Nursing Interventions and Rationales
1. Observe client for self-esteem, self-worth, feelings of futility, or hopelessness.
R/ : Verbalization of feelings of low self-esteem, low self-worth, and hopelessness may indicate a spiritual need.
2. Monitor support systems. Be aware of own belief systems and accept client's spirituality.
R/ : To effectively help a client with spiritual needs, an understanding of one's own spiritual dimension is essential (Highfield, Carson, 1983).
3. Be physically present and available to help client determine religious and spiritual choices.
R/ : Physical presence can decrease separation and aloneness, which clients often fear (Dossey et al, 1988). This study showed an overwhelming response that client's faith and trust in nurses produces a positive effect on client and family. Spiritual care interventions promote a sense of well-being (Narayanasamy, Owens, 2001).
4. Provide quiet time for meditation, prayer, and relaxation.
R/ : Clients need time to be alone during times of health change.
5. Help client make a list of important and unimportant values.
R/ : The number one need expressed by clients who had been hospitalized, which was expressed by persons of all denominations and faiths, was for their pastor/rabbi/spiritual advisor to not abandon them. For those who did not belong to a religious/spiritual group, their number one need was to at least be asked for some type of religious/spiritual preference (Moller, 1999). Clients are experts on their own paths, and knowing their values helps in exploring their uniqueness (Dossey et al, 1988).
6. Ask how to be most helpful, then actively listen, reflect, and seek clarification.
R/ : Listening attentively and being physically present can be spiritually nourishing (Berggren-Thomas, Griggs, 1995). Obtain permission from the client to respond to spiritual needs from own spiritual perspective (Smucker, 1996).
7. If client is comfortable with touch, hold client's hand or place hand gently on arm. Touch makes nonverbal communication more personal.
8. Help client develop and accomplish short-term goals and tasks. R/ : Accomplishing goals increases self-esteem, which may be related to the client's spiritual well-being.
9. Help client find a reason for living and be available for support. "The need for a positive attitude for optimum healing was by far the most commonly mentioned subtheme by these participants and the strongest area of literature" (Criddle, 1993).
10. Listen to client's feelings about death. Be nonjudgmental and allow time for grieving
R/ : All grief work takes time and is unique. Acceptance of client differences is essential to open communication.
11. Help client develop skills to deal with illness or lifestyle changes. Include client in planning of care.
R/ : Clients perceived the experience of healing as an active process and expressed a desire to take conscious control (Criddle, 1993).
12. Provide appropriate religious materials, artifacts, or music as requested.
R/ : Helping a client incorporate rituals, sacraments, reading, music, imagery, and meditation into daily life can enhance spiritual health (Conrad, 1985).
13. Provide privacy for client to pray with others or to be read to by members of own faith.
R/ : Privacy shows respect for and sensitivity to the client.
14. See care plan for Readiness for enhanced Spiritual well-being.
Geriatric
15. Assist client with a life review and help client identify noteworthy experiences.
16. Discuss personal definitions of spiritual wellness with client. R/ : Listening attentively and helping elderly clients identify past coping strategies is part of helping with life review and finding meaning in life (Berggren-Thomas, Griggs, 1995).
17. Identify client's past sources of spirituality. Help client explore his or her life and identify those experiences that are noteworthy. Client may want to read the Bible or have it read to them.
R/ : Older adults often identify spirituality as a source of hope (Gaskins, Forte, 1995).
18. Discuss the client's perception of God in relation to the illness. R/ : Different religions view illness from different perspectives.
19. Offer to pray with client or caregivers.
R/ : Prayer was described as an important part of spirituality by caregivers (Kaye, Robinson, 1994).
20. Offer to read from the Bible or other book chosen by client. A religious ritual may comfort the client.
Multicultural
21. Assess for the influence of cultural beliefs, norms, and values on the client's ability to cope with spiritual distress
R/ : How the client copes with spiritual distress may be based on cultural perceptions (Leininger, 1996).
22. Acknowledge the value conflicts from acculturation stresses that may contribute to spiritual distress.
R/ : Challenges to traditional beliefs are anxiety provoking and can produce distress (Charron, 1998).
23. Encourage spirituality as a source of support.
R/ : African-Americans and Latinos may identify spirituality, religiousness, prayer, and church-based approaches as coping resources (Samuel-Hodge et al, 2000; Bourjolly, 1998; Mapp, Hudson, 1997).
24. Validate the client's spiritual concerns, and convey respect for his or her beliefs.
R/ : Validation lets the client know the nurse has heard and understands what was said (Stuart, Laraia, 2001; Giger, Davidhizer,1995).
