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MODULE 4 - SPIRITUAL DEVELOPMENT ACROSS THE LIFESPAN
➢ Spiritual growth comes in ways and at times least
expected.
➢ Various religions (all Christian religions) ceremonies of
baptism/ initiation and non – Christian – Buddhist) does
not guarantee children will practice their faith. For this to
happen children need = Continual guidance from family
o Teaching friends
o Support faith community.
➢ Plus the children’s own assent to the beliefs/ practices
presented.
➢ A person may be born into a particular religion but he is
not born religious.
➢ Physical growth needs food for the body.
➢ Emotional growth needs food for the psyche
➢ Spiritual growth needs food for the spirit
SPIRITUAL VS. RELIGIOUS DEVELOPMENT
➢ Spiritual development is a dynamic process where the
individual becomes increasingly aware of the:
➢ Meaning
➢ Purpose in life
➢ Values
TWO COMPONENTS:
➢ VERTICAL
➢ HORIZONTAL
One can be more developed than the other component. Religious
development is the individual’s acceptance of a particular system:
➢ Beliefs
➢ Values
➢ Rules of conduct
➢ Rituals
Do religious and spiritual developments parallel each other? Not
always.
Individuals may strictly adhere to tenets of a faith tradition yet
never internalize the symbolic meaning of religious activities.
Individuals may appear religious but not necessarily spiritual.
Religious development ideally leads to spiritual development, but
people can get hung up in a particular stage of spiritual or religious
growth just as in psychosocial growth and development.
Spiritual/ religious milestone
Spiritual milestone are not as apparent as religious milestone which
include baptism, confirmation, Holy Communion, etc. therefore,
there is the need to examine the psychological milestones for their
implications. Hence, it cannot be pigeon-holed, staged, and
sequenced as easily as physical and emotional growth.
Role of faith and hope in spiritual development:
I. Faith
Multidimensional word:
As a noun: refers to a belief in or assent to something unseen.
Verb: a way of being, living, imaging.
It is a pre – requisite for spiritual growth to occur.
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Two qualities:
Faith given (vertical)
It is a gift from a Supreme being. “Lord, I believe, help my unbelief”
It is a leap from what is to what is not known.
Faith developed: developmental. (Horizontal)
It matures and changes in response to life events.
Belief in God as a punitive God: (“Papa Dios will punish you if are
bad.”)
To a loving God who loves unconditionally.
FOWLER’S SEVEN STAGES OF FAITH
1. PRIMAL FAITH (INFANCY): A pre-language disposition of
trust forms the mutuality of one’s relationships with
parents and others to offset the anxiety that results from
separation that occur during infancy.
2. INUITIVE: Projective faith (early childhood): Imagination,
stimulated by stories, gestures, and feelings to create
long – lasting images that represent both the protective
and threatening power surrounding one’s life.
3. MYTHIC – LITERAL FAITH (childhood and beyond): the
developing ability to think logically helps one order the
world with categories of casualty, space, and time; to
enter into the perspectives of others; and to capture life.
4. SYNTHETIC – CONVENTIONAL FAITH (adolescence and
beyond) new cognitive abilities make mutual perspective
– taking possible and require one to integrate diverse self
– images into a coherent identity. A personal and largely
unreflective synthesis of and values evolves to support
identity and to capture unite one in emotional solidarity
with others.
5. INDIVIDUATIVE – REFLECTIVE FAITH (young adulthood
and beyond): Critical reflection one’s beliefs and values,
understanding of the self and others as part of a social
system, and the assumption of responsibility for making
choices of ideology and life style open the way for
commitments in relationships and vocation.
6. CONJUNCTIVE FAITH (midlife and beyond): the embrace
of polarities in one’s life, alertness to paradox, and the
need for multiple interpretations of reality mark this
stage. Symbol and story, metaphor and myth (from one’s
own tradition and others), are newly appreciated as
vehicles for grasping truth.
7. UNIVERSALIZING FAITH (midlife or beyond): Beyond
paradox and polarities, persons in this stage grounded in
a oneness with the power of being. Their visions and
commitments free them for a passionate yet detached
spending of the self in love, devoted to overcoming
division, oppression, and brutality.
ADEN’S EIGHT STAGES OF FAITH
1. FAITH AS TRUST (infancy): Infants develops a basic sense
of trust toward self and others. This may form the basis
for trust in a higher being.
2. FAITH AS COURAGE (early childhood): Child learns when
to “let go and take hold to affirm self in an
undifferentiated way. this primitive faith allows an adult
to feel affirmation of self in relation to a higher being.”
3. FAITH AS OBEDIENCE (preschool): child learns to balance
self – assertion to the will of others. The child learns to
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balance inner desires with requirements made by others.

This faith is ultimately translated into obedience to what
are perceived to be the demands of Supreme Being.

4. FAITH AS ASSENT (school age): Child seeks to master his

or her universe and to be competent. This seeking of
competence extends to knowledge and understanding of
a supreme being.
5. FAITH AS IDENTITY (adolescence): Adolescence seeks ego
identity, which consists of a realistic knowledge and
experiences between how he or she is viewed by society.
This gives a sense of unity to self. The successful
accomplishment of this task allows the adolescent to
view the self as worthy in relationship to a supreme
being.

6. FAITH AS SELF – SURRENDER (young adulthood): the

individual learns to give of self wholeheartedly in a
reciprocal relationship. This actualizes the individual’s
need to give self to a reality that is larger and yet more
basic than the thoughts and desires of self.

7. FAITH AS UNCONDITIONAL CARING (midlife): the

individual is faced with the challenge of making a
significant contribution to humankind and becoming a
proactive source of generation and nurturance. In
relation to a higher being, the individual loves the being
with all his or her heart, soul, and mind.

8. FAITH AS UNCONDITIONAL ACCEPTANCE: Individual is HOPE

faced with the challenge of finding meaning in the face of
physical decline. In the struggle of faith emerges as the
affirmation of both the finite and the eternal value of life.
WESTERHOFF’S FOUR STAGES OF FAITH
HOPE is critical to spiritual development and possesses both
vertical and horizontal dimension
WEISSMAN identifies hope as pre – requisites for effecting
coping with the demands and challenges of life events
such as illness, misfortunes, and crises.

1. EXPERIENCED FAITH (infancy – early adolescence):
Children experience faith by interacting with others who
are living a particular faith tradition.
2. AFFILLATIVE FAITH (late adolescence): adolescents
actively participate in activities that characterize a
particular faith tradition. The adolescent feels a sense of
belonging, experiences an awe and wonderment, and
acknowledges the authority of the faith community to
which the adolescent belongs.
3. SEARCHING FAITH (young adulthood): The young adult
engages in a process of questioning and doubting his or
her faith. Out of this struggle, the individual acquires a
cognitive as well as an affective faith.
4. OWNED FAITH (middle adulthood – old age): People
desire to put faith into personal and social action, and
they are willing to stand up for what they believe, even
against their community of nurture.
FOUR MAJOR THEMES ASSOCIATED WITH HOPE
1. Orientation towards the future
Future can be anything relevant to the person
2. Goal setting
Goal can be = earthly (material) or divine
3. Action plan to meet goal achieves.
“With hope, man acts, moves achieve.
Without hope, he is often dull, listless, moribund.”
Establishing interpersonal relationship – body
experiences hunger and the satisfactions of that hunger
because of such experiences if ever since he is hungry
(hope) that his hunger will be alleviated. According to
Erickson, hope is the outcome of achieving an
appropriate balance between trust and mistrust and
therefore, is the first developmental task of life.
Trust in others, self, and the environment is the genesis of
hope. Hope that is grounded only in the world will result to
disappointed/ despair, Hope grounded on the Supreme being
is sustained with peace and joy in spite of disappointments.

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SPIRITUAL DEVELOPMENT ACROSS THE LIFE SPAN
1. INFANCY
Babies are born without religious beliefs. Have
undefined spiritual life. Therefore, infancy
plays a significant role in the development of
both religious belief and spirituality.
Without words and the ability to conceptualize
infants learn about the world through
experiences with the caregivers. Such
experiences create images linked with feelings
in the baby’s mind. If mother cares for the
baby with gentleness, consistency and love the
baby experiences, feelings of trust and the
baby begins to HOPE to anticipate the future,
to hope that needs will be met and comfort
will be given.
Q- What is the role of infancy in the development
of both religious beliefs and spirituality?
HOPE
This most critical psycho – social stage is characterized
by the need to balance trust with mistrust.
Erickson claims that the development of a healthy
balance between trust and mistrust affects all
of life’s experiences including the ability to
participate in an organized religion.
The model of the mother – baby relationship in which
the baby is totally dependent on the mother
to have needs met, can translate to a creator =
creature model.
Such a model will form the basis for religious as well as
vertical/ horizontal spiritual development.
2. EARLY CHILDHOOD (2 –3 yrs.)
Developmental task – mastering motor skills, child’s
ability to move around, explore, touch, taste
make the child assert self and acquiesced to
another. In toilet training, the child learns to
yield or assert self in the child gains a sense
of self – worth and power. In both religious
and spiritual sense, this sense of self – worth is
important.
The groundwork for spiritual development requires self
– worth.
Horizontally.
Individual who feel unworthy will have
difficulty accepting the worth of other people,
values and endeavors outside of them.
Vertically.
Spiritual development requires that individual
believe that a Supreme Being loves them for
who they are at any given moment and that
they are lovable to God.
Lack of self – worth or feeling of shame can
block an individual’s acceptance of anyone’s
love, including the love of God.
According to Fowler, the child’s faith takes the
form of images influenced by what the parents
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say, experiences at church, religious
education, stories, religious rituals such as
vocal prayers, bedtime prayers, religious
holidays create long lasting impressions/
images that influence the spiritual and
religious development – the beginning of
experienced faith passively acquired from the
interaction and experiences shared with
significant others.
3. PRE – SCHOOL (4 – 5 yrs.)
Task – balancing self – assertion and self-
discipline.
Inability to achieve this balance causes child to
feel guilty. This stage is facilitated by child’s
increasing skill in both language and task with
implications for both having horizontal/
vertical spiritual development. Strict parents
who teach child who disobeys as bad and
acceptable will have undesirable effects on
religious development.
Child will view religion as a restraining force
and God as a punitive God, not a loving God.
Others will grow up so controlled by rules they
become religious fanatics unable to
differentiate the letter of the law from the
spirit.
4. SCHOOL AGE (6 - 10)
Task – industry and competence. The child
masters proficiency and knowledge in the art
of doing things. Failure to accomplish this task
will lead to feeling of inferiority.
Effects: affects person’s participation in an organized
religion.
Decrease appreciation of personal talents and
capabilities
Diminished ability to relate with others
including God.
5. ADOLESCENCE
Time of conflicts and rebellion as individual struggles
to achieve a clear sense of who they are and
where they are going.
Must have sense of self-identity, before they can be
true to others, self and God.
Inability to accomplish this task will result to confused
person. It is a stage of
questioning.
6. YOUNG ADULTHOOD
Developmental task = generativity.
Having attained self – identify, the person can commit
herself now to intimate relationships. A healthy
balance between intimacy and isolation results to
7. MIDDLE ADULTHOOD
Developmental task = generativity.
Balance between generativity and stagnation
results to care and caring.
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Nurturing of children; sharing in the

generativity of God. There is also an increased ➢ What happens in prayer depends primarily on God. He is
turning inwards. the giver. He is in control. We come to him empty
because we are empty.
8. LATER MATURITY
Developmental task; achieve balance between ➢ As we sit in the Lord’s presence during prayer we can
ego integrity and despair results to wisdom. experience this emptiness and helplessness even
Vertical spiritual growth is manifested in: physically. Sitting is a helpless position; it is a position of
1. Service – James 2:14 – 17 waiting. This “desert experience” is a normal part of our
2. Prayer – Central to spiritual growth and progress in prayer.
God related ness
3. Stewardship – caretaker
MODULE 5 – APPROACHES TO SPIRITUALITY
Nursing Implications:
Three diverse but interrelated approaches to spirituality:
1. Spirituality is not something to be judged ➢ Spiritual distress
but assessed and accepted. ➢ Spiritual needs
2. Interventions at the physical/ ➢ Spiritual well-being
psychological – social levels are also
interventions for the spiritual needs of I. Spiritual Distress
horizontal dimension. ➢ Distress of the human spirit. A disruption in the life
3. Awareness that spirituality progresses principle which pervades a person’s entire being. (Kim et
over life span. al).

SPIRITUALITY OF THE NURSE Characteristics according to NANDA

➢ Expresses concerns with meaning of life/death or any
PRAYER belief system
I. Definition: Lifting up of one’s mind and heart to God. ➢ Anger towards God
II. Descriptions: ➢ Questions meaning of suffering
1. Prayer is an activity of faith. ➢ Verbalizes inner conflict about beliefs, relationship with
2. Prayer is a privilege. deity
o It is privilege to be able to communicate with ➢ Questions meaning of existence
God, who is totally available at any time and ➢ Unable to participate in usual religious practices seeks
for as long one wants. spiritual assistance
3. Prayer is a gift ➢ Questions moral/ethical implications of therapeutic
o It is the creator who initiates, who invites, who regimen
reaches out first. ➢ Displacement of anger towards religious representative
4. Prayer leads to union with God. ➢ Nightmares or sleep disturbances
o The most important purpose of prayer is union ➢ Alteration of behavior or mood evidenced by anger,
with God. crying, withdrawal, preoccupation, anxiety, hostility or
5. Prayer is an experience of God loving you and in return apathy.
an expression of your love for God.
6. Prayer centered more on God’s activity than on your Assessment:
own is an activity of greater faith. It takes great faith and ➢ Religious cues (verbal, literature, jewelry, behavior…)
humility to sacrifice some of the satisfaction that comes ➢ Emotional cues
from a more active form of prayer in order to be more ➢ Assessment guides
attentive to what God is doing. ➢ Item on “intake history”
7. It is spirit of God who guides and directs you in prayer.
No one can say ‘Jesus’ unless he is under the influence Spirituality is observed through the:
of the holy spirit (1 Cor 12:3) ➢ Person’s mood
8. Prayer is sacrifice possessed by God and transformed by ➢ Emotions
him. ➢ Physical well-being
9. Prayer is a sacrifice of time. ➢ Client self-report, therefore, is essential in the validation
o By spending or sacrificing time in prayer we of spiritual distress.
offer something very precious to the Lord. In
prayer, we return to the Lord some of the time Stoll’s Spiritual Assessment
that he entrusts to us. (Concept of Deity):
10. Prayer is a time to experience our helplessness and
poverty. During the day, we are busy with many ➢ Is religion or God significant to you? If so, can you
different activities. These activities especially if they are describe how?
very satisfying and successful, might create the illusion ➢ Is prayer helpful to you? What happens when you pray?
that we can get along well without God.

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➢ Does a God or deity function in your personal life? If yes, Emotional

can you describe how? ➢ Working through feelings
➢ How would you describe your God or what you worship? ➢ Showing love
➢ What has bothered you the most about being sick (or in ➢ Touching
what has happened to you)?
➢ What do you think is going to happen to you? Evaluation:
➢ Has being sick (or what has happened to you) made any ➢ Relational
difference in your feelings about God or the practice of ➢ Physical
your faith? ➢ Emotional
➢ Is there anything that is especially frightening or ➢ Intellectual
meaningful to you now? ➢ Religious/Spiritual

Stoll’s Spiritual Assessment II. Spiritual Needs

(Religious Practices)
Any factors necessary to established and/ or maintain a person’s
➢ Do you feel your faith (or religion) is important to you? If dynamic personal relationship with God (as defined by the client)
yes, would you tell me how? and out of that relationship to experience-
➢ Are there religious practices that are important to you? ➢ Forgiveness
➢ Has being sick made any difference in your practice of ➢ Love
praying? Your religious practices? ➢ Hope
➢ What religious books or symbols are helpful to you? ➢ Trust
➢ Meaning and purpose of life
Stoll’s Spiritual Assessment(Relation Between (Spiritual Beliefs
and Health) Stallwood and Stoll used a 2- dimensional approach to spiritual
needs:
➢ Who is the most important person to you? ➢ Relationship with God as defined by client
➢ To whom do you turn when you need help? Are they ➢ The person’s experiences
available?
➢ In what ways do they help? Characteristics (Flesner)
➢ What is your source of strength and hope? Lack of loving relationship characterized by:
➢ What helps you the most when you feel afraid or need ➢ Lack of healthy loving relationship with God or
special help? transcendent power
➢ Lack of belief in God, or a higher power immature love,
Other useful interview questions: dependent need of God.
➢ What Bible character do you identify with? Why?
➢ Do you have a favorite hymn? If so, what is it and why? Lack of healthy self-love
➢ Is there a Bible verse that is especially meaningful to you? ➢ Feels unworthy of the love of God or others/ inability to
If so, what is it and why? realistically accept self as a worthwhile individual with
strengths and weaknesses.
Planning:
➢ Short Term Lack of ability to give and receive love from others
➢ Long Term ➢ Uses and manipulates others to get what is wanted and
➢ Individualize feels others don’t love them as they are… must earn love.

Implementation: CIRCLE Lack of trust characterized by

Caring ➢ Lack of openness to God or higher power
Intuition ➢ Fear of God intentions
➢ Making an effort to hear what the person feels ➢ Feelings of alienation and loneliness
➢ Encouraging the person to express feelings
Respect for religious beliefs & practices Lack of meaning and purpose in life
➢ Making appropriate referrals ➢ Lack of reason for living
➢ Praying ➢ Inability to know and thus act one’s true values
➢ Encouraging devotional activities ➢ Feelings of inner emptiness
➢ Providing for specific rites, sacraments, and observations
➢ Offering religious conversation High field and Cason give 4 spiritual needs with healthy behaviors
Caution exhibited:
➢ Declining to proselytize
➢ Avoiding judgments ➢ Need for meaning and purpose in life
➢ Giving choices ➢ Lives in accordance with his/her value system
Listening ➢ Expresses desire to participate in religious rituals
➢ Making an effort to hear what the person feels ➢ Need to receive love
➢ Encouraging the person to express feelings ➢ Expresses feelings of being love by others/God

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➢ Expresses feelings of forgiveness by others/God

➢ Need to give love
➢ Expresses love for others through actions
➢ Seeks the good of others
➢ Need for hope and creativity
➢ Sets realistic health goals
➢ Values the inner self more than the physical self

Fish and Shelley identifies 3 spiritual needs:

➢ Need for meaning and purpose

➢ Need for love and relatedness
➢ Need for forgiveness

For the Christian, God through Jesus Christ is the source of these
relationships.

For the humanists – any transcendent being can be mountain,

forest, object, etc. considered sacred to him.

Role of the Nurse:

➢ Serves, as a CHANNEL to encourage the client to experience
God meeting these spiritual needs.

III. Spiritual Well-Being

The affirmation of life in a relationship with God, self, community

and environment that nurtures and celebrates wholeness.
(National Interfaith Coalition on Aging - NICA)

Indicates WHOLENESS
Dependence on the source of life
Saying yes to life in spite of negative circumstances
“For all that has been, THANKS!
For all that will be, YES!”
Inner peace - harmony

Components:
• Religious – vertical – God
• Sociopsychological – Horizontal – person’s
sense of meaning and satisfaction with life.
• SPIRITUAL WELL-BEING is the behavioral
expressions of spiritual health.
• Spiritual wellness – illness continuum of
behavior
• Ebb – peak experience flow of one’s spirituality.
• Flactuates:
• In accordance to alterations
• How they impact on daily events of life.

Role expectations of the NURSE

• To acknowledge his own personal spiritual journey.

• The greatest gift the nurse can give to his client is one’s
personal, living, spiritual richness.
• Such gift inevitably will encourage client towards spiritual
well-being.

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