Spirituality + Emotional Well-Being in General Medicine Setting

what is SPIRITUALITY refer to

- an ultimate/immaterial reality

- person's association with a transcending entity/dimension

- deepest values + meanings by which people live (PURPOSE OF LIFE)

what is SPIRITUALITY characterized by

great diversity

what is RELIGION

collection of cultural systems, belief systems + worldviews that establishes symbols that related humanity to spirituality + sometimes to moral values

what does RELIGION emphasize

community development + institutionalization of shared beliefs + practices

does RELIGION overlap/is it identical to SPIRITUALITY

overlaps spirituality

what 3 aspects does RELIGION give meaning to

1. illness

2. pain

3. suffering

what 3 situations are RELIGIOUS BELIEFS most often apparent

when patient is:

1. seriously injured

2. critically ill

3. dying

what is the influence of RELIGIOUS BELIEFS that are far removed from mainstream religious traditions

may challenge health caregivers' understanding, tolerance + willingness to make accommodations

what are 5 RELIGIOUS RECOMMENDATION for HEALTHCARE PROFESSIONALS

1. health professionals should take a brief 2 minute spiritual history on first evaluation

2. if spiritual needs present = chaplain referral

- health professional follow up to ensure patient's R/S needs are being met

3. respect religious + spirituality beliefs that are uncovered during screen

4. keep any religious + spirituality interaction patient centered + desired

5. beliefs (or lack thereof) of health professional should not influence whether patient's religious + spirituality is addressed

what are HEALTH PROFESSIONAL RECOMMENDED to carry out on their first evaluation

a brief 2 minute spiritual history

what is the requirement if SPIRITUAL NEEDS are PRESENT

chaplain referral

what does GOOD MEDICAL PRACTICE mandate

intentional practice of spiritual care

what 2 mean sensitivity values from a 2005 study (Florin) where the LOWEST in the RN assessment

1. nutrition

2. emotions/spirituality

T/F: there are more unmet needs in the physical realm that the psychosocial realm

false

what RELIGION is most prominent in AMERICA

Christianity

what DENOMINATION is most prominent in CHRISTIANITY

protestant

what DENOMINATION is the second most prominent in CHRISTIANITY

catholic

what PERCENTAGE of AMERICAN RELIGIOSITY is considered UNAFFILITATED

16%

what does the JCAHO require

spirital assessment

regarding JCAHO, at minimum what does a SPIRITUAL ASSESSMENT refer to

hospital must determine the patient's denomination, beliefs + what spiritual practices are important to the patient

regarding JCAHO, what would the information from the SPIRITUAL ASSESSMENT assist in

determining the impact of spirituality, if any, on the care/service being provided

- will identify if any further assessment is needed

what is COMPETENCE

implies having the capacity to function effectively as an individual + an organization within the context of cultural beliefs, behaviors + need presented by consumers + their communities

what are the 5 GUIDELINES for RESPECTFUL CARE

1. understand the patient's spiritual needs, resources + preferences

2. follow expressed wishes of patient

3. don't prescribe new spiritual practices/religious beliefs/prescribe the patient's existing practices or beliefs

4. understand one's own spirituality

5. proceed with integrity

what are 3 DIFFERENT PARADIGMS

1. western

2. muslim

3. tribal (Africa)

what are 2 aspects of the CHRISTIAN FAITH

1. values life + belief in eternal life

2. states that while a struggle for health can be meaningful, a struggle against death at all costs doesn't always make sense

what does the CHRISTIAN FAITH value

life + belief in eternal life

what does the CHRISTIAN FATH state

while a struggle for health can be meaningful, a struggle against death at all costs doesn't always make sense

what does the JEWISH FAITH stress

sanctity of life

in the JEWISH FAITH what does SAVING LIFE OVERRIDE

nearly all religious obligations

in the JEWISH FAITH what occurs at DEATH

soul returns to heaven + body returns to dust of earth

what are 3 GUIDELINE of ORTHODOX JEWS

1. patient not touched by care provider of opposite gender

2. all body parts buried together

3. unnecessary procedures (not those required to preserve life) may be avoided during Sabbath/other holy days

are ORTHODOX JEWS allowed/not allowed to be touched by care provide of the opposite gender

NOT ALLOWED to be touched by opposite gender healthcare providers

with ORTHODOX JEWS, when are unnecessary procedures avoided

during Sabbath/other holy days

what does the MUSLIM FAITH believe in

a judgement day + life after death

what does the MUSLI FAITH encourage

submission to will of God

what do MUSLIMS refer to their GOD as

Allah

what type of WORLDVIEW is common in the MUSLIM FAITH

fatalistic worldview

what does the FATALISTIC WORLDVIEW attribute to regarding the muslim faith

incidence + outcome of a health condition to "inshallah (God willing)"

what do some CUSTOMS PROHIBIT in the MUSLIM FAITH

handshakes/any contact between genders

regarding the MUSLIM FAITH, what must occur in the presence of FAMILY BEFORE DEATH

confession of sins + begging for forgiveness

regarding the MUSLIM FAITH, what should be RECITED as death approaches

islamic creed

what is RAMADAN

month of fasting from dawn to dusk

what does the HINDU FAITH believe in

cyclic birth + reincarnation

regarding HINDU FAITH, what is determine by BEHAVIOR IN LAST LIFE

status, condition + caste of each life

what ANIMAL is considered SACRED in the HINDU FATIH

cow

because the COW is sacred in hindu faith, what are HINDUS not allowed to eat

beef

are HINDUS strictly vegetarians/strictly vegans

strictly vegetarians

what should be LIMITED in the HINDU FAITH

direct eye contact + physical touching

what is the priest's role at death regarding the HINDU FAITH

tie a thread around neck/wrist + should NOT be removed

what does TYING a THREAD AROUND NECK/WRIST signify regarding the hindu faith

a blessing

what does BUDHI mean

to awaken

who is referred to as the BUDDHA in the buddhist faith

Siddhartha gotama

what did SIDDHARTHA GOTAMA realized about the buddhist faith

wealth + luxury do NOT guarantee happiness

what is the PRINCIPLE of BUDDHISM

dhamma (dharma)

what does DHAMMA (Dharma) mean

truth

what should be there a balance between in BUDDHIST FAITH

self-indulgence + self-mortification

what are the 5 aspects of the BUDDHIST PATH

1. lead moral life

2. be mindful + aware of thoughts + actions

3. develop wisdom + understanding

4. staying calm + collected in all circumstances

5. very tolerant + not concerned with labels

what does the BUDDHIST PATH lead to

Nirvana (enlightenment)

what is NIRVANA

is the elimination of suffering

regarding BUDDHIST FAITH, what is the result if ELIMINATE ALL DESIRE occurs

can eliminate suffering

in practice, what type of APPROACH do many Buddhists in the Far East take on

a more practical animistic approach (try to increase luck)

what NUMBER is considered LUCKY in the BUDDHIST FAITH

nine

what is KARMA

deeds, good or bad, will be rewarded in kind

what does the BUDDHA teach

non-violence towards animals

what are ANXIETY + DEPRESSIVE DISORDERS an independent risk factor for

development + recovery from coronary heart disease

what is DYSTHYMIC DISORDER

less severe depression lasting for longer periods of time

what is the 10 Day Depression Recovery Program

Dr. Nedley (internal medicine physician) emphasizes treating the cause not just the symptoms

what is classified as the most common MOOD DISORDER

major depression

what are 3 INCIDENCES of MAJOR DEPRESSION

1. affects 1 out of 3 internal medicine patients

2. overall risk increases over time

3. affect 19 million Americans

by what age do MAJOR DEPRESSION EPISODES often occur by

age 25

in youth, what GENDER is MAJOR DEPRESSION more common among

women (2-3 time more)

increased depression is linked to INCREASED/DECREASED patient exercise adherence

DECREASED patient exercise adherence

what PERCENTAGE of youth have attempted suicide by age 15

14%

what is currently the 2nd most common cause of death among COLLEGE STUDENTS

suicide

what PSYCHIATRIC DIAGNOSIS is most commonly associated with SUICIDE

depression

what PERCENTAGE of suicides is depression found in

at least 50% of suicides

___to___ of people diagnosed with depression in their lifetime will go on to complete suicide

2%-9%

how many symptoms of major depressive disorders confirm the condition

5 or more specific symptoms for at least two weeks

what are 9 MAJOR DEPRESSION SYMPTOMS

1. deep sadness/emptiness

2. apathy

3. agitation/restlessness

4. sleep disturbance

5. weight/appetite disturbance

6. lack of concentration

7. feelings of excessive guilt/worthlessness

8. morbid thoughts

9. fatigue

what are 2 common drug classes for DEPRESSION

1. SSRIs

2. dopamine reuptake blockers

what are 5 SSRIs that are used to treat DEPRESSION

1. zoloft

2. prozac

3. celexa

4. lexapro

5. paxil

what are 2 DOPAMINE REUPTAKE BLOCKERS that are used to treat DEPRESSION

1. wellbutrin

2. forfivo

what is the NEWEST ANTI-DEPRESSIVE DRUG CLASS that was FDA approved on march 5th, 2019

NMDA receptor antagonist

what is an example of an NMDA receptor antagonist

esketamine (Spravato)

what is TREATMENT-RESISTANT DEPRESSION

major depressive disorder (MMD) that is resistant to at least 2 different antidepressants of adequate dose + duration in current depressive episode

what are 7 GENERAL LIFESTYLE TREATMENTS for DEPRESSION

1. regular physical exercise

2. deep breathing exercises

3. bright light therapy

4. regular restful sleep

5. avoid negative thinking

6. classical music therapy

7. daily spiritual exercises

what are 7 DIETARY FACTORS that NEGATIVELY affect MENTAL HEALTH

1. serotonin deficiency

2. omega-3 fats deficiency

3. folic acid deficiency

4. vitamin B12 deficiency

5. homocysteine elevated levels

6. high animal protein intake

7. early puberty

what are 4 NUTRITION DEFICIENCIES that NEGATIVELY affect MENTAL HEALTH

1. serotonin

2. omega-3 fats

3. folic acid

4. vitamin B12

what should be consumed to INCREASE SEROTONIN

foods high in TRYPOTOPHAN

what are 6 FOOD PRODUCTS are high in TRYPOTOPHAN*

1. tofu

2. almonds

3. black walnuts

4. seeds (chia, flax + sesame)

5. chicken

6. turkey

what are 5 FOOD PRODUCTS are high in OMEGA-3 FATTY ACIDS

1. flaxseed/linseed oil

2. walnuts

3. green soybeans

4. fish

5. chia seeds

what can be a direct cause of depression

folic acid deficiency

what 5 FOOD PRODUCTS is FOLIC ACID found in

1. chickpeas

2. lentils

3. red kidney beans

4. spinach

5. asparagus

what do ALL DEPRESSED PATIENTS have regarding the prefrontal cortex

decreased blood flow + activity in prefrontal cortex

what are 6 FUNCTIONS of the PREFRONTAL CORTEX

1. control center of brain

2. behavior planning

3. decision-making

4. emotional control

5. self-awareness

6. self-independence

what is considered the "CROWN OF THE BRAIN"

frontal lobe

what are 4 other FRONTAL LOBE DISEASES

1. mania

2. obsessive compulsive disorder

3. appetite increase

4. ADHD

what is the frontal lobe size relative to the whole brain in HUMANS

33%

NOT EXERCISING/CONTROLLING BLOOD SUGAR results in

diabetic dying with end-stage heart + kidney disease

what does NOT STOPPING SMOKING result in

smokers dying with cancer/heart disease