The nurse creates a referral to pastoral care when he/she realizes that the patient is in need of

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The word spirituality derives from the Latin word spiritus, which refers to breath or wind. Today, spirituality is
a. Awareness of one's inner self and a sense of connection to a higher being.
b. Less important than coping with the patient's illness.
c. Patient centered and has no bearing on the nurse's belief patterns.
d. Equated to formal religious practice and has a minor effect on health care.

ANS: A
Today, spirituality is often defined as an awareness of one's inner self and a sense of connection to a higher being, to nature, or to some purpose greater than oneself. Spirituality is an important factor that helps individuals achieve the balance needed to maintain health and
well-being and to cope with illness. It positively affects and enhances health, quality of life, health promotion behaviors, and disease prevention activities. Nurses need an awareness of their own spirituality to provide appropriate and relevant spiritual care to others. The concepts of spirituality and religion are often interchanged, but spirituality is a much broader and more
unifying concept than religion. The human spirit is powerful, and spirituality has different meanings for different people.

The nurse is caring for a patient who claims that he does not believe in God, nor does he believe in an "ultimate reality." The nurse realizes that this patient
a. Is devoid of spirituality.
b. Is an atheist/agnostic.
c. Finds no meaning through relationships with others.
d. Believes that what he does is meaningless.

ANS: B
Some individuals do not believe in the existence of God (atheist) or believe that there is no known ultimate reality (agnostic). This does not mean that spirituality is not an important concept for the atheist or the agnostic. Atheists search for meaning in life through their work and their relationships with others. Agnostics discover meaning in what they do or how they live because they find no ultimate meaning for the way things are. They believe that people bring meaning to what they do.

The nurse is caring for a patient who is terminally ill with very little time left to live. The patient states, "I always believed that there was life after death. Now, I'm not so sure. Do you think there is?" The nurse states, "I believe there is." The nurse has attempted to
a. Strengthen the patient's religion.
b. Provide hope.
c. Support the patient's agnostic beliefs.
d. Support the horizontal dimension of spiritual well-being.

ANS: B
When a person has the attitude of something to look forward to, hope is present. Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. This is not evident here. Agnostics believe that there is no known ultimate
reality. This would indicate a lack of belief in life after death. The horizontal dimension of spiritual well-being describes positive relationships and connections people have with others. In this case, the patient is more concerned with the vertical dimension, which supports the
transcendent relationship with God or some other higher power.

In discussing spiritual well-being, the nurse identifies that the vertical dimension involves
a. The positive relationships and connections people have with others.
b. The transcendent relationship between a person and God.
c. Confidence in something for which there is no proof.
d. Providing an attitude of something to live for and look forward to.

ANS: B
The concept of spiritual well-being is often described as having two dimensions. The vertical dimension supports the transcendent relationship between a person and God or some other higher power. The horizontal dimension describes positive relationships and connections people have with others. Faith provides confidence in something for which there is no proof. When a person has the attitude of something to live for and look forward to, hope is present.

The nurse is admitting a patient to the hospital. The patient states that he is a very spiritual person but does not practice any specific religion. The nurse understands that these statements
a. Are contradictory.
b. Indicate a strong religious affiliation.
c. Indicate a lack of faith.
d. Are reasonable.

ANS: D
These statements are reasonable and are not contradictory. Many people tend to use the terms
spirituality and religion interchangeably. Although closely associated, these terms are not synonymous. Religious practices encompass spirituality, but spirituality does not need to include religious practice. When a person has the attitude of something to live for and look forward to, hope is present.

A complex concept that is unique to each individual; is dependent upon a person's culture, development, life experiences, beliefs, and ideas about life; and is a unifying theme in peoples' lives is called
a. Spirituality.
b. Religion.
c. Self-transcendence.
d. Faith.

ANS: A
Spirituality is a complex concept that is unique to each individual; is dependent upon a person's culture, development, life experiences, beliefs, and ideas about life; and is a unifying theme in peoples' lives. Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. Self-transcendence is the belief that there is a force outside of and greater than the person. Faith allows people to have firm beliefs despite lack of physical evidence.

Which of the following statement about religion and spirituality is true?
a. Religion is a unifying theme in people's lives.
b. Spirituality is unique to the individual.
c. Spirituality encompasses religion.
d. Religion and spirituality are synonymous.

ANS: B
Spirituality is a complex concept that is unique to each individual. Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. People from different religions view spirituality differently. Although closely associated, spirituality and religion are not synonymous. Religious practices encompass spirituality, but spirituality does not need to include religious practice.

The nurse creates a referral to pastoral care when he/she realizes that the patient is in need of
a. Psychiatric care.
b. Return to religious affiliation.
c. Spiritual care.
d. Transfer to the psychiatric unit.

ANS: C
Spiritual care helps people identify meaning and purpose in life, look beyond the present, and maintain personal relationships, as well as a relationship with a higher being or life force. The patient may need psychiatric care and may be transferred to the psychiatric unit, but referral to
pastoral care will not provide that. Return to a religious affiliation may follow a return to spiritual health.

The nurse is admitting a patient who is a member of the Seventh Day Adventist religion. The physician has written an order for specific tests to be done the next day, which is Saturday. The nurse should
a. Discuss the patient's beliefs about the Sabbath.
b. Order the tests without questioning.
c. Inform the physician that the tests cannot be performed.
d. Reorder the tests for Sunday.

ANS: A
It is essential to consider cultural differences and explore personal preferences when determining nursing interventions to enhance spiritual well-being. Some Seventh Day Adventists may not mind having tests on the Sabbath. Others might. Ordering the tests without questioning may lead to patient refusal later and to wasted resources as well as spiritual distress for the patient. Informing the physician that the tests cannot be performed is premature without speaking with the patient first. It is not in the realm of the nurse to reorder tests. Some tests may be critical and may need to be done on the Sabbath.

The nurse and the patient have the same religious affiliation. Because of this, the nurse
a. Can assume that they have the same spiritual beliefs.
b. Should not impose her personal values on the patient.
c. Must use an assessment tool to assess the patient's beliefs.
d. Can skip the spiritual belief assessment.

ANS: B
The nurse can use an assessment tool or direct an assessment with questions based on principles of spirituality, but it is important not to impose personal value systems on the patient. This is particularly true when the patient's values and beliefs are similar to those of
the nurse because it then becomes very easy to make false assumptions. It is important to conduct the spiritual belief assessment; conducting an assessment is therapeutic because it expresses a level of caring and support.

When caring for a terminally ill patient, the nurse should focus on the fact that
a. Spiritual care is possibly the least important nursing intervention.
b. Spiritual needs often need to be sacrificed for physical care priorities.
c. The nurse's relationship with the patient allows for an understanding of patient priorities.
d. Members of the church or synagogue play no part in the patient's plan of care.

ANS: C
The nurse's relationship with the patient allows the nurse to understand the patient's priorities. Spiritual priorities do not need to be sacrificed for physical care priorities. When a patient is terminally ill, spiritual care is possibly the most important nursing intervention. If the patient participates in a formal religion, involve in the plan of care members of the clergy or members of the church, temple, mosque, or synagogue.

The patient is admitted with chronic back pain. The nurse who is caring for this patient should
a. Focus on finding quick remedies for the back pain.
b. Look at how pain influences the patient's ability to function.
c. Realize that the patient's only goal is relief of the back pain.
d. Help the patient realize that there is little hope of relief from chronic pain.

ANS: B
Do not just look at the patient's back pain as a problem to solve with quick remedies, but rather look at how the pain influences the patient's ability to function and achieve goals established in life (not just pain relief). Mobilizing the patient's hope is central to a healing relationship.

In caring for the patient's spiritual needs, the nurse understands that
a. Establishing presence is part of the art of nursing.
b. Presence involves "doing for" the patient.
c. A caring presence involves listening to the patient's wishes only.
d. The nurse must use her expertise to make decisions for the patient.

ANS: A
Establishing presence is part of the art of nursing. Presence involves "being with" a patient versus "doing for" a patient. Demonstrate a caring presence by listening to the patient's concerns and willingly involving family in discussions about the patient's health. Show self-confidence when providing health instruction, and support patients as they make decisions about their health.

The patient is in the intensive care unit (ICU), which has strict posted visiting hours and limits the number of visitors to two per patient at any one time. The patient is asking to see his wife and two daughters. The nurse should
a. Tell the patient that they will be allowed to visit at the appropriate time.
b. Allow the wife and one daughter to enter the ICU, but not the other daughter.
c. Allow the two daughters to visit, and let the wife visit when they leave.
d. Allow the wife and daughters to visit at the patient's request.

ANS: D
Use of support systems is important in any health care setting. When patients depend on family and friends for support, encourage them to visit the patient regularly. As long as no interference with active patient care is involved, there is no reason to limit visitation.

The nurse is caring for a patient who has been diagnosed with a terminal illness. The patient states, "I just don't feel like going to work. I have no energy, and I can't eat or sleep." The patient shows no interest in taking part in his care. The nurse should
a. Not be concerned about self-harm because the patient has not indicated any desire toward suicide.
b. Ignore individual patient goals until the current crisis is over.
c. Encourage the patient to purchase over-the-counter sleep aids to help him sleep.
d. Assess the potential for suicide and make appropriate referrals.

ANS: D
A decreased appetite and level of energy and not wanting to be involved in care are signs of hopelessness. The nurse should assess for risk of the patient harming himself or others. The nurse should set goals that are important to the patient. Recommending good sleep hygiene habits is more appropriate than giving over-the-counter sleep aids.

The patient is having a difficult time dealing with his AIDS diagnosis. He states, "It's not fair. I'm totally isolated from my family because of this. Even my father hates me for this. He won't even speak to me." The nurse needs to
a. Assure the patient that his father will accept his situation soon.
b. Use therapeutic communication to establish trust and caring.
c. Point out that the patient has no control and that he has to face the consequences.
d. Tell the patient, "If your father can't get over it, forget it. You have to move on."

ANS: B
The nurse needs to use therapeutic communication to establish trust and a caring presence because providing spiritual care requires caring, compassion, and respect. The nurse should not offer false hope. The nurse should help the patient maintain feelings of control. The nurse
should encourage renewing relationships if possible and establishing connections with self, significant others, and God.

The nurse is caring for a patient who is in the final stages of his terminal disease. The patient is very weak but refuses to use a bedpan, and wants to get up to use the bedside commode. What should the nurse do?
a. Explain to the patient that he is too weak and needs to use the bedpan.
b. Insert a rectal tube so that the patient no longer needs to actively defecate.
c. Enlist assistance from family members if possible and assist the patient to get up.
d. Put the patient on a bedpan and stay with him until he is finished.

ANS: C
Establishing presence is part of the art of nursing. Presence involves "being with" a patient versus "doing for" a patient. Demonstrate a caring presence by listening to the patient's concerns and willingly involving family in discussions about the patient's health. The nurse should support patients as they make decisions about their health. If at all possible, the nurse should encourage the patient to maintain as much independence as possible. Inserting a rectal tube involves "doing for" instead of "being with." Placing the patient on the bedpan is against
the patient's wishes and is another form of "doing for."

In assessing the spiritual health of her patients, the nurse understands that
a. Spiritual beliefs change as patients grow and develop.
b. Spiritual health in older adults leads to peace and acceptance of others.
c. Older adults often express spirituality by focusing on themselves.
d. The basis of beliefs among older people is focused on one or two factors.

ANS: A
Spiritual beliefs change as patients grow and develop. Health spirituality in older adults leads to peace and acceptance of self. However, older adults often express their spirituality by turning to important relationships and giving of themselves to others. Beliefs among older
people vary based on many factors, such as gender, past experience, religion, economic status, and ethnic background.

When evaluating a patient's risk for spiritual crises, which of the following are part of the evaluation process? (Select all that apply.)
a. Review the patient's self-perception regarding spiritual health.
b. Review the patient's view of his/her purpose in life.
c. Discuss with family and associates the patient's connectedness.
d. Ask whether the patient's expectations are being met.
e. Impress on the patient that spiritual health is permanent once obtained.

ANS: A, B, C, D
One critical thinking model for spiritual health evaluation lists the evaluation process as including a review of the patient's self-perception regarding spiritual health, the patient's view of his/her purpose in life, discussion with the family and close associates about the patient's connectedness, and determining whether the patient's expectations are being met. Attainment of spiritual health is a lifelong goal.

Spiritual distress has been identified in a patient who has been diagnosed with AIDS. Upon evaluating the following interventions, which are appropriate for the diagnosis of Spiritual distress? (Select all that apply.)
a. Develop activities to heal body, mind, and spirit.
b. Assess for potential suicide.
c. Offer to pray with the patient.
d. Teach relaxation, guided imagery, and meditation.
e. Have patient avoid church attendance.

ANS: A, C, D
Interventions that are appropriate for the nursing diagnosis of Spiritual distress include (1) helping the patient develop/identify activities to heal body, mind, and spirit; (2) offering to pray with the patient; and (3) teaching relaxation, guided imagery, and medication. Assessing
for potential suicide would be appropriate for the nursing diagnosis of Hopelessness. Attendance at church should be encouraged.

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