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Spirituality in Nursing


Spirituality in Nursing N237 ... vital dimension of nursing theology of caring ... adolescence *begins as black and white on issues & then develops more abstract ... – PowerPoint PPT presentation

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Title: Spirituality in Nursing

Spirituality in Nursing
  • N237 Cultural Spiritual Dimensions In Healthcare

Spirituality in Nursing
  • What is Spirituality?
  • What is Holistic Nursing?
  • 3 Characteristics of Spirituality
  • 3 Phases of Moral Development
  • 7 Stages of Faith Development Fowler
  • Spiritual Assessment Scale

Definition of Spirituality
  • a broad concept that encompasses values,
    meaning, purpose one turns inward to the human
    traits of honesty, love, caring, wisdom,
    imagination, and compassion existence of a
    quality of a higher authority, guiding spirit or
    transcendence that is mystical a flowing dynamic
    balance that allows and creates healing of
    body-mind-spirit and may or may not involve
    organized religion Dossey
    B.(1988). Nurse as healer toward an inward
    journey. In B.M. Dossey, L. Keegan, C.E.
    Guzzetta, L. G. Kolkmeier,(Eds.), Holistic
    Nursing a handbook for practice. (pp. 39-54).
    Rockville, MD Aspen.

Definition of Holistic Nursing
  • Overall, Holistic Nursing is supported by and
    alternately supports the intimate connection of
    body, mind, and spirit.
  • The body is the physical substance of a person
    that can be perceived in empirical reality
  • The mind is that dimension of an individual that
  • The spirit is the life principle that is shared
    with all humanity and with God.

  • It is the dimension of personhood that drives us
    to create, love, question, contemplate and
    transcend. Emeth Greenhut (1991). The Holistic
    Handbook care of body, mind and spirit for
    optimal health. New York Continuum.
  • Here is a link to the Standards for Holistic
    Nursing Practice.

3 Characteristics of Spirituality

by Margaret Burkhardt
  • Unfolding the mystery ones attempt to
    understand the meaning purpose of life.
  • Harmonious interconnectedness
    individuals relationship to other persons
    /or to God.
  • Inner strength relationship to ones
    personal spiritual resources and sense of
    the sacred.

The Nurse as Healer
  • The nurse truly is well situated to be the
    instrument of Gods healing
  • The concept of the nurse as healer incorporates
    the characteristics of all three definitions
    that is, the nurse healer must listen to the
    voice of God desire to restore health either of
    body or of spirit and attempt to assist the
    patient in achieving wholeness and integrity of
    body, mind, and spirit. -- OBrien, M.E. (1999)
    Spirituality in nursing. Sudbury, MAJones
    Bartlett, p. 10.

Concept of CARING
  • Numerous theorists have defined Caring as being
    essential to nursing.
  • M. Leininger described caring as the central
    focus or dimension of nursing practice.
  • Sr. Simone Roach postulated 5 attributes of the
    Caring concept compassion, conscience,
    competence, commitment, confidence

Dimensions of Caring Practicing Spiritual
Caring 3 essentials
  • BEING being with a sick person without judgment
    creates space for meaning to emerge and for the
    holy to be revealed. E.
    Emeth J.Greenhut (1991, p.65).

3 essentials of spiritual caring (contd)
  • LISTENING Many people are looking for an ear
    that will listen He who no longer listens to his
    brother will soon no longer be listening to God
    either One who cannot listen long and patiently
    will presently be talking beside the point and
    never really speaking to others, albeit he be not
    conscious of it. --Dietrich
    Bonhoeffer (1959). Life together.
    New York Harper
    Brothers. p.11

3 essentials of spiritual caring (contd)
  • TOUCHING Loving, empathetic, compassionate
    touch is perhaps the most vital dimension of
    nursing theology of caring. OBrien, M.E.
    (1999) p. 16. It can be physical touch, or

Moral Development (Kohlberg) -- 3 Phases
  • Preconventional level early childhood simple
    acceptance of right wrong as identified
    through punishment or nonpunishment for an act.
  • Conventional level later childhood to
    adolescence begins as black and white on issues
    then develops more abstract understanding of
  • Postconventional level adulthood encompassing a
    societal view of right and wrong

7 Stages of Faith Development (James Fowler)
  • Undifferentiated faith (infancy- 3 years)
  • Neonates toddlers are acquiring the fundamental
    spiritual qualities of trust mutuality,
    courage, hope, and love.
  • As they develop and begin to communicate,
    toddlers develop the use of symbolism that
    transitions them to the next stage (Taylor,

7 Stages of Faith Development (James Fowler)
  • Intuitive- Projective Faith (3-7 yrs old)
  • Older toddlers and preschooler live in a world of
    fantasy and imagination. They imitate and can be
    powerfully influenced by examples moods, actions
    stories of the visible faith
  • Santa Claus is real and God may be perceived as a
    grandpa depending on how he is portrayed by
    adults in the childs life (Taylor, 2002).

7 Stages of Faith Development (James Fowler)
  • Mythic-Literal Faith (7-12 yrs old)
  • Children attempt to sort out what is fantasy from
    what is fact. They want proofs of reality.
  • Stories help this age child learn beliefs and
    practices of their community.
  • Stories are believed literally rather than with
    abstract meanings (Taylor, 2002)

7 Stages of Faith Development (James Fowler)
  • Synthetic-Conventional Faith (13-20 yrs)
  • The adolescent some adults begin to notice the
    incongruities between stories.
  • It integrates the individuals experiences beyond
    the family unit (school, media, the environment
    around them).
  • Faith synthesizes values and information but also
    is a basis for identity and outlook.
  • Individuals tend to conform to the beliefs around
    them because they have not yet reflected or
    studied them objectively. (Taylor, 2002)

7 Stages of Faith Development (James Fowler)
  • Individuative-Reflective faith (21-30 yrs)
  • Young adults and beyond develop a self-identity
    and worldview that is different from those of
  • Individuals form independent commitments,
    lifestyles, beliefs, and attitudes.
  • Those who obediently attended their parents
    church, or synagogue, or mosque every week, now
    examine independently what religious practices
    and beliefs to accept personally.

7 Stages of Faith Development (James Fowler)
  • Conjunctive Faith (31-40 yrs)
  • Past mid-life adults find a new appreciation for
    their past, value inner voices, become aware of
    deep-seated myths, prejudices, and images that
    are within them because of their social
  • This age may embrace persons of other faith
    traditions, recognizing that in their faith there
    may be new understanding.
  • Persons with conjunctive faith strive to unify
    opposites in mind and experience. (Taylor, 2002)

7 Stages of Faith Development (James Fowler)
  • Universalizing Faith (41 yrs)
  • This level of faith if rarely achieved.
  • Fowler describes it as having a sense of an
    ultimate environment that is inclusive of all
    being. Such persons have become actualizers of
    the spirit of a holistic and fulfilled community.
  • Examples of such persons Mahatma Gandhi Mother
    Teresa Martin Luther King Taylor, E.J. (2002)
    Spiritual carenursing theory, research, and
    practice. Upper Saddle River, NJ Prentice Hall.

The Spiritual Assessment Scale There are
numerous Assessment Scales available in the
literature. Dossey has included the following 3
dimensions in her model. It avoids religious
biases in use of language and offers specific
assessment questions for clinical use.
  • Meaning and Purpose
  • Inner Strength
  • Interconnections

The Joint Commission for the Accreditation of
Healthcare Organizations J.A.H.C.O.
Standards Clarification on spiritual
assessment states Spiritual assessment should,
at a minimum, determine the patients
denomination, beliefs, and what spiritual
practices are important to the patient. This
information would assist in determining the
impact of spirituality, if any, on the
care/services being provided and will identify
if any further assessment is needed.
  • The standards require organizations to define the
    content and scope of spiritual and other
    assessments and the qualifications of the
    individual(s) performing the assessment.
  •   Therefore, three elements need to be included
    in a spiritual assessment
  • Data Gathering
  • Assessment of Data
  • Treatment Planning

  • Data Gathering
  • A basic spiritual assessment should include
  • faith-based data on the patients relationship
  • institutional religious organizations (or
  • spiritually based groups e.g., 12-step programs).
  • The assessment should also include a description
  • of the patients belief system.
  • Finally the assessment needs to identify
  • spiritual practices that may impact care.

Assessment of Data It is not enough to
enumerate the patients faith, beliefs and
practices. A spiritual assessment should also
assess the impact of faith, belief and practice
on the patients understanding of wellness or
illness. Further, the assessment should indicate
if other assessment is needed (e.g., assessment
of spiritual pain, spiritual injury, moral or
ethical issues related to treatment, etc.).  
Treatment Planning The third element of
spiritual assessment is the development of a plan
of care that includes provisions for caring for
the spiritual needs of the patient. This pastoral
or spiritual care plan should be integrated into
the Multidisciplinary Treatment Team care plan.
Kimble, M.A. (2001). The use of spiritual
assessments by the veterans administration
health care system with regards to dying and
death. Retrieved online 7/14/03 Joint
Commission directives on Spiritual Assessment
  • Spiritual Assessment implications for Nursing
    Practice-qualitative research
  • Borysenko, J., Borysenko, M.(1994). The
    power of the mind to heal. Carson, CA Hay
    House, Inc.
  • Dossey, B., Keegan, L., Guzzetta, C.
    (2005).Holistic nursing (4th ed.)

For as Florence Nightingale asserted so many
years ago, Gods precious gift of life is often
placed literally in the nurses hands. This is
spirituality in nursing this is standing on
holy ground.
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