Nurse’s Role

in
Spiritual Care

Genelyn V. Malana, RN,MAN,LPT

Brief Review of Spiritual Health
When taking a patient’s history, your first questions
about spirituality should focus on the basics. Ask the
patient the following questions:
■ Do you identify with any organized religion? If so,what
religion?
■ If you do not identify with a particular religion,do you
have a belief system that provides comfort and
strength?
■ Are you an agnostic or an atheist? If so, do you have
any belief system that gives meaning to your life?
While asking these questions, keep in the
back of your mind:
■ What is the primary nature of the patient’s
religion?
■ Are people of this religion monotheistic
(worshipping one God) or polytheistic
(worshipping many gods)?
 Spiritual care is not:
• Just about religious beliefs and practices
• About imposing your own beliefs and values on
another
• Using your position to convert
• A specialist activity
• The sole responsibility of the Chaplain
 Role of Health Care
Professionals
• Systematic approach - Assess, plan, implement and
evaluate.

• Individualised, person-centred care,

• Symptom control

• Listening and attending

• Support

• Facilitation - other agencies

 Skills Required
• Self Awareness - introspection - we need to reflect upon ourselves
identifying our own personal and unique spirituality.

• Counselling and interpersonal skills - we need to be able to relate

confidently to individuals.

• Trust building - establish a rapport and therapeutic relationship with patients.

• Non judgmental (if this is possible) be accepting and tolerant

acknowledging we are a unique.

• Education - we need to develop our knowledge and understanding of the

concepts of spirituality.
 SELF-UNDERSTANDING OF
SPIRITUALITY

Ask yourself:
What are my views on the interaction
between spirituality and health?
How would I respond to someone in
spiritual distress or to someone requesting
an intervention relating to spirituality?
How can I provide spiritual care?
 SPIRITUAL ASSESSMENT
APPROACH. There is no absolute in the timing of a spiritual
assessment. Some professionals recommend inclusion with the
initial assessment, while others argue for a delayed assessment
after the nurse–client relationship has been established. The
integration of both techniques may be the most useful because
the spiritual assessment should not be viewed as static but
rather an ongoing conversation between the nurse and client. If
the nurse were proceeding through an initial assessment with
relevant past medical history, it would be very appropriate to
include general screening questions related to clients’ integration
of spirituality into their personal health (e.g., Do you consider
yourself to be a religious or spiritual person? If so, how is this
related to your health or health care decisions?
 CLINICAL TIP
Briefly addressing a client’s spirituality will
establish an open dialogue, and provide a
foundation for any intervention or care that maybe
needed in the future.
TECHNIQUES
•Non-Formal
Taking a Spiritual History: SPIRIT Acronym)
and can serve as excellent reminders when
assessing a concepts of many attributes.
• Formal
The client’s spirituality and religiosity can
also be assessed with formal self-
assessment form.
• Sample Format
A spiritual assessment differs substantially from a health
assessment of an organ system. Spiritual well-being or
distress is entirely subjective and the only objective data
concern stress or depression that may accompany spiritual
distress. For this reason, the format for the following spiritual
assessment does not follow the same style as organ system
chapters. Both normal and abnormal findings are included to
provide better evidence of spiritual distress if present. The
normal and abnormal findings in no way encompass all of
the appropriate responses from the client. Use the informal in
the normal and abnormal sections as a guide only.
 Incorporating Religion and
Spirituality into Care
There are many ways to incorporate religion
and spirituality into care. For example,
providing a time of silence for the client may
encourage spiritual practices such as
meditation, or the nurse may gather family
members or clergy to participate in a prayer
ritual.
Collaboration and referral with pastoral chaplains or
clergy are also extremely important when dealing with
religious issues in a health care setting. Many
hospitals have staff pastoral chaplains, and
community resources of different faiths are usually
available through the pastoral office or social work
professionals. While nurses can assess and support
many clients’ spiritual needs, some situations are
beyond the scope of nursing practice and require
someone with more experience and knowledge about
a particular faith.
In whatever form spirituality is incorporated
into client care, the nurse should be
respectful, open, and willing to discuss
spiritual issues if seen as appropriate. In the
process, the nurse should avoid conveying
a judgmental attitude toward the client’s
spiritual beliefs and religious practices.
 CLINICAL TIP
Plans for referral or intervention will develop
out of the ongoing dialogue between the
nurse and the client.
Spiritual Assessment
 VALIDATING AND
DOCUMENTING FINDINGS
Validate the subjective and objective data
collected during assessment. Noticeably, the
subjective data will be the primary source of
information during a spiritual assessment,
but the objective data can validate or call
into question information presented to the
nurse. Document both normal and abnormal
findings.
 Analysis of Data :
Diagnostic Reasoning
A client’s spirituality often affects his or her health.
There are numerous capacities in which this
occurs and frequently will go unnoticed without
assessment. After collecting subjective and
objective data pertaining to the client’s spiritual
assessment, identify abnormal findings and client
strengths using diagnostic reasoning. Then, cluster
the data to reveal any significant patterns or
abnormalities.
SELECTED NURSING DIAGNOSES

• Health Promotion Diagnoses

 Readiness for enhanced spiritual well-being

 Readiness for enhanced hope
• Risk Diagnoses

 Risk for spiritual distress

 Risk for loneliness
 Risk for social isolation
• Actual Diagnosis

 Spiritual Distress
 Hopelessness
 Moral Distress
SELECTED COLLABORATIVE
PROBLEM
The following is a list of collaborative problems that
may be identified when assessing spirituality.
These problems are worded as risk for
complications (RC), followed by the problem.
•RC: Depression
•RC: Hypertension
•RC: Hypoglycemia
•RC: Opportunistic infection
 MEDICAL PROBLEMS
After grouping the data, it may become
apparent that the client has signs and
symptoms that require medical diagnosis
and treatment. Referral to a primary care
provider is necessary.
Assignment: (Deadline 3-13-19)
• Patient’s Needing Spiritual Care

1. Patient with acute illness

2. Chronically ill patient
3. Children and Families
4. Older Adult
5. Dying and Bereavement
6. During Disasters
7. During Emergencies
THANK YOU