Chapter 6
Spiritual Assessment
Copyright 2002, Delmar, A division of Thomson Learning
Competencies




Describe how different spiritual beliefs
might influence the patient’s view of
health.
Conduct a spiritual assessment on a
patient.
Identify signs and symptoms that indicate
the patient is experiencing spiritual
distress.
Formulate nursing interventions that
promote the patient’s spiritual well-being.
Copyright 2002, Delmar, A division of Thomson Learning
Spirituality and Religion


Spirituality—the concern for the
meaning and purpose of life
Religion—an organized system of
beliefs usually centered around the
worship of a supernatural force or
being



Rituals
Faith
Dogma
Copyright 2002, Delmar, A division of Thomson Learning
Spiritual Theory: Key
Terms







God
Prayer
Monotheistic religions
Polytheistic religions
Sin
Heretic
Schismatic
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Spiritual Theory: Key
Terms








Atheist
Agnostic
Cult
Soul
Spirit
Reincarnation
Heaven
Nirvana
Copyright 2002, Delmar, A division of Thomson Learning
Holistic Health and
Spirituality


Spiritual well-being
Spiritual distress
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Judaism

Core beliefs



Religious leaders


Monotheistic, Yahweh (God)
Jewish people are “chosen” people
Rabbi, cantor, mohel
Holy books and artifacts

Bible, Torah, yarmulkes
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Judaism

Holy day of the week


Holy holidays, festivals,
observances


Friday from sundown until Saturday
sundown
Rosh Hashana, Yom Kippur,
Hanukkah, Passover
Dietary restrictions
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Judaism


Period of fasting


Kosher foods, meat, and dairy
products and not be taken together
Associated with special holidays
Medical treatment

Seek care for oneself, prayers and
visitation proper for the sick, medicine
and physicians held in high esteem
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Judaism

Birth control


Abortion



Sex and birth control permitted within
marriage
High respect for life, fetus not human until
birth
Observances of birth—Circumcision
Rites of initiation

Bar mitzvah, Bat mitzvah
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Judaism


Withdrawal of life support
Death



Burial within 24–48 hours of death
Shiva: 7-day period of mourning
Organ donation permitted
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Islam

Core beliefs


Religious leaders


Imam
Holy books and artifacts


Monotheistic, Allah (God)
Koran, Shari’a
Holy day of the week

Friday
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Islam

Holy holidays, festivals,
observances



Pray five times per day from sunup to
after sundown
Ramadan
Dietary restrictions


No pork, pork products, alcohol
Fasting from dawn to sundown during
Ramadan
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Islam

Medical treatment



Seeking medical care is encouraged
Female bodies should remain covered
Birth control

Sexual relations and use of birth
control are permitted within marriage
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Islam

Abortion



Observances of birth
Rites of initiation


Forbidden after ensoulment
Circumcision
Withdrawal of life support
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Islam

Death





Suicide is forbidden
Family and friends present at death
Ceremonial cleansing of the body
Burial preferably same day
Organ donation

May receive organ donations, transplanted
organs, and blood transfusions
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Roman Catholic

Core beliefs



Religious leaders


Monotheistic
God (father), Jesus (son), and the Holy
Spirit
Priests, bishops, monks, nuns
Holy books and artifacts

Bible, crucifixes, rosary beads
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Roman Catholic

Holy day of the week


Holy holidays, festivals,
observances


Sunday
Christmas, Good Friday, Easter,
Pentecost, and the Assumption
Dietary restrictions

No meat on Fridays during Lent
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Roman Catholic

Period of fasting


Medical treatment



Ash Wednesday and Good Friday
Encouraged to seek care
Anointing the sick, prayer, visitation
Birth control


Sexual relations permitted within marriage
Natural family planning
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Roman Catholic

Abortion


Observances of birth


Prayers, blessings, baptism
Rites of initiation


Prohibited
Baptism
Withdrawal of life support

Permitted under certain circumstances
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Roman Catholic

Death



Prayers
Burial, cremation, autopsies permitted
Organ donation

Permitted
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Protestant

Core beliefs



Religious leaders


Monotheistic
God (Father), Jesus (Son), and the
Holy Spirit
Priests, ministers, pastors
Holy books and artifacts

Bible, cross
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Protestant

Holy day of the week


Holy holidays, festivals,
observances


Sunday
Christmas, Easter
Dietary restrictions and period of
fasting

None
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Protestant

Medical treatment


Birth control


Anointing of the sick, prayer, seek
medical attention
Sexual relations and birth control
permitted within marriage
Abortion

Usually permitted to preserve health of
mother
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Protestant

Observances of birth


Rites of initiation



Prayers and blessings
Baptism
Withdrawal of life support
Death

Burial, cremation, and autopsies
permitted
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Protestant

Organ donation

May/may not be permitted
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Jehovah’s Witness

Core beliefs


Religious leaders


Elders
Holy books and artifacts


Jesus is God’s son but inferior in status to
God
New World Translation of the Bible
Holy day of the week

No one day is holier than any other
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
Religions and Health
Care: Jehovah’s Witness

Holy holidays, festivals,
observances


Dietary restrictions


Meat should be free of blood
Period of fasting


Do not celebrate Christmas or Easter
None
Medical treatment
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Jehovah’s Witness



Birth control



Seek medical care for illness
Prohibits ingestion of blood—no blood
products
Sex is permitted within marriage
Birth control is permissible
Abortion

Permitted if required to save mother’s life
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Jehovah’s Witness

Observances of birth


Rites of initiation



Baptism
Withdrawal of life support
Death


None
Burial and cremation permitted
Organ donation

Permitted
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Native American

Core beliefs


Religious leaders


Cultural traditions
Medicine man, elder
Holy books and artifacts


No books; tradition is passed on verbally
Feathers, gourds, shells, medicine pouch
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Native American

Holy day of the week


Holy holidays, festivals,
observances


None
Associated with changes in season
Dietary restrictions

Variable
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Native American

Period of fasting


Medical treatment


Illness may be related to a sin or
unhappy spirit or god
Birth control and abortion


May be related to prayer
Usually not practiced
Observances of birth
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Religions and Health
Care: Native American

Rites of initiation


Withdrawal of life support


Viewed as unnatural
Death


Possibly at puberty
Spirit of person lives on after death
Organ donation

Discouraged
Copyright 2002, Delmar, A division of Thomson Learning
Spirituality and the
Nursing Process

Spiritual assessment





Establish rapport
Maintain eye contact
Quiet, private environment
Maintain nonjudgmental manner
Respect silence and diversity
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Spirituality and the
Nursing Process

Conducting the spiritual history



Establish therapeutic relationship
Inquire about the use of advance
directives and organ donation
Ask if patient has a specific religious
affiliation, or if any spiritual or
religious beliefs will affect the health
care received
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Spirituality and the
Nursing Process



Observe for clues about
spirituality (religious jewelry,
clothing)
Inquire who should be notified
in case of emergency
Nursing diagnosis


Spiritual distress
Potential for enhanced spiritual
well-being
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Spirituality and the
Nursing Process

Signs of spiritual distress





Crying, sighing, withdrawn behavior
Questioning spiritual beliefs
Statements of worthlessness,
hopelessness, or death
Statements about God or God’s
purpose
Requests for spiritual assistance
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Spirituality and the
Nursing Process

Planning and implementation




Listen actively
Provide an empathetic, warm,
interested response to patient’s
concerns
Show respect for patient’s spiritual
beliefs
Refer to hospital chaplain or patient’s
spiritual leader
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Spirituality and the
Nursing Process


Provide patient and family with
opportunity to practice religion and
spirituality
Nursing actions to avoid



Do not proselytize your own spiritual
beliefs
Do not instruct the patient in religious
or spiritual doctrine
Do not serve as a spiritual advisor
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
Spirituality and the
Nursing Process


Do not use clichés
Evaluation



Acceptance of spiritual support
Decrease in signs of spiritual distress
(crying, restlessness, statements of
worthlessness or hopelessness)
Verbalization of satisfaction with
spiritual beliefs
Copyright 2002, Delmar, A division of Thomson Learning