Spiritual Assessment in Intensive & Cardiac Care Nursing
No less an authority than the Joint Commission on Accreditation of Healthcare Organizations (formerly known as JCAHO) has recently revised its standards to include spiritual care. These include the right to care that is respectful and considerate of personal beliefs, permission to express spiritual beliefs and cultural practices, and access to visits from clergy and other representatives of the patient's religious and spiritual community.
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Beliefs
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Because cardiac care requires informed consent from patients, it's very important for nurses to find out how the patient's decision-making is affected by his or her religious beliefs. For instance, Jehovah's Witnesses will not accept whole blood products, which means that alternatives must be sought in advance.
Other faiths have specific dietary prohibitions which may not directly affect treatment but have deep spiritual significance: Muslims and kosher-abiding Jews, for example, do not eat pork. For cardiac nurses, it can be very helpful to have an introductory conversation in which patients are invited to speak about their religious beliefs and in turn assured that these beliefs will be respected.
Religion
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Another important part of doing a spiritual assessment involves finding out about religious and cultural practices and discussing ways they can be accommodated. For instance, many Muslim patients pray five times a day in the direction of Mecca. Talking about this ahead of time can allow you to work out a system in which your patient has the time and space needed to pray without interfering with his or her medical care.
Similarly, a Buddhist patient undergoing high-risk surgery may wish to discuss with you arrangements for how he or she wants his body to be treated in the event that the surgery is not successful (this could include chanting or being covered by a special blanket.) A patient from the Latter-day Saint tradition may want a more modest hospital gown in order to accommodate the wearing of temple garments. The way to find out about such needs is to ask.
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Coping
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Every individual facing a serious illness has a different coping style and a unique way of finding meaning, which has been shaped by his or her life experience, beliefs, and relationships. During a spiritual assessment, a nurse should try to get some sense of this by asking questions such as, "What helps you to cope during difficult times?" "Where do you find meaning in every day life?" "What gives you a sense of purpose and hope?" For cardiac patients in particular, changes in function, independence, and ability may be a cause of stress that can be relieved in the course of a spiritual assessment.
Community Resources
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One of the lessons learned by spiritual caregivers is that illness affects not just individuals but systems: couples, extended families, churches and workplaces - in short, communities. The flip side of this is that individuals cope with illness by drawing on community resources. These can include family members, neighbors, clergy, and professional caregivers such as social workers and home health aides. Nurses should use the spiritual assessment to get a basic sense of these relationships and to build a sense of trust, assuring the patient that his or her community will be part of the healing process.
Other Cultural Needs
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The impact of cultural diversity on the modern clinical environment is hard to overstate. Patients come from all over the world and from every faith tradition, bringing with them specific cultural, religious, and spiritual needs. Most obviously, patients who do not speak English as their first language may require the services of a translator. Less obvious, however, are needs that have to do with gender and decision-making authority.
In some traditional Asian cultures, for instance, it is considered polite for a physician to address the patient's husband or eldest son rather than the patient herself. In traditional Islamic societies, it is considered inappropriate for a doctor to be alone with a patient of the opposite gender. A spiritual assessment can be a perfect opportunity to show cultural respect and avoid common misunderstandings.
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References
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