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Assessing a Patient’s Spiritual Needs

FEATURESA ssessing a Patient s Spiritual NeedsAComprehensive Instrument Kathleen Galek, PhD Kevin J. Flannelly, PhD Adam Vane, MA Rose M. Galek, MS, RNSeven major constructs belonging, meaning, hope, the sacred, morality, beauty, and acceptance of dying wererevealed in an analysis of the literature pertaining to patient Spiritual Needs . The authors embedded theseconstructs within a 29-item survey designed to be inclusive of traditional religion, as well as non institutional-basedspirituality. This article describes the development of a multidimensional instrument designed to assess a patient sspiritual Needs . This framework for understanding a patient s Spiritual Needs hopefully contributes to the growingbody of literature, providing direction to healthcare professionals interested in a more holistic approach to WORDS:hospitalization,palliative care,patient care, Spiritual assessment , Spiritual needsHolist Nurs Pract2005;19(2):62 69 Although empirical research is just beginning tounveil the causal links among spirituality, religion, andhealth,1,2the importance of religion and spirituality incoping with loss, stress, and illness has long 5 Many, such as Puchalski and Rom

spiritual needs. This framework for understanding a patient’s spiritual needs hopefully contributes to the growing body of literature, providing direction to healthcare professionals interested in a more holistic approach to patient well-being. KEY WORDS: hospitalization, palliative care, patient care, spiritual assessment, spiritual needs

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Transcription of Assessing a Patient’s Spiritual Needs

1 FEATURESA ssessing a Patient s Spiritual NeedsAComprehensive Instrument Kathleen Galek, PhD Kevin J. Flannelly, PhD Adam Vane, MA Rose M. Galek, MS, RNSeven major constructs belonging, meaning, hope, the sacred, morality, beauty, and acceptance of dying wererevealed in an analysis of the literature pertaining to patient Spiritual Needs . The authors embedded theseconstructs within a 29-item survey designed to be inclusive of traditional religion, as well as non institutional-basedspirituality. This article describes the development of a multidimensional instrument designed to assess a patient sspiritual Needs . This framework for understanding a patient s Spiritual Needs hopefully contributes to the growingbody of literature, providing direction to healthcare professionals interested in a more holistic approach to WORDS:hospitalization,palliative care,patient care, Spiritual assessment , Spiritual needsHolist Nurs Pract2005;19(2):62 69 Although empirical research is just beginning tounveil the causal links among spirituality, religion, andhealth,1,2the importance of religion and spirituality incoping with loss, stress, and illness has long 5 Many, such as Puchalski and Romer,have long believed that patients learn to cope withand understand their suffering through their spiritualbeliefs, or the Spiritual dimension of their lives.

2 6(p129)The intention of this study was to develop acomprehensive quantitative measure, inclusive of bothtraditional religion and noninstitutionally basedspirituality, for evaluating the Spiritual Needs ofhospitalized patients . The measure was designed inorder to be brief enough to include in clinical orepidemiologic surveys, allowing for an extensiveinvestigation of various of a patient s Spiritual Needs is nowbeing formally expressed through the JointCommission on Accreditation for Health CareOrganizations (JCAHO) and the Commission onAccreditation of Rehabilitation Facilities (CARF)mandates to conduct Spiritual assessment andFrom The HealthCare Chaplaincy, New York (Drs Galek and Flannelly);Paragon Global Consulting (Mr Vane); and the Community College ofRhode Island, Warwick (Ms Galek).

3 This research was funded, in part, by grants from the John TempletonFoundation and the Arthur Vining Davis author: Kathleen Galek, PhD, The HealthCare Chaplaincy,307 E 60th St, New York, NY 10022 (e-mail: arrangements for meeting a patient sspiritual ,8 This is particularly important inhospice and palliative care settings, where thefocus is on quality of life; controlling pain; andmeeting a person s social, emotional, and and Koenig10stated,there is little disagreement any more in the healthcarecommunity aboutwhetherspiritual care should bepart of the treatment process. In many forums, thequestion has shifted tohowspiritual care is to beprovided and, more specifically,whoshould recognizing the importance of this line ofinquiry, the authors of this study believe that thefundamental preceding question should be whatreally are a patient s Spiritual Needs .)

4 Only throughacquiring a better understanding of patients spiritualneeds will professionals be able to develop tailoredand effective Spiritual theorists and researchers11 14have writtenabout the inherent difficulties in attempting toencapsulate something as intangible and mystical asspirituality. For example, Moya and Brykczynska15write, the human spirit is not easy to define and,perhaps, there is an argument human spiritis indescribable. The question, therefore, becomeshow to understand and investigate a phenomenon thatis both transcendent and beyond the sphere of thefinite a Patient s Spiritual Needs63 Spiritual TYPOLOGIEST odiscern essential aspects of patient Spiritual Needs ,the authors reviewed several articles delineatingtypologies related to spirituality. The need tocommune with something beyond the self or toconnect with something transcendent or nonmaterialin nature is central to the Spiritual domains presentedin these articles.

5 Leder,16for example, demarcated 3distinct domains of spirituality: (1) the capacity tocommune with the sacred; (2) the capacity to becomeabsorbed by the aesthetic wonder of life; and (3) thecapacity to give and receive , Leder16observed that to becomeaware of and to deepen interconnections betweenoneself, others, and the divine is to realizeontological relatedness. Ontology, the branch ofmetaphysics that deals with the nature of being andexistence, examines the nature of spirituality and thesense of joining with the universe. A central theme ofeastern ontology is that all phenomena are unique andyet interdependently related. This is the great mysterythat keeps humankind in flux between a desire forseparateness and a yearning for intimacy. Trying tomeet our Needs , we engender a sense of separatenessand suffering in our attempts to control people andevents.

6 Consequently, interventions aimed at meetingthe Spiritual Needs of patients can be more effectivewhen we as caregivers recognize, acknowledge, andlet go of our Needs for control and allow for our innateknowledge and compassion to and Seligman17delineated a series ofcharacter strengths associated with the capacity toforge a connection with the transcendent. Theysuggested that individuals who notice and appreciatebeauty and excellence in the various domains of lifepossess the character strength of awe that connectsthem to something larger than themselves whether itis beautiful art or music or the majesty of nature. William James (1902 1999) described theappreciation of beauty as a mystical experience. Inaddition, the appreciation and cultivation of humor is acharacter strength related to experiencing defined as the capacity tolaugh; the skill of bringing smiles to the faces ofothers; the ability to see the lighter side of serioussubjects; and the talent for making, but not necessarilytelling, was one of the first healthcare professionsto address the Spiritual Needs of patients and torecognize Spiritual distress as a diagnosis,18 20and thecurrent nursing literature has some respectablescholars on spirituality.

7 For example, throughqualitative interviews with cancer patients , Tayloridentified 7 Spiritual need categories: (1) the need torelate to an Ultimate Other; (2) the need for positivity,hope, and gratitude; (3) the need to give and receivelove; (4) the need to review beliefs; (5) the need tohave meaning; (6) the need for religiosity; and (7) theneed to prepare for found that familycaregivers also experienced significant Spiritual needssimilar to the Needs of those in their care. Patientstypically turn to family members for support beforeturning to healthcare professionals. To ensure totalholistic care, it is important for nurses to attend to thespiritual Needs of family caregivers in addition to theneeds of their and Halstead22compared the narrativeresponses of nurses, chaplains, and patients regardingthe nature of Spiritual Needs .

8 The 6 category typologythat emerged from their phenomenological analysisincluded (1) religious aspects, such as prayer andtranscendence; (2) referring to experiences that arebeyond earthly existence; (3) affective feeling,including peace, comfort, and happiness; (4) values,such as health, faith, and hope; (5) communication,including talking, listening, and touching; and (6) an other category, referring to such items as questionswith death and voids. Emblen and Halstead22concluded that the provision of compassionatespiritual care can create optimal potential forhealing in biological, psychological, and socialdimensions. SPIRITUALITY IN RELATION TOTRADITIONAL RELIGIONA number of writers have explored spirituality withinthe Judeo-Christian traditions. Although the termspiritualitydoes not occur in Hebrew or Christianscriptures, there are various approaches tounderstanding the concept.

9 While some authors suchas Jones23believe that contemporary spirituality avoids the disciplined practices necessary forengagement with God, many others align withApostle Paul, who affirmed notions of thetranscendent being present in all people (Romans1:18 21). For example, Bash,24in his exploration ofspirituality within the Judeo-Christian tradition,writes, Spiritual experience is what each person saysit is, and the task of nurses is to identify and respect64 HOLISTICNURSINGPRACTICE MARCH/APRIL2005that person s expression of their Spiritual experienceand to offer them support. Western ontology, drawing more on a Cartesianunderstanding of mind-body dualism, is based on along philosophic and theologic tradition in whichspiritual experience is thought to be divorced from thebodily sphere.

10 In interviews, Fagerstr om et al25foundthat certain patient Spiritual Needs were expressedthrough caring for their bodily Needs . One patient, forexample, commented that having one s hygiene needsmet allows a sense of cleanliness which can beexperienced as confirmation of their human dignity. Pargament and colleagues26present an interestingmodel of Spiritual struggle that embracesJudeo-Christian themes as well as those from otherreligious traditions, such as Buddhism. The authorshighlight the many obstacles faced on the spiritualjourney, which they classify into 3 dimensions. (1)interpersonal struggle,asreflected in mythic storiessuch as Moses struggle for freedom against apowerful authority (the Pharaoh), (2)intrapsychicstruggle,asillustrated by Siddhartha Gautama sstruggle with his own inner demons before becomingthe enlightened Buddha, and (3)struggle with thedivine,asreflected in Christians who seek to embodythe Holy Spirit in their daily Nightingale, the founder of modernnursing, considered spirituality to be an intrinsic partof human experience and treasured the spiritualteachings of eastern texts, such as the we did not find contemporary piecesthat explored a patient s Spiritual Needs from aneastern perspective, we searched contemporaryBuddhist writings for a comprehensive model ofspirituality.