8/11/16
Presenter
Dinorah Martinez-Anderson, MSN, RN, FNP-C
Clinical Assistant Professor, PhD student
University of Texas at Tyler
[email protected]
Integrating Spiritual Wellness
into Practice
Texas Nurse Practitioners ♦ 2016 Fall Conference
World Health Organization
“Health is a state
Dimensions of
Wellness
of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity”
•
Definition-adopte d
Health Conference,
•
1973- W HO Director-general, Dr. H.Mahler, submitted the proposal of the adoption of
“ spiritual” to be included in the definition of health….it was presented at 1 st W orld
A ssembly of Health in 1998, for revision of constitution but not addressed.
•
A s of today, the W HO has not amended their definition of health. W ith 193 members to
date, Dr. Mahler’s definition that incorporates the “ spiritual” dimension is widely used as
the new paradigm of integrative medicine.
as preamble to the Constitution of W HO, adopted by the International
New York , signed by 61 states, and entered into force on A pril 7,1948.
W HO: http://who.int/ abo ut /de fini tion /en /pri nt .h tml
Luchetti, Luchetti, Bassi, Vera, & Peres, 2012
Objectives
•
Why Spirituality?
•
State of Spiritual Health Education
•
When is the Right time to talk about the Spiritual
•
Standards, Guidelines, and Tools
•
Spiritual Wellness Strategies
Why
Spirituality?
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Spirituality vs Religiosity
What about…?
§ Spirituality… is the dynamic dimension of human life that relates to the
way persons (individual or community) experience, express and/or seek
meaning, purpose and transcendence, and the way they connect to the
moment, to self, to others, to nature, to the significant and/or the
sacred (Martin & George, 2016).
• What about Atheist, Agnostics, and Non-religious
• Spiritual/ Religious vs Non Spiritual/ Religious vs Spiritual/ Non
Religious
§ Religion…”involves beliefs, practices, and rituals related to the
transcendent…an organized system of beliefs, practices, and symbols
designed to facilitate closeness to the transcendent…and foster an
understanding of one’s relationship and responsibility to others in living
together as a community” (Koening, 2012)
• Cultural Competence- Spirituality as an aspect of Cultural
Identity
• Spirituality in Primary care
Background and Context
State of Spiritual &
Health Education
§
1992 First Spirituality in Health course introduced as elective in a US medical school
§
Today, 75% of all US medical schools have incorporated spirituality topics in to the
curricula
§
In nursing education, there is widespread support for the inclusion of spirituality, there is
little content incorporated in didactic and clinical practicum, about 12.3% are integrating
spirituality into institutional policy.
§
In 2015, a study of spirituality in fundamental nursing textbooks found that only 22%
contained the word “spirituality” in the index. Out of 580 nursing textbooks, only 130
contained the word “spirituality” in the index
§
Out of the 130 textbooks: 33% provided a clear distinction between spirituality and
religion, 15% advocated in providing spiritual activities or a sacred space for patients,
36.2% described the role of the nurse in providing spiritual care, 20% included using a
spiritual assessment tool, and 44.6% considered spiritual care a component of holistic
nursing care.
Timmins, , Neill, Murphy, Begley, and Sheaf, 2015
Spiritual Care Competencies
National Organization of Nurse Practitioner Faculty
NONPF 2012 Amended Core Competencies
As s ociation of American Medical Colleges (A A MC)
•
Knowing how to apply knowledge about spirituality in patient care
•
Integrating spirituality into clinical practice
•
Establishing compassion and communication with patients, families,
and colleagues
•
Incorporating spirituality into professional and personal
development
Independent Practice Competency
4. Provides patient-centered care recognizing cultural diversity
and the patient or designee as a full partner in decision-making.
c. Incorporates the patient’s cultural and spiritual
preferences, values and beliefs into health care
NONPF, 2012
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Nursing Diagnoses r/t Spirituality
Spiritual Care Provider Characteristics
*Spiritual distress-Impaired ability to experience and integrate meaning and
purpose in life through the individual’s connectedness with self, others, art, music,
literature, nature, or a power greater than oneself.
§ Acknowledging spiritual self-awareness
§ Being present; presence
*Risk of spiritual distress- at risk for altered sense of harmonious
connectedness with all of life and the universe in which dimensions that transcend and
empower the self may be disrupted.
§ Empathetic listening
§ Documenting spiritual history
*Readiness for enhanced spiritual well-being- ability to experience and
integrate meaning and purpose in life through connectedness with self, others, art,
music, literature, nature, or a power greater than oneself.
§ Incorporating patient’s spiritual traditions or preferences into plan of
care
Medical Diagnoses r/t Spirituality
§ Encouraging patients to practice their spirituality behaviors for coping;
touching through emotional support
ICD-10-CM- Z65.8 Other specified problems related to psychosocial circumstances,
including spiritual problem
ICD-10-CM- Z71.81 Spiritual or religious counseling
§ Refer and promote the use resources of their spiritual/faith traditions
for overall wellness
Ethical Guidelines
For appropriate delivery of spiritual care
The Right time to
talk about the
Spiritual
§
Spiritual history: non-coercive, patient-centered
§
Professional boundaries: no abuse of patient’s trust
§
Broad definition of spirituality: patient’s own personal meaning
§
Avoidance of trying to answer unanswerable questions: Why me? Why now?
§
Not going beyond one’s scope of practice or level of expertise
§
Recognize pastoral care professionals are experts
§
Proselytizing is not acceptable
§
In-depth spiritual counseling should be under the direction of spiritual leader
Puchalski, 2013
Who?
•
Older patients, hospitalized patients, and terminal patients are the
usual populations that wish to discuss beliefs with their provider.
•
Every new patient should have a spiritual history documented on
their record. Not just in the hospital, but in the outpatient setting
Spiritual Distress Cues
Spirit ual Theme
K ey words from Hist ory
St at ement s
Existential
Lack of meaning of existence; concern
about afterlife; seeks spiritual
assistance
“ My life is meaningless”
“ I feel useless”
A bandonment
•
•
Also, when an established patient voices or presents with spiritual
distress cues.
Today, consider all patients, across the lifespan, in need of spiritual
care, or at the minimum, a documented spiritual history.
Lack of love; loneliness, no
interconnectedness
“ God has abandoned me”
No one comes by anymore”
A nger {at God or others}
{of God or others}
A nger towards religious
representatives; inability to forgive
“ W hy would God take my child…it’s
not fair”
Despair/ Hopelessness
Hopeless about health, life; no hope
for value in life
“ Life is being cut short”
There’s nothing left for me to live for”
Grief/lLoss
Feeling or Process with a loss of a
person, health, etc…
“ I miss my loved one so much”
“ I wish I could run again”
Guilt
Feeling guilt for doing something
wrong/evil; shame
“ I don’t deserve to die pain-free”
Reconciliation
Need for forgiveness
“ I need to be forgiven for that”
“ I would like my wife to forgive me”
Puchalski, 2013
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When?
§ When taking a medical history during a new patient
Team Roles and Responsibilities
evaluation
Patient
§ When taking a medical history while admitting a patient to
the hospital, nursing home, hospice or palliative care setting
§ When doing a Health Maintenance visit, as part of a well-
Medical
Neighborhood
person evaluation
§ Whenever the medical situation calls for it
Medical
Provider
Pastoral
Counselor
Koenig, 2013
Chaplain
/Minister
Faith-based
Community
Approach to Addressing Spirituality
Spiritual
Assessment Tools
•
Spiritual Screening – is to identify a need for an immediate referral
•
Spiritual History – is to learn more about the person spiritual and
inmost story, to identify spiritual resources of strength and to
diagnose spiritual distress. Also known as an assessment.
•
Spiritual In-depth Assessment – done primarily by chaplain, or
spiritual counselors, in a narrative-reflective process. Used to further
delineate the spiritual issues, confirm or change the diagnosis
initially made or to assist in appropriate plan of care with regard to
patient and patient’s family.
Puchalski, 2013
Spiritual Assessment Tools
•
Today more than 40 spiritual history assessment tools are available
•
Primarily developed by chaplains and nurses and inter-disciplinary teams
•
First spiritual assessment – Spiritual Profile Assessment (SPA) introduced
in 1980 by Physician Elizabeth McSherry
•
Category
Sample questions
Fait h and belief
Do you have spiritual beliefs that help you cope with stress?
If the patient responds "no," consider asking: what gives your life
meaning?
I mport ance
Have your beliefs influenced how you take care of yourself in this illness?
C ommunit y
A re you part of a spiritual or religious community?
1990 Gary Berg’s Computer Spiritual Assessment andthe Spiritual Injury
Scale for chaplains in the VA system
•
FICA Spiritual History Tool
1996 Dr. Christina Puchalski published her FICA tool, the most common
used and validated tool today
Is this of support to you, and how?
Address
in care
How would you like me to address these issues in your health care?
Saguil and Phelps, 2012, A merican Family Physicians
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HOPE Questions for Spiritual Assessment
Category
Sample questions
H: sources of hope
W hat are your sources of hope, strength, comfort,
Open Invite Mnemonic
Category
and peace?
Open (i.e.,
Sample questions
open t he door t o
conversat ion)
O: organized religion
A re you part of a religious or spiritual community?
Does it help you? How?
Invite
(i.e., invit e t he pat ient t o
discuss spirit ual needs)
P: personal spirit ualit y and Do you have personal spiritual beliefs?
pract ices
W hat aspects of your spirituality or spiritual practices do you find
most helpful?
E: effect s on medical care
and end-of-life issues
May I ask your faith background?
Do you have a spiritual or faith preference?
W hat helps you through hard times?
W hat do you hold on to during difficult times?
Does your current situation affect your ability to do the things that
usually help you spiritually?
Do you feel that your spiritual health is affecting your
physical health?
Does your spirituality impact the health decisions you
make?
Is there a way in which you would like for me to account
for your spirituality in your health care?
Is there a way in which I or another member of the
medical team can provide you with support?
A re there resources in your faith community that you
would like for me to help mobilize on your behalf?
Saguil and Phelps, 2012, A merican Family Physicians
Saguil and Phelps, 2012, A merican Family Physicians
Other Tools…Know your acronyms
§ SPIRIT
§ CSI-Memo
§ FACT
Spiritual
Wellness
Strategies
§ 7X7
§ LORD’S LAP
Macro to Micro Approach for Spiritual Wellness
Micro-level Approach for Spiritual Wellness
Macro-level
§
Reflective Journaling
§ Religious affiliation
§
Prayer/Meditation
§ Shared decision-making
§
Group Therapy
§
Music Therapy
§
Aroma Therapy
§
Yoga/ Exercise
§
Nutrition
§
Scrapbooking
Micro-level
§ Coping
§ Daily Spiritual behaviors
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Thank you
Let’s continue the dialogue….
References
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