4 Spiritual Health ca sinpleion of this chapter, the leamer will be able to do the following: + Relate theconcepts of spirituality, religion and faith ~ Identify spiritual needs of self and others ~ Discuss the factors affecting a client’s spiritual needs ~ Assess client’s spiritual well-being” ~ Discuss nursing interventions for enhanc ing spiritual well-being ~~ Evaluate interventions for relieving spiritval distress Terminology + A sense of fulfillment in life and interaction with self and others + The ability to discover and articulate a basic purpose in life Spirituality is defined as the experience and expressions of one’s spirit in a unique and dynamic process reflecting faith in God or °! . | supreme being; connectedness with oneself, with * The ability to experience love, joy, peace and others, universe, or God and integration of the contentment dimension, mind, body and spirit. Spirituality is * The ability to live in wholeness consistent with the quality or essence that pervades, integrates _the values of community and self and transcends one's biopsychosocial nature. Spiritual distress is a disruption that Religion is a belief system, including dogma, Pervades the entire being, and that integrates rituals and traditions or it isa social institution in 4nd transcends the biological and social nature which people participate together rather than an resulting in anguish of the human spirit. individual searching alone for the meaning of life. Spiritual need represents a normal expression Monotheism is the belief irs the existence of one of a person's inner being that seeks meaning in all God who created and who rules the universe. experiences and a dynamic relationship with self, others, universe and to the supreme being, as the Polytheism is the belief in more than une God. person defines it. Atheist is a person who disbelieves the existence of God or supreme being Holism is the position of viewing the universe as a system of harmonious interconnection rather Agnostic is a person who is indecisive about the — than a sum of isolated parts; it integrates the existence of God or supreme being. mind and body and emphasizes spirit Faith is a belief in or commitment to something Spiritual well-being is a condition marked by or someone greater than the self that helps a an affirmation of life, peace, harmony and a sens person realize purpose. Faith is a belief without of interconnectedness with God, self, community proof. and the environment that nurtures and celebrates Spiritual health refers to a state of wholeness wholeness, or it is the process of being and of the spiritual dimensions and includes the becoming by reflecting one’s spirituality. following: Spiritual well-being includes the following: + A sense of personal contentment + Aconcern for others and self + Asense of peace with the self and the world + Asense of meaning and enjoyment in life 31« Acommitment to purpose rather than the self « Asense of relatedness + A means for moving through debilitating guilt, anger or anxiety + Life affirming relationship or harmonious interconnectedness with deity, self, community and environment Spiritual care can be defined as a mutual, potential healing or integrating process in which the client's spiritual needs are met. Spiritual dimension is quality that goes beyond religious affiliation, that strives for inspiration, reverence, awe, meaning and purpose, even for those who do not believe in any God. Although all people have spiritual dimension with their being, not all have the same depth or intensity of it in their lives. Characteristics of spirituality 1. Asense of wholeness and harmony within oneself 2. Asense of wholeness and harmony with others 3. A sense of wholeness and harmony with God ora supreme power 4. A sense of wholeness and harmony with the ecosystem Spirituality in nursing Nursing recognizes the spiritual aspect of human nature as an integral component of a person's sense of wellness. Nurses have an opportunity to contribute to or participate in the spiritual care of clients. The word spirituality is derived from the latin word “spiritus” which refers to breath of wind. The spirit gives life to or animates a person. Spirituality is a concept that is unique to each individual. Individual’s definitions of their own spirituality is influenced by their culture, development, life experiences, beliefs and ideas about life. An individual's spirituality enables a person to love, have faith and hope and contribute towards society building and seek meaning in life and to nurture relationship with others. Spirituality offersa connectedness intrapersonally (connected within oneself), interpersonally (connected with 32 others and environment) and transpersonally (connected with unseen God or a supreme power), Spirituality and health Health is defined as a state of well-being resulting from harmonious interaction of body, mind, spirit and the environment. Health must be considered in its broadest, holistic. sense, which includes the following components. + Physical health: Physical fitness - the body functioning at its best. + Emotional health: Feelings and attitudes that make one comfortable with oneself. + Psychological or mental health: A mind that grows and adjusts, is in control and is free of serious stress. + Social health: A sense of responsibility and care for the health and welfare of others. + Spiritual health: Inner peace and serenity, comfort with one’s supreme power, as one perceives it. A person's health depends on a balance of physical, psychological, sociological, cultural, developmental and spiritual factors. Spirituality is considered as one of the important factors that helps to achieve the balance needed to maintain health and well-being and to cope with illness. Spiritual health is achieved when a person finds a balance between his or her own life values, goals and belief system and those of others. The Spiritual Dimension. An Integrated Aj Spiritual care in nursing In holistic nursing, the nurse provides care not only for the physical body and mind, but also forthe client's spirit. Meeting the client's spiritual needs can decrease suffering and aid in physical and mental healing. To implement spiritual care, nurses need to be skilled in establishing a trustworthy nurse-client relationship. Because involvement in the meeting of spiritual needs is personal for both the nurse and the client, nurses need to communicate with sensitivity and empathy to have a good understanding of their own values. Many clients have spiritual strengths that the nurse can nurture to help them attain or maintain a feeling of spiritual well-being to recover from illness, and to face a peaceful death. It is important for nurses to develop a broad concept of spirituality. A nurse should know the different aspects of spirituality which are explained as follows. Spiritual health / spiritual well-being It is manifested by a feeling of being generally alive, purposeful and contented. Characteristics of spiritual well-being: - Sense of inner peace - Compassion for others ~ Reverence for life - Gratitude - Appreciation of both unity and diversity - Humor - Wisdom - Generosity ~ Ability to transcend the self ~ Capacity for unconditional love Spiritual needs Just as everybody has a spiritual dimension, all clients have needs that reflect their spirituality. These needs are often brought forward by an illness or any other health crisis. Clients who have a well-defined spiritual belief may find that their beliefs are challenged by their health situation; clients who have no defined belief may suddenly come face to face with challenging, questions related to the meaning and purpose of life. Nurses need to be sensitive to indications of 33 the client's spiritual needs and should respond appropriately. Spiritual needs include the following: - Need for love - Need for hope - Need for trust - Need for forgiveness - Need to be respected and valued - Need for dignity - Need for meaning to the fullness of life - Need for values - Need for creativity = Need to be connected with God or supreme power, or to be a being greater than oneself = Need to belong to a community - Sense of purpose Factors which affect the spiritual health ‘A number of factors affect the expression of spiritual needs. Individual reactions vary depen- ding on personality and past coping styles.-The spiritual needs of the client vary depending on the spiritual belief, stage of faith, degree of illness. and adaptation to illness. 1. Culture: Culture means attitude, beliefs and values that arise from one’s sociocultural back- ground. Usually people follow the spiritual and religious traditions of their family's ori- gin. Children learn the importance of religious practices, including moral values from family relationships and from participation in religi- ous activities. 2.Gender: Each religion has its own expected behaviours for males and females. A person's organized religion determines the type of dress and the way of dressing for male and female. 3. Previous experience: At the-time of crisis, an individual's past experience in handling such situations can be of help. These coping mecha- nisms can be healthy and adaptive or they can be maladaptive too. 4.Crisis and change: Crisis most often streng- thens an individual's spirituality. But in some cases, crisis can weaken one’s spirituality.Persona! changes thet occar due to death of a loved cae. 2 change in personal status ete can 6 Factors across the fe spar: The dif=zent stzges of = such as childhood, adolescence, Saleh eg have different spiritual adaithood = a 7. Plzgsiological factors: Uiness may be perceived asa thredt to the sense of well-being which can seitiete spiriteal omnflict. 2. Moral issues regarding therapy. There are certain religions which object some modem regesding cerizin therapeutic measures can edt it ig and ses ‘tual distress It refers to 2 challenge to the spiritual well- beg oF to the belief system that provides ssreagth, hope and meaning to life. Spiritual Gatress incorporates the five spiritual needs— forgiveness, lave, hope, trust and meaning and porposs in life. There may be various behaviours znd expressions which are warning signs that the client is experiencing spiritual concerns. The cient may express the distress both verbally and bekaviessrally. The characteristics of spiritual Gatress inciade the following: + Showing maladaptive behaviours + Showing discomfort with self awareness + Fearing Con's intentions, believing that God is judgemental + Expressing ambivalent feelings about God + Lacking, love relationship with God + Pesting, distant / separate from God + Lacking, faith in a transcendent power/God + Having, une'ear values, beliefs and goals + Having value comflicas 34 + Behaving self destructively + Fearing dependence on others + Refusing to cooperate with health regimen + Worrying about separation from loved ones + Fearing death/life after death + Sensing isolation from faith/community + Being bitter/frustrated/angry with God + Having unclear values, beliefs and goals + Lacking commitment + Expressing fear of loss of control + Lacking vision of possible alternatives + Fearing therapy + Unable to enjoy anything + Feeling of worthlessness about life + Finding no meaning in suffering + Questioning the meaning of suffering + Having unattainable goals + Being anxious about past/future + Focusing on regret/remorse + Questioning the purpose of illness + Expressing lack of hope + Refusing interaction with friends or family + Requesting to see a religious leader + Feeling excessively anxious + Abusing substance Spiritual support is required for a client who has spiritual distress or who shows any of the above said problems. Goals of spiritual care + Help the client fulfil religious obligations + Help the client draw on and use inner resources more effectively to meet the present situation + Help the client maintain or establish a dynamic, personal relationship with a supreme being in the face of unpleasant circumstances + Help the client find meaning of existence and the present situation + Promote a sense of hopeAssessment In the spiritual assessment of a client, four important areas are considered: 1. Concept of God or deity 2. Source of hope and strength 3. Religious practices and rituals 4. Relationship between spiritual beliefs and state of health Based on these four areas, questions are asked to the client to make an assessment. For example, ~ Significance of religion /faith/God to the client ? - Whether the illness has affected the client's faith, relationship with God, self and others? - Client's important needs at the time of this illness? - During trouble/crisis does the client turn to God/self/others? ~Is there any feeling of despair, helplessness, hopelessness, guilt, anger, anxiety? - Observe the client's verbal and non-verbal expressions, which will greatly help in the assessment of the client. Nursing diagnosis 1. Spiritual distress R/T ~ Loss of child - Sense of guilt - Conflict about belief - Sexual abuse ~ Crisis of illness - Suffering and death of significant figures in life 2. Potential for enhanced spiritual well-being 3. Risk for spiritual distress 4. Ineffective coping R/T ~ Loss of loved one - Psychiatric disorder - Alcoholism 5. Readiness to enhanced spiritual well-being R/T terminal illness 6. Dysfunctional grieving R/T - Multiple losses ~ Loss of employment, career - Lack of physical independence Planning The nurse must plan the nursing care of the clients who have spiritual distress, establishing expected outcomes in conjunction with the client. The overall expected outcome can be “the client develop an inner spiritual peace and a sense of well-being” or it can be that “the client experiences a greater sense of meaning, purpose and hope in living with an illness”. There can be four goals which may help the client who confront spiritual distress: 1. Help the client create, maintain or renew relationships. 2.Help to meet the need for love expressed through relationship and seen in words and acts of kindness. 3. Help the client to search for meaning. 4.Create a need of hope in the person, possibility of good future. Interventions Communicating about spiritual needs ‘This requires sensitivity, concern, empathy, a willingness to listen, and a non-judgemental attitude. Besides, there should be communication that is direct, specific and clear. The support to the client by the nurse's physical presence demonstrates their availability and care. Nurse must use herself / himself therapeutically The nurse must establish connection with each client which includes caring behaviour, taking time, touching, listening, being available, giving good nursing care, giving extra attention and being understanding and accepting. Accompanying the client This includes the nurse's consoling presence among the clients.Promoting a therapeutic environment Encourage family and friends to bring in spiritual arts such as painting or prints. Personal spiritual articles must be allowed. Bible/Quran/ Gita etc. are also helpful. Music can be used therapeutically. Providing access to spiritual advisors The client should be given opportunity to meet the religious leaders whom they like. Any request by a client for a spiritual counsellor must be honoured. In emergency situations, clergy must be called. Referrals can be made for hospitalized clients and their families through the hospital chaplain's office if available. Referrals may be necessary when the nurse makes a diagnosis of spiritual distress. In this situation, the nurse and the religious counsellor can work together to meet the client's needs. Helping the client maintain relationships Most often, illness causes isolation. Family members and members of the spiritual community must arrange for regular visits, phone calls or gift cards and flowers as appropriate Supporting the client's religious practices + Create a trust relationship with the client - If unsure of client's religious need, ask how nurses can assist in having their needs met = Do not discuss personal spiritual beliefs with a client unless the client requests - Inform clients and family caregivers about spictual support available at your institution (e.g., Chapel, meditation room, chaplain’s services, counselling services, pastoral care services) ~ Allow time and privacy and provide comfort measures prior to private worship, prayer, meditation, reading or other spiritual activities ~ Respect and ensure safety of client's religious articles > If desired ty the client, facilitate clergy or spiritual care specialist visitation - Prepare client's environment for spiritual rituals or clergy visitation as needed - Acquaint yourself with the religion, spiritual practices and cultures of the area in which you are working and see that the spiritual sentiments are honoured by our words, actions, facial expressions and body language. - All spiritual interventions must be done within agency guidelines. Support the client's spiritual practices because of the following reasons: - Prayer has been called for the raising of ming and heart to God. - Prayer involves a sense of love and connection as well as reaching out. It has many health benefits and healing properties. It offers a means for someone to talk to, a mechanism for expressing care and a sense of serenity. Illness can interfere with some client's ability to pray. Feelings such as anxiety, fear, guilt, grief despair and isolation can produce bamers to relationship in general and to the relationship the person has with the divine. In these situations, the client may ask the nurse to pray with him Prayers with clients should only be done when there is mutual agreement between the client and those praying with him/her. Because prayer can evoke deep feelings, the nurse needs to spend time with the client following a prayer to enable the client to express those feelings. Helping the client explore meaning While giving routine care, nurse can help the client to explore his/her thoughts about the meaning of illness, suffering of life. Nurse can utilise therapeutic techniques such as reminiacence, life review, visualization and cont- emplation of literature Reminiscence helps the client to examine his life experiences, to discover new meanings, to reconnect the forgotten moments that represent significant meaning. This method will help the client to maintain ego, integrity.A life review will help the client to get an increased understanding of his own life. Such an understanding may help the client to accept current circumstances, regardless of the long- term outcome. Contemplation of literature may also help the client to explore meaning. Myths, metaphor, biographies, poetry and song lyrics can help the client to find meaning in life. ‘Transcending the present situation and perceiving higher meaning and purpose can be achieved by the nurse's own personal life experiences of the past. Interventions to enhance spiritual well-being - Encouraging hope: Hope helps a client to cope since hope is necessary for life; a nurse must confirm that the client has hope. - Help the client to interpret crisis as spiritual growth: Physical illness can be a crisis that forces clients to seek meaning. The client must be helped to interpret crisis as a means of spiritual growth. During illness, the client may try to resolve interpersonal problems and their relationship with God. Many people find that crisis deepens their faith and make it more real. They learn to live with hope believing in a higher being. Reconciliation with self, others, God and environment has got a positive impact on health and healing. - Help the client to cope with suffering: Different religions attribute different meaning to suffering. The nurse can help the client to “identify and explore their own interpretation of suffering. Be with the client and help them to verbalize their concerns about the meaning of suffering. Listening and clarifying the interpretations of suffering can help clients deal with them. Clients must be encouraged to find some positive aspect in suffering. It helps in ego shedding, in becoming realistic, understandable, generous and helpful. Evaluation Spiritual health and a sense of spiritual well- being constitute a process that spans an entire lifetime. The expected outcome can be evaluated. If the nurse's interventions are successful, the client will show the characteristics of a spiritual well-being. Nurse have got a vital role in the health care team in meeting the spiritual needs of their clients who are in distress. By implementing appropriate interventions, the nurse can contribute to the achievement of holistic health.