Spirituality refers to that part of being human that seeks meaningfulness through intra-, inter-, and transpersonal connection (Reed, 1992).
Spirituality generally involves a belief in a relationship with some higher power, creative force, divine being, or infinite source of energy.
E.g. A person may believe in "God", "Allah", and "Lord Jesus"
According to Martsolf & Mickley, 1998, spirituality includes the following aspects:-  
         Meaning (having purpose, making sense of life)
         Value (having cherished beliefs and standards)
         Transcendence (appreciating a dimension that is beyond the self)
         Connecting (relating to others, nature, Ultimate Other)
         Becoming (which involves reflection, allowing life to unfold, and knowing who one is)
Spiritual health:
       "Spiritual health, or spiritual well-being, is manifested by a feeling of being "generally alive,  purposeful, and fulfilled"---Ellison, 1983 
       Spiritual well being:
       According to -Pilch (1998), spiritual wellness is "a way of living, a lifestyle that views and lives  life as purposeful and pleasurable, that seeks out life-sustaining and life-enriching options to be chosen freely at every opportunity, and- that sinks its roots. deeply into spiritual values and/or specific religious beliefs"
      People nurture or enhance their Spirituality in many ways. Some focus on development of the inner self; others focus on the expression of their spiritual energy with others or the outer world.
       Indicators of spiritual health:
         Meaning and purpose in life
         Achievement of spiritual world
         Feelings of peacefulness Ability to love
       Spiritual distress:
       Spiritual distress refers to a challenge to the spiritual well-being or to the belief system that provides strength, hope, and meaning to life.
      Factors that may be associated with or contribute to a person's spiritual distress include:-
·         Physiologic problems
·         Treatment related concerns,     
·         Situational concerns.
        Physiologic problems include having a
·        Medical diagnosis of a terminal or debilitating disease
·        Experiencing pain
·        Experiencing the loss of a body part or function
·        Experiencing a miscarriage or stillbirth.
Treatment related:
·        Recommendation for blood transfusions
·        Abortion,
·        Surgery,
·        Dietary restrictions, 
·        Amputation of a body part, or isolation
Situational factors:
·        Death or illness of a significant other,
·        Inability to practice one's spiritual rituals, or
·        Feelings of embarrassment when practicing them 
Characteristics of spiritual distress:-
·        Expresses lack of hope, meaning and purpose in life, forgiveness of self
·        Expresses being abandoned by or having anger toward God 
·        Refuses interaction with friends, family
·        Sudden changes in spiritual practices     
·        Requests to .see a religious leader
·        No interest in nature, reading spiritual literature .

       Related concepts:
     Concepts related to spirituality include religion, faith, hope, transcendence, and forgiveness
·        Religion
     Religion is an organized system of beliefs and practices. It offers a way of spiritual expression that provides guidance for believers in responding to life's questions and challenges. 
     According to Vardey (1996) the organized religions offer
(a)  A sense of community bound by common beliefs
(b) The collective study of scripture (the Bible, Koran, or others)
(c)  The performance of ritual
(d) The use of disciplines and practices, commandments, and sacraments
(e)  Ways of taking care of the person's spirit (such as fasting, prayer, and meditation)
Religious development of an individual refers to the acceptance of specific beliefs, values, rules of conduct, and rituals.
    Agnostic is a person who doubts the existence of God or a supreme being or believes the existence of God has not been proved.
    Atheist is one without belief in a God.
    Monotheism is the belief in the existence of one God
    Polytheism is the belief in more than one god
·        Faith 
  Faith is to believe in or be committed to something or someone. Faith gives life meaning, providing the individual with strength in times of difficulty
·        Hope
        Hope is a concept that incorporates spirituality.
       "A process of anticipation that involves the interaction of thinking, acting, feeling, and relating, and is directed toward a future fulfillment that is personally meaningful"----Stephenson (1991)
·        Transcendence
      "The capacity to reach out beyond oneself, to extend oneself beyond personal concerns and to take on broader life perspectives, activities, and purposes"---Coward (1990)
·        Forgiveness
     The concept of forgiveness is receiving increased attention among health care professionals. For many clients, illness or disability bring a sense of shame or guilt. Clients facing imminent death may seek forgiveness from others as well as from God.
      Spiritual practices affecting nursing care:
     The most common practices affecting the nursing care of clients include holy days, sacred writings, sacred symbols, prayer, meditation, and those associated with diet, nutrition, healing, dress, birth, and death.
     Holy Days
    A holy day is a day set aside for special religious observance, and all the world religions observe certain holy days.
   Clients who are devout in their religious practices may want to avoid any special treatments or other intrusions on their holy days
    E.g. Most Christians observe the Sabbath on Sunday, whereas Jews and Sabbatarian Christians.
   (e.g. Seventh-Day Adventists) observe Saturday as their Sabbath.
     Sacred Writings
    Each religion has sacred and Authorative scriptures that provide guidance for its adherents beliefs and behavior. People often gain strength and hope from reading religious writings when they are ill or in crisis.
    For example, blood transfusions are in conflict, with the religious admonitions of Jehovah's Witnesses, Job's suffering (The Bible)
      Sacred Symbols
    Sacred symbols include jewelry, medals, amulets, icons, totems, or body ornamentation (e.g., tattoos) that carry religious or spiritual significance.
    They may be worn to pronounce one's faith, to remind the practitioner of the faith, to provide Spiritual protection, or to be a source of comfort or strength E.g. Rosary, mala, or string of prayer beads
    Hospitalized clients or long - term care residents may wish to have their spiritual icons or statues with them as a source of comfort.
     Prayer and Meditation
    Prayer is a spiritual practice. According to Gill 1987 "human communication with divine and spiritual entities". Some religions require daily prayers or dictate specific times for prayer and worship.  
    Meditation is the act of focusing one's thoughts or engaging in self- reflection or contemplation.
     Beliefs Affecting Diet and Nutrition
    Many religions have proscriptions regarding diet. There may be rules about which foods and beverages are allowed and which are prohibited. 
    Some solemn religious observances are marked by fasting, which is the abstinence from food for specified period of time. Fasting requirements for seriously ill believers for whom fasting may be a detriment to health (e.g.', diabetic clients)
     Beliefs Related to Healing
      The nurse needs to assess the client's beliefs and, if possible, include some aspects of healing that are part of the client's belief system in the planning of care
     Beliefs Related to Dress
Many religions have laws or traditions that dictate dress. Orthodox Jewish women cover their hair with a wig or scarf as a sign of respect
     Beliefs Related to Birth
Many religions have specific ritual ceremonies that consecrate the new child to God. E.g. naming ceremonies, ritual circumcision, and baptism).
 When nurses are aware of the religious needs of families and their infants, they can assist amilies in fulfilling their religious obligations. Important when the newborn infant is seriously ill or in danger of dying.
     Beliefs Related to Death   
Spiritual and religious beliefs play a significant role in the believer's approach to death just as they do in other major life events.
Some religions have special rituals surrounding dying and death that must be observed by the faithful. Observance of these rituals provides comfort to the dying person and their loved ones.
        Nursing management:
           Assessment Inteview
·        Are any particular religious practices important to you? If so, could you please tell me about them.
·        How will being sick interfere with your religious practices?
·        In what ways can I support your spirit? For example, would you like me to read your prayer book to you?
·        Would you like a visit from your spiritual counselor or the hospital chaplain?

Nursing Diagnosis:
·        Fear related to apprehension about soul's future after death and unpreparedness for death
·        Chronic or Situational Low Self-Esteem related to failure to live within the precepts of one's faith
·        Disturbed Sleep Pattern related to spiritual distress
·        Ineffective Coping related to feelings of abandonment, by God and loss of religious faith
·        Decisional Conflict related to conflict between treatment plan and religious beliefs Spiritual Distress
·        Readiness for Enhanced Spiritual Well-Being
·        Risk for Spiritual Distress
·        Impaired Religiosity

·        Help the client fulfill religious obligations       
·        Help the client draw on and use inner resources more effectively to meet the present situation
·        Help the client maintain or establish a dynamic, personal relationship with a supreme being in the face of unpleasant circumstances.
·        Help the client find meaning in existence and the present situation.
·        Promote a sense of hope.
·        Provide spiritual resources.
·        Providing presence
·        Supporting religious practices
·        Assisting client with prayer
·        Referring client for spiritual counseling 



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notes.nursium.com: Spirituality
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