Tuesday, December 4, 2007

The Role of the Nurse in Incorporating Spirituality within the Healthcare Field

Thesis: Nurses, as caretakers, are in the position to offer spiritual health care through education in recognizing spiritual distress w/in their patients, developing or utilizing an preexisting spiritual assessment tool to measure the level of spirituality in each client and providing unique interventions to attend to their spiritual needs.

Patients that now come into health care facilities seeking care are inflicted with many multiple acute or chronic diseases that are not curable but, perhaps, manageable. Despite how manageable these diseases are, they are debilitating to the patient physically and psychologically. Many clients spend the majority of their time in rehabilitative care, slowly progressing to some level of self-sufficiency. Although long term care facilities have advanced to a more humane caring environment than before, it can be a lonely, depressing, isolating experience for clients previously independent or involved. This is a time that clients are endowed with plenty of time to think about their lives in retrospect and their lives to be. Many develop/enhance their spirituality as means of coping and emotional support. Methods of spiritual engagement, such as prayer, have been associated with benefits to physical health. Nurses, as caretakers and a client’s most frequent visitor, are in the position to offer spiritual health care by allowing themselves to be educated in recognizing spiritual distress w/in their patients, develop or utilize an preexisting spiritual assessment tool to measure the level of spirituality in each client and provide unique interventions to attend to their spiritual needs.

Many patients in hospitals do not perceive their nurses at spiritual caretakers. According to a study in the New York Metropolitan area of hospitalized adults, the participants in the study perceived that nurses were not having enough time to provide spiritual care because of short staffing and heavy work loads, were not comfortable discussing another's spirituality, and were not well prepared to provide spiritual care (Cavendish, Konecny, Naradovy, Luise, Kraynya, June & et al., 2006). They believed the nurses were kind and caring but didn’t attend to their spiritual care. However, many nurses feel that spirituality can promote the health of their patients but do not engage confidently in the responsibility of assessing and implementing spirituality into the care plan. In a nationwide study, Piles (1990) found that although 96% of nurses believed spiritual care is a component of holistic care, almost two thirds of them felt inadequate to perform spiritual interventions. Between 75-90% (of 299 nurses providing care in one of the largest hospitals in the southwest) believed spirituality could reduce bodily pain, provide an experience of God’s forgiveness and assurance of eternal life, produce physical healing through the powers of the mind, and half patients discover the deeper meaning of their illness. (Grant, 2004).

One nursing strategy is for nurses in training and nurses in the field to be educated to recognize manifestations of spirituality. The focus of this strategy mostly targets nursing education programs to prepare students to identify spiritual distress and provide spiritual care. Since 2004, the National Council of State Boards of Nursing have been moving towards this goal by requiring students (RNs and LPNs)( in their most recent test plan) to be knowledgeable of religious and spiritual influences of health (as cited by Lantz, 2007, ¶ 29). The education provided should include teaching of different etiologies of spiritual distress (acute, chronic, and terminal illness, and near-death experience), the variety of concepts in spiritual health, assessment of, interventions, and applying appropriate nursing diagnoses. Nurses can also gain knowledge by examining their own spirituality. Friedemann, Mouch, and Racey (2002) believed it is important that nurses experience a self-exploration through reading, religious involvement, or activities such as meditation to understand their own beliefs and values (as cited in Potter & Perry, 2005, p. 549) . The critical thinking knowledge and skills learned from examining one’s own biases and spiritual concept as well as recognizing others will help the nurse to enhance the client’s spiritual well-being and health.

Because spirituality is a very subjective concept, nurses in health care facilities should develop different assessment strategies in defining the client’s spiritual well-being. According to Lantz (2007), JCAHO enforces the standard through a requirement that every patient be assessed for spiritual needs on admission and resultant spiritual care interventions be provided by a team of caregivers (¶ 31). One approach is the JAREL spiritual well-being scale which provides nurses with a simple tool comprised of three key dimensions (faith/belief, life/self-responsibility, and life-satisfaction/self-actualization) for assessing a client’s health (Potter & Perry, 2005, p. 551). Another assessment is called the two step approach suggested by Catterall and others (1998). Identification of the client’s religious beliefs, preferences, affiliations, and practices are documented in the initial assessment. The second step includes an ongoing in-depth assessment of the client spiritual well-being over the course of their stay. During the assessment, the nurse becomes more acquainted to the client’s behaviors and emotions enough to identify if the client is at risk for spiritual distress. Both assessments provide nurses with excellent strategies to gather subjective and objective data from their clients.

After gathering information about the client’s faith, religion, rituals, and beliefs, reviewing the client’s view of life, life satisfaction, and meaning, and developing appropriate nursing diagnoses, the nurse can provide effective collaborative management and/or nursing management. Many health care facilities have chaplains on staff to provide spiritual counseling and provide information about community support resources for the patient. Nursing management includes providing different coping methods for care receivers and offering “support to the patient’s religion by encouraging prayer and church attendance, readings, music, and other religious activities” (Baila, Biordi, Coeling, Nalepka, & Theis, 2003, ¶ ). According to Gorman, Raines, & Sultan, 2002), some nursing interventions include seeking assistance of or referrals to hospital chaplain or other resources, promoting the use of prayer and scripture when appropriate if within the patient’s belief systems, allowing patient to ventilate thoughts and feelings, allow family to participate in religious rituals, and being open to the patient’s expression of spiritual concern (p. 326). The use of support systems, diet therapies, supporting rituals, prayer, meditation, and supporting grief work can be incorporated into the plan of care.

Because many clients faced with multiple diagnosis and end-stage diseases spend the majority of their remaining time in health care facilities without receiving satisfactory spiritual support, it is the nurse’s responsibility to be educated in providing spiritual care and implementing care plans that support the client’s spiritual needs appropriately in order to reverse this problem. By recognizing their own aptitude and knowledge of spirituality, nurses can become aware of the client’s spiritual climate. By following a devised spiritual assessment tool for every admitting client, nurses will gather subjective and objective data for measurement or to diagnose a patient in danger of spiritual distress or ineffective coping methods. Afterwards, can nurses implement a nursing care plan unique to the client and apply appropriate nursing interventions such as prayer, chaplain assistance, and meditation. The client’s perception of the attempts of spiritual support made by the nurse would change for the better after these interventions, allowing comfortable and receptive communication between the patient and nurse about spiritual concerns and, in return, enable quality spiritual care to be implemented.

1. Intervention 1: One nursing strategy is for nurses in training and nurses in the field to be educated to recognize manifestations of spirituality. The focus of this strategy mostly targets nursing education programs to prepare students to identify spiritual distress and provide spiritual care

a. Disadvantage 1. Proper educator training of spirituality remains a problem that impedes the student’s spiritual education. Greenstreet (1999) postulated that nurse educators do not teach this content well and have a poor record in preparing nursing students for the delivery of spiritual care (as cited by Lantz, 2007, ¶37). As cited by Lantz (2007), Clark (2005) “acknowledged problems with traditional nursing education based on Western medical methods and suggested a shift to a partnership model that includes holistic and intuitive approaches to nursing” (¶5). According to Meyer (2003), less than 6% of classroom topics and less than 10% of clinical discussions were related to spirituality (as cited by Bennett, Manfrin-Ledet, Mitchell, 2006, ¶7). These problems are manifested in nursing students whom are ill prepared to handle spiritual crises during clinicals and many nurses, today, that do not take the time and energy to conduct a thorough spiritual assessment of their patients. As cited by McEwen (2004), Highfield et al. (2000) found that only “approximately half of the nurses reported receiving formal education in spiritual care through academic work and/or continuing education and that a majority of the nurses stated they were inadequately prepared to provide spiritual care” (¶8). In addition, research remains inadequate and nursing textbooks lack much information to provide nursing educators guidelines to proper delivery of spiritual content. McSherry and Ross (2002) agreed that there is indeed little “research about the assessment of client spirituality and delivery of spiritual care” (as cited by Lantz, 2007, ¶39).

b. Disadvantage 2: Besides nursing educators not being properly equipped and trained for proper teaching of spirituality in nursing care, legal complications, alone, set limitations upon the educator’s depth of teaching. According to Lebold and Douglas (1998), "although nursing is widely known as a caring profession, little is known about how to teach and enhance caring practices" (as cited by Lantz, 2007, ¶18). Besides adequate training, nursing educators in publicly funded colleges are face with legal roadblocks to their curriculum and undefined intricacies relating to separation of church and state. Lantz (2007) states that nursing education textbooks such as Bilings and Halstead test Teaching in Nursing: A Guide for Faculty, did not address the legal implications of teaching spiritual care content (¶ 7). According to Lantz (2007), “inability to engage in prayer, avoidance of religious discussions between students and faculty, cautious display of religious symbols, and sensitivity to the use of the Bible and other religious literature in public education” makes it very “difficult for nurse educators in publicly funded institutions of higher education to teach spirituality principles and spiritual care intervention” (¶ 26).

2. Intervention 2: Because spirituality is a very subjective concept, nurses in health care facilities should develop different assessment strategies in defining the client’s spiritual well-being.

a. Disadvantage 1: Assessments that are created by healthcare facilities are often conducted towards the population of patients in oncology, hospice, with AIDS, and/or with compromised mental health. Patients in other health settings are given little consideration regarding their spiritual health. This occurs because many current spirituality assessments are cumbersome, irrelevant, and time consuming in situations in which physiological care takes priority. According to Bennett, Manfrin-Ledet, and Mitchell (2006), “spirituality is often the last in a long series of assessments for patients” (¶14). If the nurse continues to perceives it as being low priority, the result will be little or no focus upon developing and implementing spiritual care plans, In a study conducted by Narayanasamy in 1993, it was found that the majority of nurses viewed spirituality as a religious matter and rarely offered spiritual care (as cited in McEwen, 2004, ¶7). According to Wakefield, Gerdner, and Tripp-Reimer (2002), there appears to be "collective amnesia of scientists regarding the significance of spiritual issues and religion for health" (as cited by McEwen, 2004, ¶4). Even if health care policies require spiritual assessment with admittance, will there be proper implementation of nursing interventions to alleviate spiritual distress and support the patient’s spirituality?

b. Disadvantage 2: Spiritual assessments, currently, appear to be more focused on information related to specific religious backgrounds and practices. Biases from the nurse with controversial religions may unintentionally instill their own values in assessing and providing care. O’Reilly (2004) states that “in a society characterized by religious pluralism, preconceived notions of clients' religious affiliations or spiritual beliefs must be set aside, and assessment must be guided by cues provided by clients” ¶14). Anandarajah and Hight (2001) proposed that “health care providers assess their own spiritual beliefs, values, and biases before initiating spiritual assessment with clients, in order to remain client centered and nonjudgmental” (as cited by O’Reilly, 2004, ¶ 13). Assessments created for identifying spiritual and religious elements of each patient should include spiritual and religious components that can be easily defined by nurses. As cited by Mohr (2006), Richards and Bergin (1997) differentiate religious interventions as “more structured, denominational, external, cognitive, ritualistic, and public, whereas spiritual interventions are more ecumenical, cross-cultural, internal, affective, transcendent, and experiential” (¶ 32).

References

Baila, M., Biordi, D. L, Coeling, H., Nalepka, C., & Theis, S. (2003). Spirituality in caregiving and care receiving. Holistic Nursing Practice, p48(8). Retrieved November 4, 2006 from Expanded Academic ASAP database.

Bennett, M.J., Manfrin-Ledet L., Mitchell, D.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), 365-70. Retrieved November 2, 2007, from Platinum Full Text Periodicals database. (Document ID: 1121916271).

Cavendish, R., Konecny, L., Naradovy, L., Luise, B., Kraynyak, C., June, O., et al. (2006). Patients' perceptions of spirituality and the nurse as a spiritual care provider. Holistic Health. Retrieved October 21, 2006, from Expanded Academic ASAP via Thomson Gale.

Lantz, C. M, (2007). Teaching spiritual care in public institution: Legal implications, standards of practice, and ethical obligations. Journal of Nursing Education, 46(1). Retrieved February 18, 2007, from Expanded Academic ASAP database.

McEwen, M. (2004). Analysis of Spirituality Content in Nursing Textbooks. Journal of Nursing Education, 43(1), 20-30. Retrieved November 2, 2007, from Platinum Full Text Periodicals database. (Document ID: 523561021).

Mohr, W.K. (2006). Spiritual Issues in Psychiatric Care. Perspectives in Psychiatric Care, 42(3), 174-83. Retrieved November 2, 2007, from Research Library database. (Document ID: 1157381211).

O'Reilly, M.L. (2004). Spirituality and Mental Health Clients. Journal of Psychosocial Nursing & Mental Health Services, 42(7), 44-53. Retrieved November 2, 2007, from Research Library database. (Document ID: 670735571).

Perry, A. G., & Potter, P. A. (2005). Fundamentals of nursing (6th ed). St Louis, Missouri: Mosby.

Gorman, L. M., Raines, M. L., Sultan, D. F. (2002) Psychosocial Nursing for general patient care (2nd Ed). Philadelphia, PA: F.A. Davis Company.

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