The field of nursing has experienced significant changes within the realm of the delivery of competent nursing care to all patients within the past two decades. Much of the recent changes can be seen in the trend towards holistic care of all patients irrespective of race, ethnicity, gender, religious affiliation, and other important characteristics. The notion of holistic care is one that involves the construct of spirituality.
In treating patients, it is prudent for a nurse to assess the spiritual needs of the patient. In fact, the Joint Commission on Accreditation for Health Care Organizations (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF) mandates that all nursing facilities conduct a spiritual assessment and incorporate the provision of care aimed at meeting the spiritual needs of their patients into their nursing care plan (Galek, Flanneily, Vane & Galek, 2005).
Galek, Flanneily, Vane & Galek (2005) posit that there are seven major constructs to examine when one assesses the spirituality of the patient—conceptualizing the constructs of belonging, meaning, hope, the sacred, morality, beauty, and acceptance of dying paints a clear picture of the spiritual needs of a patient and can serve as a means of determining the deficits within the realm of spirituality. This picture can then be used to create a nursing care plan that addresses the whole patient in a manner that proves to be beneficial to the patient.
It was noted that the construct of spirituality was one that proved very esoteric in nature, and it was one that had to be operationally defined. In an attempt to conceptualize this construct, it is prudent that the literature on the subject is closely examined. This investigation yielded the discovery of several topologies on which a conceptualization of spirituality can be based and can utilize the notion that individuals who suffer from a terminal condition can obtain the optimal benefit from holistic care. This operates based on the presumption that individuals who are in the process of dying can benefit from embracing their spirituality. In so doing, acceptance of the inevitable is facilitated, and the stress level of the patient is kept at a minimum.
In examining the construct of spirituality as a means of determining the needs of a patient who is approaching the end of his/her life, six general themes emerged, and a six-category topology emerged. The most fundamental aspect of this topology was the notion that religion played a vital part in the paradigm of spirituality. Religion was examined in the formal sense of the word, and it was determined that prayer and transcendence were important components to a spiritual existence.
Additionally, many patients exhibited the notion that there was life beyond existence on earth. The thought of such an existence served to facilitate a feeling of comfort, happiness, and peace. Furthermore, values such as hope and faith proved significant. It was determined that it was prudent that the patient communicates their conceptualization of these constructs to health care providers (Galek, Flanneily, Vane & Galek, 2005).
Galek, Flanneily, Vane & Galek (2005) were able to develop an assessment tool that served as a precursor to any treatment plan. The assessment tool consisted of a 29 item four-point scale which examined the constructs of Love/belonging/ respect, divinity, positivity/gratitude/hope/peace, meaning and purpose, mortality and ethics, appreciation of beauty, resolution/death, and control. This tool is able to recognize deficits in any or all of the aforementioned areas and will aid the nurse in devising a culturally competent treatment plan for the patient.
McEwen (2005) examined the notion of spirituality, and in so doing, the concept of nursing intervention was explored. In this vein, the constructs of spiritual growth facilitation were examined, and proposed interventions included active listening, the reading of scriptures, the creation of a journal, establishing a connection with God, instilling faith, and other similar measures. Incorporating these interventions with a patient involves a certain level of trust on the part of the patient in that religion and spirituality are entities that are extremely personal to many individuals.
In order for the patient to be able to share his/her religion with a nurse and for the nurse to act responsibly in rendering spiritually sensitive care, there must be a dyadic relationship which is built on the notion that both the nurse and the patient are operating in the best interest of the patient.
In examining the notion of how I would incorporate spirituality as an approach to the holistic care of the patient, I would have to say that I would first conduct an assessment of the spirituality of the patient utilizing the assessment tool developed by Galek, Flanneily, Vane & Galek (2005). This tool proves to be effective in detecting the various aspects of a patient’s spirituality. After the administration of this assessment tool, I was addressing the areas of deficit utilizing an eclectic approach that is based on the needs of the patient as well as the capability of the patients to respond to certain methods of intervention.
For instance, a patient may be very spiritual, but he/she may not be religious. In deriving my intervention, I would take that into consideration, and in lieu of reading the bible to that patient, I would possibly engage in therapeutic communication and active listening as a means of learning about the patient’s spirituality. Essentially my intervention would be very individualistic and guided by the needs of the patient and his/her willingness to participate in the method of intervention.
When dealing with the aspects of spirituality and religiosity, it is prudent to examine interventions that the patient is willing to explore as these aspects of an individual are very personal. I consider myself to be a spiritual individual but object to the notion of organized religions. For a patient with a similar belief system, scripture reading may prove to be counterproductive. For a patient who is very religious, the reading of scriptures may prove to be very beneficial. It all depends on both the comfort level of the nurse and that of the patient. It is prudent that those levels be examined when rendering spiritually competent care. It is important to keep in mind that irrespective of the intervention used, the whole goal of holistic nursing care is to assure that the physical, psychosocial, as well as spiritual needs of the patient, are met.
References
McEwen, M. (2005). Spiritual nursing care. Holistic Nursing Practice, 19(4): 161-168.
Galek, K., Flanneily,K.J., Vane, A. & Galek, R.M. (2005). Assessing a patient’s spiritual needs: A comprehensive instrument. Holistic Nursing Practice, 19(2): 62-69.