Spirituality: Faith and Healthcare

1) Spirituality

Spirituality refers to a belief in a higher power, an awareness of life and its meaning,

the centering of a person with purpose in life. It involves relationships with a higher

being, with self, and with the world around the individual. Spirituality implies living

with moral standards.

“The spirit of a human is his essence, that part of him or her that is not visible.

The part that does not die but is immortal. Webster defines spirit as “a life giving

force” and as the “active presence of God in human life.”

2) Religion

Religion is an organized and public belief system of worship and practices

that generally has a focus on a god or supernatural power. It generally offers

an arrangement of symbols and rituals that are meaningful and understood

by it ’s followers.

“Religion is primarily a set of beliefs, a collection of prayers, or rituals. Religion

is first and foremost a way of seeing. It can’t change the facts about the world we

live in, but it can change the ways we see those facts, and that in itself can often

make a difference.” (Harold Kushner)

Major World Religions

– Christianity

 Catholic, Lutheran, Presbyterian, Methodist,Nazarene, Episcopal

 Baptist (largest protestant denomination in US)

  Non-denominational

 Other Western faiths

– Judaism

 Reform, Conservative, and Orthodox

– Hinduism

– Buddhism

– Islam (Muslims)

Spirituality

 Spirituality fulfills specific needs

– Meaning to life, illness, crises, and death

– Sense of security for present and future

– Guides daily habits

– Elicits acceptance or rejection of other people

– Provides psychosocial support in a group of like-minded people

– Strength when facing life’s crises

– Healing strength and support

Spiritual Care

• Practice of compassionate presence

• Listening to patient’s fears, hopes, pain, dreams

• Obtaining a spiritual history

• Attentiveness to all dimensions of the patient and patient’s family: body, mind

and spirit

• Incorporation of spiritual practices as appropriate

• Involve chaplains as members of the interdisciplinary healthcare team

Spiritual care is recognizing and responding to the multifaceted expressions of

spirituality we encounter in our patients and their families. The purpose is to

determine the nature of a person’s relationship to God and other people, and to give

the person the opportunity to accept spiritual support. Themes such as the search

for meaning, feelings of connection or isolation, hope or hopelessness, and fear of

dying are all clues that a person is struggling with spiritual issues.

A More Compassionate Model of Care

 Focus on The Whole Person

 Physical

 Emotional

 Social

 Spiritual

Bio-Psycho-Social-Spiritual

 Schools of Medicine have been slow to recognize & appropriate this model

of whole person care.

 The Nursing profession has long recognized the spiritual aspects of patient

care.
  Chaplains and clergy have often assisted patients with the spiritual aspects

of illness and the search for meaning & purpose.

Where does spirituality fit?

 Patients may have coping mechanisms related to their belief

 May be supported by a community of caring others.

 May feel themselves to be in the company of God who gives them peace

and comfort.

Spiritual Needs

• May be dynamic in patient understanding of illness

• Religious convictions / beliefs may affect healthcare decision-making

• May be a patient need

• May be important in patient coping

• Integral to whole patient care

Five basic spiritual needs of every person:

 A meaningful philosophy of life (values, and moral sense).

 A sense of the transcendent (outside of self, view of God and something

beyond the immediate life, having hope.)

 A trusting relationship with God (faith).

 A relatedness to nature and people (friendship). Experiencing love and

forgiveness.
  A sense of life meaning.

Needs

The need for meaning and purpose

The search for meaning is one of the primary motivators that keeps us going.

When a person comes to a place where his or her life makes no sense, and the seems

to be no meaning or purpose, depression and indifference set in.

If the person can find no help for meaning and purpose in the future, he or she

longs for death.

Man’s Search for Meaning

Victor Frankl

Sometimes external circumstances in our life situation are beyond our control.

 Frankl maintains that the attitude we choose to take toward our life situation

is within our control.

 The spiritual journey relates to our inner struggle to shape our attitude

toward illness and even death itself.

 A relationship with God gives meaning to life.

Where do we find hope?

 Ultimately from our faith or understanding of our relationship to a higher

power.

 The belief that a higher eternal power is in control provides meaning and

purpose to any situation.

 The need for love and relationships

  We were created with this need. Humans are social beings.

 The emotional need for love and relationship is met in the context of

significant human relationships.

 The spiritual need for love and fellowship is met only through a personal

relationship with God.

Three kinds of love

 Eros -If you satisfy my needs then I will love you. A physical love.

 Phileo - a brotherly love, a friendship live. I love you because of what you

have or who you are. This may be conditional love also, because things

might change.

 Agape – God’s kind of love. I love you, in spite of …, I love you no matter

what. Not deserved, not earned. Freely given. Unconditional- Important

for the dying person because he or she is no longer in a position to earn love.

Therefore it is important to encourage and support the person’s belief in and

relationship to God who offers unconditional love. Examples of how a

person might experience this might be through prayer, and the appropriate

use of Scripture.

The need for forgiveness

 Guilt is one of the biggest burdens in our lives. It results from the failure to

live up to expectations, either our own or those of others.

 True guilt may come as a result of rebelling against the belief in God, and

the consequences of that rebellion.

  A sense of forgiveness within the context of one’s faith, often brings a sense

of inner peace for that person in their relationship with God, self, and others.

Forgiveness results in:

 Less anxiety and depression

 Better health outcomes

 Increased coping with stress

 Closeness to God and others

 Resolves guilt

 Restored relationships

Sharing the patient’s faith

 Ask questions. Allow people to discover the truth for themselves by

stimulating their thinking through questions, which is much more powerful

than having them simply listen to your thoughts.

 Don't react negatively to objections. Realize that expressing doubt is

actually a good thing because it means that someone is genuinely thinking

about an issue. Expect emotions such as anger and hostility to surface

during an exploration of faith as people wrestle with the most important

issues in life. Don't take objections personally as people go through this

process. Express your disagreements with respect, affirming the value of

the people with whom you speak and leaving the door open for further

discussions.

 Sharing the patient’s faith

  If the patient expresses a need for assist with their spiritual situation, a

chaplain should be made available. In the effort to assist the patient to

understand their faith, the chaplain might ask these questions: "Who is

God?," "Who are We?," "Who is Jesus?," "What Did Jesus Do?," "What

Can We Not Do?," "What Do We Have to Do?," and "What Does God

Promise to Those Who Believe?.”

 Don't discount the beliefs or experiences of others. Show respect for

them. Simply ask people to evaluate how their current belief system is

working in their lives. Don’t proselytize. When appropriate, sharing your

own testimony can be powerful.

Ethics & professional boundaries

 Spiritual History: patient-centered

 Recognition of pastoral care professionals as experts

 More in-depth spiritual counseling should be under the direction of

chaplains and other spiritual leaders

 Praying with patients:

You can, if the patient requests, or make a referral to pastoral care for

chaplain led prayer.

9 Dimensions of Patient Assessment

1. Illness / treatment summary

2. Physical

3. Psychological
4. Decision making

5. Communication

6. Social

7. Spiritual

8. Practical

9. Anticipatory planning for death

 Approach to

spiritual assessment

 Suspect spiritual pain

 Establish a conducive atmosphere

 Express interest, ask specific questions

 Listen for broader meanings

 Be aware of your own beliefs and biases

A Spiritual Inventory might include questions about:

 The patient’s perception of what is going on.

 What gives meaning and purpose to life?

 How, or whether belief and faith enter in.

 Love: By whom do you feel loved-accepted?

 Forgiveness--need it? Do you need to grant it to others?

 Prayer--What do you pray for?

  Quiet and meditation--What helps get you on center?

Spiritual assessment

 Meaning, value – personal, of the illness

– burden, control, independence, dignity

 Faith

 Religious life, spiritual life

 Identify areas of spiritual crises. Would pastoral intervention be needed or

desired – their own pastor or the hospital or hospice chaplain?

 Spiritual assessment should, at a minimum, determine the patient’s

denomination, beliefs, and what spiritual practices are important to the

patient.

 This information assists in determining the impact of spirituality, on the care

and services being provide, and will identify if further assessment or

services are needed.

 An integral part of a patient’s initial assessment should include data about

the patient’s spiritual and religious beliefs.

 Spiritual care needs to be individualized, with the patient given the

opportunity to participate

 Open ended questions that are specific regarding beliefs can be helpful. A

formal assessment guide can provide a review of the strength and meaning

of person’s religious practices that can open the door to helping the person

establish a meaningful relationship with their higher power.

Spiritual History

• Taken at initial visit as part of the social history, and at follow-up visits as

appropriate

• Recognition of cases to refer to chaplains

• Opens the door to conversation about values and beliefs

• Uncovers coping mechanism and support systems

• Reveals positive and negative spiritual coping

• Opportunity for compassionate care

 Taking a spiritual history.

 S-Spiritual Belief System

 P-Personal Spirituality

 I- Integration in a Spiritual Community

 R-Ritualized Practices and Restrictions

 I-Implications for Health Care

 T-Terminal Events Planning (advance directives, DNR wishes, DPOA etc..)

Assess for spiritual activities

 Religious denomination (past or present) Where do you go to church when

you are able?

 Activity level- Do you go all the time?

 Prayer / scriptural resources Do you read your Bible? Do you pray much?
Assess for spiritual crises

 Search for meaning or purpose in one’s life.

 Loss of a sense of connection with people or God.

 Feelings of guilt or unworthiness

 No relationship with God

 Anger, denial, and bitterness expressed toward self, others, or God.

Questioning of faith

 Desire for forgiveness

 Sense of abandonment by God

FICA assessment tool

F-Faith, Belief, Meaning

I-Importance and Influence

C-Community

A-Address

A Shift of focus: from the biomedical to the psycho-social-spiritual

For many patients facing serious illness or the end of life, the focus shifts from the

biomedical to the spiritual.

When symptom management and pain control are appropriately provided, patients

are set free to address their “final agenda.”

Spiritual Issues

 Suffering

 Meaning and Purpose

 Loss or Abandonment

 Guilt or Shame

 Trust

 Reconciliation

 Hope

Spiritual Identifiers in Dying Patients

• Is there purpose or value to their life?

• Are they able to transcend their suffering?

• Are they at peace with themselves and others?

• Are they hopeful, or are they despairing?

• What nourishes their personal sense of value: prayer, religious commitment,

personal faith, relationship with others?

• Do their beliefs help them cope with their anxiety about death and with their pain,

and do they aid them in attaining peace?

Patients raise spiritual questions

 Who am I, now that I am sick or dying?

 What is the meaning of my life when I am no longer productive and

independent?
  Where am I connected to others who value me and see me as a person of

worth?

 What is my relationship to God and am I going to Heaven?

 What do I now value most in the time that is left to me?

Unresolved issues and fears

 Old feuds or broken relations

 Last visits, seeing people for the last time

 Lifetime project

 Unfinished business

 Funeral plans

 Financial plans

 Need to forgive or be forgiven

 Loss of control and dignity

 Loss of relationships

 Being a burden

 Physical suffering

Spiritual Coping

• Hope: for cure, for healing, for finishing important goals, for a peaceful death

• Sense of control

• Acceptance of situation

• Strength to deal with situation

• Meaning and purpose: in life in midst of suffering

Spiritual Care for the dying

• Practice of compassionate presence

• Listening to patient’s fears, hopes, pain, dreams

• Obtaining a spiritual history

• Attentiveness to all dimensions of the patient and patient’s family: body, mind

and spirit

• Incorporation of spiritual practices as appropriate

• Involve chaplains as members of the interdisciplinary healthcare team

Community support

 Sources of assistance

 Church

 Disease support groups

 Hospice

 Social groups

 Friends, neighbors, and employment peers

Nurses must be compassionate and empathic in caring for patients… In all of their

interactions with patients they must seek to understand the meaning of the patients’

stories in the context of the patients’ beliefs and family and cultural value. They

must continue to care for dying patients even when disease-specific therapy is no

longer available or desired.