual matters. Highfield and Carson (1983) suggest that the absence of spiritual care education for nurses hinders the nurse's ability to deal effectively with the client's spiritual needs. Nursing education has a responsibility to the profession to incorporate the spiritual and religious realms into the curriculum. Spirituality is not well integrated into practice, and there is a dearth of research in this area of study.

PROBLEM The renewed interest in spirituality emphasizes it as an integral part of holistic nursing care (Taylor, Highfield, & Amenta, 1994). Narayanasamny (1993) suggested that nurses must obtain knowledge of spirituality if it is to be accurately used within the holistic care process. Nurses reported that they were aware of the spiritual needs of clients but felt that they had not been adequately prepared to provide effective spiritual care. A study by Highfield (1991) further supported the need for additional education. Highfield found significant differences between the scores of nurses and clients on the Spiritual Health Inventories (SHI), suggesting that nurses lack the ability to accurately assess the spiritual needs of the client. The data indicated that nurses focused on the physical and psychiatric problems, and not on spiritual care. Research reflects differing views of the role of nurses in providing spiritual care (Emblen, 1992; Emblen & Halstead, 1993). Spiritual care was viewed by some nurses and clients as outside the scope of nursing practice; they relegated the responsibility to hospital chaplains, clergy, or other religious professionals. Sodestrom and Martinson (1987) found that about half of the clients interviewed in their study depended on the nurse for spiritual guidance. This finding clearly highlights the importance of incorporating spiritual assessment and support into daily nursing care.

Health system struggles with spiritual care

By Liz Szabo, USA TODAY

For patients who are dying of cancer, few things are as profound as their relationship with God. Among the terminally ill, studies show, being at peace with God is more important than just about anything else, ranking only marginally lower than the desire to ease physical pain. Tracy Balboni says she was inspired to study the spiritual needs of dying patients because of her work as a radiation oncologist. About 40% of the services she provides, she says, go to patients who have little to no hope of cure but who need relief for pain or other symptoms. In a new survey, Balboni found that 88% of terminal cancer patients said religion was at least somewhat important to them. And about half had been visited by clergy. Yet Balboni's research also suggests that hospitals, doctors and even religious communities fail to support the spiritual needs of their cancer patients at the end of life. In her survey of 230 people with less than a year to live, nearly half say they received little to no support for their spiritual needs from religious communities. More than 70% say their spiritual needs weren't met by hospital chaplains or others in the health care system, says the study, published Saturday in the Journal of Clinical Oncology. "This is terribly sad," says Betty Ferrell, who wrote an editorial accompanying the study. "When you hear the words, 'You have cancer,' your life is changed forever. Your spiritual needs are very important." Patients in spiritual pain may decline physically, as well, says Ferrell, a researcher who specializes in palliative care at City of Hope National Medical Center in Duarte, Calif. These patients may become anxious and depressed, which may lead them to stop taking their medication or miss appointments. "We spend enormous amounts of time providing less than quality care for people because we don't address their spiritual needs," Ferrell says. Patients who felt "completely supported" spiritually reported better quality of life, Balboni says. On a 50-point scale, those who felt totally supported rated their quality of life 14 points higher than those who had no support, according to the survey, part of the Coping with Cancer Study. It was financed by the National Cancer Institute. Balboni notes that the study has some limitations. Patients who answered the survey may have had different biases than those who didn't participate. Though the survey was racially diverse, it was relatively small. But experts from religious and medical organizations acknowledge that the study reflects an uncomfortable truth: Many professionals, from pastors to physicians, lack the training or skills to help dying patients cope with spiritual questions. Doctors and nurses are usually uneasy when it comes to talking about God because they fear that they might be imposing their religious beliefs on others or appearing unprofessional, says Balboni, a senior resident in the Harvard Radiation Oncology Program. Doctors also are unsure what to say. So, most often, they ignore the issue. Plus, insurance plans typically don't pay doctors to discuss spiritual needs, says Janet Snapp, president of the Hospice and Palliative Care Nurses Association. There often aren't enough chaplains to go around, Ferrell says. Many hospitals facing tight budgets have cut their chaplain services. It's also easy for congregations to lose touch with members who are too sick to attend regular services, Snapp says. Ferrell says doctors don't

need to become religious counselors. Instead, they should be advocates to try to connect patients with chaplains, spiritual communities or non-religious groups that might help them find solace. In her editorial, Ferrell notes that cancer specialists who "dare" to ask about spirituality send "a vital message to the patient that they are being cared for by someone who has not forgotten that a broken patient remains a whole person and that healing transcends survival."