Clinical Day 04.18.13

Providing holistic and culturally sensitive spiritual care involves more than meeting the physical needs of the client. It involves a respectful inquiry about the dying client’s belief system, past spiritual experiences, and current spiritual needs.

How might you provide spiritual support to those with values that differ from your own?

"When a patient is unwell, or is suffering from a terminal illness, he or she goes through a series of trauma which affects the physical, emotional, as well as the spiritual health. Therefore, to be efficient in nursing, one needs to be efficient in identifying and catering to all these needs, especially the spiritual needs, which most of the time, are left unnoticed and unattended.during the times of spiritual distress, it is only a nurse that can comfort the patient by bonding with the patient on a spiritual level. This bonding and connection enables the patient to spiritually confide in the nurse. On the other hand, the nurse too, goes through the spiritual journey with the patient, as he or she can see what the patient is going through. Doing simple things like listening to what the patient has to say, conversing with the patient and responding to what he or she expresses, acknowledging the patient's thoughts and ideologies, and making sure that you help the patient find peace of mind through your presence, is what is required to comfort the spiritual distress that the patient is suffering from." (Bhatti) It's important for the nurse to study what a patients spiritual background is so the care can be more efficient and have a better outcome for the patient and the nurse. To be able to provide spiritual care to patients that have beliefs different than your own can be challenging, you have to look past judgement and accept what your patient believes in. When you are in a situation where your patient is dying and has a request for a spiritual or religious being like a priest or rabi the nurse must help make this happen for the patient by contacting the right people. Some patients might have spiritual rituals that are frowned upon by others, and if the nurse is confronted with this while taking care of a patient they can't stop the patient from doing the ritual but rather have to support it as it may be apart of their beliefs.


Bhatti, S. (n.d.). Retrieved from http://www.buzzle.com/articles/the-role-of-spirituality-in-nursing.html

The nurse plays a role in providing spiritual support to patients, even if the patient’s beliefs differ from the nurse’s beliefs. Although they share different beliefs, it is important to respect the wishes of the patient to aide in their healing or end of life process. Community as Partner states that “Asking clients to teach us about themselves will extend to others our sensitivities about being different and will empower others to share their own awareness. Taking the time to value both differences and commonalities across ethnic and cultural groups will provide us with valuable insight into the human experience and enable us to build bridges between providers and the growing number of diverse clients” (Anderson, McFarlane, 2011). If a nurse is unfamiliar with the beliefs of the client, asking the client to explain their beliefs can be very beneficial. They will share information about themselves and help the nurse value their beliefs. It also aides in developing differences and commonalities between the beliefs. This can help the nurse fully understand their beliefs to assure they are carried out and create a greater connection between the patient and the care provider. By discussing beliefs with the client, it helps them feel spiritual support, and show them that you are truly interested in their belief system. During one of my visits, I was at a home with a patient who was transitioning into passing away. He was an elderly man who had a Spanish speaking family. They had very strong Catholic beliefs, and wished for a priest to come see him. This was arranged before we arrived. The wife of the patient was very religious, and I observed them saying prayers and holding rosary beads, with religious pictures on the walls. For this family, their spiritual beliefs were extremely important during this difficult time, and it was very important that the nurse did not interfere with the rituals. The nurse was very respectful and accepting, despite the spiritual beliefs she may have had. I was able to see in this household how their spiritual beliefs helped them cope with the loss of their loved one. Community as Partner also explains that “The healing goals of culturally sensitive care can only be achieved through conscious efforts at gaining knowledge of different groups’ ways of explaining, understanding, and treating health problems” (Anderson, McFarlane, 2011). Understanding a patient’s view of their health is very important when providing their care. A key intervention that the nurse can take is to ask the patient about their cultural beliefs regarding health and make a conscious effort to understand and incorporate these beliefs into the health care plan.

Anderson, E., McFarlane, J. Community as Partner, Theory and Practice in Nursing. 2011. Sixth Edition.

LM makes a great point about avoiding judgment. Although a nurse may have certain feeling regarding a belief or practice, it is important to not allow this judgment to play a role in the nurse/patient relationship. It is important to support and respect the spiritual beliefs and rituals of patients during their end of life process, or any point during the care process. These beliefs may have significant meaning to the patient and may provide them with motivation to get better and continue treatment. LM also explains how supporting a patient’s belief can make a greater connection in the nurse/patient relationship. Having a better connection may motive the patient to follow their treatment regimen more closely and be motivated to take part in their recovery or dying process.

The world we live in is becoming more diverse. As the decade pass by the United States, which was primarily composed of Catholics and Protestants, is filled with people that have many different spiritual beliefs. “Nursing has historically viewed humans as holistic: body, mind, and spirit. As the United States of America (USA) becomes more diverse in culture, lifestyles, religions, and worldviews, nurses are challenged more than ever before in providing holistic care to patients” (Dunkin, Dunn, 2009). The reason nurses are more challenged is because we cannot possibly understand everyone’s beliefs and spirituality, we can only support them. Of course it is very important for nurses to take the time to learn a little bit about their patient’s beliefs, but more importantly we need to recognize how those beliefs will affect the patient’s decisions. “Religion and spirituality are two important aspects of one’s culture that permeates this holistic view, particularly in the healthcare arena where RS beliefs may determine the patient’s choices for treatment or end-of-life decisions, as well as affect the way one copes with illness or finds sustaining comfort and support in illness”(Dunkin, Dunn, 2009).
When a nurse is caring for a patient with different spiritual beliefs, it is important for the nurse to first recognize his or her biases. Once the nurse recognizes those biases he or she must support the patient and his or her decisions and give the patient the most competent care. As nurses, we are there to provide care for our patients, not to judge their culture or beliefs. I think understanding the patients cultural and spiritual beliefs can aid the nurse in providing holistic care. There are certain characteristics, which are key factors in holistic care, education and support are two of them; and as long as the nurse provides these aspects, the patient will benefit from the care the nurse is providing. Although I think leaving your feeling at the door, especially for those who must care for people like the terrorist at Beth Israel right now, we must always remember our role as professional nurses.

Dunkin, J., & Dunn, L. (2009). Spiritual perspectives and health: a random survey in a Southern State. Online Journal Of Rural Nursing & Health Care, 9(2), 23-32.

Providing holistic and culturally sensitive spiritual care can benefit clients mentally and emotionally. It is important to keep patients’ spiritual needs in mind when caring for them, that way the whole person can be healed, rather than just the physical ailments. To provide spiritual support to those with values that differ from your own doesn’t have to be uncomfortable, it simply means to acknowledge their beliefs and treat them accordingly. A study by Caaron & Cumbie (2011) found, “The results indicated that spiritual care for adults included a need for kindness, compassion, and gentleness from a caring, personal relationship,” things that should be included in every patients care already. I think that by listening, talking, providing support and being present with patients their spiritual needs will be met.


Carron, R., & Cumbie, S. (2011). Development of a conceptual nursing model for the implementation of spiritual care in adult primary healthcare settings by nurse practitioners. Journal Of The American Academy Of Nurse Practitioners, 23(10), 552-560.

LD states that asking the patient to explain themselves will help the nurse understand the patient, which is very true. By the nurse showing interest in the patient and his or her beliefs, the patient gain trust in the nurse and that rapport will aid in communication and patient outcomes. Although one may not believe in the same religion as the patient and their loved ones, it is important to respect their rituals as the nurse and LD did when the family was praying. Respect will allow the nurse to develop strong relationships with his or her patients, which begins with understanding who that patients is.

LD,
I agree with you that it could be very beneficial to have a client explain their beliefs to the nurse if he/she doesnt understand because that shows the client that the nurse truly cares and will advocate for them based on their spiritual needs. I also agree that it will help strenghten the nurse-patient relationship. I’m glad you have seen firsthand how big of a role religion can play in helping one cope and that it was a good, respectful experience for you.

Holistic care, Culture and Belief remains to be very sensitive in aspects of caring for the sick patients. Respect and dignity should always prevail within everyones cultural understanding in collaboration with nursing practice and capabilities. Its very hard to change a patients spiritual belief system of living to whatever the case may be. "Cultural competence has become a major issue in nursing practice, given the current and projected US demographics as well as the long-standing health disparities in people of diverse racial, ethnic, and cultural backgrounds" http://www.medscape.com/viewarticle/513607. This is to say, there are many cultures out there and its really challenging not to follow the beliefs and practices they may have.In a nurses aspect and view, advocating for a patients culture and spiritual needs and respecting them, promotes the quality of care and provides optimal health. When patients are happy and con-tempted, they seem to recover quickly and heal well.

CMOS
As simple as it may sound "listening, talking, providing support and being present with patients their spiritual needs will be met" is a vital way of caring for our patients without complicating their care and comfort. Your thoughts may seem to be an everyday 'thing' but most nurses ignore them. Its my believe that every nurse should be providing all the aspects you mentioned in order to provide optimal care and generate a proper way of communicating.

I like how you brought up the idea of asking the patient to explain their spiritual beliefs so it can be a way of bonding and building a trusting relationship. I think it's very important to take time to listen to what your patient believes in and what they would like from you as the nurse to fulfill their spiritual beliefs. I think asking the patient to explain their spirituality is a better idea than doing research on your own and trying to surprise the patient with what you have learned because it can end up being very different than what they believe in. Thanks for sharing the story about your patient you saw that was entering end of life and how the family showed their spiritual beliefs, and the nurse had to respect and accept what they were doing to comfort themselves.

I couldn't agree more that spiritual care should be included among the holistic approach that we take as nurses in caring for our patients. It is beneficial for us to take care of individuals who have different spiritual beliefs than we do so that we can see the full spectrum of spirituality and be culturally compotent to all of our clients. I will continue to care for individuals not only for their physical ailments, but for their emotional and spiritual as well, as this will improve patient outcomes.

We provide care to patients with differing values all the time. The concept of ones spirituality is just one of those areas that may be same, similar, or plain opposite. With that in mind, I would argue that we should continue to treat the patient as we normally would, that is if you indeed do practice without prejudice. If they prefer chicken to steak, get them chicken. If they prefer last rights to no rights, arrange for last rights. This is just another area of patient preference that we chose to categorize.

During the patients initial assessment, inventory should be taken as to patient preferences that include those in the spiritual realm. In fact according to tnbutterfly, (2012) In the United States, Joint Commission on Accreditation of Healthcare Organizations (JCAHP) requires that a spiritual assessment be completed on every patient. By assessing and assisting in facilitating the various needs of patients, the nurse is in better position to promote mental wellness. While the nurse might not subscribe to the patient beliefs, and may not want to participate in say prayer, the nurse should remain sensitive to such things.

Another aspect of providing spiritual support to a patient is advocating for "alternative" treatments the patient may elect to under go. Some examples of this would be, if im not mistaken, coining, and cupping? Did I get those right? We have patients that's may not desire certain treatments based on beliefs. It has always driven me nuts to hear nurses commiserating with one another about a patients decision for code status. This is arguably the biggest decision in a patients life as it relates to there own mortality, to live or die. All to often nurse snicker and bicker at those patients who choose to live when the nurse thinks they should just be left for dead. The nurse should accept the patients wish and preferences without denigrating them behind the scene and in some cases performing the "slow code."

We should encourage patients, even the younger ones to have there wishes written out and the appropriate surrogates named.

tnbutterfly. (2012). The nurse's role in providing spiritual care, is it OK to pray. Allnurses.com. Retrieved from http://allnurses.com/nursing-and-spirituality/nurses-role-providing-368327.html

Nice discussion piece by the way. I always enjoy reading your comments. Your right in iterating that "it is important to first recognize biases." This is what we have been taught and what the literature often says. I've always thought this concept to be a bit backwards and here's why. As individuals we have difficulty finding faults in ourselves. We are incline to think of ourselves as correct in thinking and others not so much. I even recall reading about a study that looked at people and there dogs. It sought to see if there was any credence to the notion that people tend to gravitate to dogs that hard similar characteristics to themselves; it turned out they did. I mention this to illustrate the depth of love and righteousness we truly have for ourselves. So when I hear this line being used, that we must first recognize our biases, I think yah right; good luck. I think it would be best if in fact, if someone else had to first identify your biases. I don't know about you but im great at picking out other people faults, and realizing my perfection:P What are your thoughts?

Often, patients don't require spiritual care until an impending crisis is upon them where they inevitably turn to their spiritual background and ask for guidance through this process. A definition of spiritual care is 'that care which recognizes and responds to the needs of the human spirit when faced with trauma, ill health or sadness and can include the need for meaning, for self worth, to express oneself, for faith support, perhaps for rites or prayer or sacrament, or simply for a sensitive listener. Spiritual care begins with encouraging human contact in compassionate relationship, and moves in whatever direction need requires’ (NHS Education for Scotland, 2009). The nurses role in spiritual care is not so much to provide their own beliefs on spirituality, rather to affirm the patients. Nurses can also provide spiritual care by praying with the patient, holding hands, and listening attentively to the patients concerns. It is a critical element among the holistic nursing care spectrum that is vastly underused and patients will appreciate it if we include it in their care


NHS Education for Scotland (2009) Spiritual care matters: an introductory resource for all NHS Scotland staff, Edinburgh: NES.

Its a great point that you made about educating yourself about the religious beliefs of the patient. By doing this you can support your patient better and also really listen and understand what they are saying. Each belief system has different values and mantras and rituals and if the nurse understands these, she can better be there for the patient.

Death and dying is a subject that I think a lot of people actively try to avoid. When someone is forced to deal with death and dying whether it is their own death or the death of a loved one, many people have a difficult time dealing with it because it is something that hadn’t been thought over or considered. This is a little different in the hospice setting because often the client and the family is well aware of the dying process that is happening and they have a support system to help them along the way. On the other hand, you have clients and families who are in complete denial of death regardless of what the physician says. One of my clients in home care last week was an older woman who was diagnosed with cancer and was extremely ill, but the nurse I was following was telling me that she is not accepting her diagnosis and will not even tell her husband what is going on- he didn’t even know of her cancer diagnosis. In her case, dying may come very suddenly and make it that much harder on the family. Death is a very spiritual issue- some people believe in some sort of a higher power while others believe in nothing at all. That can make death a very frightening thing- I can only imagine how terrified I would be if I was faced with death and didn’t know where I was going or who/what I would encounter. Regardless of spiritual beliefs, I think that the nurse’s main responsibility is to simply listen to what the client has to say- concerns, thoughts, and fears. As nurses we need to be okay with the fact that we will not have all the answers and that clients will ask us questions that we really aren’t sure of. I think it’s okay to tell the client that you don’t know for sure, but at the same time be present and provide them the comfort that they may need. The article I found was interesting- it talked about the lack of spiritual care in health care settings. It goes on to say that the research showed that there were very few health care professionals who had received training and expressed a desire to do so.

Balboni M, Sullivan A, Balboni T, et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. Journal Of Clinical Oncology [serial online]. February 2013;31(4):461-467. Available from: CINAHL with Full Text, Ipswich, MA. Accessed April 26, 2013.

My blessing are always with you....