NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021.
Demonstrate principles of holistic care by incorporating cultural, religious, and spiritual influences on patient health
Explain the interconnection between spirituality and religious concepts as they relate to health and spiritually sensitive nursing care
Describe methods to assess the spiritual and religious preferences, strengths, concerns, or distress of clients and plan appropriate nursing care
Spirituality includes a sense of connection to something bigger than oneself and typically involves a search for meaning and purpose in life. People may describe a spiritual experience as sacred or transcendent or simply feel a deep sense of aliveness and interconnectedness. Some people’s spiritual life is linked to a religious association with a church, temple, mosque, or synagogue, whereas others pray and find comfort in a personal relationship with God or a higher power and still others find meaning through their connections to nature or art. A person’s definition of spirituality and sense of purpose often change throughout one’s lifetime as it evolves based on personal experiences and relationships. [ 1 ]
Over the past decade, research has demonstrated the importance of spirituality in health care. Spiritual distress is very common in patients and their family members experiencing serious illness, injury, or death, and nurses are on the front lines as they assist these individuals to cope. Addressing a patient’s spirituality and providing spiritual care have been shown to improve patients’ health and quality of life, including how they experience pain, cope with stress and suffering associated with serious illness, and approach end of life. [ 2 ] , [ 3 ]
Consensus-driven recommendations define a spiritual care model where all clinicians address spiritual issues and work with trained chaplains who are spiritual care specialists. [ 4 ] , [ 5 ] By therapeutically using presence, unconditional acceptance, and compassion, nurses often provide spiritual care and help patients find hope and meaning in their life experiences. [ 6 ] The Interprofessional Spiritual Care Education Curriculum (ISPEC), developed by George Washington University for health care professionals, is an education initiative to improve spiritual care for seriously ill patients in the United States and internationally. This chapter will introduce concepts included in the ISPEC curriculum, review religious beliefs and practices of various world religions, and discuss therapeutic interventions that nurses can use to promote patients’ and their own spiritual well-being.
Pilger C., Molzahn A. E., de Oliveira M. P., Kusumota L. The relationship of the spiritual and religious dimensions with quality of life and health of patients with chronic kidney disease: An integrative literature review. Nephrology Nursing Journal. 2016; 43 (5):411–426. ↵ [PubMed : 30550069 ]
Puchalski C., Jafari N., Buller H., Haythorn T., Jacobs C., Ferrell B. Interprofessional spiritual care education curriculum: A milestone toward the provision of spiritual care. Journal of Palliative Medicine. 2020; 23 (6):777–784. ↵ [PubMed : 31895621 ] [CrossRef]
Pilger C., Molzahn A. E., de Oliveira M. P., Kusumota L. The relationship of the spiritual and religious dimensions with quality of life and health of patients with chronic kidney disease: An integrative literature review. Nephrology Nursing Journal. 2016; 43 (5):411–426. ↵ [PubMed : 30550069 ]
Puchalski C., Jafari N., Buller H., Haythorn T., Jacobs C., Ferrell B. Interprofessional spiritual care education curriculum: A milestone toward the provision of spiritual care. Journal of Palliative Medicine. 2020; 23 (6):777–784. ↵ [PubMed : 31895621 ] [CrossRef]
Erickson, H. (2007). Philosophy and theory of holism. The Nursing Clinics of North American, 42(2). 10.1016/j.cnur.2007.03.001 ↵. [PubMed : 17544676 ] [CrossRef]
When patients are initially diagnosed with an illness or experience a serious injury, they often grapple with the existential question, “Why is this happening to me?” This question is often a sign of spiritual distress. Spiritual distress is defined by NANDA-I as, “A state of suffering related to the inability to experience meaning in life through connections with self, others, the world, or a superior being.” [ 1 ] Nurses can help relieve this suffering by therapeutically responding to patients’ signs of spiritual distress and advocating for their spiritual needs throughout their health care experience.
Provision 1 of the ANA Code of Ethics states, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person” and “optimal nursing care enables the patient to live with as much physical, emotional, social, and religious or spiritual well-being as possible and reflects the patient’s own values.” [ 2 ]
Spiritual well-being is a pattern of experiencing and integrating meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself. [ 3 ] Spirituality is defined by the Interprofessional Spiritual Care Education Curriculum (ISPEC) as, “A dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence and experience relationship to self, family, others, community, society, nature, and the significant or sacred.” [ 4 ] Spiritual needs and spirituality are often mistakenly equated with religion, but spirituality is a broader concept. Elements of spirituality include faith, meaning, love, belonging, forgiveness, and connectedness. [ 5 ] Spirituality and spiritual values in the context of nursing are closely intertwined with the concept of caring. [ 6 ] See Figure 18.1 [ 7 ] for an illustration of spirituality.
An integrative review of nursing research and resources was completed in 2014 to describe the impact of spirituality and spiritual support in nursing. [ 8 ] See the following box for discussion of findings from this integrative review.
An integrative review of nursing literature selected 26 articles published between 1999 and 2013 to describe the experiences of spirituality and the positive impact of spiritual support in nursing literature. [ 10 ] Spirituality was described as the integration of body, mind, and spirit into a harmonious whole (often referred to as holistic care). Spirituality was associated with the development of inner strength, looking into one’s own soul, believing there is more to life than worldly affairs, and trying to understand who we are and why we are on this earth.
Transcendence was described as an understanding of being part of a greater picture or of something greater than oneself, such as the awe one can experience when walking in nature. It was also expressed as a search for the sacred through subjective feelings, thoughts, and behaviors. Spirituality was found to have a positive effect on patients’ health and promoted recovery by viewing life from different perspectives and looking beyond one’s own anxiety to develop an understanding of illness and change.
Relationships and connectedness were also found to be powerful spiritual interventions that contributed to an individual’s spirituality. This included embracing, crying together, gift giving, having coffee together, and visiting each other. Laughter, happy thoughts, and the smiles of others were considered comforting. Being with others was described as a primary spiritual need, and conversation was unnecessary. Spirituality brought about the realization that the relationship with family and friends is important and involves finding a healthy balance in relationships among friends, family, society, and a higher power. Presence was the most influential element in positively influencing recovery. The presence of family and friends was a calming experience that brought forth comfort, peace, happiness, joy, acceptance, and hope.
Nurses facilitate their patients’ search for meaning by enabling them to express personal beliefs, as well as by supporting them in taking part in their religious and cultural practices. Furthermore, nurses assess and meet their patients’ spiritual needs by using active listening when talking, asking questions, and picking up patient cues. Active listening requires nurses to be fully present, especially when patients appear depressed or upset.
Nurses were found to use their own spirituality when helping patients achieve spiritual well-being. A desire to help others in need is an important part of spirituality, which is also described as discovering meaning and purpose in life and offering the gift of self to others. Helping others also brings a sense of self-worth, personal fulfilment, and satisfaction.
The Joint Commission requires that health care organizations provide a spiritual assessment when patients are admitted to a hospital. Spiritual assessment can include questions such as the following:
Who or what provides you with strength or hope? How do you express your spirituality? What spiritual needs can we advocate for you during this health care experience?In addition to performing a routine spiritual assessment on admission, nurses often notice other cues related to a patient’s spiritual distress or desire to enhance their spiritual well-being. When these cues are identified, spiritual care should be provided to relieve suffering and promote spiritual health. There are several nursing interventions that can be implemented, in addition to contacting the health care agency’s chaplain or the patient’s clergy member. See the “Applying the Nursing Process” section for a discussion of spiritual assessment tools and nursing interventions related to spiritual care.
Many hospitals, nursing homes, assisted living facilities, and hospices employ professionally trained chaplains to assist with the spiritual, religious, and emotional needs of patients, family members, and staff. In these settings, chaplains support and encourage people of all religious faiths and cultures and customize their approach to each individual’s background, age, and medical condition. Chaplains can meet with any individual regardless of their belief, or lack of belief, in a higher power and can be very helpful in reducing anxiety and distress. A nurse can make a referral for a chaplain without a provider order. See Figure 18.2 [ 11 ] for an image of a hospital chaplain offering support to a patient.
A chaplain assists patients and their family members to develop a spiritual view of their serious illness, injury, or death, which promotes coping and healing. A spiritual view of life and death includes elements such as the following:
Suffering occurs at physical, mental, emotional, and spiritual levels. Sociocultural factors, religious beliefs, family values and dynamics, and other environmental factors affect a person’s response to suffering.
Hope is a desire or goal for a particular event or outcome. For example, some people may view dying as “hopeless” whereas a spiritual view can define hope as a “good death” when the patient dies peacefully according to the end-of-life preferences they previously expressed. Read more about the concept of a “good death” in the “Grief and Loss” chapter.
Mystery is knowing there is truth beyond understanding and explanation. Peacemaking is the creation of a space for nurturing and healing.Forgiveness is an internal process releasing intense emotions attached to past incidents. Self-forgiveness is essential to spiritual growth and healing.
Prayer is an expression of one’s spirituality through a personalized interaction or organized form of petitioning and worship.
Herdman, T. H. & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020. Thieme Publishers New York, pp. 365, 372-377. ↵.
Herdman, T. H. & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020. Thieme Publishers New York, pp. 365, 372-377. ↵.
Puchalski C. M., Vitillo R., Hull S. K., Reller N. Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine. 2014; 17 (6):642–656. ↵ [PMC free article : PMC4038982 ] [PubMed : 24842136 ] [CrossRef]
Rudolfsson G., Berggren I., da Silva A. B. Experiences of spirituality and spiritual values in the context of nursing - An integrative review. The Open Nursing Journal. 2014; 8 :64–70. ↵ [PMC free article : PMC4293736 ] [PubMed : 25598856 ] [CrossRef]
Rudolfsson G., Berggren I., da Silva A. B. Experiences of spirituality and spiritual values in the context of nursing - An integrative review. The Open Nursing Journal. 2014; 8 :64–70. ↵ [PMC free article : PMC4293736 ] [PubMed : 25598856 ] [CrossRef]
"960_720 .jpg” by Activedia is licensed under CC0 ↵.Rudolfsson G., Berggren I., da Silva A. B. Experiences of spirituality and spiritual values in the context of nursing - An integrative review. The Open Nursing Journal. 2014; 8 :64–70. ↵ [PMC free article : PMC4293736 ] [PubMed : 25598856 ] [CrossRef]
Rudolfsson G., Berggren I., da Silva A. B. Experiences of spirituality and spiritual values in the context of nursing - An integrative review. The Open Nursing Journal. 2014; 8 :64–70. ↵ [PMC free article : PMC4293736 ] [PubMed : 25598856 ] [CrossRef]
Rudolfsson G., Berggren I., da Silva A. B. Experiences of spirituality and spiritual values in the context of nursing - An integrative review. The Open Nursing Journal. 2014; 8 :64–70. ↵ [PMC free article : PMC4293736 ] [PubMed : 25598856 ] [CrossRef]
"Pastoral_Care .jpg" by WikiDavidUser is licensed under CC BY-SA 3.0 ↵.Religion & Ethics NewsWeekly. (2016, September 16). Spiritual healthcare. [Video]. YouTube. All rights reserved. https://youtu .be/97d1JMKTuk4 ↵.
Northwell Health. (2015, December 14). A Day in the life of a chaplain. [Video]. YouTube. All rights reserved. https://youtu .be/0mERMJikQkg ↵.
Harvard T. H. Chan School of Public Health. (2017, August 29). Focus on the spiritual health can benefit patients--and doctors. [Video]. YouTube. https://youtu .be/mDfkhILODtE ↵.
Intermountain Healthcare. (2017, February 21). Chaplains and the role of spiritual care in healthcare. [Video]. YouTube. All rights reserved. https://youtu .be/l6n6chrQX0A ↵.
It can be helpful for nurses to learn basic knowledge about common religions and religious practices as they support their patients’ beliefs. This section will review basic elements of common religions and religious practices.
For centuries, humankind has sought to understand and explain the “meaning of life.” Many philosophers believe this contemplation and the desire to understand our place in the universe are what differentiate humankind from other species. Religion, in one form or another, has been found in all human societies since human societies first appeared. [ 1 ]
Religion is a unified system of beliefs, values, and practices that a person holds sacred or considers to be spiritually significant. Spiritual practices often unite a moral community called a church. Some people associate religion with a place of worship (e.g., a synagogue or church), a practice (e.g., attending religious services, being baptized, or receiving communion), or a concept that guides one’s daily life (e.g., sin or kharma). [ 2 ] See Figure 18.3 [ 3 ] for an illustration of symbols from many worldwide religions.
The symbols are arranged in clockwise order starting at the 12:00 position: Judaism, Christianity, Islam, Bahá’í faith, Hinduism, Taoism, Buddhism, Sikhism, Rodnoveril, Celtic paganism, Heathenism, Semitic paganism, Wicca, Kemetism, Hellenic paganism, and Roman paganism.
Religions have been classified based on what or whom people worship (if anything). See Table 18.3 for a list of religious classifications. [ 4 ]
Religious Classifications [ 5 ]
Every culture has atheists who do not believe in a divine being or entity and agnostics who hold that ultimate reality (such as God) is unknowable. However, being a nonbeliever in a divine being does not mean the individual has no morality. For example, many Nobel Peace Prize winners have classified themselves as atheists or agnostics. [ 6 ]
Monotheism includes the religions of Judaism, Christianity, and Islam. People who practice Judaism are called Jews, people who practice Christianity are called Christians, and people who practice Islam are called Muslims. Jews, Christians, and Muslims believe in many of the same historical sacred stories, referred to by Christians as the “Old Testament.” In these shared sacred stories, it is believed that the son of God (a messiah) will return to save God’s followers. While Christians believe that the messiah has already appeared in the person of Jesus Christ, Jews and Muslims believe the messiah has yet to appear. [ 7 ]
The following subsections describe the general beliefs of five worldwide religions. However, as with all cultural beliefs, nurses should recognize an individual’s specific spiritual values, beliefs, and practices and not assume they believe in these elements based on the religion they profess.
After their exodus from slavery in Egypt in the thirteenth century B.C., Jews became a nomadic society worshipping only one God. The Jewish covenant, a promise of a special relationship with Yahweh (God), is an important element of Judaism. The sacred text of Judaism is the Torah, which contains the same sacred stories in the first five books of the Christian’s Bible. Talmud is a collection of additional sacred Jewish oral interpretations of the Torah. Jews emphasize moral behavior and action in life. [ 8 ] Jewish religious services are held in a synagogue. See Figure 18.4 [ 9 ] for an image of the Torah and the Star of David, a traditional symbol of Judaism.
The Torah and Star of David
Christianity began over 2,000 years ago in Palestine with the birth of a Jew named Jesus Christ. Jesus was a charismatic leader and believed by Christians to be the son of God, who taught his followers to treat others as one would like to be treated. The sacred text for Christians is the Bible that includes the “Old Testament” and the “New Testament.” The New Testament describes the life and teachings of Jesus. [ 10 ] Christians attend religious services in a church or cathedral. See Figure 18.5 [ 11 ] for an image of a sculpture depicting Jesus Christ crucified on a cross, a common symbol of Christianity.
Sculpture of Jesus Christ on a Cross
Christianity is broadly split into three branches: Catholic, Protestant, and Orthodox. The Catholic branch is governed by the Pope and many bishops around the world. There are many different denominations of Protestant faiths, such as Lutherans, Baptists, Presbyterians, Methodists, Seventh-Day Adventists, Pentecostals, and Mormons. Although all Christians believe the Bible is a sacred text, different denominations have variations in their sacred texts. For example, The Church of Jesus Christ of Latter-day Saints uses the Book of Mormon that they believe details other parts of Christian doctrine and Jesus’ life that aren’t included in the Bible. Similarly, the Catholic Bible includes a collection of stories that were part of the King James translation created in 1611 but are no longer included in Protestant versions of the Bible. [ 12 ]
Although monotheistic, Christians often describe God through three manifestations called the Holy Trinity: the father (God), the son (Jesus), and the Holy Spirit, similar to how water can be in different forms of ice, water, and gas. Another foundation to Christian faith is the Ten Commandments, a set of rules that includes acts considered sinful, such as theft, murder, and adultery. [ 13 ]
Islam is monotheistic religion that follows the teaching of the prophet Muhammad, born in Mecca, Saudi Arabia, in 570 C.E. Muhammad is viewed as a prophet and a messenger of Allah (God), who is divine. The followers of Islam are called Muslims who attend religious services in mosques. [ 14 ] See Figure 18.6 [ 15 ] for an image of a mosque.
Islam means “peace” and “submission.” The sacred text for Muslims is the Qur’an (or Koran).
Muslims are guided by five beliefs and practices, often called pillars of their faith, including believing that Allah is the only god and Muhammad is his prophet, participating in daily prayer, helping those in poverty, fasting as a spiritual practice, and participating in pilgrimage to the holy center of Mecca. [ 16 ]
Hinduism originated in the Indus River Valley about 4,500 years ago in what is now modern-day northwest India and Pakistan. Hindus believe in a divine power that can manifest as different entities. Three main incarnations, Brahma, Vishnu, and Shiva, are sometimes compared to the Christian belief in the Holy Trinity. [ 17 ]
Multiple sacred texts, collectively called the Vedas, contain hymns and rituals from ancient India and are mostly written in Sanskrit. Hindus believe in a set of principles called dharma that refer to one’s duty in the world and correspond with “right” actions. Hindus also believe in karma, the notion that spiritual ramifications of one’s actions are balanced cyclically in this life or a future life (referred to as reincarnation). [ 18 ] Most Hindus observe religious rituals at home. The rituals vary greatly among regions, villages, and individuals. See Figure 18.7 [ 19 ] for a statue of Shiva in a yogic meditation. Yoga is a Hindu discipline that trains the body, mind, and consciousness for health, tranquility, and spiritual insight.
Statue of Shiva in Yogic Meditation
Buddhism is a philosophy founded by Siddhartha Gautama around 500 B.C.E. Siddhartha is believed to have given up a comfortable, upper-class life to follow one of poverty and spiritual devotion. At the age of thirty-five, he famously meditated under a sacred fig tree and vowed not to rise before he achieved enlightenment, called bodhi. After this experience, he became known as Buddha or “enlightened one.” Followers were drawn to Buddha’s teachings and the practice of meditation, and he later established a monastic order. [ 20 ]
Buddha’s teachings encourage Buddhists to lead a moral life by accepting the four Noble Truths: life is suffering, suffering arises from attachment to desires, suffering ceases when attachment to desires ceases, and freedom from suffering is possible by following the “middle way.” The concept of the “middle way” is central to Buddhist thinking and encourages people to live in the present, practice acceptance of others, and accept personal responsibility. [ 21 ] See Figure 18.8 [ 22 ] for a statue of the enlightenment of Buddha.
Statue of Enlightenment of Buddha
Now that we have reviewed the basic beliefs of various world religions, this section describes common religious beliefs and practices that may impact nursing care. As always, customize nursing interventions according to each patient’s specific values, practices, and beliefs.
Buddhism places strong emphasis on “mindfulness,” so patients may request peace and quiet for the purpose of meditation, especially during crises.
Some Buddhists may express strong, culturally-based concerns about modesty (for instance, regarding treatment by someone of the opposite sex).
Some Buddhists are strictly vegetarian and refuse to consume any meat or animal by-product. For such patients, even medications that are produced using animals are likely to be problematic. See Figure 18.9 [ 23 ] for an image of a vegetarian meal in a Buddhist temple.
The importance of mindful awareness of all of life’s experience may affect patients’ or family members’ decisions about pain medications out of worry that analgesics may unduly cloud awareness. Nonpharmacological pain management options are often attractive.
Patients or families may pray or chant out loud repetitiously. This is often done quietly, and any noise concerns in a hospital can usually be negotiated easily. Families sometimes wish to place a picture of the Buddha in the patient’s room.
In end-of-life care, Buddhists may be very concerned about safeguarding their awareness/consciousness. Clarification of the patient’s wishes about the use of analgesics in the days and hours before death is strategically important for developing an ethical pain management plan.
As a patient approaches death, medical and nursing staff should minimize actions that might disturb their concentration or meditation in preparation for dying. Near the time of death, a Buddhist patient’s family may appear quite emotionally reserved and even keep their physical distance from the patient’s bed. This can be a custom for the purpose of supporting the patient’s desire to concentrate without distraction on the experience of dying.
After the patient has died, staff should try to keep the body as still as possible and avoid jostling during transport. Buddhism teaches that the body is not immediately devoid of the person’s spirit after death, so there is continued concern about disturbing the body. Such belief may also be an impediment to discussion of organ donation.
Families may request that after a patient has died the patient’s body be kept available to them for a number of hours for the purpose of religious rites. All such requests should be negotiated carefully, maximizing the opportunity for accommodation in recognition of the religious significance. [ 24 ]
Vegetarian Meal in a Buddhist Temple
Sacraments and blessings by a Catholic priest can be viewed as highly important, especially before surgery or as a perceived risk of death.
If a patient is near death, there may be an urgent request for a Catholic priest to offer “Sacrament of the Sick” (which some Catholics may call “Last Rites”). Even if the sacrament has already been offered, there may still be a request for a priest to offer prayers and bless the patient.
All requests for the sacrament of baptism should be relayed to a Catholic priest. However, if an infant is likely to die before a priest can arrive, the infant may be baptized by any person with proper intent. The person would say, “[name of infant], I baptize you in the name of the Father, and of the Son, and of the Holy Spirit,” pouring a small amount of water over the infant’s head three times. Emergency baptisms are reported to the local Catholic parish priest.
Patients may request Holy Communion (Eucharist) prior to surgery. While a Catholic priest or Eucharistic Minister would typically offer such a patient only a tiny portion of a wafer, patients who are NPO (to have nothing by mouth) should have this request approved by the care team as medically safe.
Some patients may keep religious objects with them, such as a rosary (a loop of beads with a crucifix used for prayer), a scapula (a small cloth devotional pendant), or a religious medal. See Figure 18.10 [ 25 ] for an image of a rosary. If patients request that such an object remain with them during medical procedures, discuss the option of placing the object in a sealed bag that can be kept on or near the patient. If an object is metal and the patient is having a radiological procedure or test (like an MRI scan), ask the patient or family if they can bring in a nonmetal substitute.
Interruption of religious practices, such as regular attendance at Mass or special observance of special holy days, may be highly stressful to Catholic patients. Discuss contacting clergy and/or a hospital chaplain.
Patients may have moral questions about treatment decisions such as the withholding/withdrawing of life-sustaining treatment. A priest can offer authoritative guidance in specific situations.
Patients may request non-meat diets, especially during the time of Lent (the 40 days before the festival of Easter). [ 26 ]
Hindu patients may express strong, culturally-based concerns about modesty, especially regarding treatment by someone of the opposite sex. Genital and urinary issues are often not discussed with a spouse present.
Hindus are often strictly vegetarian and do not consume meat or animal by-products. For such patients, even medications that are produced using animals are likely to be problematic. Some Hindus may also refrain from eating certain vegetables, like onions or garlic.
Fasting is a common practice in Hinduism, and patients may wish to discuss the implications in light of the medical/dietary care plan.
The act of washing is generally conceived as requiring running water, either from a tap or (poured) from a pitcher. A patient may have a strong desire to wash their hands after meals. See Figure 18.11 [ 27 ] for an image of a Hindu worshipping with water.
For many Hindu patients, there is a cultural norm to use the right hand for “clean” tasks like eating (often without utensils) and their left hand for “unclean” tasks like toileting. Medical and nursing staff should consider this right-left significance before hindering a patient’s hand or arm movement in any way. Discuss these preferences with the patient.
Patients may wear jewelry or adornments that have strong cultural and religious meaning, and staff should not remove these without discussing the matter with the patient or family.
Hinduism teaches that death is a crucial “transition” with karmic implications. There may be a strong desire that death occurs in the home rather than in the hospital. Family may wish to perform a number of pre-death rituals (for example, tying a thread around the person’s neck or wrist). After death, family members may request to wash the patient’s body (by family members of the same sex as the patient).
Family may request constant attendance of the deceased’s body. A family member or representative may wish to accompany the body to the morgue (where the person may sit outside any restricted area yet relatively near the body). [ 28 ]
Worship with Water
The most defining tenant for Jehovah’s Witnesses in health care is the strict prohibition against receiving blood (i.e., red blood cells, white blood cells, platelets, or plasma) by transfusion (even the transfusion of a patient’s stored blood), in medication using blood products, or in food. Some blood fractions (such as albumin, immunoglobulin, and hemophiliac preparations) are allowed, but patients are guided by their own conscience.
Organ donation and transplantation are allowed, but patients are guided by their own conscience.Jehovah’s Witnesses are usually well-prepared to work with health care providers to seek all possible options for treatment that do not conflict with religious concerns. It is very common for adults to carry a card at all times stating religiously-based directives for treatment without blood.
Contrary to popular misconceptions, faith-healing is not a part of Jehovah’s Witness tradition. Prayers are often said for comfort and endurance.
Tradition of Jehovah’s Witnesses does not teach that those who die experience an immediate afterlife. It would be inappropriate to say to the family of a deceased patient, “He’s in a better place now.”
Jehovah’s Witnesses do not celebrate birthdays or Christian “holidays.” [ 29 ]Some Jewish patients may strictly observe a rule not to “work” on the Sabbath (from sundown on Friday until sundown on Saturday) or on religious holidays. If so, this religious injunction against “work,” including prohibitions against using certain tools or engaging in tasks that initiate use of electricity, can prevent tasks like writing, flipping a light switch, pushing buttons to call a nurse, adjusting a motorized bed, or operating a patient controlled analgesia (PCA) pump. The tearing of paper can be considered “work,” so roll toilet paper may need to be replaced with an opened box of individual sheets. Medical procedures should not be scheduled during the Sabbath or religious holidays (unless they are life-saving) nor should hospital discharges be planned during such times without the consent of the patient. While these restrictions on “work” are generally associated with Orthodox Judaism, they may be important for any Jewish patient.
Jewish holidays are usually highly significant for patients, especially Passover in the spring and Rosh Hashanah and Yom Kippur in the fall. These holidays may affect the scheduling of medical procedures and may involve dietary changes (related to a need for special food or to a desire to fast). All Jewish holidays run from sundown-to-sundown.
Jewish patients often request a special Kosher diet in accordance with religious laws that govern the preparation of certain foods (e.g., beef), the prohibition of certain foods (e.g., pork and gelatin), or the combination of some food (e.g., beef served with dairy products). During the holiday of Passover, an important distinction is made between food that is merely “Kosher” and that which is specifically “Kosher for Passover.” Hand washing before eating may have a religious significance.
Some Jewish patients may have culturally-based concerns about modesty, especially regarding treatment by someone of the opposite sex. However, because Jewish tradition holds the expertise of medical practitioners in high regard, this may reduce concerns about treatment by the opposite sex.
Questions about the withholding or withdrawing of life-sustaining therapy are deeply debated within Judaism, and some Jews are strongly opposed to the idea. Family members often wish to consult with a rabbi about the specific circumstances and decisions regarding end-of-life care.
After a patient has died, Jewish tradition directs that burial happen quickly and that there be no autopsy (unless the autopsy is deemed necessary by a mandate from the Medical Examiner). Also, the family may request that a family member or representative constantly accompany the body in the hospital or even to the morgue (where the person may sit outside any restricted area yet relatively near the body) to say prayers and read psalms.
There may be a request that amputated limbs be made available for burial. Details should be arranged through the patient’s/family’s funeral home.
Jewish religious laws pose a complex set of restrictions that can affect medical decisions, and patients or family members may request to speak with a rabbi to determine the moral propriety of any particular decision. Exceptions are often made when an action is understood in terms of “saving a life,” such as emergency surgery or organ donation during the Sabbath. The value of “saving a life” is held in extremely high regard in Jewish tradition.
It is common for male Jewish patients to wear a yarmulke or kippah (skull cap) during prayer, and some Jews may wish to keep them on at all times. Patients or family members may wear prayer shawls and use phylacteries (two small boxes containing scriptural verses and having leather straps, worn on the forehead and forearm during prayer). There may be a request that at least ten people (called a minyan) be allowed in the patient’s room for prayer. See Figure 18.12 [ 30 ] for an image of a skull cap worn during prayer.
A Jewish person need not be religious to identify culturally as “Jewish” and may observe Jewish religious traditions for cultural reasons.
The word “Jew” is commonly used within Jewish culture, but non-Jews should be mindful of its complex historical connotations that can sometimes be perceived as disrespectful when spoken by non-Jews. [ 31 ]
Skull Caps (Kippa)
Muslim patients may express strong concerns about modesty, especially regarding treatment by someone of the opposite sex. A Muslim woman may need to cover her body completely and should always be given time and opportunity to do so before anyone enters her room. Women may also request that a family member be present during an exam and may desire to remain clothed during an exam if at all possible. Muslim men may find examination by a woman to be extremely challenging. Nudity is emphatically discouraged. There should be no casual physical contact by non-family members of the opposite sex (such as shaking hands). Some Muslims may avoid eye contact as a function of modesty.
Muslims may specifically request a diet in accordance with religious laws for “Halal” food, though many Muslims opt for a vegetarian diet as a simple way to avoid religious prohibitions against such things as pork products or gelatin. Forbidden foods are referred to as “Haraam.”
Muslim dietary regulation can affect patients’ use of medications, especially drugs that have pork origins or that contain gelatin or alcohol. The dietary prohibition against alcohol has occasionally raised questions about Muslims’ use of alcohol-based hand rubs in the hospital. Because hand rubs do not have an intoxicating effect and are used for life-saving hygiene, any concern should be addressed thoroughly and sensitively and perhaps with the input of an imam. An imam is a person who leads prayers in a mosque.
The act of washing may require running water, either from a tap or poured from a pitcher. As a result, Muslim patients typically do not feel truly cleaned by a sponge bath. Many Muslims wash with running water before and after meals and also before prayers.
Muslim prayers are conducted five times a day. Patients may desire to pray by kneeling and bending to the floor, but Islamic tradition recognizes circumstances when this is not medically advisable. If patients are disturbed by their inability to pray on the floor, advice should be encouraged from an imam. See Figure 18.13 [ 32 ] for an image of Muslim men prostrate in prayer.
Muslim patients may react to suffering with emotional reserve and may hesitate to express the need for pain management. Some may even refuse pain medication if they understand the experience of their pain to be spiritually enriching.
There may be a request that amputated limbs be made available for burial. Details should be arranged through the patient’s/family’s funeral home.
Muslim tradition generally discourages the withholding or withdrawing of life-sustaining therapy. However, because decisions on this subject involve the particular circumstances of the patient and the complexities of medical treatments, family members who are morally conflicted may wish to bring an experienced imam into their discussion with physicians.
A family member may request to be present with a dying person, so as to be able to whisper a proclamation of faith in the patient’s ear right before death. (Similarly, a husband may request to be present at a birth to whisper a proclamation of faith in the ear of the newborn.)
After a death, the family may request to wash the patient and to position their bed to face Mecca. The patient’s head should rest on a pillow.
Burial is usually accomplished as soon as possible. Muslim families rarely allow for autopsy unless there is an order by a Medical Examiner. Some Muslims may consider organ donation, but the subject is open to great differences of opinion within Islamic circles.
During the thirty-day month of Ramadan, Muslims refrain from food and drink from dawn until sundown. Physicians should explore with patients whether it is medically appropriate to fast while in the hospital. If so, investigate options for predawn meals, for providing patients with dates and spring water in the late afternoon (a traditional way to break the daily fast), and for delaying dinner until after sunset. While anyone who is ill is not obligated to fast, the Ramadan observance can be powerfully meaningful to patients if they can participate. The month of Ramadan shifts according to a lunar calendar, and when it occurs during the summertime, longer days can make the fast more physically stressful. [ 33 ]
Muslim Men Prostrate in Prayer
Pentecostal patients may pray exuberantly. Noise concerns in a hospital can sometimes present a problem in this regard, but simply shutting the door to the patient’s room can usually provide an adequate solution.
Pentecostals may pray by “speaking in tongues,” expression of words that seem unintelligible to an individual hearer but holds very deep religious significance for worshippers.
Patients or families may request that relatively large numbers of people be allowed in the patient’s room for prayer.
Patients or families may express strong belief in miraculous healing. [ 34 ]Ehman, J. (2012, May 8). Religious diversity: Practical points for healthcare providers. Penn Medicine: Pastoral Care and Education. https://www .uphs.upenn .edu/pastoral/resed/diversity_points .html ↵.
“SilverRosary .png” by Aprilwine is licensed under CC BY-SA 3.0 ↵.Ehman, J. (2012, May 8). Religious diversity: Practical points for healthcare providers. Penn Medicine: Pastoral Care and Education. https://www .uphs.upenn .edu/pastoral/resed/diversity_points .html ↵.
“hindu-1588337 _960_720.jpg” by gauravaroraji0 is licensed under CC0 ↵.Ehman, J. (2012, May 8). Religious diversity: Practical points for healthcare providers. Penn Medicine: Pastoral Care and Education. https://www .uphs.upenn .edu/pastoral/resed/diversity_points .html ↵.
Ehman, J. (2012, May 8). Religious diversity: Practical points for healthcare providers. Penn Medicine: Pastoral Care and Education. https://www .uphs.upenn .edu/pastoral/resed/diversity_points .html ↵.
“Casamento_judeu1 .jpg” by David Berkowitz is licensed under CC BY 2.0 ↵.Ehman, J. (2012, May 8). Religious diversity: Practical points for healthcare providers. Penn Medicine: Pastoral Care and Education. https://www .uphs.upenn .edu/pastoral/resed/diversity_points .html ↵.
“Mosque .jpg” by Antonio Melina/Agência Brasil is licensed under CC BY 3.0 ↵.Ehman, J. (2012, May 8). Religious diversity: Practical points for healthcare providers. Penn Medicine: Pastoral Care and Education. https://www .uphs.upenn .edu/pastoral/resed/diversity_points .html ↵.
Ehman, J. (2012, May 8). Religious diversity: Practical points for healthcare providers. Penn Medicine: Pastoral Care and Education. https://www .uphs.upenn .edu/pastoral/resed/diversity_points .html ↵.
Now that we have reviewed the concepts related to spirituality and discussed beliefs and practices of common world religions, let’s apply the nursing process to promoting spiritual health.
Agencies often provide a standardized spiritual assessment tool to complete when a patient is admitted. If a standardized assessment tool is not available, the FICA model can be used. [ 1 ] The FICA model contains open-ended questions to ask patients about their personal spiritual beliefs in a way that is open and nonjudgmental.
F–Faith or beliefs: What are your spiritual beliefs? Do you consider yourself spiritual? What things do you believe in that give meaning to life?
I–Importance and influence: Is faith/spirituality important to you? How has your illness and/or hospitalization affected your personal practices /beliefs?
C–Community: Are you connected with a faith center in the community? Does it provide support/comfort for you during times of stress? Is there a person/group/leader who supports/assists you in your spirituality?
A–Address: What support can we provide to support your spiritual beliefs/practices? [ 2 ]The HOPE tool is also helpful for incorporating spiritual assessment questions into a medical interview. HOPE stands for:
H: Sources of hope, meaning, comfort, strength, peace, love and connection
O: Organized religion
P: Personal spirituality and practices
E: Effects of spirituality on medical care and end-of-life issues
The first part of the mnemonic, H, pertains to a patient’s basic spiritual resources, such as sources of hope, without immediately focusing on religion or spirituality. This approach allows for meaningful conversation with a variety of patients, including those whose spirituality lies outside the boundaries of traditional religion or those who have been alienated in some way from their religion. It also allows those for whom religion, God, or prayer is important to volunteer this information. The second and third letters, O and P, refer to areas of inquiry about the importance of organized religion in patients’ lives and the specific aspects of their personal spirituality and practices that are most helpful. A useful way to introduce these questions is a normalizing statement such as: “For some people, their religious or spiritual beliefs act as a source of comfort and strength in dealing with life’s ups and downs. Is this true for you?” [ 3 ]
In addition to asking open-ended questions, it is important for the nurse to observe patients for cues indicating difficulties in finding meaning, purpose, or hope in life. It is also important to monitor for supportive relationships. [ 4 ]
Patients experiencing chronic or serious illness may make statements indicating spiritual distress that should cue the nurse that spiritual care is needed. Examples of these statements/concepts are as follows:
Lack of Meaning: “I am not the person I used to be.” Hope: “I have nothing left to hope for.” Mystery: “Why me?” Isolation: “All my family and friends are gone.” Helplessness: “I have no control over my life anymore.” [ 5 ]See Table 18.4 for common NANDA-I diagnoses associated with spiritual health. [ 6 ]
Common NANDA-I Nursing Diagnoses Related to Spiritual Health [ 7 ]
Many people experienced feelings of isolation as they sheltered at home during the COVID-19 pandemic. A sample PES statement for this shared experience is, Readiness for Enhanced Spiritual Well-Being as evidenced by expressed desire to enhance time outdoors. The nurse could encourage patients to visit local parks and walk outdoors while wearing a mask and maintaining social distancing.
Hospitalized patients may be unable to attend religious services they are accustomed to attending. A sample PES statement is, “Impaired Religiosity related to environmental barriers to practicing religion as evidenced by difficulty adhering to prescribed religious beliefs.” The nurse could contact the patient’s pastor to arrange a visit or determine if services can be viewed online.
Events that place patient populations at risk for developing spiritual distress include birth of a child, death of a significant other, exposure to death, a significant life transition, severe illness or injury, exposure to natural disaster, racial conflict, or an unexpected life event. [ 9 ] Associated conditions that place a person at risk for developing spiritual distress include actively dying, chronic illness, illness, loss of a body part, loss of function of a body part, or a treatment regimen. [ 10 ]
For example, a patient diagnosed with life-threatening medical diagnoses like cancer may experience spiritual distress as they move through the typical stages of loss. A sample PES statement is, “Spiritual Distress related to anxiety associated with illness as evidenced by crying, insomnia, and questioning the meaning of suffering.” A nurse would implement interventions to enhance coping.
Goals and SMART outcomes should be customized to each patient and their situation.
When a patient has the nursing diagnosis Readiness for Enhanced Spiritual Well-Being, a sample goal statement is, “The patient will demonstrate hope as evidenced by the following indicators: expressed expectation of a positive future, faith, optimism, belief in self, sense of meaning in life, belief in others, and inner peace.” [ 11 ] An example of a related SMART outcome is, “The patient will express a sense of meaning and purpose in life by discharge.” [ 12 ]
When a patient has the nursing diagnosis Spiritual Distress, a sample goal statement is, “The patient will demonstrate improved spiritual health as evidenced by one of the following indicators: feelings of faith, hope, meaning, and purpose in life with connectedness with self and others to share thoughts, feelings, and beliefs.” [ 13 ] A sample SMART outcome is, “The patient will express a purpose in life by discharge.” [ 14 ]
When providing spiritual care, the RN must not impose their religious or spiritual beliefs on the patient. There are several guidelines for therapeutically implementing nursing interventions to support patients’ spiritually:
Take cues from the patient: When bringing up spiritual health with patients, understand this may be a difficult topic for them to discuss. Let them lead the conversation and do not press further than they want to share. Also, be aware of the patient’s nonverbal cues. They may be saying one thing but their body language is saying something different. Gently point out the contradiction and seek clarification. For example, a patient may state that they don’t blame God for their illness, but begin to tear up as they say it. By responding, “I noticed you became tearful when you said that…what is causing the tears,” the door is opened for them to share more of their thoughts and feelings.
Ask the patient how you can support them spiritually: An important way to assist a patient with their spiritual health is to ask them what they need to feel supported in their faith and then try to accommodate their requests, if possible. For example, perhaps they would like to speak to their clergy, spend some quiet time in meditation or prayer without interruption, or go to the onsite chapel. Explain that spiritual health helps the healing process. Many agencies have chaplains onsite that can be offered to patients as a spiritual resource.
Support patients within their own faith tradition: Because patients can sometimes feel as if they are a captive audience, it is not appropriate for the nurse to take this opportunity to attempt to persuade a patient towards a preferred religion or belief system. The role of the nurse is to respect and support the patient’s values and beliefs, not promote the nurse’s values and beliefs.
Listen to a patient’s fears and concerns without adding your own stories: In an effort to empathize with a patient who is telling their story, it is easy for the nurse to start adding personal examples from their own life. Although this may seem helpful, it is usually only distracting and shifts the focus from the patient to the nurse. Focus on the patient’s fears and concerns. Name and validate the emotions that are heard when possible. Sometimes patients don’t realize what they are feeling until it is pointed out to them.
Pray with a patient if requested (or provide someone who will): Some nurses may feel reluctant to pray with patients when they are asked for various reasons. They may feel underprepared, uncomfortable, or unsure if they are “allowed to.” Nurses are encouraged to pray with their patients to support their spiritual health, as long as the focus is on the patient’s preferences and beliefs, not the nurse’s. See Figure 18.14 [ 15 ] for an image of a nurse praying with a patient. Having a short, simple prayer ready, that is appropriate for any faith, may help in this situation. If a nurse does not feel comfortable praying, the chaplain should be requested to participate in prayer with the patient.
Share an encouraging thought or word: Similar to the preceding prayer suggestion, a scripture verse (based on the patient preferences) or an inspirational poem may be helpful to share during difficult times. Having a few verses or thoughts readily available can be very helpful during critical moments. [ 16 ]
Use presence and touch: Sometimes the mere presence of a nurse is spiritually comforting for patients. Words are not always needed. It can be very comforting to know that someone will be sitting quietly next to them as they fall asleep or are in pain. Touch can also be a very powerful therapeutic tool to provide comfort (after asking permission of the patient). [ 17 ]
Nurse Praying with a Patient
See the following box for a summary of therapeutic interventions that nurses can implement to provide spiritual support. Review additional interventions for enhancing coping for patients and family members experiencing grief in the “Grief and Loss” chapter.
Encourage the individual to reminisce and review their past and focus on events and relationships that provided spiritual strength and support.
Provide privacy and quiet time for spiritual activities. Offer opportunities for the patient to practice their religion.Encourage the patient to engage in spiritual, meditative, or mind-body practices to promote spiritual healing.
Arrange visits with the chaplain, patient’s pastor, or other spiritual advisor. Pray with the individual, as appropriate. Provide spiritual music, literature, radio, television, or online programs as appropriate.Promote hope however the individual defines it for their situation without providing false reassurance.
Encourage forgiveness. Encourage participation in interactions with family members, friends, and others. Encourage participation in support groupsNurses should support patients’ spiritual and religious preferences when implementing interventions to support their spiritual well-being. The nurse should respect and listen to the patient’s expression of beliefs and not impose their own beliefs on the patient. Spiritual or religious practices should be accommodated if safe and feasible to do so. If a patient has a spiritual belief, value, or practice that conflicts with their treatment plan, the nurse should explain the rationale for the intervention or treatment. If the patient is not willing to complete the treatment as planned due to their spiritual or religious beliefs, the nurse should attempt to negotiate the treatment plan with the patient and/or health care provider. For example, a nurse can advocate for rescheduling a procedure after the Sabbath or modifying the dietary plan and medication administration times during Ramadan.
When evaluating the effectiveness of interventions in promoting a patient’s spiritual health, refer to the overall goal, “The patient will demonstrate spiritual health as evidenced by the following indicators: feelings of faith, hope, meaning, and purpose in life with connectedness with self and others.” [ 21 ] From there, review the patient’s progress toward the personalized SMART outcomes that have been customized to their situation.
Anandarajah, G., and Hight, E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. American Family Physician. 63(1), 81-9. https://www .aafp.org/afp/2001/0101/p81 .html ↵
Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872. ↵
Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2014). Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine, 17(6), 642–656. https://doi .org/10.1089/jpm.2014.9427 ↵
Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020. Thieme Publishers New York, pp. 365, 372-377. ↵
Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020. Thieme Publishers New York, pp. 365, 372-377. ↵
Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020. Thieme Publishers New York, pp. 365, 372-377. ↵
Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020. Thieme Publishers New York, pp. 365, 372-377. ↵
Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). Nursing diagnoses: Definitions and classification, 2018-2020. Thieme Publishers New York, pp. 365, 372-377. ↵
Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872. ↵
Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872. ↵
Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872. ↵
Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872. ↵
Nourian, F. (2018, March 16). 9 ways to provide spiritual care to your patients & their families. AdventHealth. https://careers .adventhealth .com/blog/9-ways-to-provide-spiritual-care-to-patients-and-their-families ↵
Nourian, F. (2018, March 16). 9 ways to provide spiritual care to your patients & their families. AdventHealth. https://careers .adventhealth .com/blog/9-ways-to-provide-spiritual-care-to-patients-and-their-families ↵
Johnson, M., Moorhead, S., Bulechek, G., Butcher, H., Maas, M., & Swanson, E. (2012). NOC and NIC linkages to NANDA-I and clinical conditions: Supporting critical reasoning and quality care. Elsevier, pp. 222-223. ↵
Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Nursing Interventions Classification (NIC). Elsevier, pp. 351-353. ↵
Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872. ↵
Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872. ↵
Provision 5 of the American Nurses Association Code of Ethics states, “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.” [ 1 ] Spiritual care is associated with better health and well-being for everyone, including nurses and nursing students. A desire to help others in need is an important part of spirituality, which has been described as a life-giving force based on faith, discovering meaning and purpose in life, and offering the gift of self to others. [ 2 ]
Spiritual resources can help nurses and nursing students overcome the emotional toil associated with caring for seriously ill and dying patients and prevent compassion fatigue and burnout. Read more about compassion fatigue and burnout in the “Grief and Loss” chapter.
Many spiritual traditions use contemplative practices to increase compassion, empathy, and quiet the mind. [ 3 ] Examples of contemplative practices and other methods to build spiritual strength include the following:
Meditation can induce feelings of calm and clear-headedness and improve concentration and attention. Research has shown that meditation increases the brain’s gray matter density, which can reduce sensitivity to pain, enhance the immune system, help regulate difficult emotions, and relieve stress. Mindfulness meditation in particular has been proven helpful for people with depression and anxiety, cancer, fibromyalgia, chronic pain, rheumatoid arthritis, type 2 diabetes, chronic fatigue syndrome, and cardiovascular disease. [ 4 ]
Yoga is a centuries-old spiritual practice that creates a sense of union within the practitioner through physical postures, ethical behaviors, and breath expansion. The systematic practice of yoga has been found to reduce inflammation and stress, decrease depression and anxiety, lower blood pressure, and increase feelings of well-being. [ 5 ]
Journaling can help a person become more aware of their inner life and feel more connected to experiences. Studies show that writing during difficult times may help a person find meaning in life’s challenges and become more resilient in the face of obstacles. When journaling, it can be helpful to focus on three basic questions: What experiences give me energy? What experiences drain my energy? Were there any experiences today where I felt alive and experienced “flow”? Allow yourself to write freely, without stopping to edit or worry about spelling and grammar. [ 6 ]
Prayer can elicit the relaxation response, along with feelings of hope, gratitude, and compassion, all of which have a positive effect on overall well-being. There are several types of prayer rooted in the belief that there is a higher power that has some level of influence over one’s life. This belief can provide a sense of comfort and support in difficult times. A recent study found that clinically depressed adults who believed their prayers were heard by a concerned presence responded much better to treatment than those who did not believe. [ 7 ]
Find a spiritual community and friends. Join a spiritual group, such as a church, synagogue, temple, mosque, meditation center, yoga class, or other local group that meets to discuss spiritual issues. The benefits of social support are well-documented, and having a spiritual community to turn to for fellowship can provide a sense of belonging and support. [ 8 ]
Nurture your relationships with family, significant others, and friends. Relationships aren’t static – they are living, dynamic aspects of our lives that require attention and care. To benefit from strong connections with others, you should take charge of your relationships and put in the time and energy you would any other aspect of your well-being. It can be helpful to create rituals together. With busy schedules and the presence of online social media that offer the façade of real contact, it’s very easy to drift from friends. Research has found that people who deliberately make time for gatherings or trips enjoy stronger relationships and more positive energy. An easy way to do this is to create a standing ritual that you can share and that doesn’t create more stress, such as talking on the telephone on Fridays or sharing a walk during lunch breaks. [ 9 ]
Mindfulness has been defined as, “Awareness that arises through paying attention, on purpose, in the present moment, and nonjudgmentally.” Mindfulness has also been described as, “Non-elaborative, nonjudgmental, present-centered awareness in which each thought, feeling, sensation that arises is acknowledged and accepted as it is.” Mindfulness helps us be present in our lives and gives us some control over our reactions and repetitive thought patterns. It helps us pause, get a clearer picture of a situation, and respond more skillfully. Compare your default state to mindfulness when studying for an exam in a difficult course or preparing for a clinical experience. What do you do? Do you tell yourself, “I am not good at this” or “I am going to look stupid”? Does this distract you from paying attention to studying or preparing? How might it be different if you had an open attitude with no concern or judgment about your performance? What if you directly experienced the process as it unfolded, including the challenges, anxieties, insights, and accomplishments, while acknowledging each thought or feeling and accepting it without needing to figure it out or explore it further? If practiced regularly, mindfulness helps a person start to see the habitual patterns that lead to automatic negative reactions that create stress. By observing these thoughts and emotions instead of reacting to them, a person can develop a broader perspective and can choose a more effective response. [ 10 ]
Spending time in nature is cited by many individuals as a spiritual practice that contributes to their mental health. [ 11 ]
Explore additional resources about developing spiritual well-being to avoid burnout at the University of Minnesota’s Earl E. Bakken Center for Spirituality & Healing.
Rudolfsson G., Berggren I., da Silva A. B. Experiences of spirituality and spiritual values in the context of nursing - An integrative review. The Open Nursing Journal. 2014; 8 :64–70. ↵ [PMC free article : PMC4293736 ] [PubMed : 25598856 ] [CrossRef]
