Ch 35

Question 1

spirituality

Answer 1

defined as an awareness of one’s inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself
-It includes personal beliefs that help a person maintain hope and get through difficult situations. A person’s health depends on a balance of physical, psychological, sociological, cultural, developmental, and spir- itual factors. Spirituality helps individuals achieve the balance needed to maintain health and well-being and to cope with changes in their health status.

Question 2

Self-transcendence

Answer 2

—a sense of authentically connecting to one’s inner self.
-This contrasts with transcendence, the belief that a force outside of and greater than the person exists beyond the material world

Question 3

Connectedness

Answer 3

—being intrapersonally connected within oneself, interpersonally connected with others and the environment, and transpersonally connected with God or an unseen higher power. Through connectedness patients move beyond the stressors of ev- eryday life and find comfort, faith, hope, and empowerment

Question 4

Faith and hope

Answer 4

—Faith allows people to have firm beliefs despite lack of physical evidence and enables people to believe in and es- tablish transpersonal connections. Although many people associate faith with religious beliefs, it also exists without them

Question 5

Inner strength and peace

Answer 5

—Spirituality gives people the ability to find a dynamic and creative sense of inner strength to use when making difficult decisions. This source of energy helps people stay open to change and life challenges, provides confidence in decision making, and promotes connections with others and a positive out- look on life

Question 6

Meaning and purpose in life

Answer 6

—Spirituality also helps people find meaning and purpose in both positive and negative life events

Question 7

spiritual well-being

Answer 7

defined as feelings of contentment coming from the inner self and has been shown to be related to quality of life

Question 8

Spiritual distress

Answer 8

“a disrup- tion in the life principle that pervades a person’s entire being and transcends the person’s biologic and psychosocial nature

Question 9

CRITICAL THINKING

Answer 9

Successful critical thinking requires a synthesis of knowledge, experi- ence, environmental factors, information gathered from patients, critical thinking attitudes, and intellectual and professional standards. Critical thinking allows a nurse to anticipate what to assess about a patient and to make clinical judgments about the patient’s nursing diagnoses so that clinical decisions can be made for planning and providing relevant patient-centered interventions. During assessment, consider all elements that build toward making nursing diagnoses

Question 10

FICA

Answer 10

The FICA assess- ment tool evalu- ates spirituality and is closely correlated to quality of life. FICA stands for the following criteria: F—Faith or belief; I—Importance and In- fluence, C—Community; A—Address (interventions to address).

Question 11

Summary

Answer 11

• Research shows that spirituality positively affects and enhances physical and psychological health, quality of life, health promotion behaviors, and disease prevention activities.
• Faith and hope are closely linked to a person’s spiritual well-being, providing an inner strength for dealing with illness and disability.
• Spirituality is a much broader and more unifying concept than re- ligion, as it is an inherent human characteristic that gives individu- als the energy needed to discover themselves, cope with difficult situations, and maintain health.
• Religion differs from spirituality in that it is an organized, institution- related practice that is commonly associated with particular beliefs.
• During nursing assessment of a patient’s spiritual needs, be sure to recognize cues that show problems or distress related to the pa- tient’s faith, connectedness, life and self-responsibility, life satisfac- tion, and fellowship and community. Include the patients’ cultural backgrounds, including their values about health care problems and impending treatments when conducting your assessment.
• Learning to practice caring and compassion helps you discover a patient’s life values and meaning.
• The personal nature of spirituality requires open communication and the establishment of trust and a caring relationship between you and a patient.
• As a spiritual care provider, you use clinical judgment to plan and implement direct spiritual interventions, addressing and support- ing the spiritual or religious needs of a patient and family and hav- ing discussions about family members’ feelings and patient values.
• Prayer is an evidence-based coping resource for physical and psy- chological symptoms that is often helpful in promoting a patient’s spiritual health.
• Establishing presence involves attentive listening, talking with pa- tients and answering questions, conveying a sense of trust, and simply offering your time.
• During evaluation successful outcomes reveal a patient developing an increased or restored sense of connectedness with family and maintaining, renewing, or reforming a sense of purpose in life.

Question 12

Reflective learning

Answer 12

Six years after her initial diagnosis of breast cancer and treatment, Lisa Owens was diagnosed with stage IV breast cancer. At this time, Lisa has undergone three rounds of chemotherapy. She has given up her job as a nurse manager because of the physical strain and pain due to the cancer spread and side effects from the chemotherapy. Lisa has numerous side effects from her advancing disease and chemotherapy. She has ongoing hip pain from the cancer spread to the bone, reduced sensation in her feet, chronic fatigue, and difficulty in sleeping. Joe, her husband, is still working as an accountant and continues to provide support to Lisa. Their two children are adults now and do not live at home. Their daughter is unmarried and lives two miles away. Their son is married; his wife is pregnant, and they live out of town two hours away. Lisa is worried that she will not be alive when her grand- child is born. Her husband provides most of her support at home, but this continues at times to interfere with his ability to do the work that he brings home. The nurse who has been seeing Lisa knows that she regularly attends church with her husband. Lisa is coming to the outpatient chemotherapy infusion center to begin another course of chemotherapy. She tells the nurse, “I am so tired; I am not sure that I can do this next round of chemotherapy. Each round gets harder and harder, and I have more nausea and pain. I am losing hope that the treatment is helping me.”

• What assessment information in Lisa’s situation is the most impor- tant or of immediate concern for the nurse? (Recognize Cues)
• Considering Lisa’s situation, what environmental, organizational, or other factors did you see that influence Lisa’s spiritual health? (Analyze Cues)
• Considering her assessment data and history, what would be the priority nursing problem in caring for Lisa and her family? (Priori- tize Diagnoses)
• Identify two expected outcomes for Lisa. Consider Lisa’s situa- tion and describe what nursing and medical interventions that you could utilize to achieve the expected outcomes? (Generate Solutions)
• Which nursing and medical interventions should have priority when implementing Lisa’s care plan? (Take Action)
• Considering the implementation of your plan of care for Lisa, what assessment data should you gather to determine whether the inter- ventions were effective? (Evaluate Outcomes)

Question 13

A nurse is caring for a patient who has just had a near-death expe- rience (NDE) following a cardiac arrest. Which intervention by the nurse best promotes the spiritual well-being of the patient after the NDE?
1. Allowingthepatienttodiscusstheexperience
2. Referringthepatienttopastoralcare
3. HavingthepatienttalktoanotherpatientwhohadanNDE 4. Offeringtoprayforthepatient

Answer 13

1

Question 14

2. The nurse is caring for a patient who is very depressed and decides to complete a spiritual assessment using the FICA tool. Using the FICA assessment tool, match the criteria on the left with the ap- propriate assessment question on the right.
3. F—Faith
4. I—Importance of
   spirituality
5. C—Community
6. A—Interventions to address spiritual needs
   A. Tell me if you have a higher power or authority that helps you act on your beliefs.
   B. Describe which activities give you comfort spiritually.
   C. To whom do you go for support in times of difficulty?
   D. Your illness has kept you from attending church. Is that a problem for you?

Answer 14

1a.,2d.,3c.,4b.,

Question 15

The nurse is planning spiritual care interventions for an 8-year-old patient. Based on the patient’s age, the nurse must consider which growth and development factor when planning the spiritual care? 1. This age-group’s concept of spirituality is provided by parents,
and love and affection promote spirituality.
2. This age-group begins to ask about God or a Supreme Being
and is influenced by spiritual and religious stories.
3. This age-group is fascinated with magic and mystery and often
believes illness is related to bad behavior.
4. This age-group has a clear concept of a higher spiritual being
and is interested in learning about spirituality.

Answer 15

4

Question 16

A nurse is caring for a patient who is Muslim and has diabetes mel- litus. Which of the following items does the nurse need to remove
from the meal tray when it is delivered to the patient? 1. Smallcontainerofvanillaicecream
2. Adozenredgrapes
3. Baconandeggs
4. Garden salad with ranch dressing

Answer 16

3

Question 17

A 44-year-old male patient has just been told that his wife and child were killed in an auto accident while coming to visit him in the hospital. After analyzing the assessment findings, the nurse recog- nizes that which statements made by the patient support a nursing diagnosis of Spiritual Distress related to loss of family members? (Select all that apply.)
1. “Ineedtocallmysisterforsupport.”
2. “Ihavenothingtolivefornow.”
3. “WhywouldmyGoddothistome?”
4. “Ineedtoprayforamiracle.”
5. “Iwanttobemoreinvolvedinmychurch.”

Answer 17

2.,3.,

Question 18

A patient has just been diagnosed with a malignant brain tumor.
She is alone; her family will not be arriving from out of town for an hour. What intervention does the nurse implement that best pro- vides support of the patient’s spiritual well-being at this time?
1. Make a referral to a professional spiritual care adviser.
2. Sit down and talk with the patient; have her discuss her feelings and listen attentively.
3. Move the patient’s Bible from her bedside cabinet drawer to the top of the over-bed table.
4. Ask the patient whether she would like to learn more about the implications of having this type of tumor.

Answer 18

2

Question 19

A nurse is preparing to teach an older adult who has chronic arthri- tis how to practice meditation. Which of the following teaching strategies are appropriate? (Select all that apply.)
1. Encourage family members to participate in the exercise.
2. Have the patient identify a quiet room in the home that has minimal interruptions.
3. Suggest the use of a quiet fan running in the room.
4. Explain that it is best to meditate about 5 minutes 4 times a day.
5. Show the patient how to sit comfortably with the limitation of
his arthritis and focus on a prayer.

Answer 19

2.,3.,5.,

Question 20

A nursing student is developing a plan of care for a 74-year-old-
female patient who has spiritual distress over losing a spouse. As the nurse develops appropriate interventions, which characteristics of older adults should be considered? (Select all that apply.)
1. Older adults do not routinely use complementary medicine to cope with illness.
2. Older adults dislike discussing the afterlife and what might have happened to people who have passed on.
3. Older adults achieve spiritual resilience through frequent ex- pressions of gratitude.
4. Have the patient determine whether her husband left a legacy behind.
5. Offer the patient her choice of rituals or participation in exer- cise.

Answer 20

3.,4.,5.,

Question 21

A nurse used spiritual rituals as an intervention in a patient’s care. Which of the following questions is most appropriate to evaluate the efficacy of the intervention?
1. Do you feel the need to forgive your wife over your loss?
2. What can I do to help you feel more at peace?
3. Did either prayer or meditation prove helpful to you?
4. Should we plan on having your family try to visit you more
often in the hospital?

Answer 21

3

Question 22

The nurse is caring for a 50-year-old woman visiting the outpa-
tient medicine clinic. The patient has had type 1 diabetes mellitus since age 13. She has numerous complications from her disease, including reduced vision, heart disease, and severe numbness and tingling of the extremities. Knowing that spirituality helps pa- tients cope with chronic illness, which of the following principles should the nurse apply in practice? (Select all that apply.)
1. Pay attention to the patient’s spiritual identity throughout the course of her illness.
2. Select interventions that you know scientifically support spiri- tual well-being.
3. Listen to the patient’s story each visit to the clinic, and offer a compassionate presence.
4. When the patient questions the reason for her longtime suffer- ing, try to provide answers.
5. Consult with a spiritual care adviser, and have the adviser recommend useful interventions.

Answer 22

1.,3.,