Meeting Human Responses in the Spiritual Domain Assignment # 2

Meeting Human Responses in the Spiritual Domain Assignment #2 1

Meeting Human Responses in the Spiritual Domain Assignment # 2

By

Tatsiana Navitskaya

NUR 4050

SEC 2735

Prof. Lynda M. Konecny

05/02/2012

1. Define the following terms:

Spirituality (5 points)

The word spiritual derives from the Latin word spiritus, which means “to blow” or “to breath”, and has come to connote that which gives life or essence to being human. Spirituality refers to that part of being human that seeks meaningfulness through intra-, inter-, and transpersonal connection. Spirituality generally involves a belief in a relationship with some higher power, creative force, divine being, or infinite source of energy (Berman, Snyder, Kozier, & Erb, 2008). According to Martsoff and Mickley (1998), spirituality includes the following aspects:

• Meaning (having purpose, making sense of life)
• Value (having cherished beliefs and standards)
• Transcendence (appreciating a dimension that is beyond the self)
• Connecting ( relating to others, nature, Ultimate Other)
• Becoming (which involves reflection, allowing life to unfold, and knowing who one is)

Understanding spirituality is far more intangible than learning about the pathophysiology or illness and disease. Spirituality is abstract, it cannot be measured, and is often associated with religion, and area considered off limits for scientific medicine.Spirituality is an intrinsic part of holism and overlooking a person’s spiritual needs hinders a comprehensive understanding of the whole person (Zerwekh, 2006).

Covier (2000) distinguishes five R’s of spirituality:

• (1) Reason and (2) Reflection

Search for meaning and purpose in one’s life. Finding the will and reason to live. Reflection and meditation on one’s existence (may be enhanced through music, or literature.

• (3) Religion

Means of expressing spirituality through a framework of values and beliefs, often actively pursued in rituals, religious practices, and reading of sacred texts. Religion might be institutionalized or informal.

• (4) Relationships

Longing to relate to oneself, others, and a deity / higher being (may be expressed via service, love, relationships, trust, hope, and / or creativity). Appreciation of the natural environment

• (5) Restoration

Ability of the spiritual dimension to influence health and well-being positively.

Spirituality is a primary concern for dying patients and their families and an essential component of end-of-life care.The definition of spirituality proposed by the White House Conference on Aging in 1971 endorsed this view: the term spiritual pertains to one’s inner resources, especially one’s ultimate concerns; the basic values around which all values are focused; the central philosophy of life - religious, non-religious or anti-religious - which guides conduct, and the non-material and / or supernatural dimensions of human nature (Moberg, 1984).

Spiritual care (5 points)

Spiritual care is the care including the capacity of the health professional to enter the world of others, to respond to fears, concerns, and feelings with compassion and bear witness to the physical, emotional, social and spiritual dimensions of their suffering (Matzo & Sherman, 2010).

Spiritual care should not be provided by the nurse or any other member of the caregiving team in isolation. It is always enhanced by a strong spiritual counselor or chaplain. Spiritual counselors are essential members of hospice teams are often included in palliative care team. The chaplain is a healthcare professional who has been trained to offer spiritual care to all people of any or no religious tradition and whose primary focus is spiritual needs of patients, families, and staff. Chaplains are alert to the expressed needs of the patient. As counselors, they take time to listen, discern the significance of the words spoken, intuit what is the importance of what is unspoken, and affirm the value of silence (Matzo & Sherman, 2010). An effective spiritual counselor will sit with the dying person to help them discover their own spiritual end-of-life journey (Zerwekh, 2006).

Patients and their families experience spiritual support when interdisciplinary team members actively listen to their anxiety and allow discussion of the question, “Are we doing the right thing here?” Health professionals can also provide support by silent witnessing, as well as serving as a liaison with other health professionals in addressing physical, emotional, and spiritual needs. Humor also has an effect on the spiritual aspect of healing, as many patients and family members find humor “spiritually uplifting”. Spiritual uplifting in the present moment can also occur as a practitioner attempts to create meaning and a source of pleasure in the present moment (Matzo & Sherman, 2010).

1. How does the definition of spirituality influence attitudes about providing spiritual care? (5 points)

Spirituality is a primary concern for dying patients and their families and an essential component of end-of-life care. Even as the physical body decline, healing, which means to make whole, can occur as spiritual needs are identified and spiritual care is given to restore a person to wholeness. Healing can be accomplished through the spiritual journey of remembering, assessing, searching for meaning, forgiving, reconciling, loving, and maintaining hope (Puchalski, 1998).

All clients have needs that reflect their spirituality. These needs are often accentuated by an illness. People do want their spiritual needs addressed at the end of life and feel that health professionals should speak to patients about their spiritual concerns. Furthermore, elder individuals who are dying express the need for companionship and spiritual support, particularly human contact, and to have the opportunity to pray alone or with others (Matzo & Sherman, 2010).

It is through spirituality that people find meaning in illness and suffering and are liberated from their despair. Spiritual care changes chaos to order, and seeks to discern what if any blessings might be revealed in spite of and even through tragedy (Purdy, 2002). As people are dying, they want to be listened to, to have someone share their fears, to be forgiven by God or by others, and believe that they will live on it in the hearts of others or through their good work (Puchalski, 2002).

Health care organizations, the Joint Commission on the Accreditation of Healthcare Organizations, the American Association of Colleges of Nursing, and the Association of American Medical Colleges have recognized the importance of addressing spiritual needs in health care. The importance of spiritual care was emphasized in a position statement published by the Hospice and Palliative Care Nurses Association (2007). The statement emphasized the commitment of Hospice and palliative care nursing to compassionate care at the end of life, acknowledging the importance of spiritual care, encouraging support of The National Consensus Project Guidelines for Quality Palliative Care on spirituality, encouraging organizational support in the provision of spiritual care, commitment to education and resources to promote spiritual care, and recognition of the right of individuals to decline spiritual care (Matzo & Sherman, 2010).

1. How do culture and/or religion affect spirituality? (5 points)

Spiritual care may be different for each individual dependent on his/ her religious or cultural background. Through sensitive and competent cultural and spiritual care, nurses can protect patients and families from the ultimate tragedy of depersonalization. Spirituality and religiosity are often fundamental to the way patients face life-threatening diseases, dying, and death. Spirituality and religiosity are integral to holistic care and are important considerations. Particularly since spirituality may be a dynamic in the patient’s understanding of his disease and way of coping, and religious convictions may also affect healthcare decision making (Puchalski, 2001). According to Matzo and Sherman (2010), although spirituality and religion are often used interchangeably in common conversation, spirituality is a broader concept than religiosity. Spirituality refers to the energy in the deepest core of the individual. It is encompasses a person’s search for meaning, relationships with a higher power, with nature, and with other people.According to Zerwekh (2006), religious systems and needs are not universal and are different for each person. Spiritual needs are essentially the same for everyone. The way individuals meet these needs are different and may change over the course of a person’s life, but the core spiritual needs are universal.

The concepts of spirituality and religion influence the health and lives of the patients and nurses must be knowledgeable about them. According to Zerwekh (2006), nurses often view spirituality and spiritual care in religious terms and as the responsibility of chaplains or other religious leaders. They worry about the ethics of health professionals entering into discussions that may be construed as religious in nature, or the implied risk of imposing their own beliefs on patients. Conflicts may occur when nurses are faced with caring for a patient whose beliefs differ from their own. Many nurses struggle with these issues and this has been identified as one of the reasons they may be hesitant or uncomfortable with spiritual care.

Cultural and spiritual assessments have to be done for patients. It is essential to complete individualized assessmentof the cultural influences on the life of patients. Cultural assessment will guide individualized care planning. Standardized interventions may not be helpful and could contradict deeply held cultural ideologies. Cultural misunderstanding is a major barrier to providing emotional, spiritual, and physical comfort at the end-of-life.

Nurses have to be aware of the diverse spiritual and cultural beliefs and practices that their clients may possess. Because spiritual and cultural beliefs and practices are coping resources for persons, understanding how such beliefs and practices help or hinder a client’s health is vital. A client’s experience with what is seen as sacred or divine is complex and individual. Thus, each client needs to be approached in light of these unique needs (Berman et al., 2008).

1. What expectations do you have in caring for dying patients or bereaved family members? Incorporate information you have acquired from the lecture, textbook readings and independent research on this topic. (10 points)

In caring for dying patients or bereaved family, it is expected that the suffering in the form of physical, emotional, social and spiritual distress, often becomes an experience not only of the patient, but also the family caregivers, as the suffering of one magnifies the distress of the other (Foley, 1995).As the patient’s illness progresses, the needs of the family also increase and change. Both patient and family potentially experience a significant compromise in the quality of their lives (Sherman, 1998).

Family caregivers may feel powerless in the face of a loved one’s pain and suffering. They can become frightened, confused by the dramatic physical and emotional changes they perceive in their loved one as the disease progresses (Loscalzo & Zabora, 1998). Family caregivers may express symptoms of depression, anxiety, psychosomatic symptoms, restrictions of roles and activities, strain in relationships, and poor physical health (Higginson, 1998).

There are also conflicting emotions and adjustment tasks, including conflict among feelings of loss, sadness, guilt, difficulty in knowing how to talk with the dying person, and worry about dying and death (Beeney, Butow, & Dunn, 1997).The family caregiver must adapt to changes in family roles and responsibilities, while attempting to meet the increased emotional needs of other family members and performing standard family functions (Doyle, 1994).

Once a patient has been identified as terminal, they begin to live in a world set apart from mainstream society (Zerwekh, 2006).The patient’s illness sets them apart from healthy and ill individuals alike.

One of the reasons that caring for the dying is so difficult is that dying patients often experience dying gradually, through a series of losses. Each dying patient feels each loss acutely and nurses should be sensitive to the unique experience of each individual. As death draws near, symptoms become more apparent and bodily systems begin to fail.The daily tasks of life are more difficult and greater expenditures of energy are needed to perform them. The patient and family witness bodily disintegration.

Activities of daily living (ADLs) will require personal assistance and supportive devices, such as walkers, bedside commodes, wheelchairs, and hospital beds. The patient may no longer be capable of bathing, dressing, or eating independently. Some patients are uncomfortable with their increasing dependence upon others and issues of privacy may cause personal discomfort for the patient and caregivers alike. Cultural and prior family dynamics concerning matters of personal hygiene and privacy are especially relevant.

Feeling inadequate and uncomfortable with their own feelings, friends and relatives often distance themselves. The anticipated death may trigger personal fears concerning their own eventual death. With an extended course of terminal illness, loss of friends and loved ones can be quite pronounced to the point of social death, which involves no longer being acknowledged or seen in the eyes of others (Kastenbaum, 1995).

The dying person, family, and friends grieve continually over their losses and it is important that nurses recognize this and are supportive. Nurses shouldbe aware and address the consequences in case ofpatients’

• Loss of intimacy
• Loss of roles
• Loss of independence
• Loss of future

In addition to sustained grief reactions, the extraordinary losses lead to a variety of other emotional reactions. Profound emotional suffering is caused by a threat to the wholeness and continued existence of the self (Cassell, 1991).The sufferer becomes aware of the disintegration of identity and purpose. Suffering of seriously ill people begins with their inability to achieve previously important purposes. The person recognizes what they cannot do and is conscious of a lost sense of possibility in the future.It is important that the nurse recognize that emotional suffering cannot be adequately addressed until the physical suffering is relieved.

Anger is a natural manifestation of the grief process. Nurses should help the patient name the underlying causes of anger and identify changes that can be made to alleviate the problem. More constructive ways to express feelings and solve problems should be explored by patients. Nurses should advocate for the person when misunderstanding or injustice can be righted and guide the person to recognize negative consequences of angry behavior (Kemp, 1999).

Sadness is a normal human response at the end-of-life. However, profound sadness can progress to the point of clinical depression. Nurses should recognize depressive disorders when patients demonstrate significant signs and symptoms:

• Disinterest in activities and loved ones
• Inability to experience pleasure
• Expression of worthlessness
• Persistent guilt and hopelessness
• Poor concentration
• Indecisiveness
• thoughts on death and dying
• Suicidal thinking(Abraham, 2006)

Suicidal ideation, or thoughts of suicide, may be due to mental illness or to feelings of profound despair. Physical pain, real or anticipated, may lead to thoughts of suicide. Nurses should expect to observe the manifestations of anxiety and depression and should address them to improve the quality of life of patients and their family members.

1. Identify three of the most difficult aspects of end-of-life care. (15 points)

Ethical issues are very difficult and controversial aspects of end-of-life care.Contemporary health-care ethics focuses primarily on what is good for the person, and sometimes, on what is good for society. The person lives in context with the family. Purely an individualistic focus ignores the consequences of decisions made and gives little regard to family well-being. In fact, the family and loved ones are intensely involved when a family member is dying. Nurses, out of respect for patient autonomy need to ask the patient to define what role they want the family to have in decision-making.The needs of the family must be balanced with the needs of the suffering family members. It is most important that conflicts between patient and family needs be identified and carefully considered, sometimes by the interdisciplinary team and sometimes through ethical consultation.

Examples of conflict of needs:

• A family’s desire that the patient remain alert as long as possible leads to failure to give sedating medication to relieve suffering
• A family over-sedates the patient avoid demands in care
• A family desires to reduce its burden and accelerate dying by refusing all life-prolonging therapies for a family memberA family insists on a treatment that it believes will be helpful, although such treatment is known to be burdensome for the patient
• Families are divided with some members wanting aggressive care to continue and others choosing palliation

Ethical decisions should consider the limits of family obligation and how community resources can be mobilized to relieve caregiving burden. At the end-of-life, it is especially important that the family and other loved ones be considered in all ethical decision-making.

Three types of ethical challenges commonly faced by nurses caring for patients at the end-o-life are

• Respecting autonomy
• Fostering social justice
• Avoiding killing while relieving suffering

There are many challenges to the ideal of autonomy at the end-of-life, which pose ethical dilemmas for health professionals. Challenges include

• Uncertain and denied truth
• Informed consent
• Decisional capacity
• Noncompliance
• Advance planning
• Surrogate decision-making

In the United States, socially marginalized people continue to be disenfranchised from the health-care mainstream and to die young, posing ethical burdens of health professionals. Commitment to social justice is a commitment to treat all people equally and to work toward ensuring that all people have access to food, water, shelter, and health care. Millions of impoverished people throughout the world are brought closer to death for lack of food, clean water, clean air, and health care. They are denied the very means to sustain life. It is important for nurses to maintain a broad perspective whenever they can to influence social and health policy in their agencies, communities, or country.