SPIRITUAL CARE Nursing

 Reflective practice
 Caring for the carers
 Valuing staff
 Holistic care
 Cleaning the toilet seat for the next person
 Spiritual care is just “good care”

SPIRITUAL CARING

o Nursing faculty and students recognize that people are holistic beings = physical, mental,
spiritual, emotional

- “Considering a light bulb analogous to a human, think of the glass, aluminum, and
other tangible materials that compromise it as representing the physical dimension;

- think of the light and warmth the bulb elicits as the psychological; and the electrical
current that energizes and ultimately provides the meaning and function for the
bulb as the spiritual dimension.” Stallwood & Stoll 1975 as cited by Taylor, E. F. (2002)

DEFINITION OF CARING INCLUDES THE SPIRITUAL COMPONENT

*Caring actions are directed toward the welfare of the patient and family while focusing on
health promotion, disease prevention, health restoration and management of chronic disease.

>This focus addresses the whole patient, bio-psychosocial and spirituality, and facilitates
the movement toward a high level of wellness.

*A caring attitude is the respectful deference to others, positive connectedness, professional

knowledge and skill and the attentiveness to another’s experience.

NURSING... YESTERDAY, TODAY, TOMORROW

 PAST—Florence Nightingale, and religious groups who cared for the body & soul (Egyptian
priests & priestesses, monks, nuns, etc)

 PRESENT—Nurses/MD’s/Spiritual Experts are researching and publishing the impact of

spiritual care on medical conditions

 FUTURE—An increase in spiritual based treatments and interventions interwoven with

medical care for illnesses and diseases.

PIONEERS IN SPIRITUALITY

 Florence Nightingale, Martha Rogers, Betty Nueman, Jean Watson

 Florence Nightingale

o Born: May 12, 1820

o Best remembered for her work as a nurse during the Crimean War
o Credited with developing nursing documentation
o Established School of Nursing
o Died: August 13, 1910
o Found meaning in life through caring for others
o Perceived as “Angel of Mercy”
o Not bound by traditions or societal beliefs

 Martha E Rogers

o Born May 12, 1914

o Nursing Diploma 1936
o B.S. Public Health Nursing 1937
o Master’s degree 1945
o Science of Unitary Human Beings - 1st published 1964
o Died March 13, 1994
o Martha Rogers
o Human beings are continually engaged with the environment
o Used the term mysticism instead of spirituality

 Jean Watson

o Born: West Virginia

o Education: BSN, University of Colorado, 1964; MS, University of Colorado, 1966; PhD,
University of Colorado, 1973
o Theory of Human Caring
o Nontraditional view of nursing
o Transpersonal Caring
o Unity of life
o Concentric circles of caring - from individual, to others, to community, to world, to planet
earth, to the universe.

 Betty Neuman

o Born 1924 Lowell, Ohio

o 1947 RN Diploma Peoples Hospital School of Nursing, Akron, Ohio
o 1957 UCLA with double major in psychology and public health
o Received BS in nursing from UCLA
o 1966 Masters degree in Mental Health, Public Health Consultation from UCLA
o 1972 Nueman System Model published
o 1985 Doctorate in Clinical Psychology from Pacific Western University
o 1998 Received second honorary doctorate - from Grand Valley State University, Allendale,
Michigan
o Neuman System Model
o
 o

o Spirituality a variable that affects the individual’s environment

 WHAT IS SPIRITUALITY?

 Spirituality is the essence of a being that permeates all of life.

 It is the life force that gives meaning to a how a person understands, views, and lives life.
 It is characterized by LOVE, CARING, COMPASSION, FORGIVENESS, AND THE
INTERCONNECTEDNESS WITH SELF, OTHERS, NATURE AND GOD/HIGHER
POWER/UNIVERSAL LIFE FORCE (Ohlone College ADN curriculum)

Difference between Religion & Spirituality

Religion--a system of beliefs and practices that a person can use to express their spirituality.
Not required for spirituality
Examples: Christians—cross, Bible
Islam—Qur’an, prayer
Jewish—Torah, festivals
Buddhism—kharma, Buddha
• Remember—not all members of a religion practice, express their spirituality the same.
CULTURE/SPIRITUALITY

Spirituality can be
. . . determined by culture
. . . determined by life experiences unrelated to culture
. . . Influenced by both culture and personal experiences that are opposite to the cultural
norm.

SPIRITUAL DEVELOPMENT -We grow spiritually, just like we grow cognitively, physically, and
morally.

o Review of Fowler’s Stages of Faith

o Faith is defined as universal human phenomenon that leads persons to need and
find meaning and understanding of themselves in relation to their world

 Not necessarily tied to a religion

o Spirituality in Nursing Education

 o Increase in textbooks on spirituality

o Increase in literature on spirituality

STAGES OF FOWLER’S FAITH DEVELOPMENT

 Stage 0: age 0-2 Primal - Undifferentiated > is characterized by an early learning of the
safety of their environment (i.e. warm, safe and secure vs. hurt, neglect and abuse). If
consistent nurture is experienced, one will develop a sense of trust and safety about the
universe and the divine. Conversely, negative experiences will cause one to develop
distrust with the universe and the divine.

 Stage 1: age 3-7 Intuitive-Predictive > Egocentric, becoming aware of time. Forming
images that will affect their later life.

 Stage 2: age 6-12 Mythical-Literal > Aware of the stories and beliefs of the local
community. Using these to give sense to their experiences.

 Stage 3: age 12 Synthetic-Conventional > Extending faith beyond the family and using
this as a vehicle for creating a sense of identity and values.

 Stage 4: early adult Individuative-Reflective> The sense of identity and outlook on the
world are differentiated and the person develops explicit systems of meaning.

 Stage 5: adult Conjunctive > The person faces up to the paradoxes of experience and
begins to develop universal ideas and becomes more oriented towards other people.

 Stage 6: adult Universalizing > The person becomes totally altruistic and they feel an
integral part of an all-inclusive sense of being. This stage is rarely achieved.

TO EXPLAIN IT IN MUCH SIMPLER TERMS:

1. Undifferentiated (infant - toddler) love, hope

2. Intuitive-projective (3-7) fantasy filled
3. Mythic-literal (up 12) sort out fantasy/real
4. Synthetic-conventional (adolescent-adult) incongruities, experiences
5. Individual-reflective-examine owns faith/beliefs apart from childhood
6. Conjunctive-appreciation for past/value self
7. Universalizing-infrequently reached, inclusive of all people/faiths, unshackle
society burdens.

SPIRITUAL HEALTH - for Ourselves and Our Patients

Includes:
Self—meaning & purpose, cope with life, personal dignity, love and be loved, significance,
etc
Others—meaning relationship with family, friends, forgiveness, etc.
God/Life Force/Absolute—faith in the unseen, receive support and love, worship and
serve, etc
Community—contribute, fellowship, respect, participant of a vital group, etc.

Holistic Caring - Includes Spiritual Care

*Physical—bathing, massage, touch, procedures, etc
*Psychological—therapeutic communication, understanding, listening, etc
*Spiritual—empathy, praying or meditating with the patient, etc
 -Attending to the spiritual needs of patients is part of our daily nursing care

SPIRITUAL CARE IN NURSING

 Roy’s Adaptation Model

o The moral-ethical-spiritual self is part of self-concept mode and adaptation

problems in this mode can interfere with ability to heal or promote healing
behaviors (Andrews & Roy, 1986, Essentials of the Roy Adaptation Model)

o [Link] Roy, a prominent nurse theorist, writer, lecturer, researcher and teacher.

~ Influencing Factors: family, education, religious background, mentors, clinical

experience

~ Theory description:

o The central questions of Roy’s theory are: Who is the focus of nursing
care? What is the target of nursing care? When is nursing care
indicated?;

~ Explicit assumptions of Roy’s Adaptation Theory

o The person is a bio-psycho-social being

o The person is in constant interaction with a changing environment

o To cope with a changing world, person uses both innate and acquired
mechanisms which are biological and social in origin

o Health and illness are inevitable dimensions of the person’s life

o To respond positively to environmental changes, the person must

adapt

~ Roy Adaptation Model Concept

o Adaptation – goal of nursing

o Person – adaptive system

o Environment – stimuli

o Health – outcome of adaptation

o Nursing – promoting adaptation and health

 Nursing Mandates

o All clients should be assessed for spiritual beliefs/practices and offered spiritual
support

o International Council of Nurses--Promotes environment in which human rights,

values, customs, and spiritual beliefs of the individual, family and community are
respected
  Concepts of Self-awareness /Nurse Healer

 Activities - Connecting, disconnecting, journeying, transforming

Nonverbal/Verbal - Empathy - Presencing (Being present, being there, being with) - Caring -
Spiritual Caring

THE NURSING PROCESS: ASSESSMENT

FICA Model (Puchalski, 1996)

Faith (believe, tradition, etc?)
Important (How important to you?)
Community (church, support, involvement?)
Apply/Address (beliefs apply to health? how can we address those needs?)

 NURSING PROCESS: NURSING DIAGNOSIS

*Risk for Spiritual Distress—at risk for an altered sense of harmonious connectedness with all of
life and the universe in which dimensions that transcend and empower the self may be
disrupted.

*Spiritual Distress—disruption in the life principle that pervades a persons’ entire being and that
integrates and transcends one’s biological and psychosocial nature.

*Readiness for Enhanced Spiritual Well-Being—process of developing/unfolding of mystery

through harmonious interconnectedness that springs forth from inner strengths.

 NURSING PROCESS: INTERVENTIONS

What can I (the nurse) do?? A LOT!

o Active listening
o Bibliotherapy (reading spiritually uplifting materials, including sacred writings)
o Caring touch
o Dream analysis
o Expressive art (music, sculpture, painting, knitting, dance, etc)
o Facilitate religious practices & social support
o Humor
o Journal writing/scrapbook making
o Meditation
o Nature
o Praying with or for clients or assisting clients to pray
o Presencing
o Story listening, reminiscence, or life review
o Collaborate w/ spiritual leaders – cited Taylor, E.F. (2002)

 NURSING PROCESS: EVALUATION

Patient/client will be

-less anxious
-verbalize feelings, concerns, fears, etc
-report feeling peace
-open to discuss spiritual concerns, issues, etc
õ Spiritual health is a PROCESS - Focus on the client outcome - NOT the nurse’s desired
outcome.

Spiritual Crisis: A crisis of illness, suffering, and/or death

MANY EVENTS IN LIFE CAN CREATE A SPIRITUAL CRISIS:

o Health care: Chronic Illness, Life Threatening Trauma and/or Disease, and others

o Loss: of a loved one, perceived self, health, support, and others

 SPIRITUALITY . . . CURRICULUM & REALITY

 Beyond the curriculum and what the students are learning, we are embracing
spirituality on campus. – samples: Capping Ceremony, etc

CONCLUSION – Let us start to recognize that quality, holistic nursing care includes
caring for the spiritual, as well as the physical, emotional and mental needs of our
patients and, we also recognize to care for our patients requires we first care for
OURSELVES!

MARIA DELLA RAÑESES-

CRUZ, PhD
Bicol University College of
Nursing
Legazpi City