18.2 Basic Concepts

Spiritual Distress

When patients are initially diagnosed with an illness or experience a serious injury, they often grapple with the existential question, “Why is this happening to me?” This question is often a sign of spiritual distress. Spiritual distress is defined by NANDA-I as, “A state of suffering related to the inability to experience meaning in life through connections with self, others, the world, or a superior being.”^[1] Nurses can help relieve this suffering by therapeutically responding to patients’ signs of spiritual distress and advocating for their spiritual needs throughout their health care experience.

Spirituality

Provision 1 of the ANA Code of Ethics states, “The nurse practices with compassion and respect for  the inherent dignity, worth, and unique attributes of every person” and “optimal nursing care enables the patient to live with as much physical, emotional, social, and religious or spiritual well-being as possible and reflects the patient’s own values.”^[2]

Spiritual well-being is a pattern of experiencing and integrating meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself.^[3] Spirituality is defined by the Interprofessional Spiritual Care Education Curriculum (ISPEC) as, “A dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence and experience relationship to self, family, others, community, society, nature, and the significant or sacred.”^[4] Spiritual needs and spirituality are often mistakenly equated with religion, but spirituality is a broader concept. Elements of spirituality include faith, meaning, love, belonging, forgiveness, and connectedness.^[5] Spirituality and spiritual values in the context of nursing are closely intertwined with the concept of caring.^[6] See Figure 18.1^[7] for an illustration of spirituality.

An integrative review of nursing research and resources was completed in 2014 to describe the impact of spirituality and spiritual support in nursing.^[8] See the following box for discussion of findings from this integrative review.

Spiritual Assessment

The Joint Commission requires that health care organizations provide a spiritual assessment when patients are admitted to a hospital. Spiritual assessment can include questions such as the following:

• Who or what provides you with strength or hope?
• How do you express your spirituality?
• What spiritual needs can we advocate for you during this health care experience?

In addition to performing a routine spiritual assessment on admission, nurses often notice other cues related to a patient’s spiritual distress or desire to enhance their spiritual well-being. When these cues are identified, spiritual care should be provided to relieve suffering and promote spiritual health. There are several nursing interventions that can be implemented, in addition to contacting the health care agency’s chaplain or the patient’s clergy member. See the “Applying the Nursing Process” section for a discussion of spiritual assessment tools and nursing interventions related to spiritual care.

Many hospitals, nursing homes, assisted living facilities, and hospices employ professionally trained chaplains to assist with the spiritual, religious, and emotional needs of patients, family members, and staff. In these settings, chaplains support and encourage people of all religious faiths and cultures and customize their approach to each individual’s background, age, and medical condition. Chaplains can meet with any individual regardless of their belief, or lack of belief, in a higher power and can be very helpful in reducing anxiety and distress. A nurse can make a referral for a chaplain without a provider order. See Figure 18.2^[11] for an image of a hospital chaplain offering support to a patient.

A chaplain assists patients and their family members to develop a spiritual view of their serious illness, injury, or death, which promotes coping and healing. A spiritual view of life and death includes elements such as the following:

• • Suffering occurs at physical, mental, emotional, and spiritual levels. Sociocultural factors, religious beliefs, family values and dynamics, and other environmental factors affect a person’s response to suffering.
  • Hope is a desire or goal for a particular event or outcome. For example, some people may view dying as “hopeless” whereas a spiritual view can define hope as a “good death” when the patient dies peacefully according to the end-of-life preferences they previously expressed. Read more about the concept of a “good death” in the “Grief and Loss” chapter.
  • Mystery is knowing there is truth beyond understanding and explanation.
  • Peacemaking is the creation of a space for nurturing and healing.
  • Forgiveness is an internal process releasing intense emotions attached to past incidents. Self-forgiveness is essential to spiritual growth and healing.
  • Prayer is an expression of one’s spirituality through a personalized interaction or organized form of petitioning and worship.