Spiritual Assessment of Intervention and Ethical Decision Making Processes

December 15, 2022

Spiritual Assessment of Intervention and Ethical Decision Making Processes

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Type of Project	ESSAY
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Spiritual Assessment of Intervention and Ethical Decision Making Processes

Assessing the spiritual needs of patients Timmins F, Caldeira S (2017) Assessing the spiritual needs of patients. Nursing Standard. 31, 29, 47-53. Date of submission: 18 October 2015; date of acceptance: 1 July 2016. doi: 10.7748/ns. 2017.e10312

Fiona Timmins Associate professor, School of Nursing and Midwifery, Trinity College, Dublin, Ireland

Sílvia Caldeira Assistant professor, Universidade Católica Portuguesa, Instituto de Ciências da Saúde, Lisbon, Portugal

Conflict of interest None declared

Peer reviews This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Online For related articles visit the archive and search using the keywords. Guidelines on writing for publication are available at: journals.rcni.com/r/ author-guidelines

Abstract Assessing spirituality and the spiritual needs of patients is fundamental to providing effective spiritual care. This article, the second in a series of three, discusses the assessment of patients’ spirituality and spiritual needs in healthcare settings. Several formal spiritual assessment tools are available to assist nurses to identify patients’ spiritual needs and to determine whether they are experiencing spiritual distress.

However, it may be more appropriate to assess patients’ spirituality informally, by asking open questions about their spiritual beliefs and needs. It is important for nurses to be aware of the limits of their competence in undertaking spiritual assessment and providing spiritual care, and to refer patients to the healthcare chaplain or other spiritual support personnel where necessary. The third and final article in this series will discuss spiritual care nursing interventions.

Keywords faith, holistic care, religion, spiritual assessment, spiritual care, spirituality

The First Article in this short series on spirituality, explored various definitions and understandings of spirituality, and established that addressing the spiritual needs of patients and their families is an increasingly important aspect of nursing care (Timmins and Caldeira 2017).

Addressing spiritual needs can provide support for patients and families coping with difficult or challenging situations (Weathers et al 2016). For example, parents might have difficulty coping with their child’s diagnosis of cancer. Despite being aware that many children make a full recovery, parents often fear the death of their child and will attempt to make sense of the situation (Taylor et al 2015).

Parents in this situation will have to make significant psychological adjustments, and for some, using spiritual resources will be an essential part of coping. Spiritual care may also be particularly important in palliative care, serious or life-threatening illness, and for older people recently admitted to nursing homes, where spiritual distress or needs might be anticipated.

Nurses should first understand how to assess patients’ spiritual needs, so that they can plan and provide appropriate spiritual care. This article, the second in a series of three, will address four areas in relation to spiritual assessment: » How patients’ spiritual needs might manifest in healthcare settings.

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» What is required to conduct a spiritual assessment and whether nurses are well placed to do this.

» What is involved in undertaking a spiritual assessment, including important questions to ask.

» Whether it is better to use a formal assessment tool, or to assess spiritual needs informally as part of developing a therapeutic relationship with the patient and their family.

Spiritual needs in healthcare settings Many patients in hospital have spiritual needs and will draw on their personal resources, as well as their family and healthcare chaplaincy services, for spiritual

nursingstandard.com4 8 / 15 March 2017 / volume 31 number 29

evidence & practice / spirituality series: 2

support (Ellis et al 2013). However, nurses and other healthcare professionals should to be able to identify and support patients’ spiritual distress as a component of providing holistic care (Balboni et al 2014).

NANDA International defines spiritual distress as: ‘a state of suffering related to the impaired ability to experience meaning in life through connections with self, others, the world, or a superior being’ (Herdman and Kamitsuru 2014).

Spiritual distress occurs when an individual experiences suffering that undermines their sense of purpose and personal identity; that which constitutes a meaningful life for them (Caldeira et al 2017). Such distress raises questions for people about who they are and why they are suffering, and is common in patients with cancer.

Caldeira et al (2017) found that patients with cancer undergoing chemotherapy who expressed both suffering and a lack of meaning in life were most likely to be experiencing spiritual distress. NANDA International recommends that nurses determine at what point the patient’s suffering becomes spiritual distress (Herdman and Kamitsuru 2014).

In practice, it may not be straightforward to determine when patients are experiencing spiritual distress, since their spiritual needs might be unclear, and nurses may lack specific guidance about the spiritual care they should provide. In these circumstances, a structured, formal spiritual assessment tool could be used to inform nurses and other healthcare professionals of patients’ spiritual needs and indicate if they are experiencing spiritual distress.

Patients may express their spiritual needs by: raising spiritual topics; showing a reverence for religious items; celebrating a special spiritual season in their tradition; and raising existential questions about the afterlife. It is important to consider that not everyone has a spiritual or religious outlook on life. For some, even the suggestion of spiritual distress or need may be considered offensive. Many societies, while historically religious, are becoming increasingly secular, with fewer people subscribing to formal religions.

There are also varying perspectives within religions and populations, and an increase in personalised and selective approaches to spirituality, with new and alternative ‘spiritualities’ and beliefs arising. Even within religions, there may be nuances in beliefs; therefore, it is increasingly complex to conduct a spiritual assessment, and determining the patient’s spiritual needs may be challenging for nurses and other healthcare professionals (Heelas and Woodhead 2005).

If the patient’s spiritual needs are personal, the assessment process might be more complex and based on an established therapeutic relationship between the nurse and patient. In these circumstances, it is less likely that beliefs codified in a religion can guide the nurse in undertaking a spiritual assessment and planning suitable spiritual care.

When considering whether patients and families would like or would benefit from spiritual support in healthcare settings, the best approach is often for nurses or other healthcare professionals to ask them. This not only demonstrates a person-centred approach to care, but is also beneficial to nurses, because it means they can avoid making assumptions about the patient’s spiritual needs and beliefs (McSherry 2006).

However, these assumptions are often made in healthcare settings (McSherry 2006), with patients and families assumed to have particular spiritual needs, or none. Assuming the individual requires spiritual support when they do not, or assuming they are religious, when they are not, may cause offence. Moreover, providing spiritual support that is inappropriate for patients may be deemed unprofessional behaviour (BBC News 2009).

Not providing adequate religious or spiritual support to people who have strong religious beliefs might be similarly offensive, particularly to those whose religious beliefs or practices have been negatively affected by their hospital or healthcare experience (Radford 2008). For example, Catholic patients who regularly attend church may feel distressed that they are unable to do so while they are in hospital.

To address some of these issues in healthcare settings, it is suggested that

Key Point

For some, even the suggestion of spiritual distress or need may be considered offensive. Many societies, while historically religious, are becoming increasingly secular, with fewer people subscribing to formal religions nurses and other healthcare professionals engage in a preliminary assessment to identify whether patients and families have spiritual needs, and whether they require spiritual support services, such as healthcare chaplaincy (Royal College of Nursing (RCN) 2011, 2015).

Patients are usually asked whether they have a religious denomination on admission to hospital, but this might not receive due attention. For example, during their admission, the patient might state that they are ‘Church of England’, but not express whether they practise the rituals and customs associated with this denomination of Christianity. It may be suggested that patients answer this question only for the purpose of completing the forms necessary as part of their admission to hospital.

Rather than only asking the patient about their religious denomination, it may be better if the nurse or healthcare professional establishes whether the individual practises a faith of some kind, by asking: ‘do you have a religious faith that you practise?’

However, even patients who express no religious faith during their hospital admission may experience spiritual distress at a later time, for example during a difficult diagnosis or prognosis, difficult treatment choices, and changes or challenges related to their hospitalisation. Nevertheless, hospital admission questions can indicate potential spiritual needs and may be crucial in planning individualised spiritual care.

To provide spiritual care, healthcare chaplains often rely on nurse referrals (Flannelly et al 2005), which require some initial information or assessment of the patient’s spiritual needs. Often, it is the patient or family who requests spiritual care or to see the healthcare chaplain (Jennings 2013, Timmins 2013), but while patients’ religion is often a question in hospital admission forms and nursing assessment paperwork, nurses often do not complete this section (Swift et al 2007, Timmins 2013).

Requirements of a spiritual assessment by nurses’ Formal spiritual assessment and the use of spiritual assessment tools is a predominant theme in the literature on spirituality

(Narayanasamy 2004, Buswell et al 2006, Tanyi 2006, Timmins and Kelly 2008, Gomi et al 2014, Bryson 2015, Hodge 2015). The primary purpose of a spiritual assessment is to identify specific spiritual care needs and formulate a care plan for patients (Power 2006, Caldeira et al 2013). Nurses may use different methods and tools to do this, although these have undergone limited testing (Draper 2012).

In the US, standards for spiritual care assessment and spiritual care delivery have been requirements for accreditation with The Joint Commission since 2001 (National Center for Cultural Competence 2015). This means spiritual assessment is required as the first step in delivering spiritual care, and it is recognised as an important component of healthcare delivery (La Pierre 2003).

While chaplains are employed in approximately half of all healthcare facilities in the US (Cadge et al 2008), spiritual assessment is not the responsibility of the healthcare chaplain alone, and may be conducted by other members of the healthcare team. For example, Koenig (2014) supported the importance of spiritual assessment in the medical profession, relating it to the desire of patients to have their religious and spiritual needs acknowledged and addressed by healthcare professionals.

It is important to remember that nurses have a duty to work within the limits of their competence (Nursing and Midwifery Council (NMC) 2015); therefore, they should not undertake spiritual assessment and provide spiritual care unless they are competent and confident to do so. Nurses should have an understanding of the importance of referring patients to the healthcare chaplain or other spiritual support personnel where necessary.

The assessment of spiritual distress and spiritual needs involves not only determining whether nurses can answer patients’ questions and explore their concerns with them, but also identifying when is an appropriate time to discuss spiritual matters. In practice, patients often select particular members of staff with whom they will express their concerns. For example, patients might express their key point.

Spiritual Assessment of Intervention and Ethical Decision Making Processes

RUBRIC

Excellent Quality

95-100%

Introduction

45-41 points

The context and relevance of the issue, as well as a clear description of the study aim, are presented. The history of searches is discussed.

Literature Support

91-84 points

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Methodology

58-53 points

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Average Score

50-85%

40-38 points

More depth/information is required for the context and importance, otherwise the study detail will be unclear. There is no search history information supplied.

83-76 points

There is a review of important theoretical literature, however there is limited integration of research into problem-related ideas. The review is just partly focused and arranged. There is research that both supports and opposes. A summary of the material given is provided. The conclusion may or may not include a biblical integration.

52-49 points

The content is somewhat ordered, but there is no discernible organization. The use of typeface, color, graphics, effects, and so on may sometimes distract from the presenting substance. It is possible that the length criteria will not be reached.

Poor Quality

0-45%

37-1 points

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75-1 points

There has been an examination of relevant theoretical literature, but still no research concerning problem-related concepts has been synthesized. The review is just somewhat focused and organized. The provided overview of content does not include any supporting or opposing research. The conclusion has no scriptural references.

48-1 points

There is no logical or apparent organizational structure. There is no discernible logical sequence. The use of typeface, color, graphics, effects, and so on often detracts from the presenting substance. It is possible that the length criteria will not be reached.