The nurses’ role in providing holistic care for a patient should include a spiritual assessment upon hospitalization. The question is, are nurses given the proper training on when to use an assessment tool and if so, how to plan care based on the results for a more holistic healing?

Providing spiritual care for patients becomes more complicated for the nurse as the definition of religion and spirituality seems to blend together. Addressing key nursing strategies, such as educating nurses on how to properly use a spiritual assessment tool, identifying what spiritual therapies are provided or available to patients, and what therapies nurses have found to be beneficial during the healing process are essential in allowing nurses to provide a plan of care that is focused on the overall holistic healing of the patient.
Nurses are in an excellent position to provide spiritual care to patients that can positively impact their healing process. Recognizing the patient’s spirituality may also help to enhance the nurse-patient relationship. Spiritual or holistic nursing is an area that has been neglected within nursing education. Concern over conflicting spiritual values between nurse educators, students, and patients may cause educators and students to avoid these difficult areas of care. (Lovanio & Wallace 2007). When approaching a patient about their spirituality, the nurse must be sensitive and cautious. Spiritual assessment and care should be based on a relationship of trust between patient and nurse. It will involve awareness of the person's culture, social and spiritual preferences, as well as a respect for their beliefs and religious practices. Spirituality is a core component of holistic healing as it provides the foundation for hope and faith that life will continue on through their sickness. When spirituality and emotional needs are not addressed, a patient’s hope can quickly turn to depression, their faith to disbelief, and their will to live can fade. Nurses are in an ideal position to provide spiritual care to patients but many are hesitant to because they lack the experience and education to do so.
Educating nurses on how to properly use a spiritual assessment tool to address patient’s needs is a crucial part of the solution. According to Power (2006), one problem nurses run into in America is that spirituality is often linked to religion. With spirituality being such an important part of the health assessment, nurses are struggling with ways to integrate any assessment tool that is acceptable for everyone. There are several different tools used but the most effective tool is simply using general observation and encouraging patients to talk about their spirituality. Power (2006) states that for nurses to be more sensitive to a patient’s culture and religious practices, a nurse might simply ask what a patients’ belief system is and if there is a pressing concern. Nurses might also consider taking a simple spiritual history. This history should address the patient's spiritual attitudes and value system, spiritual development, and sense of meaning and purpose spirituality may play in the patient's life. The biggest problem found in hospitals is nurses admit they need more education in conducting a spiritual assessment and feel they would be better prepared if there was a way to combine an informal assessment with a more specific assessment tool such as a spiritual history (Power 2006). No matter when, how, or what assessment tool is used, nurses agree that by gaining valuable information about the patients spirituality can be vital to their healing.
While educating nurses is important, another key strategy is identifying what spiritual therapies are available to the patient. Since many nurses feel they are undereducated when it comes to spiritually assessing their patients, Grant (2004) says that nurses are equally unaware of the different interventions and therapies available to their patients. Spiritual interventions should not be limited to services provided by a chaplain or priest but should also include more basic human needs. Some simple therapies that could be given to patients include things such as touch, therapeutic conversation, listening, prayer or meditation, or a referral to other resources inside or outside of the hospital.
Many patients do not think to ask nurses for spiritual support. But if nurses provide simple therapies, then patients develop a bond with their nurse that will make it easier to seek the support they need. Other interventions that patients should be made aware of are alternative therapies such a biofeedback and acupuncture. No matter which therapies or interventions patients choose, nurses should make all options available and encourage patients to seek out what fits their needs and beliefs best.
Knowing what therapies are available is important, but also knowing what therapies and interventions other nurses have found beneficial can greatly impact nurse’s ability to make the biggest difference. Dembner (2005) concludes that many people use prayer as an acceptable belief or tool for healing their loved ones. The difference that prayer makes is to the patient’s spirit and the level of hope they have during their healing process. Other nurses say that their patients do not pray but like to meditate or take quiet moments to reflect on the past and future. Adopting a nursing philosophy that routinely includes therapeutic touch, active listening, appropriate humor, referral to a spiritual counselor and understanding can keep hope alive in patients when physical healing is not taking place. Healing of the soul can give the patient the peace they need to deal with the physical stress of the illness.
Educating nurses on how to approach a patient with spiritual needs is crucial if a patient’s hope is going to be kept alive. Holistic healing can only take place if the whole body is healing as one. Recognizing a nurses own limitations and knowing when to make a referral, or utilizing other members of the team is as important for spiritual care as it is for other aspects of care. Implementation of key nursing strategies such as educating nurses on how to properly use a spiritual assessment tool to address the patients needs, identifying what spiritual therapies are available, and what therapies nurses have found to be beneficial during the healing process are essential in allowing nurses to provide a plan of care that is focused on the overall holistic healing of the patient.


a. Intervention 1 – Educating nurses on how to properly use a spiritual assessment tool to address patient’s needs is crucial part of healing

i. disadvantage 1 – Nurses do not receive enough education in school to be able to use the spiritual assessment tool correctly
1. Nurses may lack the confidence to broach spiritual issues with patients and their families owing to limited dialogue on spirituality in education and practice.(Cavendish 2005) Most educational experience is limited in assessments practiced in nursing school or during a school’s clinical setting, with spiritual care inconsistently or infrequently addressed.
2.Cavendish, R., DiJoseph, J. (2005 July/Aug). Expanding the Dialogue on Prayer Relevant to Holistic Care. Holistic Nursing Practice. 19(4), 147-154. Retrieved February 4, 2008 from EBSOC Research Database.


ii. disadvantage 2 –Spirituality is difficult to teach to a wide range of people
1. There may be as many different spiritual values and beliefs as there are individuals. Varying spiritual values may make the range of spiritual interventions difficult
for nurses. The lack of emphasis on spiritual assessments and care in nursing school may be because some educators believe that spirituality cannot be taught, but must be modeled by nurse educators in order for students to learn to address the spiritual needs of patients. Nursing educators often lack spiritual education and are consequently ill-prepared to teach spiritual assessment and interventions to students.(Lovanio (2007) Plus, concern for conflicting spiritual values between nurse educators, students and patients, may cause nurse-educators to avoid these difficult areas.
2. Lovanio, K., & Wallace, M. (2007 Jan/Feb). Promoting Spiritual Knowledge and Attitudes: a student nurse education project. Holistic Nursing Practice, 21(1), 42-48. Retrieved January 3, 2007 from Expanded Academic ASAP database.



b. Intervention 2 –Identifying what spiritual therapies & interventions other nurses have found beneficial can greatly impact nurse’s ability to make the biggest difference

i. disadvantage 1 – Spiritual care is not clearly defined
1. Nurses are often not comfortable providing spiritual care and they may not be able to distinguish spiritual needs from religious needs. Cavendish found that spiritual care activities are not clearly defined in the nursing education, and few spiritual care interventions are outlined in nursing care books to guide nurses with their care. The private nature of spirituality may be another reason that spiritual interventions are not initiated.
2. Cavendish, R., Konecny, L., Mitzeloitis, C., Russo, D. (2003 Oct-Dec). Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels. International Journal of Nursing Terminologies and Classifications. Retrieved February 4, 2008 from http://findarticles.com/p/articles/mi_qa4065/is_200310/ai_n9312174/pg_7

ii. disadvantage 2 – Many time spiritual care and interventions are not notated in the patients charts
1. Spiritual care activities (eg, praying with patients or supporting their prayer activities) are rarely found in nursing notes. If nurses are providing spiritual care, many times it is not being documented correctly. In a 2004 study some nurses claim the reason they do not document the type of spiritual care they provided is because they do not know how to document it. Typically, the only reference to spirituality in acute care settings relates to asking if patients would like to visit with a chaplain.
2. Grant, Don. (2004 Jan/Feb). Spiritual interventions: How, when, and why nurses use them. Holistic Nursing Practice, 18 (1), 36 – 42. Retrieved January 3, 2007 from Expanded Academic ASAP database.


References

Cavendish, R., Konecny, L., Naradovy, L., Kraynyak Luise, B., Como, B.,Okumakpeyi, P., Mitzeliotis, C., & Lanza, M. (2006 Jan/Feb). Patients' perceptions of spirituality and the nurse as a spiritual care provider. Holistic Nursing Practice, 20(1), 41-48. Retrieved January 3, 2007 from Expanded Academic ASAP database.

Cavendish, R., DiJoseph, J. (2005 July/Aug). Expanding the Dialogue on Prayer Relevant to Holistic Care. Holistic Nursing Practice. 19(4), 147-154. Retrieved February 4, 2008 from EBSOC Research Database.

Cavendish, R., Konecny, L., Mitzeloitis, C., Russo, D. (2003 Oct-Dec). Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels. International Journal of Nursing Terminologies and Classifications. Retrieved February 4, 2008 from http://findarticles.com/p/articles/mi_qa4065/is_200310/ai_n9312174/pg_7

Dembner, A. (2005, July 25). A Prayer for health. The Boston Globe, Retrieved March 15, 2007.

Grant, Don. (2004 Jan/Feb). Spiritual interventions: How, when, and why nurses use them. Holistic Nursing Practice, 18 (1), 36 – 42. Retrieved January 3, 2007 from Expanded Academic ASAP database.

Lovanio, K., & Wallace, M. (2007 Jan/Feb). Promoting spiritual knowledge and attitudes: a student nurse education project. Holistic Nursing Practice, 21(1), 42-48. Retrieved January 3, 2007 from Expanded Academic ASAP database

Power, Jeanette. (2006 March). Spiritual assessment: developing an assessment tool. Nursing Older People, 18 (2), 16-21. Retrieved January 3, 2007 from Expanded Academic ASAP database.

Ray, Rebecca. (2004 February). The faith connection. Retrieved February 4, 2007 from http://www.nurseweek.com/news/features/04-02/faith_3.asp