Wednesday, October 10, 2012
The forgotten body system
Cardiac, respiratory, gastrointestinal…all body systems that prudent, careful nurses are sure to assess. But what about our spiritual system, which is often as essential to the optimal functioning of a human being as any other body system?
Taking a nurse educator’s approach to informing others about this system, it’s important to provide a definition. The spiritual system is composed of a person’s inner self, belief systems, and, possibly, religious practices. It may be expressed outwardly through particular behaviors, and it affects the patient’s mental status and coping abilities.
Extensive research has occurred demonstrating the beneficial effects of applying spiritual practices to end-of-life care. If spiritual and/or religious interventions are important to assess and encourage when caring for patients at the end of life, why don’t we view those same interventions as effective and meaningful for patients during the course of a regular hospital stay?
To assess a patient’s spiritual system, simply asking his or her religious preference on admission isn’t sufficient. Complete assessment of the spiritual system requires astute observation. Note the presence of religious symbols in the patient’s belongings or visible on their clothing or jewelry. Being able to recognize the symbols of our world’s multiple religions requires some self-education. Nurses should view educating themselves about the various religions equivalent to remaining up to date on the latest procedures. Although continuing education units on spirituality and religion aren’t easily found, quick Internet searches or cultural diversity courses can expand knowledge in this area.
Ask about more than religious preference; also inquire about the patient’s support system that may include members of his or her congregation. Rather than waiting for a crisis or upsetting situation to occur, ask about the patient’s preference for a visit by the hospital chaplain during the early part of the hospital course or offer assistance with contacting his or her personal clergy. As you ask these exploratory questions, be sure to actively listen. Maintain eye contact during the conversation regarding support systems and religious practices. Ask reflective and clarifying questions, signaling to the patient that you’re truly listening to his or her answers.
A vital part of assessing the spiritual system is the willingness to perform appropriate interventions. But what are the appropriate interventions when caring for the spiritual system? They can range from standing in the room respectfully as the patient observes his or her religious practices to actively participating in such practices. Be prepared to provide assistance with obtaining materials he or she may need to perform religious practices. Know how to contact the hospital chaplain for either assistance with performing spiritual interventions or contacting others in the religious community that may be more knowledgeable about the patient’s particular religion.
Interventions for the spiritual system should be of the same structure as all other patient interventions—they should be patient-centered, realistic, and measurable. Ensure that you don’t impose your spiritual or religious beliefs on your patient. There will be no therapeutic benefit for the patient in observing practices that don’t align with his or her beliefs. Therefore, investigate the patient’s spiritual and religious preferences and develop your spiritual interventions around those particularities.
Don’t make promises to the patient that you can’t uphold. For example, a couple adhering to American Indian practices asking to burn a piece of wood in the labor and delivery room after the birth of their child is an unrealistic request. However, making arrangements for the burning in a safe place outside the hospital building so that the ashes can then be brought back in for a religious ceremony is a compromise that might satisfy the couple while preserving the safe environment of the hospital.
The success of spiritual interventions can be measured by the patient’s words and actions and the words and actions of their family or support system. They’ll convey their appreciation to you for acknowledging and assisting with their spiritual and religious needs.
Of utmost importance is the need to convey respect for the patient’s religious or spiritual practices despite personal beliefs or opinions. Even if you completely object to the beliefs and tenets of the patient’s religion, you must not show your objection. It’s our duty as nurses to provide for our patients according to their needs, and this includes assessing and intervening for the system that’s too often neglected—the patient’s spiritual system.
By Ann N. Hellman, MSN, RN
Tennessee Technological University
Whitson-Hester School of Nursing