N105/7

NURSING INTERVENTIONS
~ SPIRITUAL & PSYCHOSOCIAL ISSUES IN CARE ~

 Providing psychosocial care

o Nurses spend most time in the bedside, which is why we are in the key position to identify spiritual and psychosocial needs of the
client and their family
 Addressing these needs, like physiologic and mental issues, are equally important
 Nurses and Psychosocial Care
o In a unique position to monitor patients and their psychosocial care
o Need to be more inclusive when planning care, in terms of the patient’s sexuality, spirituality, optimism, and hope
 Heightened sensitivity of the nurse to their unseen needs
o Psychosocial support involves culturally sensitive provision of psychological, social, and spiritual care
 Adequate Psychosocial Care
o Reduction of sources of psychological distress and physical symptoms
o Therapeutic use of self or therapeutic presence
o Improved symptoms
o Better quality of life
o Enhanced coping
o Pain reduction
o Conservation of hospital resources
 Nurses and Psychosocial Care
o Before providing psychosocial care, it is important to routinely include psychosocial assessment
 Cultural considerations, values, religious beliefs
 Influence on receiving care, participating in care, and on dying experience (symptoms and family bereavement)
o Treating the client as a unique individual
o Protecting confidentiality and privacy
o Using touch and personal space in a therapeutic manner
o Recognizing and respecting cultural differences
o Decreasing anxiety through stress management techniques
 Goals in Psychosocial Care
o Improve self esteem
o Establish trusting relationships
o Developing social skills
o Coping with loss
 Spiritual Wellbeing
o Regardless of their belief, they are subjected to spiritual or existential distress
 Brought about my actual or perceived threat to continued experience (often in death and dying)
o Spirituality
 One’s relationship with oneself, a sense of connection with others, and a relationship with a higher power or divine
source
 Spirituality contains features of religiosity, but the two concepts are not interchangeable
 Religiosity – compliance in religious doctrine
 Involves the “search for meaning and purpose in life and relatedness to a transcendent dimension”
 Within or external to a particular religious belief
o Is a subjective experience that occurs both within and outside of traditional religious systems
o Spirituality is especially awakened at the end of life as patients seek purpose and meaning
 Needs to be promoted regardless if the person has any religious affiliation
Characteristics Description
Knowledge with self Knowledge of who one is and one’s capabilities
Relationship with others Caring for others when they need help
Sharing self
Harmony with nature Knowledge of plants and animals
Preserving nature
Communing with nature
Relationship with a higher power Meditation
Prayer
Participating in religious activities
Performing religious rituals

 It is important to contextualize our understanding to provide appropriate caring response

o Filipino Spirituality
 Cultural values and beliefs related to religion, family, and interpersonal harmony (kapwa)
 Family plays a key role in shaping death anxiety among older adults
 Older adults tend to keep their spiritual belief rather than doctrines
 Early exposure to the concept of death among older adults can help decrease their level of death anxiety
  Assessing spirituality and religiosity of older adults can inform nurses to engage in quality nursing practice through
care: affirming the vulnerability, preserving the personhood
 Spirituality and Health
o Religion-motivated medical neglect can harm health.
o 98% of patients interviewed with advanced cancer were spiritually grounded to their faith and religion and believed that God
would help them
o Spirituality was the strongest predictor of social well-being and a significant predictor of emotional and functional well-being in
the quality of life of patients and families with cancer
o Mechanisms between Spirituality and Health
 Heath Behaviors
 Religious and spiritual beliefs influence health behaviors including diet and vices
 By treating the body as a temple, religious involvement benefits health
 Social Support
 Many reasons  protect health and facilitate recovery from illness
 Coherence Hypothesis
 Sense of coherence and meaning so people understand their role in the universe, the purpose of life, and
develop courage to endure suffering
 Not exclusively positive  people can suffer yet minimize risk for health and wellbeing if they find meaning
in that suffering
o On spirituality and health
 How about the “dasal nalang” mentality?
 How about religious gatherings in the middle of a pandemic?


 In the PH, there are different kinds of Christian sects such as El Shaddai, who believe in putting cloth with text of El
Shaddai on the forehead of the patient
 Sagrado Katoliko and holding rosary for the patient/supot na pula
 Respect patients even if it can cause injury, just reduce possibility of pressure sores, etc.
o Questions to ponder upon
 Considering the common religious beliefs in the Philippines, what are your nursing responsibilities when providing
care?
 How about in proving care for the dying?
 How would your care differ if the patient does not have a religious belief? Does it matter?
 Nursing Diagnoses related to Spirituality
o Addressing ‘Existential distress’ brought about by the actual or perceived threat to one's continued existence.
o At end of life, patients’ needs differ depending on their gender and ethnicity.
o Before we provide psychosocial care, it is important to routinely include spiritual assessment (questions)
 Is there anything we should know about your spiritual belief that may affect the treatment regimen?
  Is there anything that we can help you with so that you can practice your religious beliefs under our care?
 Death and dying: is there anything that we should know about your spiritual and religious belief about death? Any
practices that you want us to observe as death is nearing.

o
 Meeting Spiritual Needs
o 4Cs – common spiritual needs
Need Description
Comfort Convey a sense of caring, communicate a sense of respect
Companionship Spend time with client
Encourage family, significant others, and clergy to visit
Arrange for the client to visit the chapel
Conversation Listen actively
Use concrete terms
Be genuine rather than authoritative
Consolation Be prepared for difficult questions (i.e why me?)

 Summary
o This session focused on addressing the psycho-spiritual needs of our clients using related bio-behavioral interventions
o Underscored the value of assessing the psychosocial and spiritual needs of our patients in relation to the unique cultural,
religious, and individual beliefs.
o Identified general principles in meeting the psychosocial and spiritual needs of patients and families
o Psychosocial and spiritual care is not only focused during death and dying; should encompass the continuum of care.

OPTIONAL ACTIVITY

Share a story of your past patient who presented spiritual and/or psychosocial issues during your care. How did you assess this and how did
you address this? In case you were not able to ‘intervene’ for their spiritual and/or psychosocial needs, how would you have rendered care
differently?