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Chapter: Medical Surgical Nursing: End-of-Life Care

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Spiritual Care - Nursing Care of the Terminally Ill Patient

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.

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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