Spiritual Care Spiritual Care in Nursingin Nursing

Marcia Schnorr, RN, EdDMarcia Schnorr, RN, EdD

Certified Lutheran Lay Minister-Certified Lutheran Lay Minister-Parish NurseParish Nurse

Sielunhoito HoitotyossaSielunhoito Hoitotyossa

Spiritual care in nursingSpiritual care in nursing

Is included in most nursing textsIs included in most nursing texts Is often over-looked or discouraged in Is often over-looked or discouraged in

traditional nursingtraditional nursing Is the foundation for parish nursing Is the foundation for parish nursing

(diaconal nursing)(diaconal nursing)

St. Paul Lutheran Church St. Paul Lutheran Church (Rochelle, IL USA)(Rochelle, IL USA)

Spiritual Distress isSpiritual Distress is

““the state in which the individual the state in which the individual experiences or is at risk for experiencing a experiences or is at risk for experiencing a disturbance in his belief system that is the disturbance in his belief system that is the source of his strength and hope.” source of his strength and hope.” (Carpenito)(Carpenito)

Defining characteristicsDefining characteristics

Expresses concern with the meaning of Expresses concern with the meaning of life, suffering, and/or deathlife, suffering, and/or death

Expresses concern about belief systemExpresses concern about belief system Expresses anger toward GodExpresses anger toward God Expresses concern about his/her Expresses concern about his/her

relationship with Godrelationship with God Questions meaning of own existenceQuestions meaning of own existence

Characteristics continuedCharacteristics continued

Unable to participate in usual religious Unable to participate in usual religious practicespractices

Seeks spiritual assistanceSeeks spiritual assistance Demonstrates gallows humorDemonstrates gallows humor Displaces anger toward religious Displaces anger toward religious

representativesrepresentatives Suffers from sleep disturbances Suffers from sleep disturbances

Characteristics continuedCharacteristics continued

Alterations in mood or behaviorAlterations in mood or behavior Separated from cultural or religious tiesSeparated from cultural or religious ties Feels hopeless and helplessFeels hopeless and helpless Others…Others…

AssessmentsAssessments

Religious cues (verbal, literature, jewelry, Religious cues (verbal, literature, jewelry, behavior…)behavior…)

Emotional cuesEmotional cues Assessment guidesAssessment guides Item on “intake history”Item on “intake history” OtherOther

Stoll’s Spiritual Assessment Stoll’s Spiritual Assessment (Concept of Deity)(Concept of Deity)

Is religion or God significant to you? If so, Is religion or God significant to you? If so, can you describe how?can you describe how?

Is prayer helpful to you? What happens Is prayer helpful to you? What happens when you pray?when you pray?

Does a God or deity function in your Does a God or deity function in your personal life? If yes, can you describe personal life? If yes, can you describe how?how?

How would you describe your God or what How would you describe your God or what you worship?you worship?

Stoll’s Spiritual AssessmentStoll’s Spiritual Assessment(Source of Hope and Strength)(Source of Hope and Strength)

Who is the most important person to you?Who is the most important person to you? To whom do you turn when you need To whom do you turn when you need

help? Are they available?help? Are they available? In what ways do they help?In what ways do they help? What is your source of strength and hope?What is your source of strength and hope? What helps you the most when you feel What helps you the most when you feel

afraid or need special help?afraid or need special help?

Stoll’s Spiritual AssessmentStoll’s Spiritual Assessment(Religious Practices)(Religious Practices)

Do you feel your faith (or religion) is important to Do you feel your faith (or religion) is important to you? If yes, would you tell me how?you? If yes, would you tell me how?

Are there religious practices that are important Are there religious practices that are important to you?to you?

Has being sick made any difference in your Has being sick made any difference in your practice of praying? Your religious practices?practice of praying? Your religious practices?

What religious books or symbols are helpful to What religious books or symbols are helpful to you?you?

Stoll’s Spiritual AssessmentStoll’s Spiritual Assessment(Relation Between Spiritual Beliefs and Health)(Relation Between Spiritual Beliefs and Health)

What has bothered you the most about being What has bothered you the most about being sick (or in what has happened to you)?sick (or in what has happened to you)?

What do you think is going to happen to you?What do you think is going to happen to you? Has being sick (or what has happened to you) Has being sick (or what has happened to you)

made any difference in your feelings about God made any difference in your feelings about God or the practice of your faith?or the practice of your faith?

Is there anything that is especially frightening or Is there anything that is especially frightening or meaningful to you now?meaningful to you now?

Other useful interview questionsOther useful interview questions

What Bible character do you identify with? What Bible character do you identify with? Why?Why?

Do you have a favorite hymn? If so, what Do you have a favorite hymn? If so, what is it and why?is it and why?

Is there a Bible verse that is especially Is there a Bible verse that is especially meaningful to you? If so, what is it and meaningful to you? If so, what is it and why?why?

PlanningPlanning

Short-termShort-term Long-termLong-term individualizeindividualize

CIRCLE ModelCIRCLE Model

ImplementationImplementation

C C aringaring II ntuition ntuition R R espect for religious beliefs & practicesespect for religious beliefs & practices C autionC aution L L isteningistening E motionalE motional

CaringCaring

Demonstrating care and compassionDemonstrating care and compassion Possessing an attitude that caresPossessing an attitude that cares Caring enough to take/use the available Caring enough to take/use the available

timetime

IntuitionIntuition

Making an effort to hear what the person Making an effort to hear what the person feelsfeels

Encouraging the person to express Encouraging the person to express feelingsfeelings

Respect for Religious Beliefs Respect for Religious Beliefs and Practicesand Practices

Making appropriate referralsMaking appropriate referrals PrayingPraying Encouraging devotional activitiesEncouraging devotional activities Providing for specific rites, sacraments, Providing for specific rites, sacraments,

and observationsand observations Offering religious conversationOffering religious conversation

CautionCaution

Declining to proselytizeDeclining to proselytize Avoiding judgmentsAvoiding judgments Giving choicesGiving choices

ListeningListening

Making an effort to hear what the person Making an effort to hear what the person feelsfeels

Encouraging the person to express Encouraging the person to express feelingsfeelings

Emotional SupportEmotional Support

Working through feelingsWorking through feelings Showing loveShowing love TouchingTouching

EvaluationEvaluation

RelationalRelational PhysicalPhysical EmotionalEmotional IntellectualIntellectual Religious/SpiritualReligious/Spiritual

Case studiesCase studies

Jeff and VickiJeff and Vicki Les and DebLes and Deb LauraLaura OthersOthers

Jumalalle olkoon kunnia!Jumalalle olkoon kunnia!

To God be the glory!To God be the glory!