SPIRITUAL INTERVENTION AND THE SCIENCE OF UNITARY HUMAN BEINGS

Australian College of Holistic Nurses5th INTERNATIONAL CONFERENCE 2002

Touching the Spirit:Ancient Wisdom in the Art and Science of Future Nursing

Hahndorf, SA Australia

Thomas Cox RN, MS, MSW, MS (Nursing)Doctoral Candidate

Virginia Commonwealth UniversitySchool of NursingNovember, 2002

Objectives

• Describe the context for spiritual interventions from a Rogerian paradigm

• Review literature on spirituality relevant to spiritual interventions

• Describe two successful interventions delivered with minimal organizational backing

• Suggest paths to spiritual intervention in practice

PremisesOpportunities for spiritual interventions arise naturally when

we attend to the integrality of the human-environment fields, can be provided with minimal cost, time, and help if the caregiver is attentive, responsive and creative.

Barriers to spiritual expression impair the ability of clients to address their own spirituality - whether the clients and staff perceive them as internal or external to the client, or do not see them at all.

Removing obstacles to spiritual expression are likely to be more effective than efforts to compensate for such obstacles, allowing people to engage naturally in spiritually meaningful activities is easier than mobilizing resources

Science of Unitary Human BeingsHumans are energy fields - integral with and in continuous mutual process with environmental energy fields

• Though Rogers does not specifically address spirituality, integrality is similar to other spiritual conceptions such as oneness, prime mover, Freud’s ‘oceanic feeling’, flow, presence, nature, being

• Malinski - integrality is what is experienced when people have spiritual experiences.

• SUHB nurses often center and meditate before nursing activities, as do other nurses

Dimensions of SpiritualityMeaning-making

Meaning, purpose, or significance of human lifeValues clarification

beliefs and standards about what we hold to be true, beautiful, sacred, profane

Transcendental or integral relationship to the infiniteexperience and appreciation of pandimensionality; oceanic

feeling, synchronicity, archetypes, unboundedness Connecting with self and others

including relationship with God(dess), higher power, Gaia Unfolding/Becoming

Beliefs regarding an evolutionary course to life, that we evolve consciously, and to a higher state of being

Defining Characteristics of Spiritual Distress

• Necessary: Experiencing a disturbance one’s belief system.

• Possible:– Questioning of one’s own belief system.– Experiences discouragement, despair, spiritual emptiness– Unable to practice usual religious rituals.– Has ambivalent feelings (doubts) about beliefs.– Believe (s)he has no reason to live.– Emotionally detached from oneself and significant others.– Is concerned, angry, resentful, afraid – regarding life,

anguish, death.– Asks for help dealing with spiritual issues/doubts

S 1

• Impaired Coping• Humor• to facilitate appreciation of that which is funny, to relieve

tensions• Hopelessness• Hope instillation• to promote a positive sense of the future• Spiritual Distress• Spiritual support• to facilitate a sense of inner peace• Spiritual Well-Being• Spiritual growth facilitation• to support growth/reflection reexamination of values

Institutional Support for Spiritual Work• Joint Commission for Accreditation of Healthcare

Organizations (JCAHO) – Address the spiritual needs of diverse clients

• World Health Organization – The definition of health includes four domains of well-

being: physical, mental, social and spiritual. • The North American Nursing Diagnosis Association

– spiritual distress is a nursing diagnosis

• International Council of Nurses Code for Nurses– Requires that nurses address patients’ spiritual needs

• Nursing Interventions Classification System – "hope instillation", "spiritual growth facilitation" and

"spiritual support" are appropriate nursing interventions

Examples of Spiritual InterventionsIssue/Diagnosis Action Justification

Hopelessness Instill Hope

Help clients achieve a

positive view toward the

future

Spiritual DistressSpiritual support

Help clients achieve a sense of inner peace

regardless of the situation they

face

Spiritual Well-Being

Assist clients with

spiritual growth

Support clients efforts to grow, reflect on and re-examine values, decisions, and

actions

Impediments to Spiritual Intervention

• Lack of specific resources

• Differing definitions of spirituality and religion

• Uncertainty of the appropriateness of spiritual intervention

• Lack of peer support and limited continuity for spiritual interventions

• Inadequate resources for specific spiritual interventions.

The Clients

• J - A short term, though considered to be a potentially long-term referral for chronic care, voluntary, acute admission to a university affiliated in-patient, mental health facility

• S – a long-term (15+ years) patient at a state run psychiatric hospital on a ward for aggressive male clients

J 1

• Young, White/American-Indian male, severe depression, suicidal ideation – deemed long-term.

• Had not spoken since admission and refused medications

• Approached casually, sat side by side for 20 minutes, and eventually asked how he felt about being ‘here’.

• He stated distaste for being unable to be ‘outside’.

J 2• Upon further gentle probing around Native

American issues – explains that he spent most of his time hunting, fishing and scavenging on family land.

• Intervention - pharmaceuticals are a method of healing, blended by powerful, shamanic figures, based on natural healing remedies found in nature

• J accepts meds, works on several healing issues, and leaves in a matter of days.

S 1

• Older, African-American male.

• Hospitalized in a public psychiatric hospital for 20+ years.

• Refuses to sleep in a bed

• Frequently heard mumbling: “Come to Jesus”

• Behavioral intervention team tries traditional behavior modification approach with edible re-inforcers.

S 2

• S eats treats and refuses to stay in room

• Intervention – secure a tape player from behavioral team and play Gospel music in client’s room.

• Client eats snack, listens to music, unfolds unused bed, climbs in and sleeps for several hours – first use of a bed in 8 years

• Over several days, when nursing staff took the time to set the environment in his new room up, and sit with him for a few minutes, S would quietly eat his snacks and spend some time sleeping in his room

Recommendations 1• Spiritual interventions are as much a matter of

recognizing the need as of developing the intervention.

• Often, all that is needed is permissions frequently denied in the setting, to be themselves.

• Resources for spiritual interventions are low cost, flexible, and need not present conflicts for staff.

• Attend to the expressed needs, the impediments to immediate gratification, and use a little creativity.

Recommendations 2J’s behavior and ideation could have been interpreted

as delusional or a symptom of substance abuse rather than spirituality – accepting his frame of reference for his behavior as spiritual was a key to working with him.

Recommendations 2S was a frequently violent and nearly impossible to

understand when agitated. Nobody ever thought about why he was singing or how it might be used to help him.

In fact, it was conventional wisdom on the unit that when S started singing he was soon likely to get violent.

In fact, an entire team of psychologists, nurses, behavior therapists, and social workers designed a behavioral intervention that was nowhere near as effective as a cassette tape with hyms.

S 1

• Older,

S 1

• Older,