Spiritual Care in Nursing: Assessment and Implementation

The current trend in nursing care is a holistic approach: connection of mind, body, and spirit. A person’s interpretation of meaning and beliefs can be a great instrument in the healing process (Potter, 2004). Nurses may have some difficulty in evaluating spiritual needs and implementing spiritual care to their patients. However, their involvement is essential in promoting spiritual health among patients, and spiritual training should be incorporated in nursing education. To address the lack of adequate spiritual nursing care, it is important to establish a straightforward definition of “spirituality”, teach nurses how to address the subject of spirituality, and to introduce approaches of assessing spiritual distress in patients.
In a survey performed in 2002, 50% of Americans indentified themselves as religious, whereas another 33% considered themselves as spiritual, but not religious (Arnold, Herrick, Pankratz, & Mueller, 2007). “Meeting patients’ spiritual needs” is a medical professional duty as defined by the Joint Commission on Accreditation of Healthcare Organizations (Bensing, 2000). In fact, the North American Nursing Diagnoses Association lists “spiritual distress” as a nursing diagnosis. Spiritual well-being is proven to be helpful in dealing with stressful events in life. Previous studies demonstrated the positive outcomes of nursing spiritual care, but they were generally focused on certain nursing specialties such as oncology, hospice nursing, mental health, and parish nursing (Grant, 2004). According to the research, 77 percent of the patients prefer to talk about their spiritual concerns as part of their care (Brown, 2007). All these studies support the importance of addressing spirituality in nursing care.
The difficulty nurses face in implementing spiritual care with patients starts with their incorrect interpretation of the concept of spirituality. Results of the research by Grant (2004) suggest that most nurses believe in the usefulness of spiritual care. They feel that spirituality can “produce a variety of emotional and physical benefits, ranging from inner peace to bodily healing” (Grant, 2004, p.40). However, many nurses associate spirituality with religion. Bensing notes that common words heard from nurses are, “I’m not a religious person and I don’t know anything about the patient’s religion” (2000, p.1). Theses non-religious nurses are not comfortable talking about patients’ spiritual needs. That is why it is essential to have a clear-cut and easy definition of “spirituality” that makes sense to both nurses and patients. Spirituality is defined as an experience that a person has had that gives purpose and meaning to life and death; it may or may not include relationships with God, or other divine power (Power, 2006). Once the clarity is established, the next step is teaching nurses how to address their patient’s spirituality.
Most nursing schools incorporate the subject of spirituality in the program of study. However, for some it is still a challenge. There are several strategies used when encouraging spirituality awareness in novice nurses. One of the main approaches is to promote understanding of one’s own spirituality. This understanding can help nurses in providing adequate spiritual care to the patients. Research shows that the majority of patients regard a God as a healer (Pesut, 2003). Not talking about God and spirituality in nursing education is to eliminate the beliefs of a significant part of the population the nursing student would be caring for. Discussions of the topic might be sensitive in the classroom setting, but instructors need to promote open dialogue and encourage all students to reflect critically. Beginning nurses need to recognize differences in people and acknowledge the distinctive traits each person possess (Pesut, 2003). Once the knowledge foundation is laid, the next step is implementing it in practice.
The third strategy in eliminating lack of spiritual care among nurses is to establish a spiritual assessment tool that would help nurses evaluate a patient’s spiritual needs. Spirituality is diverse and personal. There is no one assessment tool that works on every patient. Power (2006) suggests several spiritual assessment methods such as direct questioning, the indicator-based tool, Likert scale, informal assessments, and the Spiritual Index tool. Direct questioning works well in rehabilitation, continuing care and long-stay settings where patients and staff have a chance to develop therapeutic relationships. It could be intrusive and is not appropriate as a first admission tool, or in acute and critical care. Using the indicator-based tools the nurse indentifies verbal and non-verbal cues that show spiritual distress, but there is a chance of misinterpreting the information, which could lead to an incorrect spiritual diagnosis and unsuitable care plan. The Likert scale and Spiritual Index assessments include asking patients to what extent they agree or disagree with certain statements. Some hospitals use a chaplaincy team to perform spiritual assessments. They encourage people to talk about themselves, their lives, illness, and worries. Due to the diversity of patients, nurses need to be able to ask adequate questions during spiritual assessment and to not discriminate between different belief systems (Power, 2006).
The nurse’s role in providing holistic care should include a spiritual assessment. As research shows nurses have difficulty in addressing spirituality of their patients. Identifying the problems that lead to nursing inadequacy in spiritual care helps to eliminate the problem. Educating nurses about the meaning of spirituality, implementing spiritual knowledge and understanding in nursing practice, and establishing proper spiritual assessment tools are some of strategies that lead to satisfactory spiritual care of patients. Putting in practice these strategies helps nurses to become more competent in attending spiritual needs of the patients.
References
Arnold, S., Herrick, L., Pankratz, S., Mueller, P. (2007). Spiritual well-being, emotional distress, and perception of health after a myocardial infarction. Internet Journal of Advanced Nursing Practice, 9(1), 4-11. Retrieved January 15, 2008 from Academic Search Premier database.
Bensing, K. (2000, March 27). Spirituality in Nursing: Part 1- enhancing the journey. Retrieved January 16, 2008 from nursing.advanceweb.com/Editorial/Content/Editorial.aspx?CC=9046
Brown, M. (2007, December 5). Spiritual advocacy. Nursing Standard, 22(13), 24-25. Retrieved January 15, 2008 from Academic Search Premier database.
Grant, D. (2004, Jan/Feb). Spiritual interventions: How, when, and why nurses use them. Holistic Nursing Practice, 18(1), 36-42. Retrieved January 16, 2008 from Academic Search Premier database.
Pesut, B. (2003, Nov-Dec). Developing spirituality in the curriculum: worldviews, intrapersonal connectedness, interpersonal connectedness. HYPERL I NK "http://find.galegroup.com/itx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T002&prodId=EAIM&docId=A111695097&source=gale&userGroupName=tacoma_comm&version=1.0"Nursing Education Perspectives, 24(6), 290-295. Retrieved January 16, 2008 from Academic Search Premier database.
Potter P., Perry, A., (2004). Fundamentals of Nursing. St. Louis: Elsevier Mosby.
Power, J. (2006). Spiritual assessment: developing an assessment tool. Nursing Older People, 18(2), 16-19. Retrieved January 16, 2008 from Academic Search Premier database.


Intervention 1. It is essential to have a clear-cut and easy definition of “spirituality” that makes sense to both nurses and patients.
• Disadvantage 1. Diverse perception of spirituality.
Unfortunately, there is no precise terminology in defining the idea of spirituality. There is a variety of opinions and views on what spirituality is based on people’s faith, cultures, and experiences. As a result, there are a lot of misunderstandings of what adequate nursing spiritual care comprises of. A number of nurses associate spirituality with religion, some see spirituality totally separate from religion, and some have hard time relating to the idea of spirituality. “The concept of spirituality (as used in health care) may not be universally recognized, emphasizing the need for caution when trying to apply directly the concept to diverse groups” (McSherry, Cash, Ross, 2004, p.939)
• Disadvantage 2. Spirituality is not the same as religion.
Quite often terms “spirituality” and “religion” are used interchangeably. In reality, they are two distinct concepts. “Spirituality is characterized by an experience of the individual. Religion is characterized as formal, organized, associated with rituals and beliefs, and sometimes conflated with culture” (Pesut, 2008). Spirituality might include religious beliefs, but it can exist independently as well. Addressing spiritual needs of client doesn’t necessarily mean dealing with religious needs. Therefore, nurses shouldn’t disregard spiritual assessment and evaluation of spiritual needs of patients who claim to be nonreligious.
Intervention 2. One of the strategies in eliminating lack of spiritual care among nurses is to establish a spiritual assessment tool that would help nurses evaluate a patient’s spiritual needs.
• Disadvantage 1. Finding the right spiritual assessment tool for diverse patients.
There are several spiritual assessment tools used currently in the hospital settings. Some of the most well-known and widely used are Spiritual Well-Being Scale, which measures psychological dimensions of spiritual well-being, and the Religious Orientation Scale, which measures the degree of spiritual motivation within religious traditions. Unfortunately, no single assessment method would be appropriate for all situations. Patients have diverse needs and interests. An assessment method that works well with one client may be inappropriate with another (Hodge, 2005). Some methods are more appropriate for acute settings, and some for long-term care or palliative care situation. Furthermore, the nurses need to take in consideration the developmental stages of the patients when assessing the spiritual needs as they vary (Farneti, 2006).
• Disadvantage 2. Spiritual assessment could be seen as intrusive by the patients.
The purpose of a spiritual assessment is to encourage spiritual well-being. Many existing spiritual assessments are uncomfortable, irrelevant, and lengthy. Most spiritual assessments focus on detailed and specific information often related to religious preferences. Patients get irritated and tired when completing these assessments. Some patients might take offense to or be confused by reasons of such evaluations. That is why it is important to explain the reasons for these questions to the patients. It is recommended that spiritual assessment takes place after the nurse has established therapeutic relationship with patients to improve sharing (Mitchell, Bennett, Manfrin-Ledet, 2006).
References
Farneti, S., (2006, November 1). Spirituality and the NP role. Retrieved March 8, 2008 from http://nurse-practitioners.advanceweb.com/editorial/search/aviewer.aspx?cc=78917
Hodge, D. (2005, Nov). Developing a spiritual assessment toolbox: a discussion of the strengths and limitations of five different assessment methods. Health & Social Work, 30(4), 314-323. Retrieved May 11, 2008 from Academic Search Premier database.
McSherry, W., Cash, K., Ross, L. (2004, Nov). Meaning of spirituality: implications for nursing practice. Journal of Clinical Nursing, 13(8), 934-941. Retrieved May 11, 2008 from Academic Search Premier database.
Mitchell, D., Bennett, M., Manfrin-Ledet, L. (2006, Sept). Spiritual development of nursing students: developing competence to provide spiritual care to patients at the end of life.
Journal of Nursing Education, 45(9), 365-70. Retrieved May 11, 2008 from Academic Search Premier database.
Pesut, B. (2008, Apr). Spirituality and spiritual care in nursing fundamentals textbooks. Journal of Nursing Education, 47(4),167-173. Retrieved May 8, 2008 from Academic Search Premier database.