Fundamentals of Nursing Spiritual Health *BOO!* Spirituality 1.

Refers to that part of being human that seeks meaningfulness through intra, inter and transpersonal connection 2. Involves a belief in a relationship with some higher power, force, diving being or infinite source of energy 3. A concept unique to each individual, dependent upon a persons culture, development, life experiences, beliefs, and ideas about life Two important characteristics of Spirituality 1. It is a unifying theme in peoples lives 2. It is a state of being Spiritual Well-being / Spiritual Health 4. A sense of harmonious interconnectedness between self, others / nature and an ultimate other that exists throughout and beyond time and space Spiritual Care 5. Helps people maintain personal and relationships and relationship to a higher being or life force, to identify meaning and purpose in life and to hopefully look beyond the present Faith 6. 7. To believe in or be committed to something or someone It incorporates a reasoning faith (belief and confidence on something for which there is no proof) and a trusting faith (action)

Religion 8. Organized system or framework of beliefs and practices 9. Offers a way of spiritual expression that provides guidance for believers in responding to lifes questions and challenges 10. Influences how the person exercises a faith of belief and action Religious Care 11. Seen as helping clients maintain their faithfulness to their belief systems and worship practices Agnostic 12. A person who doubts the existence of God or supreme being Atheist 13. One without belief in a God Monotheism 14. Belief in only one God Polytheism 15. Belief in more than one God
Organized Religion Offer Sense of Collective study of Performance of community bound scriptures rituals by common belief Ways of taking Use of disciplines care of the and practices, persons spirits commandments (fasting, prayer and sacraments and medication)

Hope

16. A process of anticipation that involves the interaction of thinking, acting, feeling and relating, and is directed
toward a future fulfillment that is personally meaningful (Stephenson, 1991) Weh, sinama ko nuh

Transcendence 17. The capacity to reach out beyond oneself to extend oneself beyond personal concerns and to take on broader life perspectives, activities and purposes (Coward, 1990) 18. Recognition that there is something other or greater Life Stages Consideration 1. Neonates and Toddlers a. Acquiring fundamental qualities of trust, mutuality, courage, hope and love b. Transition to next stages of faith begins when childs language and thought begin to allow use of symbolism Pre-school a. Fantasy filled, imitative phase when child can be influenced by examples, moods, actions b. Make-believe is experienced as reality (Santa Clause, God as grandfather in the sky) c. Relates intuitively to ultimate conditions of existence School-age a. Attempts to sort fantasy from fact by demanding proofs or demonstrations of reality b. Ability to learn the beliefs and practices of the culture and religion c. Stories are important for finding meaning Adolescent a. Often reconsider than child-like concept of spiritual power and in the search for an identity, they may either question practices and values or find the spiritual power as the motivation to seek a clearer meaning to life Young Adult a. Development of self-identity, the world view differentiating from those of others b. Forms independent commitments, lifestyle, belief, and attitudes Middle Adult a. Newfound appreciation for the past b. Increased respect for inner voice c. More awareness of myths, prejudices and image, social background d. Older a. Often turn to important relationships and the giving of themselves to others as spiritual tasks b. Believe in and live with a sense of participation in a non-exclusive community c. May work to resolve social, pollution, economical / ideological problems in society d. Able to embrace life, yet hold it loosely NURSING PROCESS

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Assessment
19. The nurse should never assume that a client follows all the practices of the clients stated religion Nursing History 20. Assess spirituality and spiritual health 21. Assess the clients faith and beliefs 22. Review the clients view of life, self-respect and life satisfaction 23. Assess the clients fellowship and community 24. Review if the client practices religion and rituals FICA 1. F (Faith and or beliefs) What spiritual beliefs are most important to you? 2. I (Implications or Influence) How is your faith affecting the way you cope now? 3. C (Community) Is there a group of like-minded believers with which you regularly meet? 4. A (Address) How would you like your health care team to support?

JAREL Spiritual well-being Scale 25. Provide nurses and other health care professionals with a simple tool for assessing a clients spiritual well being 26. Developed for clients from Christian, non-Christian, and atheist belief system 27. 3 Key Dimensions 1. Faith/Belief 2. Life/Self-respect 3. Life-satisfaction/Self-actualization Belief Assessment Tool 28. Help nurses clarify values of assessing spirituality among pediatric clients as well as the child and familys spiritual and religious needs

B Belief System E Ethics/Values L Lifestyle I Involvement in a spiritual community E Education F Future Events
Spiritual Well-Being Scale (SWB) 29. Has 20 items that assess the individuals view of life and relationship with a higher power Spiritual Perspective Scale (SPS) 30. Is a 10-item tool that measures connectedness to a higher power, others, and self KEEP IN MIND 31. Initial spiritual assessment is best taken o At the end of the assessment process o Following the psychosocial assessment o After the nurse has developed a relationship with the client and or support person Clinical Assessment Factors (Taylor, 2002) 1. Environment 2. Behavior 3. Verbalization 4. Affect and Attitude 5. Interpersonal Relationship

Nursing Diagnosis
Anxiety Ineffective coping Fear Complicated grieving Hopelessness Powerlessness Readiness for enhanced spiritual well-being Spiritual distress Risk for spiritual distress Compromised family coping

Plan of Care
32. The client will be able to express an acceptance of his or her illness 33. The client reports the ability to rely on family members for support 34. The client initiates social interactions with family and friends

Implementation
Health Promotion 35. Establish presence (Presence) o Giving attention, answering questions, listening and having a positive and encouraging but realistic attitude o Being with a client, Doing for a client o Offering a closeness with the client, physically, psychologically and spiritually 4 Ways of Being Present for Client 1. Presence The nurse is physically present, but not focused on the client 2. Partial Presence The nurse is physically present and attending to some task on the clients behalf, but not relating to the client, but most superficial level 3. Full Presence The nurse is mentally, emotionally, physically present; intentionally focused on the client 4. Transcendent Presence The nurse is physically, mentally, emotionally and spiritually present for a client; involves a transpersonal and transforming experience Supporting a Healing Relationship 36. Looking beyond isolated clients problems and recognizing the broader picture of a clients needs 37. Holistic view of the client Acute Care Supporting Systems o Plan care with the client and the clients supporting network to promote interpersonal bonding that is needed for recording Family Encourage the family to bring meaningful religious symbols to the clients bedside Ask a clergy to visit during hospitalization Inform the clergy of any physical, psychological, spiritual affecting the client Provide privacy for the client, family, and clergy o Diet Therapy Consult with the dietitian to integrate the clients dietary preferences into daily care o Supporting Rituals Taped meditations, classical or religious music, and televised religious services provide options Make arrangements with pastoral care staff for the client and family to participate in religious practices Restorative and Continuing Care 1. Prayer a. Renew personal faith and belief in a higher being in a specific, focused way which can be formal or informal b. Suggest prayers, it is a known coping resource for the client c. Provide privacy if the client desires to pray privately 2. Meditation a. Creates a relaxation response that reduces daily stress b. Use guided imagery 3. Supporting Greif Work a. Clients who experience terminal illness or who have suffered permanent loss in body function because of a disabling disease or injury require the nurses support in grieving over and coping with their loss

Fundamentals of Nursing Death and Dying!! (PATAY NA ME) Loss Occurs when a valued object, person or situation is changed or made inaccessible so that its value is diminished or removed Painful, frightening and lonely. It triggers an array of emotional responses

Bereavement An individual response to the loss of a significant person Subjective state of having suffered the loss of a person or object with which a significant relationship existed Grief

Death

It develops from the bereavement and is a dynamic, psychologic, physiological and spiritual response Emotional response to loss Behavioral response in relation to loss, death and dying An ongoing process of adaptation It is the irreversible cessation of circulatory and respiratory function or the irreversible cessation of brain and brain stem Loss

Forms of Loss 1. Actual Loss a. Can be identified by others not just by the person experiencing it b. Occurs when a person can no longer feel, hear or know a person or object 2. Perceived Loss a. Internal; uniquely defined by the person experiencing the loss and are less obvious to other people 3. Anticipatory Loss a. Experienced before the loss actually occurs 4. Maturational or Developmental Loss a. Losses that occur in the process of normal development or all normally expected life changes across the life span 5. Situational Loss a. Sudden, unpredictable external events bring about situational loss Types of Loss

Loss of External Object a. Loss of inanimate objects that have importance to the person b. Loss of animate (live) objects *theft, deterioration, misplacement, destruction Loss of Known Environment a. Separation from an environment and people who provide security b. Example: Leaving home, hospitalization, new job Loss of Significant Other a. Example: Divorce, loss of friend, trusted care giver, pet, separation or illness Loss of Aspect of Self a. Changes a persons body image Loss of Life a. Example: Death of a family member Bereavement

Bowlbys Phases of Mourning 1. Numbing a. Shortest phase (few hours to a week or more) b. Feeling stunned or unreal c. Protects the person from the full impact of the loss

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Yearning and Searching a. Lasts for months or longer b. Emotional outburst of tearful sobbing, an acute distress c. An inner intense yearning for the lost person or object d. Common physical symptoms i. Tightness in the chest and throat ii. Insomnia iii. Loss of appetite iv. Lethargy Disorganization and Despair a. Endlessly examines how and why the loss occurred b. Retells the loss story again and again c. May express anger at anyone who seems responsible for the loss Reorganization a. Takes a year or more b. Begins to accept change, assume unfamiliar roles, acquire new skills, and build new relationships c. Begin to untie themselves from their lost relationship without feeling that they are lessening its importance

Wordens Four Task of Mourning (T_T) Task I: Accept the reality of the loss Even when death is expected, survivors register some disbelief and surprise that the event has really happened Involves the process of accepting that the person or object is gone and will not return Task II: Work through the pain of grief People react with sadness, loneliness, despair, or regret and will work though painful feelings using the coping mechanisms most familiar and comfortable to them Task III: Adjust to the environment in which the deceased is missing Impact of a loss for at least 3 months Finality of the loss becomes real Begin to take on roles formerly filled by the deceased Task IV: Emotionally relocate the deceased and move on with life The deceased person is not forgotten, but rather takes a different and less prominent place in the survivors emotional life Realizing that it is possible to love other people without betraying the deceased, the person moves forward Caring for the Bereaved 1. Have contact physically and emotionally with the person 2. Assess where the person is in the grieving process 3. Demonstrate genuine compassion and caring 4. Give permission to grieve and normalize the grieving process 5. Mention the loss or deceased persons name 6. Encourage the person to talk about the relationship he or she had with the deceased person 7. Understand the peoples need to talk about the events and feelings around the death and will repeat themselves 8. Tell the person to expect mood swings 9. Focus on clarifying and using coping skills 10. Allow the person to take a break from grieving and focus on self-care 11. Encourage sources of comfort, such as religion/nature 12. Identify secondary losses and unfinished business 13. Acknowledge that there will be eventual recovery 14. Discuss the anniversary phenomenon 15. Encourage medical / psychiatric care as needed Two Basic Goals 1. Healing the self 2. Recovering from the loss Four Major Tasks of the Grief Client 1. Acceptance of the loss

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Acknowledgment of the intensity of the pain Adapting to life after loss Creating new relationship and activities

Physical Response to Grief 1. Sensation of somatic distress 2. Tightness in the throat followed by choking sensation or shortness of breath 3. Needs to sigh 4. An empty feeling inside the abdomen Theories of Grief Kubler-Ross Stages of Dying a. Denial Stage i. A person acts as though nothing has happened ii. Refuses to accept the fact of the loss iii. Shows no understanding of what has occurred b. Anger Stage i. Person expresses resistance ii. Feels intense anger at God, other people, or the situation c. Bargaining Stage i. Cushions and postpones awareness of the loss by trying to prevent it from happening ii. Makes promises to self, God, or loved ones that they will live or believe differently if they can be spared the dreaded outcome d. Depression Stage i. Person realizes the full impact of the loss ii. Feel overwhelmingly sad, hopeless and lonely iii. Resigned to the bad outcome, they sometimes withdraw from relationships and life e. Acceptance Stage i. The person incorporates the loss into life and finds a way to move forward Stages of Grieving by George Engle 1. Shock and Disbelief a. Refuses to accept loss b. Has stunned feelings c. Accepts the situation intellectually but denies emotionally 2. Develop Awareness a. Reality of loss begins to penetrate 3. Restitution a. Conducts rituals of mourning 4. Resolving the loss a. Attempts to deal with painful void b. Still unable to accept now love object to replace lost person or object c. May accept more dependant relationship with support 5. Idealization a. Produces images of lost object that is almost devoid of undesirable features b. Reinvest feelings in others c. Repress 6. Outcome a. Behavior influenced by several factors b. Degree of dependence on relationship c. Degree of ambivalence toward lost object Factors Influencing Loss and Grief 1. Human Development (Age and Stage Development) a. Toddler i. Cannot understand loss or death, but often feel anxiety over the loss of objects and separation from parents ii. Changes in eating and sleeping patterns, fussiness, or bowel and bladder disturbances b. School-age i. Understand the concepts of permanence and irreversibility but do not always understand the cause of loss c. Young Adults

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i. Undergo many necessary, developmental losses related to their evolving futures Midlife Adults i. Experience major life transitions such as caring for aging parents, dealing with changes in marital status, and adapting to new family roles e. Older Adults i. Aging process leads to some necessary and developmental losses ii. May experience age discrimination iii. Show resilience after a loss as a result of their prior experiences Personal Relationship a. Quality and meaning of the lost relationship influences the grief response Nature of the Loss a. Exploring the meaning a loss has for a client helps the nurse better understand the impact of the loss on the clients behavior, health and well-being Psychosocial Perspectives of Loss and Grief a. Use of familiar coping strategies b. Life experience shape the coping strategies a person uses to deal with the stress of loss Socioeconomic Status a. Influences a persons ability to access support and resources for coping with loss and physical responses to stress Culture and Ethnicity a. Persons culture and other social structures influence the interpretations of loss, establish acceptable expressions of grief and provide stability and structure in the midst of chaos and loss Spiritual and Religious Beliefs a. A persons faith in a higher power or influence d.

Signs of Impending Death Inability to swallow Pitting edema Decreased gastrointestinal and urinary tract activity Bowel and bladder inconfidence Loss of motion, sensation and reflexes Elevated temperature, but cold/clammy skin, cyanosis Decreased blood pressure, noisy respiration Focus of End-of-Life (EOL) Care Physician For both the client and significant other i. Primary GOAL is to: 1. Provide comfort and supportive care 2. Improve quality of remaining life 3. Help ensure dignified death Physical Death Occurs when vital organs and systems cease to function *AFTER NUN WALA NA =)), MARAMI AKONG HINDI NAKOPYA SA LAST PART @_@...* Death and Dying and concept e MUKA na nga akong bangkay e! - LOLLLLLL