Definitions Spirituality refers to a belief in a higher power, an awareness of life and its meaning, the centering of a person with

h purpose in life. It involves relationships with a higher being, with self, and with the world around the individual.. Spirituality implies living with moral standards. The spirit of a human is his essence, that part of him or her that is not visible. The part that does not die but is immortal. Webster defines spirit as a life giving force and as the active presence of God in human life. Spirituality is recognized as a factor that contributes to health in many persons. The concept of spirituality is found in all cultures and societies. It is expressed in an individuals search for ultimate meaning through participation in religion and / or belief in God, family, naturalism, rationalism, humanism and the arts. All these factors can influence how patients and health care professionals perceive health and illness and how they interact with one another. Religion Religion is an organized and public belief system of worship and practices that generally has a focus on a god or supernatural power. It generally offers an arrangement of symbols and rituals that are meaningful and understood by its followers. Religion is primarily a set of beliefs, a collection of prayers, or rituals. Religion is first and foremost a way of seeing. It cant change the facts about the world we live in, but it can change the ways we see those facts, and that in itself can often make a difference. (Harold Kushner) Major World Religions Christianity Catholic, Lutheran, Presbyterian, Methodist,Nazar ene, Episcopal Baptist (largest protestant denomination in US) Nondenominational Other Western faiths Judaism Reform, Conservative, and Orthodox Hinduism Buddhism Islam (Muslims)

Spirituality

Spirituality fulfills specific needs Meaning to life, illness, crises, and death Sense of security for present and future Guides daily habits Elicits acceptance or rejection of other people Provides psychosocial support in a group of like-minded people Strength when facing lifes crises Healing strength and support Spiritual Care Practice of compassionate presence Listening to patients fears, hopes, pain, dreams Obtaining a spiritual history

 Attentiveness to all dimensions of the patient and patients family: body, mind and spirit Incorporation of spiritual practices as appropriate Involve chaplains as members of the interdisciplinary healthcare team A More Compassionate Model of Care Focus on The Whole Person Physical Emotional Social Spiritual Bio-Psycho-Social-Spiritual Schools of Medicine have been slow to recognize & appropriate this model of whole person care. The Nursing profession has long recognized the spiritual aspects of patient care. Chaplains and clergy have often assisted patients with the spiritual aspects of illness and the search for meaning & purpose. Spiritual care defined Spiritual care is recognizing and responding to the multifaceted expressions of spirituality we encounter in our patients and their families. The purpose is to determine the nature of a persons relationship to God and other people, and to give the person the opportunity to accept spiritual support. Themes such as the search for meaning, feelings of connection or isolation, hope or hopelessness, and fear of dying are all clues that a person is struggling with spiritual issues.

Spirituality and Health Medical Compliance Those who participated in religious activities and said their beliefs were important showed: - better compliance with follow-up treatment - improved physical functioning at the 12-month follow-up - higher levels of self-esteem - less anxiety and fewer health worries Where does spirituality fit? Patients may have coping mechanisms related to their belief May be supported by a community of caring others. May feel themselves to be in the company of God who gives them peace and comfort. Spiritual Needs May be dynamic in patient understanding of illness Religious convictions / beliefs may affect healthcare decision-making May be a patient need May be important in patient coping Integral to whole patient care Five basic spiritual needs of every person: A meaningful philosophy of life (values, and moral sense). A sense of the transcendent (outside of self, view of God and something beyond the immediate life, having hope.) A trusting relationship with God (faith). A relatedness to nature and people (friendship).

Experiencing love and forgiveness. A sense of life meaning. The need for love and relationships We were created with this need. Humans are social beings. The emotional need for love and relationship is met in the context of significant human relationships. The spiritual need for love and fellowship is met only through a personal relationship with God. Three kinds of love Eros -If you satisfy my needs then I will love you. A physical love. Phileo - a brotherly love, a friendship live. I love you because of what you have or who you are. This may be conditional love also, because things might change. Agape Gods kind of love. I love you, in spite of , I love you no matter what. Not deserved, not earned. Freely given. Unconditional. Unconditional love Important for the dying person because he or she is no longer in a position to earn love. Therefore it is important to encourage and support the persons belief in and relationship to God who offers unconditional love. Examples of how a person might experience this might be through prayer, and the appropriate use of Scripture.

The need for forgiveness Guilt is one of the biggest burdens in our lives. It results from the failure to live up to expectations, either our own or those of others. True guilt may come as a result of rebelling against the belief in God, and the consequences of that rebellion. A sense of forgiveness within the context of ones faith, often brings a sense of inner peace for that person in their relationship with God, self, and others. Forgiveness results in: Less anxiety and depression Better health outcomes Increased coping with stress Closeness to God and others Resolves guilt Restored relationships

Sharing the patients faith Ask questions. Allow people to discover the truth for themselves by stimulating their thinking through questions, which is much more powerful than having them simply listen to your thoughts. Don't react negatively to objections. Realize that expressing doubt is actually a good thing because it means that someone is genuinely thinking about an issue. Expect emotions such as anger and hostility to surface during an exploration of faith as people wrestle with the most important issues in life. Don't take objections personally as people go through this process. Express your disagreements

with respect, affirming the value of the people with whom you speak and leaving the door open for further discussions. 9 dimensions of patient assessment 1. Illness / treatment summary 2. Physical 3. Psychological 4. Decision making 5. Communication 6. Social 7. Spiritual 8. Practical 9. Anticipatory planning for death Approach to spiritual assessment Suspect spiritual pain Establish a conducive atmosphere Express interest, ask specific questions Listen for broader meanings Be aware of your own beliefs and biases A Spiritual Inventory might include questions about: The patients perception of what is going on. What gives meaning and purpose to life? How, or whether belief and faith enter in. Love: By whom do you feel loved-accepted? Forgiveness--need it? Do you need to grant it to others? Prayer--What do you pray for? Quiet and meditation--What helps get you on center?

Spiritual assessment Meaning, value personal, of the illness burden, control, independence, dignity Faith Religious life, spiritual life Identify areas of spiritual crises. Would pastoral intervention be needed or desired their own pastor or the hospital or hospice chaplain? Spiritual assessment Spiritual assessment should, at a minimum, determine the patients denomination, beliefs, and what spiritual practices are important to the patient. This information assists in determining the impact of spirituality, on the care and services being provide, and will identify if further assessment or services are needed. An integral part of a patients initial assessment should include data about the patients spiritual and religious beliefs. Several tools exist for spiritual assessment. Spiritual care needs to be individualized, with the patient given the opportunity to participate Open ended questions that are specific regarding beliefs can be helpful. A formal assessment guide can provide a review of the strength and meaning of persons religious practices that can open the door to helping the person establish a meaningful

relationship with their higher power. Spiritual History Taken at initial visit as part of the social history, and at follow-up visits as appropriate Recognition of cases to refer to chaplains Opens the door to conversation about values and beliefs Uncovers coping mechanism and support systems Reveals positive and negative spiritual coping Opportunity for compassionate care Taking a spiritual history. . . S Spiritual Belief System P Personal Spirituality I Integration in a Spiritual Community R Ritualized Practices and Restrictions I Implications for Health Care T Terminal Events Planning (advance directives, DNR wishes, DPOA etc..) Assess for spiritual crises Search for meaning or purpose in ones life. Loss of a sense of connection with people or God. Feelings of guilt or unworthiness No relationship with God Anger, denial, and bitterness expressed toward self, others, or God. Questioning of faith Desire for forgiveness Sense of abandonment by God Spiritual Assessment Tools FICA assessment tool F Faith, Belief, Meaning

Importance and Influence C Community A Address The HOPE Questions H: Sources of hope, meaning, comfort, strength, peace, love and connection O: Organized religion P: Personal spirituality and practices E: Effects on medical care and end-of-life issues LET GO Listening to the patients story Encouraging the search for meaning Telling of your concern and acknowledging the pain of loss Generating hope whenever possible Owning your limitations Spiritual History F Do you have a spiritual belief? Faith? Do you have spiritual beliefs that help you cope with stress? What gives your life meaning? I Are these beliefs important to you? How do they influence you in how you care for yourself? C Are you part of a spiritual or religious community? A How would you like your healthcare provider to address these issues with you? Spiritual needs neglected Why? Many people have not recognized their own spiritual needs, and thus are uncomfortable in assessing them in others.

 Religion is often considered a private matter and one not to be discussed. It is important in medicine to assess a persons physical situation related to his bowel movements or his or her sex life. Arent these private matters as well? Should a nurse be interested in spiritual needs in their patients? Yes. Patient care is done by a team of interfacing disciplines Medical specialties Nursing and allied health professions Psychology Pastoral care/health chaplaincy Philosophy: bioethics Community services: faith or need based service groups Hospice and parish nursing Each discipline contributes a special perspective on human experience, which when taken together, can lead to a general understanding of the healing process.