Spirituality as a Principle of Practice of Holistic Care - Coursework Example

Spirituality is a principle of practice of holistic care and as such should be part of each nurses everyday practice Introduction Brooks et al (2005, p.22) indicates a patient is a holistic biopsychosocial unit and nurse’s should restore patient’s wholeness to promote state of harmony between body, mind and soul. Spirituality is a principle of practice and takes into account holistic approach meant to provide spiritual needs1 necessary to support patient’s spiritual strengths (Lehman 2004,p.7) or to provide for patient’s spiritual deficits (Hoban 2004,p.57). Spirituality care is a core element of palliative care (Brooks et al 2005,p.22) that addresses patient’s spiritual distress2. Spirituality care as component of holistic care Spirituality care as a derivative of holistic care approach (Arraf,Cox and Oberlek 2004,p.604) conforms to code of ethics of registered nurse that requires provision of safe compassionate and competent ethical care; promoting health and well being of patient (Barbera,Paszat and Chartier 2006,p.15), promoting and respecting patient’s or family decision making (Parish et al 2006,p.23,p.24), preserving patient’s dignity and maintaining and respecting privacy and confidentiality (Terry et al 2006,p.341). Spirituality care incorporates nursing practice (New York State Nurse’s Association, 2006, p.1) subject to caring practices that nurses should exhibit. It recognizes patient’s spiritual beliefs (Mylott 2005, p.117) by incorporating patient’s beliefs system into medical intervention (International Council of Nurses 2006). Spirituality care should touch patient’s spirit (World Health Organization n.d.) like shared laughter and comforting chronically-sick (AAIDD, 2005) patients and enable them to define their worth and meaning of life in the light of their sickness. It should shape patient’s spirituality (Dodd et al 2005, p.211) subject to patient’s cultural stimulation (Dunn 2008). It involves formal religious practices like making prayer meditation and worship subject to patient’s or family decision (Baldacchind 2009, p.271). It should be reinforced by being present and listening to their concerns and fears, highlighting aspect of love (Van-Dover and Bacon 2005, p.20), relatedness and communicating hope. Spirituality care ensures congruency is achieved between patient’s physical conditions that affect mind and spirit (Taylor 2005,p.26) and prioritizes abstract spiritual needs and psychosocial needs (Van-Dover and Bacon 2005,p.21). Spirituality care is integrated into nursing process of assessment (Dameron 2005, p.18), nursing diagnosis (Robichaux and Clark 2006, p.483), planning, implementation and evaluation (Volker et al 2004, p.946). The knowledge utilized in nursing process like ethics of practice (Dunbrack 2006), practice wisdom and scientific knowledge (Mallory and Allen 2006, p.218) are important aspects in meeting and planning spiritual care. Spiritual care can be documented in nursing care plans (Robichaux and Clark 2006, p.484) to pave way for continuity of care. Spirituality care should be a team effort (Dunbrack 2006) by facilitating environment for inter-professional referrals hence part of holistic care approach. The role of spirituality nurse Spirituality nurse should plan spiritual need and spiritual care of the patient within framework of nursing ethics of care (Burkhart 2005, p.6). The nurse should encourage patient to make choices about their preferred care plan (Dameron 2005, p.14) by educating patient on treatment options. The nurse should carry out patient’s spiritual diagnosis (Dameron 2005, p.13) to determine patient’s preferred location of death (Doornboos, Groenhout and Hotz 2005), choices relating to organ donation (Mauk and Schmidt 2004), whether patient prefers life-sustaining treatment like cardiopulmonary resuscitation (Meyer 2005,p.39), artificial nutrition or hydration, dialysis or mechanical ventilation (Taylor 2005,p.23,p.24). The nurse should inform the patient about proposed current treatment and future treatment modalities including patient’s right to refuse treatment3. The nurse should examine own spirituality beliefs and utilize knowledge to truths and religion principles that guide lives (Taylor 2005). The nurse should differentiate spirituality care and psychosocial care4 and provide for wholeness by factoring holiness and holistic view of life and self and then convey the same feel to patient. The nurse should communicate patient’s potential to face reality of one’s own mortality by believing they can assist patients die well and in peace by realizing human life is temporary and human beings are mortals and accept life is a transient (Doorbboss et al 2005). The nurse should educate patient (Dameron 2005) and offer interpretation of medical information (Mauk and Schmidt 2004) in a manner that the patient or family members can understand. If the patient is not able to make reliable decision on their treatment care plan, the nurse should liaise with family and patient to designate a person who can make decision on treatment options for the patient. The nurse should work with other inter-professional providers to ensure the patient needs are met. The nurse should refer for advanced support of pastoral care (Brooks et al 2005) in order to meet emotional, social and spiritual needs of the patient and family and also meet specifications of holistic approach that incorporates patient’s private values and choices in every aspect of care (Hoban 2004).The nurse should create an environment to foster patient’s comfort, alleviate suffering and support a dignified and peaceful death (Van-Dover and Bacon 2005) by supporting patient and family during and after death. Clinical placement case study Karen* and her husband Jones*5 visited our voluntary counseling and testing center for an HIV/AIDS test. Five minutes before their HIV/AIDS results were out; Jones excused himself and left never to return. Karen tested positive for HIV/AIDS, her husband too. Karen, a strong Christian regretted why it had to happen to her despite her commitment to serve Her God. Her 76 year old grandmother who had come for her routine medical check-up following her cardiac arrest overheard Karen laments and came in. She looked at the spot test and asked, ‘why did it happen to you Karen? Why couldn’t it have happened to me?’ Karen continued with her laments. ‘What will happen to my children after I die? Will my daughter survive my death? Who will miss me upon my exit from earth? Will the remaining time be adequate to complete the tasks ahead of preparing my children for my death or should I die and leave relatives mourning the death of a caring responsible mother?’ After a short while Karen was able to explain. ‘My husband is very faithful. I am faithful too but I came with a scar into the marriage. I was raped by a gang of men before I completed my ‘O’ level examinations. I conceived but I could not accept to shame my respected parents and I secured an abortion when I had been preaching against abortion. I committed a sin before the eyes of my God.’ Karen declined to accept any treatment citing her religion didn’t value power of medicines and I resorted to make a follow up with a chaplain. She used to pray for God’s intervention to heal her citing other men and women in the bible who God healed. She accepted 18 months later to be treated after her consoling word ‘God had a purpose for me to get AIDS so that God can use me as an instrument to spread a different approach to management of AIDS pandemic’. This was after she acknowledged nurses failure to have factored her spiritual needs. Before she left she said, ‘I pray God to give me strength to withstand all ridiculous statements that people will heap on my soul, and understanding to accept my HIV/AIDS status. Karen has been healthy and her T4 lymphocytes count is normal. Modalities of improving spirituality care Upon admission of a terminally ill patient is done, I will perform patient’s assessment and screening spiritual history (Mauk and Schmidt 2004) to determine if spiritual belief of the patient could form part of patient care management inclusion criteria or if inclusion of spirituality care has effect of interfering with medical treatment procedures prescribed for the patient (Dameron 2005). In case patient has no religious affiliation, patient spiritual history should focus attention on elements that add value or meaning to the patient’s life like hobbies (Burkhart 2005). Nurse should not impose spirituality care if it has no value to patients it may predispose stress and depression and make prescribed care plan a hard goal to achieve (Van-Dover and Bacon 2005). Nurse should be compassionately present for terminally ill-patients to support patients physically emotionally, psychologically and spiritually. Nurse should devote time to listen to the patient’s hopes and fears (Tributterfly staff 2009) and satisfy patients spirituality orientation and incorporate three dimensions of care (Van-Dover and Bacon 2005) that are a function of the body, mind and spirit by reading scriptures (Tributterfly staff 2009), reassuring patient that God is listening, loving and caring. Nurse should take time to be with patient during religious rituals, join in prayers and meditation (Dunn 2008). Nurse should alter patient’s environment setting so that patient has access to traditional spiritual ceremonies, rituals and is able to perform daily prayer for Muslim patients. Specialist care should be arranged subject to need for gender based care. Providing quality spirituality care requires continuously increasing knowledge and developing spirituality care skills (Doornboss et al 2005). Nurse should attend education courses and workshops on spirituality care, read more literature on spirituality care and interact with inter-professional colleagues like liaising with chaplains with aim of increasing awareness of spiritual needs and developing ability to integrate learnt spirituality care into practice (Mauk and Schmidt 2004). Nurse should search to understand own spirituality and values and level in which nurse’s spirituality is met and satisfied. Bibliography American Association on intellectual and Developmental Disabilities (AAIDD). (2005). AAIDD [position statement]:Caring at the end of life. Washington DC. Arraf,K.;Cox,G. & Oberlek. (2004). Using the Canadian Code of ethics for registered nurses to explore ethics in palliative care research. nursing ethics ,11 (6),600-609. Baldacchind,D.R. (2009). Spiritual Care: Is it the nurse's role? Spirituality and Health international , 9 (4),270-284. Barbera,L.; Paszat,L. & Chartier,C. (2006). 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Practice of Expert cRitical care nurses in situations of prognostic conflict at the end of life. American journal of critical care ,15 (5),480-489. Schroepfer,T.A. (2006). Mind frames towards dying and factors motovating their adoption by terminally ill elders. Journal of gerontology ,61B (3),S129-S139. Taylor,E.J. (2005). What have we learned from spiritual care research? Journal of christian nursing , 22 (1),18-28. Terry,W.; Olson,L.G.; Wilss,L & Boulton-Lewis,G. (2006). Experience of Dying: Concerns of Dying patients and of carers. Internal Medicine journal , 36 (6),338-346. Van-Dover,L. & Bacon,J.P. (2005). Trusting God: Foundation for spiritual care. Journal of christian nursing ,22 (1),18-21. Volker,D.L.; Kahn,D. & Penticuff,J.H. (2004). Patient Control and End of life care Part I: The Advanced Practice nurse perspective. oncology nursing forum , 31 (5),945-953. World Health Organization. (n.d.). WHO definition of palliative care. retrieved on 18th April 2009 from http://www.who.int/cancer/palliative/definition/en/. Read More