Addressing the End-of-Life Spiritual Care

The spiritual aspect of nursing care is neglected at the present time in the health care field. The focus seems to be more on the physical aspect of client care since hospitals and other facilities work on the systematic healing of the body.

Therefore, it is important to understand that studying the mind or the body alone in terms of health and illness is not enough but nurses should also recognize the spirit in order to fully understand the patient in context. Because of the lack of recognition of end-of-life spiritual care in the domain of nursing, nurses should acknowledge immediate innovative solutions such as exploring patient’s expectations of spiritual care by concrete definitions, working on improvement of the end-of-life process through a well-orchestrated system and lastly, providing resources for the development of spirituality of the future nurses along with end-of-life-focused nursing programs in order to maintain fair and appropriate standards of patient care.

Why is the spiritual dimension of holistic nursing being ignored in the plan of care despite the potential impact of nursing on spiritual health? Spirituality differs from Religion. The article by Lantz, (2007) includes the explanation of Amenta (1986) that defines spirituality as “the part of each individual which longs for ultimate awareness, meaning, value, purpose, beauty, dignity, relatedness and integrity” (para. 5) meanwhile “religion refers to the organized belief systems, and works of human beings” (para. 6). According to Lovanio and Wallace (2007), “Whether a person practices a particular religion or chooses to explore spirituality privately, the exploration of meaning in life is common to the human race” (para.4). In connection, it is essential that nurses integrate these concepts to achieve realistic outcome of patient’s maturity of the therapeutic healing of their bodies as well as their spirits.

One way a nurse can incorporate the spiritual aspect of care is by defining high-quality end-of-life spiritual care through exploration of patient’s expectations. Care is very individualized in all clients of health care and each one of them has their own values and beliefs on how they perceive it. One patient might define spiritual care as religious affiliation, practices and rituals like prayer and nurses could refer them to a chaplain or a minister. Another patient would define it as a feeling of comfort and connection after developing a trusting relationship wherein the nurse supports and facilitates things that give meaning to their lives. Good nursing care is not only competence and efficiency but also productive time and presence when addressing patient’s concerns. According to the study conducted by Davis (2005), “One of the most compelling conclusions reached with regard to spiritual care, based on the responses of study participants, is that existential spiritual care is the hallmark of good nursing care” (para. 52). Davis (2005) also reports that realizing appreciation of spiritual concern received by the patient develops the awareness of divine interventions presented by the nurses (para. 3). Through these responsible health care providers, spiritual needs are met and maintained.

While end-of-life spiritual care is recognized, another key strategy must be addressed by working on improvement of the end-of-life process through a well-orchestrated system of nursing care. According to Virani and Sofer (2003), “A peaceful death doesn’t depend entirely on one person. The way a person’s final days will be spent depends on the patient, the family, the physicians, the nurses, the policies of the hospital or hospice, and the insurance providers” (para. 11). All of these support groups have a specific responsibility of care with a particular dying patient. They work hand in hand together in satisfying the needs and filling all the gaps that the person may leave on his/her life at the present time. Virani and Sofer (2003) also emphasize that having advanced stages of end-of-life process from community to the nurses, themselves is a great addition to the overall patient well being (para. 12). In view of that, nurses cannot revoke death, but they can make dying more peaceful for patients and families.

As a result of improvement, another critical strategy is identified which is providing resources in the development of spirituality of the future nurses along with end-of-life-focused nursing programs in order to maintain fair and appropriate standards of health care. The article by Mitchell, Bennett & Manfrin-Ledet, (2006) includes the research of Meyer, (2003) that reports “emphasis on spirituality in the nursing program as rated by students and faculty served as the most environmental predictors of the student’s perceived ability to provide spiritual care” (para. 8). One great example of the tools that faculty introduced to the students is the use of spiritual concept in care mapping and identification of spiritual nursing diagnosis. Another study by Lovanio and Wallace (2007), point out that “the purpose of this project was to develop and test a spirituality-focused nursing student education project designed to enhance the knowledge and understanding of spiritual care among nursing students” ( para. 1). Some of the other concrete examples include assessment of patient’s spiritual needs and nursing interventions, such as prayer, music and devotional reading. These are only few of the awareness programs for future nurses that give way to an innovative learning experience in their chosen career.

Spiritual care is not acknowledged in the world of the nursing care plan. “The Nursing Interventions Classifications (NIC) standardize nursing behaviors that address the mental, physical, and spiritual needs of patients; however, nurses seem uncertain what constitutes spiritual care and report that they rarely provide spiritual care” (Davis, 2005, para. 2). There is limited literature and information on promoting spirituality in health care. For this reason, nurses should recognize abrupt ground-breaking solutions such as exploring patient’s expectations of spiritual care, working on improvement of the end-of-life process through a system and lastly, providing resources for the development of spirituality of the future nurses along with end-of-life-focused programs in order to maintain reasonable and suitable principles of patient situation. To sum up, Lovanio and Wallace (2007) stated that “the role of nursing as caring assumes the spiritual dimension of being and is thus, a priority for nursing care” (para. 2) which is a strong fact.

References

Davis, L. A. (2005). A phenomenological study of patient expectations concerning nursing care. Holistic Nursing Practice, 19, 126-. Retrieved April 13, 2007, from Expanded Academic Index ASAP database.

Lantz, C.M. (2007). Teaching spiritual care in a public institution: legal implications, standards of practice, and ethical obligations. Journal of Nursing Education, 46, (1) 33-. Retrieved April 17, 2007, from ProQuest database.

Lovanio, K., & Wallace, M. (2007). Promoting spiritual knowledge and attitudes: a student nurse education project. Holistic Nursing Practice, 21, 42-. Retrieved April 17, 2007, from Expanded Academic Index ASAP database.

Mitchell, D.L., Bennett, M.J. & Manfrin-Ledet, L. (2006). Spiritual development of nursing students: Developing competence to provide spiritual care to patients at the end of life. Journal of Nursing Education, 45, (9) 365-. Retrieved April 13, 2007, from ProQuest database.

Virani, R., & Sofer, D. (2003). Improving the quality of end-of-life care. American Journal of
Nursing, 103, (5) 52-60. Retrieved January 18, 2007, from http://www.nursingcenter.com/JournalArticle.asp?Article_ID=411323.


a. Intervention 1 (Defining high-quality end-of-life spiritual care through exploration of patient’s expectations)

i. Disadvantage 1 (Knowledge Deficit)

End-of-Life spiritual care is very individualized in all patients of the
healing community and everyone of them has their own values and beliefs on how they see it. According to the study conducted by McEwan (2004), “Because spirituality is vast in its entirely, it necessitates a discussion only of those areas that can affect the daily life of patients and those who care for them” (para. 2). Not everybody know the importance of spiritual care once they are in a health care facility, it is because it is not even a part of a routine care plan. McEwan (2004) also emphasizes that “from the literature, there are many highly negative reports of how nurses fail to provide spiritual care for their patients, and noting the comments on what is spirituality, it is possible to perceive why this may be so” (para. 8). Having knowledge about the conceptual interpretation of spirituality and the use of care plans for the promotion of health may enable health care providers to modify treatment approaches to better meet the client needs.

ii. Disadvantage 2 (Religion)

Religion is one of the respected sections in every health history
interview. It is important to value this belief because every person has their own culture and traditions. Therefore, being ignorant of this faith will not improve the meeting of patient’s expectations and defining end-of-life spiritual care. McEwan (2004) stresses out that “religious tolerance and awareness is only part of the spirituality equation, because the enlightened literature tells us that the essence of the “God and religion” discussion is having the faith to find purpose in life and not necessarily having a religion” (para. 19). Mohr (2006) also argues that “Few systematic studies have shown that religious involvement and spirituality are associated with negative physical and mental health outcomes. Like any other lifestyle choice, religion can have adverse consequences” (para. 18). Exploration of patient’s expectations will not be complete then until religion is recognized.

b. Intervention 2 (Working on improvement of the end-of-life process through a well-orchestrated system of nursing care)

i. Disadvantage 1 (Socioeconomic status)

Support groups and community resources have a purpose and specific
responsibility to a particular dying patient. Howarth (2007) reports that “In the eyes of death, we are all attractive: rich and poor, black and white, male and female, young and old. While this is true, it is only part of the story, for death is also a social event and how we understand and experience it depends on the social environment in which we live” (para. 6). The author also accentuates that “social class status will affect the nature and timing of death” (para. 7). End-of-life story is a long course of ups and downs with issues involving politics, social life and financial ability. In the article of Hardwig (2007), he mentions that “health care costs are rising much faster than GDP in almost all developed nations. Even countries that have prided themselves on an efficient, one tier health system are finding their systems unsustainable” (para. 25). It is thus known that a well-orchestrated system will not work unless the acknowledgment of these provisions.

ii. Disadvantage 2 (Discrimination)

A bias result through differences of every client in health care and
nurses, sometimes fails to understand the whole representation. They tend to side with what their own spiritual practices would be and specifically with the same people. According to the multidisciplinary review conducted by Easom (2006), White Americans viewed health promotion practices that include activities related to religious beliefs, such as church attendance and being “spiritually moved”, African American perceive spirituality differently than White Americans because studies support the adults in this race participate in spiritual activities to a high degree, lastly, Hispanics studies reflect a high degree of participation in spiritual activities for health promotion of their population as well (para. 17). It is then professed that discrimination between the races may be a hindrance in working on improvement of the end-of-life process through a series of systems in health care.


References

Easom, L.R. (2006). Prayer: folk home remedy vs. spiritual practice. Journal of Cultural Diversity, 13, (3) 146-. Retrieved October 4, 2007, from ProQuest database.

Hardwig, J. (2007). Ending life: ethics and the way we die. Social Theory and Practice, 33, (3) 501-. Retrieved October 4, 2007, from ProQuest database.

Howarth, G. (2007). Th social context of death in old age. Working With Older People, 11, (3) 17-. Retrieved October 4, 2007, from ProQuest database.

McEwan, W. (2004). Spirituality in nursing: what are the issues? Orthopaedic Nursing, 23, (5) 321-. Retrieved October 4, 2007, from ProQuest database.

Mohr, W.K. (2006). Spiritual issues in psychiatric care. Perspectives in Psychiatric Care, 42, (3) 174-. Retrieved October 25, 2007, from ProQuest database.