Human Experience Exam 3: 3.3, 3.4 Spirituality and End of Life Care

spirituality

an awareness of ones inner self and sense of connection to a higher being, nature, or purpose greater than oneself

spiritual distress

a disruption in the life principle that pervades a persons entire being and transcends the persons biological and psychosocial nature

5 overlapping constructs

self transcendence and transcendence

connectedness

faith and hope

inner strength

meaning and purpose of life

trust v mistrust

Spiritual well-being provided by parents

Trust provides basis for hope

Love, affection, security, and a stimulating

environment promote spirituality

autonomy v shame and doubt

Imitates parents' spiritual or religious actions; recites

prayers and sings simple religious songs, but does not

understand their meanings

initiative v guilt

Feels guilty when not acting responsibly

Influenced by spiritual and religious stories, examples,

moods, and actions

Models moral behaviors of parents

Begins to ask about God or supreme beings

Industry v. Inferiority

Wants to learn about spirituality

Has a clear picture of God or supreme being, morality,

and the difference between right and wrong

Sorts fantasy from fact

Demands proof of reality and believes literal meanings of

spiritual stories

identity v. role confusion

Reflects on inconsistencies in stories

Begins to question spiritual practices, forms

own opinions, and occasionally discards

parents' beliefs

Abstract reasoning leads to exploration of

moral issues

Spirituality comes from connectedness

with family, nature, and God or a supreme

being

Intimacy v. Isolation

Establishes self-identity and world view

Forms independent beliefs, attitudes, and

lifestyles

Uses principles to solve problems when

individual's and society's rules conflict

Generativity v. Stagnation

Develops appreciation of past spiritual

experiences

Embraces people from different faiths and

religions

Reviews value system during crisis

Values others

integrity v. despair

Values love and interactions with

others

Focuses on overcoming oppression

and violence

Beliefs vary based on many factors

such as gender, past experiences,

religion, economic status, and

ethnic background

spiritual wellbeing

feelings of contentment coming from the inner self and related to quality of life

faith

a confident belief in something for which there is no proof or evidence

acute illness

sudden, unexpected illness often creates spiritual distress

chronic illness

threatens a persons independence, causing fear, anxiety, and spiritual distress

terminal illness

causes fear and physical pain, loss of independence, isolation, the unknown, and dying, affects family and friends also

near death experience

psychological phenomenon of people who have been close to clinical death or have recovered from being declared dead. experiences rising above the body watching caregivers, moving toward the light, being pulled into a dark tunnel, no longer afraid of death, reluctant to share experience

Nursing Assessment Questions: Spirituality and Spiritual Health

• Which experiences in the past have been most difficult for you?

• What gives you hope during those difficult times?

• Which aspects of your spirituality have been most helpful to you?

• Which aspects of your spirituality would you like to discuss?

Faith, Belief, Fellowship, and Community

• To what or whom do you look as a source of strength, hope, or faith in times of difficulty?

• How does your faith help you cope?

• What can I do to support your religious beliefs or faith commitment? Would you like me to pray with you or perhaps read from the Koran or Bible?

• What gives your life meaning?

Life and Self-Responsibility

• How do you feel about the changes this illness has caused?

• How do these changes affect what you now need to do?

Life Satisfaction

• How happy or satisfied are you with your life?

• Which accomplishments help you feel satisfied with your life?

• What is it that makes you feel dissatisfied?

Connectedness

• What feelings do you have after you pray or meditate?

• Who do you feel is the most important person in your life?

Vocation

• How has your illness affected the way you live your life spiritually at home or where you work?

• In what way has your illness affected your ability to express what is important in life to you?

nursing diagnoses for spiritual problems

• Spiritual distress

• At risk for spiritual distress

• Powerlessness

• Hopelessness

patient goals/outcomes

Patient will:

• Express feelings of peacefulness

• Report feelings of connectedness with family and/or others

• Initiate social interactions with family and friends

• Participate in spiritual rites and practices

implementing spiritual care

• Offering a supportive presence

• Promote hope

• Facilitating patient's practice of

religion

• Nurturing spirituality

• Encourage individual spiritual

practices that promote meaning

and peace.

• During bereavement, encourage

life review to promote spiritual

well-being and alleviate

depression

• Those with chronic illness,

encourage patients to attend

meaning-centered meditation

programs, therapy, or counseling

• Praying with a patient if asked

• Praying for a patient

• Counseling the patient spiritually

• Contacting a spiritual counselor

• Encourage integration of

spirituality in healthy lifestyle

choices

Facilitating the Practice of Religion

• Familiarize the patient with religious services within the institution.

• Respect the patient's need for privacy during prayer and/or meditation

• Assist the patient to obtain devotional objects and protect them from loss

or damage.

• Promote and facilitate the use of religious rituals or practices to

support coping.

• Arrange for the patient to receive sacraments if desired.

• Attempt to meet dietary restrictions.

• Arrange for a priest, minister, religious leader, or rabbi to visit if the patient

wishes.

Counseling Patients Spiritually

• Have the patient articulate spiritual beliefs.

• Explore the origin of the patient's spiritual beliefs and practices.

• Identify life factors that challenge the patient's spiritual beliefs.

• Explore alternatives when given these challenges.

• Develop spiritual beliefs that meet the need for meaning and purpose,

care and relatedness, and forgiveness.

Room Preparation for Spiritual

Counselor Visit

• Make sure the room is orderly and free of unnecessary equipment.

• Provide a seat for the counselor near the patient's bed.

• Clear the top of the bedside table and cover with a clean white

cloth for sacraments.

• Draw the bed curtains if the patient cannot be moved to a private

setting.

Evaluating Expected Outcomes

• Identify some spiritual belief that gives meaning and purpose to life.

• Move toward healthy acceptance of the current situation.

• Develop mutually caring relationships.

• Reconcile interpersonal differences causing anguish.

• Verbalize satisfaction with relationship with God.

• Express peaceful acceptance of limitations and failings.

• Express ability to forgive others and live in the present.

• Demonstrate interior state of joy, freedom from anxiety and guilt.

loss

the act or fact of being unable to keep or maintain something or someone, the partial or complete deterioration or absence of physical capability or function, the harm or privation resulting from losing or being separated from someone or something, an instance of losing someone or something

types of loss

necessary loss, maturational loss, situational loss, actual loss, perceived loss

death

all vital organs and body systems cease to function, irreversible cessation of cardiovascular, respiratory and brain function

grief

an individualized response to a loss that is perceived, real, or anticipated by the person experiencing the loss

bereavement

the time of sadness after a person experience a significant loss through death

normal grief

a common and universal reaction characterized by complex emotional, cognitive, social, physical, behavioral , and spiritual responses to loss and death

complicated grief

when someone has a prolonged or difficult time moving forward after a loss; chronic and disruptive hearing for the deceased, have difficultly accepting the death, or feel excessively bitter, numb, or anxious about the future

delayed grief

grief response is unusually delayed or prolonged because the loss is so overwhelming the person avoids the full realization of the loss

anticipatory grief

grief experienced before the loss occurs; occurs often with prolonged or predicted loss

factors that influence loss and grief

human development, personal relationships, nature of loss, coping strategies, socioeconomic status, culture, spiritual and religious beliefs

assessment of grief

how long have you known the person who died? tell me about what your relationship with ______ meant to you. in time of loss, who is there for you?

tell me what this loss means to you?

was this loss expected or unexpected?

how have your goals changed because of their experience?

what is your belief about death?

what practices are important to you at the end of life?

nursing interventions to facilitate grief

assist with end of life decision making, palliative care or hospice care, therapeutic communication, provide psychosocial care, manage symptoms, promote dignity and self esteem, maintain a comfortable and peaceful environment, promote spiritual comfort and hope, protect against abandonment and isolation, support the grieving family, facilitate mourning

palliative care

an innate human right to all persons, focuses on symptom relief and QoL, can be added to any treatment program or chronic disease management, patients still seeking a cure can utilize palliative care

hospice care

a specialized form of palliative care, gives priority to pain and symptom management of someone approaching the end of life, provided to patients with life expectancy of less than 6 months, average length of stay is 97 day

similarities with hospice palliative care

for people with serous illness, comfort care, pain management, symptom relief

kubler-ross stages of dying and grief -denial

unable to accept the loss; pyschological protection

kubler-ross stages of dying and grief -anger

intense anger at god, other people, or the situation

kubler-ross stages of dying and grief

-bargaining

postpones awareness of loss by trying to prevent it from happening

kubler-ross stages of dying and grief

-depression

full impact of the loss is realized

kubler-ross stages of dying and grief

-acceptance

loss is incorporated into life; no longer protesting or struggling against it

physical manifestations of impending death

increased periods of sleeping or unresponsiveness, circulatory changes with coolness or color change in extremities, nose and fingers (mottling), incontinence, decreased urine output, dark urine, restlessness, confusion, disorientation, decreased intake of flood or fluids, terminal secretions (death rattle), altered breathing (apnea, labored or irregular breathing, cheyne-stokes) decreased muscle tone, relaxed jaw, sagging mouth, weakness and fatigue

psychosocial manifestations of impending death

-Acceptance of

mortality; engaging in

planning for one's

death

-Denial, defensiveness,

maladaptive coping,

anger or frustration

about situation

-Ability to talk about

the future or death

-Deep expressions of

loss, signs of

depression

-Engagement of loved

ones, able to say

goodbye or able to

give/receive forgiveness

-Legacy work and life

review

-Expressions of love to

significant persons

-Reconciling unfinished

business

organ donation

patients can choose to donate an organ or tissues or their entire body; information in the medical record, immediate family can make decisions, follow legal guidelines, notify organ donation team of death, many tissues must be used within hours of death

living wills

written documents that provide information about the patients wishes and names a designated spokesperson; used to detail a persons wishes to avoid, limit, or withhold interventions

durable power of attorney for healthcare (DPAHC)

if the patient is unable to communicate or is incapacitated, this allows a person of the patients choosing to make healthcare decisions on their behalf

DNR

the patient wishes to avoid CPR, does not mean do not treat, some include a do not intubate order "code status"

euthanasia; assisted suicide

deliberate act of hastening death, euthanasia is not legal in the US, nurses are prohibited from giving any aid in dying medications; assissted suicide is permitted in some US countries

palliative sedation

giving medication to intentionally produce sedation and relive distressing symptoms in patients who are imminently dying; goal to relive pain not hasten death

opioids in EoL

gold standard for pain relief, should not be withheld, even in those with addiction

double effect principle

administering opioids and sedatives at EoF can cause sedation but it is justified to relieve suffering

death

occurs when all vital organs and body systems cease to function -> irreversible cessation of cardiovascular, respiratory, and brain function -> brain death: the irreversible loss of all brain functions, including the brain stem