47Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 47 Spirituality

A hospice nurse is caring for a patient who is dying of pancreatic cancer. The patient tells the nurse, “I feel no connection to God” and “I’m worried that I’ve found no real meaning in life.” What is the nurse’s best response to this patient?

a Give the patient a hug and tell them that their life still has meaning.

b Arrange for a spiritual advisor to visit the patient.

c Ask if the patient would like to talk about their feelings.

d Call in a close friend or relative to talk to the patient.

c. When caring for a patient who is in spiritual distress, the nurse should listen to the patient first, then ask whether the patient would like to visit with a spiritual advisor. Arranging for a spiritual advisor first may not be respectful of the patient’s wishes. A hug and false reassurances do not address the problem of spiritual distress. Talking to friends or relatives may be helpful, but only if the patient agrees.

A nurse who was raised as a strict Roman Catholic but is no longer practicing stated they could not assist patients with spiritual distress because they recognize only a “field of power” in each person. The nurse says to her colleague, “My parents and I hardly talk because I’ve deserted my faith. Sometimes I feel really isolated from them and God—if there is a God.” These statements reveal which unmet spiritual need?

a Meaning and purpose

b Forgiveness

c Love and relatedness

d Strength for everyday living

c. The data point to an unmet spiritual need to experience love and belonging, given the nurse's estrangement from their family and God after leaving the church. The other options may represent other needs this nurse has, but the nurse's statements do not support them.

A nurse in a long-term care facility is performing spirituality assessments of residents on their unit. What is the best question the nurse could use to assess for spiritual needs?

a “Can you describe your usual spiritual practices and how you maintain them daily?”

b “Are your spiritual beliefs causing you any concern?”

c “How can I and the other nurses help you maintain your spiritual practices?”

d “How do your religious beliefs help you to feel at peace?”

c. Questioning how the staff can meet patients’ spiritual practices assesses spiritual needs. Asking the patient to describe spiritual practices is an assessment of spiritual practices. Asking about concerns assesses spiritual distress, and asking about feeling at peace assesses the need for forgiveness.

A patient who stated their religion as Jewish at the intake interview was served a kosher meal ordered from a restaurant on a paper plate because the hospital had no provision for kosher food or dishes. The patient became angry and accused the nurse of insulting him, emphatically stating, “I want to eat what everyone else does—and give me decent dishes.” After analyzing the data, the nurse returns to the patient and makes which of these statements?

a “I’m terribly sorry, I should have ordered kosher food and dishes as well.”

b “Did someone on the staff behave condescendingly or critically?”

c “It seems difficult to please you today.”

d “We did not ask about your dietary preferences; tell me what you usually eat.”

d. On the basis of the patient’s stated religion, the nurse assumed they would want a kosher diet. This is a form of stereotyping. When evaluating the outcome of the situation, the nurse returns to the first step of the nursing process and assesses the patient’s dietary practices and preferences.

A surgeon tells a patient who is a Jehovah’s Witness that they need emergency surgery to repair an aortic aneurysm, which will require blood transfusions. The patient states, “If I receive blood, I will not go to paradise. It is against my religion.” What nursing response to the patient is appropriate?

a “I understand you will not receive blood products, even if it means you will die.”

b “Please listen to the surgeon; I’ve seen many aneurysms successfully repaired”

c “Have you discussed your decision to refuse surgery with your family?”

d “What can I say to help you through this difficult decision?”

c. Patients who practice the Jehovah’s Witness faith believe blood transfusions violate God’s laws and do not allow them. The nurse supports the patient’s beliefs. It is disrespectful of the nurse to attempt to coerce a decision or impose their beliefs on the patient.

The Roman Catholic family of an infant born with hydrocephalus requests a baptism for their infant. The nurse advocates for the family’s wishes to be honored for which reason?

a Baptism frequently helps postpone or prevent death or suffering.

b It is legally required that the nurse provide for this care when requested.

c It is a nursing function to assure the salvation of the infant.

d Not facilitating the baptism may increase the family’s sorrow and suffering.

d. Failure to ensure that an infant baptism is performed when parents desire it may greatly increase the family’s sorrow and suffering. Whether baptism postpones or prevents death and suffering is a religious belief that is insufficient to bind all nurses. There is no legal requirement regarding baptism, and although some nurses may believe part of their role is to ensure the salvation of the infant, this function could be rejected by many.

A nurse is caring for patients in a long-term care facility. Which nursing actions are appropriate based on the religious beliefs of these patients? Select all that apply.

a Asking a Buddhist if they have any diet restrictions related to the observance of holy days

b Asking a Christian Scientist who is in traction if they would like to try nonpharmacologic pain measures

c Administering medications to a Muslim patient and avoiding touching the patient’s lips

d Asking a Roman Catholic patient if they would like to attend Mass in the common room on Sunday

e Avoiding scheduling treatment and procedures on Saturday for a Hindu patient

f Consulting with the medicine man of a Native American patient and incorporating their suggestions into the care plan

a, b, d, f.

The nurse should ask a Buddhist if they have any diet restrictions related to the observance of holy days. Since Christian Scientists avoid the use of pain medications, the nurse should offer nonpharmacologic pain relief measures. A nurse administering medications to a Hindu patient avoids touching the patient’s lips. A nurse should ask a Roman Catholic if they would like to attend Mass on Sunday. The nurse is careful not to schedule treatment and procedures on Saturday for a Jewish patient who observes the Sabbath. The nurse would appropriately consult with the medicine man of a Native American patient and incorporate their suggestions into the care plan.

A nurse who is caring for patients on a pediatric unit is assessing children’s spiritual needs. Which is the most important source of learning for a child’s own spirituality?

a Child’s church or religious organization

b What their parents say about God and religion

c Their parents’ behavior in relationship to the family, others, and to God

d Family’s spiritual advisor

c. Children learn most about their own spirituality from how their parents behave in relationship to one another, their children, others, and God (or a higher being). What parents say about God and religion, the family’s spiritual advisor, and the child’s church or religious organization are less important sources of learning.

A nursing student is caring for a patient admitted with chest pain related to aortic valve stenosis. The student notes the patient, who had been calm and cooperative the day before, has become contemplative and withdrawn, stating, “I’ve never thought much about dying, but my chances of making it through tomorrow’s surgery are 50-50.” How does the student best respond when the clinical professor asks the student why this behavior likely surfaced later in the patient’s admission?

a Patients usually want to maintain privacy about their spiritual needs.

b People are better able to focus on spiritual needs after their spiritual advisor visits.

c Family members and close friends often initiate spiritual concerns.

d Illness increases spiritual concerns, which may initially be difficult to verbalize.

d. Illness may increase spiritual concerns, which many patients find difficult to initially express. The other options presume patients are purposefully secretive or must speak with a spiritual advisor, friends, or family to promote discussion of spiritual concerns. Spirituality is anything that pertains to a person’s relationship with a nonmaterial life force or higher power; there is no universal definition, as the experience is individual and personal.

A nurse who is comfortable with spirituality is caring for a patient who needs spiritual counseling. What action will the nurse take first?

a Calling the patient’s own spiritual advisor

b Asking if the patient has a spiritual advisor they wish to consult

c Counseling the patient and, if unsuccessful, making a referral to a spiritual advisor

d Explaining the best health options for the patient to the spiritual advisor

b. Even when a nurse feels comfortable discussing spiritual concerns, they should always determine whether the patient has a spiritual advisor they would like to consult. Calling the patient’s spiritual advisor may be premature if it is a matter the nurse can handle. The other two options deny the patient’s right to speak privately with their spiritual advisor from the outset, if that is their preference.

A patient states they feel very isolated from their family and church, and even from God, “in this huge medical center so far from home.” When preparing expected outcomes for this patient, which most appropriately measures relief of the patient’s spiritual distress?

a The patient will express satisfaction with the compatibility of their spiritual beliefs and everyday living.

b The patient will identify spiritual beliefs that meet their need for meaning and purpose.

c The patient will express peaceful acceptance of limitations and failings.

d The patient will identify spiritual supports available to them in this medical center.

d. Each of the four options represents appropriate spiritual goals, but identifying spiritual supports available to this patient in this medical center at this point in time, is the most appropriate and realistic.

A patient who lost their home, spouse, and children in a fire is depressed and states that they have no reason to live. The patient states, “My family was my life.” The nurse documents a health problem of Spiritual Distress based on the patient’s inability to find meaning and purpose in their current situation. What is the priority nursing action for this patient?

a Asking the patient which spiritual advisor they would like you to call

b Recommending that the patient engage in spiritual or religious readings

c Determining what has given the patient meaning and purpose in the past

d Reminding the patient that God is a loving and personal God

c. The nurse prioritizes determining what, in addition to their family, has given the patient’s life meaning and purpose in the past. This helps the patient focus on their strengths. This assessment data can be used to further plan individualized spiritual care.

After terminating a pregnancy, a patient tells the nurse, “I shouldn’t have had that abortion because I’m Catholic, but what else could I do? I’m afraid I’ll never get close to my mother or back in the Church again.” They then talk with their priest about this feeling of guilt. Which evaluation statement shows a solution to the problem?

a Patient stated, “I wish I had talked with the priest sooner. I now know God b has forgiven me, and my mother is beginning to understand.”

c Patient has slept from 10 pm to 6 am for 3 consecutive nights without medication.

d Patient has developed mutually caring relationships with others.

e Patient has identified several spiritual beliefs that give purpose to their life.

a. The patient’s statements indicate feelings of guilt, which has caused spiritual distress. Only option a clearly evaluates whether the patient’s feelings of guilt have resolved after speaking to the priest.

A parish nurse is speaking to a congregant whose adolescent child was arrested for shoplifting. The congregant is very angry, stating they cannot face the child, let alone discuss the situation: “I just will not tolerate a thief.” What nursing action will best assist the congregant at this time?

a Assuring the congregant that many parents feel the same way

b Reassuring the congregant that many teenagers act rebelliously and that it will pass

c Assisting the congregant to identify how withholding forgiveness hurts them

d Asking the congregant if they have spent sufficient time with their child

c. Helping the congregant identify how their unforgiving feelings may be harmful to themselves is the only intervention that directly addresses forgiveness, a universal spiritual need. Assuring the congregant that many parents would feel the same way or that many teenagers shoplift out of rebelliousness may make them feel better initially, but this does not address the benefits of forgiveness. Suggesting the congregant may not have spent enough time with their child may be untrue and could promote guilty feelings, when they may be unwarranted

A hospice nurse who provides pastoral care is teaching nursing students about the three spiritual needs believed to be common to all people. Which of these will the nurse include in the discussion? Select all that apply.

a Food, clothing, and shelter

b Meaning and purpose

c Family

d Love and relatedness

e Forgiveness

f Rules to live by

.

b, d, e.

Meaning and purpose, love and relatedness, and forgiveness are the three spiritual needs believed to be common to all people. Option a is a human need as described by Maslow, as is family (love and belonging). Many people live by a set of rules, but this is not a common spiritual need.