SPIRITUAL CARE
Attention
to the spiritual component of the patient’s and family’s illness experience is
not new within the context of nursing care, yet many nurses lack the comfort or
skills to assess and intervene in this dimension. Spirituality contains features of religiosity, but the two concepts
are not interchangeable (Highfield, 2000). Spir-ituality involves the “search
for meaning and purpose in life and relatedness to a transcendent dimension”.
For most people, contemplating their own deaths raises many issues, such as the
meaning of existence, the purpose of suffering, and the existence of an
afterlife. In a national survey on spiritual beliefs and the dying process
conducted by Gallup for the Nathan Cummings Foundation and Fetzer Institute in
1996 and pub-lished in 1997, respondents’ greatest worries about death included
the following:
·
The medical matter of greatest worry
was the possibility of being vegetable-like for some period of time (73%).
·
The emotional matter of greatest
worry was not having the chance to say goodbye to someone (73%) or the
possibility of having great physical pain before death (67%).
·
The practical matter of greatest
worry was how family or loved ones will be cared for (65%) or thinking that
death will be a cause of inconvenience and stress for those who love them
(64%).
·
The spiritual matter of greatest
worry was not being for-given by God (56%) or dying when removed or cut off
from God or a higher power (51%).
The spiritual assessment is a key component of comprehensive nursing assessment for terminally ill patients and their families. Al-though the nursing assessment should include religious affiliation, spiritual assessment is conceptually much broader than religion and thus is relevant regardless of the patient’s expression of religious preference or affiliation. In addition to assessment of the role of re-ligious faith and practices, important religious rituals, and connec-tion to a religious community, the nurse should further explore:
·
The harmony or discord between the
patient’s and family’s beliefs
·
Other sources of meaning, hope, and
comfort
·
The presence or absence of a sense
of peace of mind and purpose in life
·
Spiritually or religiously based
beliefs about illness, medical treatment, care of the sick
Maugans
(1996) created the useful mnemonic “SPIRIT” to assist health care professionals
to include spiritual assessment in their practice:
·
Spiritual
belief system
·
Personal
spirituality
·
Integration
and involvement with others in a spiritual com-munity
·
Ritualized
practices and restrictions
·
Implications
for medical care
·
Terminal
events planning
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