Dr.

Doaa Almostadi
 Ø Identify the meaning of hope
Ø Identify spirituality term and areas for spiritual
assessment
Ø Demonstrate spiritual Care Interventions
 Ø A multidimensional, dynamic life force
characterized by a confident yet uncertain
expectation of achieving a future good which,
to the hoping person, is realistically possible
and personally significant
Ø A feeling of expectation and desire for a
particular thing to happen
Ø Want something to happen or be the case
How hope may change as illness progresses

• Diagnosis?
• When a cure is not possible and illness
progresses?
• As death approaches?
 v Often, clinicians, researchers, and
theorists believe that mentally healthy
people should choose and work toward
realistic goals
v In these frameworks, adhering to
unrealistic hopes or denying reality is a
sign of maladaptive cognitions that could
lead to negative health outcomes
v Denial and unrealistic hopes and ideas
are discouraged and treated as
pathological
End of life hope
• Hope for relief from pain

• Meaning in life, peace

• having a good quality of life in the time they have left

• Making sure their family will be okay

• Re-establishing lost connections before they die

• not having any distressing symptoms

• positive interest in the individual by doctors and nurses by “being there”;

• being cared for and dying in their preferred place

• continuing to have a spiritual existence after their physical body dies

• • Listening attentively
• • Encouraging sharing of feelings
• • Providing accurate information
• • Encouraging and supporting the patient’s
control over his or her circumstances,
choices, and environment whenever
possible
• Spiritual
 different between spirituality and
religion
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.
• 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.
*something greater than the individual self
*has many forms and can be practiced in many ways.

Spiritual distress(disruption of an individual’s life principle)

is a mind state that people experience and that comes with

displeasure sensations and the loss of life significance

 **Characteristics of spiritual distress
• Feelings of anger or hopelessness
• Feelings of depression and anxiety
• Difficulty sleeping
• Feeling abandoned by God
• Questioning the meaning of life or suffering
• Questioning beliefs or sudden doubt in spiritual or
religious beliefs
• Asking why this situation occurred
• Seeking spiritual help or guidance
Spt assessment
(1) Brief “spiritual assessment”
(2) Identifying spiritual needs
(3) Ensuring that someone meets those needs
(4) Discuss this subject with patients
Why do this? Why integrate spirituality
into patient care?
• Many patients are religious and the majority would
like it to be addressed in their health care .
• .Religion/spirituality influences coping with illness.
• Religion likely affects health outcomes.
• affects medical decisions, disease detection.
• Religion influences health care in the community
• Palliative care patients and their family members use
spiritual coping strategies
So what spiritual history questions could I
consider?

Available instruments that are short and

sweet page 651
The Spiritual History

• Health care professionals should take a brief screening

spiritual history on all patients with serious or chronic
medical illness
• The screening spiritual history is brief (2-4 minutes),
• The purpose of the SH is to obtain information about
religious background, beliefs, and rituals that are
relevant to health care
• If needs are identified à Referral
• Documentation
Purpose
To Identify the following:
• • Personal meaning of illness,
• • Relationships with others and/or a higher being,
• • Ways in which spirituality and/or religious beliefs influence care
• decisions at the end of life,
• • Personal history of loss, grief, and style of coping,
• • Sources of meaning and purpose in life,
• • Sources and targets of hope,
• • Need to give or receive forgiveness or acceptance,
• • Need to reconcile, and/or
• • Significant religious or spiritual practices.
When?
• (1) when taking the medical history
• (2) during a new patient evaluation
• 3 when taking the medical history while admitting a patient
to the hospital, nursing home, hospice, or palliative care
setting ;
• (4) when doing a health maintenance visit as part of a well-
person evaluation ;
• (5) whenever the medical situation calls for it.
How cont’d?

1- Do you have a religious or spiritual support system to help you in times of need?

2- Do you have any religious beliefs that might influence your medical decisions?

3- Do you have any other spiritual concerns that you would like someone to address?
Or

• Open (i.e., open the door to conversation)

• May I ask your faith background?
• Do you have a spiritual or faith preference?

HCP should choose the right time

Spiritual Assessment is NOT a one-time event
Invite (the patient to discuss spiritual
needs):
• Do you feel that your spiritual health is affecting your
physical health?
• Does your spirituality impact the health decisions you
make?
• Is there a way in which you would like for me to account
for your spirituality in your care?
• Is there a way we can provide spiritual support?
• Are there resources in your faith community that you
would like for me to help mobilize?
How often ?
• if any spiritual needs are identified, those should be
followed up on when the HP sees the patient again.
• if there are no spiritual needs present, then how often
should the HP review this information with the patient?
(a major change in the patient’ s health, social, or living
environment )
• What does the HP do when a patient indicates at the
beginning of the spiritual history that he or she has no
interest in religion or spirituality and that these factors play
no role in coping with illness?
Barriers
• uncertainty on how to address spiritual issues raised by patients,
• belief that discussing spiritual issues is not part of the job description
• Lack of knowledge
• Lack of time
• Workload
• Lack of private space
Nursing Role
• Take spiritual history
• Listen
• Respect and Clarify
• Document
• Consider
 Only Reading
Diagnosing
üReadiness for Enhanced Spiritual Well-Being
This wellness diagnosis describing spiritual health
acknowledges that some people respond to adversity with an
increased sensitivity to spirituality or spiritual maturation.
üSpiritual Distress can be related to situational crises
üRisk for spiritual Distress a client who presently shows no
indication of this disruption of spirit yet may if a nurse fails to
intervene.
üRisk for Impaired Religiosity; vulnerable to an impaired
ability to exercise reliance on religious beliefs and/or
participate in rituals of a particular faith tradition, which may
compromise health”.
 **Planning

• Helping clients to practice their religious rituals

• Supporting clients to recognize and incorporate
spiritual beliefs in health care decision making
• Encouraging clients to recognize positive meanings
for health challenges
• Promoting a sense of hope and peace
• Providing spiritual resources when requested.
• E.G
ØHelp the client fulfill religious obligations.
ØHelp the client draw on and use inner resources more
effectively to meet the present situation.
ØHelp the client find meaning in existence and present
situation.
v Recognizing and addressing patients’ spiritual
needs is fundamental to palliative care
v Spiritual care addresses issues of religion,
existential suffering and humanity
v Nurses provide spiritual care through deep
listening, presence, bearing witness and
compassion
v Providing Presence: the art of being present, or
just being with a client during an “existential
moment”
 Examples of supporting Religious Practices
Ø“Clients ‘preferences for prayer reflect their
personalities.”
Ø“Before praying, assess what clients would like
you to pray for.”
Ø“Prayer may be the springboard to further
discussion or release.”
summarize what you learned so far?
Need the nest slides
• • Acknowledge and respect the beliefs of the person.
• Be present for people as they experience suffering and
struggle
•Be available to listen actively, non-judgmentally, and with
acceptance.
Explore spiritual beliefs, issues and concerns with the person
and his or her family.
• Arrange for time, space, privacy, and resources to
facilitate religious or spiritual practices as
requested by the person.
• Acknowledge your limitations as a clinician and
arrange for appropriate supports
 References
Ferrell, B. R., & Coyle, N. (2006). Text Book
of palliative nursing.2nd ed New York:
Oxford, University Press,Inc