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Stephanie Scully, RN BSN New Castle Presbytery Health Ministry Chair/ Editor Christiana Care Cardiac Surgery Nurse

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Why Present this Topic to Church Leaders The Book of Order Services for Wholeness Healing was an integral part of the ministry of Jesus which the church has been called to continue as one dimension of its concern for the wholeness of people. Through services for wholeness, the church enacts in worship its ministry as a healing community.

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Objectives To display the importance of trust and meaning while caring for ill patients To describe the spiritual roots of nursing To define spiritual health, spirituality, and faith in the context of science To understand the concepts of holism and holistic health in relation to a persons well-being To explain the manifestations, causes, and ways to manage spiritual distress in the hospital setting To identify ways in which religious leaders can most effectively promote spiritual health in the hospital and home setting To recognize the importance of addressing spiritual care needs in the community after hospitalization

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Roots of Nursing Florence Nightingale 1820-1910 The mother of nursing Protestant training A Call from God Spirituality Entailed the development of courage, compassion inner peace, creative insight, and other God-like qualities Endorsement of contemplative prayer

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Roots of Nursing Other connections to religion Betty Neuman and Jean Watson Spirituality impacts development Define holistic health Watson Nurses should respect and appreciate the spiritual meaning in a persons life

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Roots of Nursing Early 1980s- the turning point Trend away from religion and spirituality focus in nursing Providing holistic care 1978- NANDA Nursing diagnosis Spiritual Distress

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Spiritual Health Holistic nursing perspective Biopsychosocial being Spiritual core Components of the self All integral to and influences the others: Physical Mental Social Spiritual Spiritual aspects contribute to individuality and create meaning in peoples lives.

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Spiritual Health What is Spirituality? The quality or essence that pervades, integrates, and transcends ones biopsychosocial nature An experience for connection to life, a way of interpreting life events; a source of hope, joy, comfort and guidance on lifes journey Includes all behaviors that give meaning to life and provide strength to the individual Provides balance

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Spiritual Health Characteristics of Spirituality Holism Sense of wholeness and harmony Spiritual Need Seeking meaning Spiritual Quest A higher level of consciousness Spiritual Well-Being Positive affirmations, celebrate wholeness

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Spiritual Health Faith More than a set of beliefs Way you act out your beliefs Making meaning central idea What needs do faith and spirituality fulfill? Meaning to life Sense of security Guide daily life Acceptance vs rejection Support Strength

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Spiritual Health Why is understanding spirituality of an individual important? A persons inner strength comes from different sources Navajo Harmony Christians God Tailor your care Caring for patients (hospitalized or not) means caring for families and friends as well

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Spiritual Health Statistics Of the major religions in the world 33% are Christian 21% are Islamic 16% are Atheist, Agnostic, or nonreligious 14% are Hindu In the United States 76.5% are Christians 13.2% are Nonreligious/ secular 2.3% are Jewish 0.5% each are Hindu, Islamic, Agnostic, and Buddhist

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Spiritual Health Factors Affecting Spiritual Health Culture- tradition Gender- spiritual expression Previous Experience- expression Crisis and Change- strength? Separation from Spiritual ties Moral Issues Regarding Therapy Inadequate or Inappropriate Care- how healthcare providers address spiritual health ****EXAMPLE: Death and Dying Rituals Ive Seen

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Spiritual Health Relation to Nursing Crisis and change Transitions are times of anxiety and vulnerability Front row seat Comforting patients **EXAMPLE: PRAYER SHAWL, DEATH/DYING RITUALS I HAVE SEEN

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Spiritual Health Community health nursing Faith community- group sharing common faith practices Health ministry- purposeful activity promoting whole person health Physical, psychological, social, and spiritual Parish nursing- health promotion and disease prevention

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Spiritual Health Why should healthcare providers assess spirituality in the healthcare setting? Greater well-being Coping mechanisms Physical manifestations Lower levels of mortality Less heart disease Lower blood pressure Less depression Lower stress levels Less alcohol and tobacco abuse Greater well-being and optimism Positive health habits

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Impact on Patient Care Why does spiritual distress occur? Questions about meaning Problems coping Anger Sleep disturbances Separation from religious practices Treatments challenging beliefs

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Impact on Patient Care Challenges hospitalized patients face End of life decisions Family members beliefs Blood transfusions Medications Minor surgeries **EXAMPLE: Blood refusal form, discussions about heart valves

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Impact on Patient Care Manifestations of Altered Spiritual Function Verbalization of distress Altered behavior Nervous Introspective Emotion response Seek information Denial of situation Signs of guilt, fear, depression, or anxiety

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Impact on Patient Care Nurturing the Spirit Assessing spiritual status- questions What is strength for you? Where can you get it? Who gives you strength? How can you increase your inner strength? What does peace mean to you? Where do you feel at peace? Who makes you feel more peaceful? What situations increase your sense of peace? When do you feel most secure? Where do you get your security from? Does someone make you feel more secure? How can you increase your security?

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Impact on Patient Care Barriers A persistent barrier to the incorporation of spirituality into clinical practice is the fear of imposing particular religious beliefs and values on others Remain open Let the client guide the discussion and tell you what THEY need **EXAMPLE: COWORKERS STORY

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The Gaps I See Spiritual Assessments Questions nurses ask **EXAMPLE: CHRISTIANAS ASSESSMENT Reality vs. Practice Shift from vocation to profession Justifying a nurses VALUE Increase in economic orientation Where YOU can help Filling the gaps My sacrifice My suggestion Increase awareness of spiritual health Increase the populations spiritual well-being

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Importance of Follow-Up Hustle-Bustle Nursing NANDA diagnosis for Spiritual Distress What can nurses do NOW? Rapid turnover of patients -What is actually done? -Consult pastoral care -Consult psych -Suggest calling a religious leader No followup post-discharge Acknowledge spiritual pain Be there, now

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Importance of Follow-up Spiritual care Ongoing process Relationships over time Community based care leadership initiatives Not just religious based Development of a sensitive spiritual relationship Parish nursing Health promotion in faith communities Missionary nursing Promoting holistic health globally

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How You Can Help Key: A warm and trusting relationship Sharing values Offering compassion, kindness, gentle words, and a supportive presence can be life changing for someone in need Spiritual Care A mutual potentially healing or integrating process in which an individuals spiritual needs are met

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How You Can Help Spiritual Health Promotion Use of Self Availability Spiritual Support Diverse audience Support of Spiritual Practices Special religious considerations Privacy

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How You Can Help Spiritual Health Interventions Respecting and encouraging a persons spiritual and religious interest and concerns enhances the healing process Listen and Support Empathy and sensitivity Refer To others as necessary Tailor your Care Infants and parents Age-appropriate Presence **EXAMPLE: HOLDING HANDS, PRAYER BEFORE INDUCTION

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How You Can Help Caring and spirituality are central among faith-based organizations CIRCLE Model of Spiritual Care Caring Intuition Respect for religious beliefs and practices Caution Listening Emotional support

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How You Can Help Alternative therapies- Spiritual Connection Prayer and Meditation Imagery Especially while hospitalized Relaxation exercises Quiet focus Controlled breathing Therapeutic touch

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PROGRESSIVE RELAXATION EXERCISE https://www.youtube.com/watch?v=h9sM24jdZ1w

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How You Can Help Physical effects of relaxation techniques over time: Lower blood pressure Decrease chronic pain Increase white blood cell production -> decreased illness Decreased dysmenorrhea

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REVIEW OF HANDOUTS 109+ Ways to say, I Care Thoughtful gifts Words that can help Offering special services (i.e. babysitting) Outings (take me somewhere) Special Spirit Lifters Hospital Visitation A guide to what you can offer Visiting Someone in the Hospital Tips and ideas for visiting someone Major World Religions and Common Health Beliefs How to address individuals of other religious within the healthcare setting

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References Assessment Technology Institute. (2010). RN community health nursing (Edition 5.0). Philadelphia: Author. Catalano, J. T. (2006). Nursing now!: Todays issues, tomorrows trends (5 th edition). Philadelphia: F.A. Davis Company. Clark, M. J. (2008). Community health nursing: Advocacy for population health (5 th edition). Upper Saddle River, New Jersey: Pearson Prentice Hall. Cole Jr., A. J. (2008). Visiting someone in the hospital. The Presbyterian Leader, p. 1-4. Cole Jr., A. J. (2009). Hospital visitation. The Presbyterian Leader, p. 1-2. Craven, R. F. & Hirnle, C. J. (2009). Fundamentals of nursing: Human health and function (6 th edition). Philadelphia: Lippincott Williams & Wilkins. Ehman, J. W., Ott, B. B., Short, T. H., Ciampa, R. C. & Hansen-Flaschen, J. (1999, Aug. 9/23). Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med, 159, 1803-1806. Mulder, K. & Jurries, G. (2002). 109+ways to say, I care. The Compassionate Congregation, p. 1-11. Purnell, L.D. & Paulanka, B. J. (2008). Transcultural health care: A culturally competent approach (3 rd edition). Philadelphia: F. A. Davis Company. Weber, J. & Kelley, J. H. (2007). Health assessment in nursing (3 rd edition). Philadelphia: Lippincott Williams & Wilkins.