This document discusses spirituality in nursing. It defines spirituality as encompassing values, meaning, purpose, and a connection to something greater. Holistic nursing supports the intimate connection of body, mind, and spirit. Spirituality has 3 key characteristics - unfolding mystery, interconnectedness, and inner strength. The document also outlines Kohlberg's 3 phases of moral development and Fowler's 7 stages of faith development. It provides a spiritual assessment scale and discusses the importance of spiritual care through being present, listening, and compassionate touch for patients.

1. Spirituality in Nursing
N237 Cultural & Spiritual
Dimensions In Healthcare
Spirituality in Health Care—an
introduction to what is spirituality

2. Spirituality in Nursing:
 What is Spirituality?
 What is Holistic Nursing?
 3 Characteristics of Spirituality
 3 Phases of Moral Development—Kohlberg

7 Stages of Faith Development– Fowler
 Spiritual Assessment Scale

3. Definition of Spirituality:
 “A broad concept that
encompasses values, meaning, &
purpose;
 One turns inward to the human
traits of honesty, love, caring,
wisdom, imagination, and
compassion;
 Existence of a quality of a higher
authority, guiding spirit or
transcendence that is mystical;
 A flowing dynamic balance that
allows and creates healing of
body-mind-spirit;
 and
 May or may not involve organized
religion

4. Definition of “Holistic Nursing”
 Overall, Holistic Nursing is supported
by and alternately supports the intimate
connection of body, mind, and spirit.
 The body is the physical substance of a
person that can be perceived in
empirical reality
 The mind is that dimension of an
individual that conceptualizes.
 The spirit is the life principle that is
shared with all humanity and with God.

5.  “It is the dimension of personhood that drives us to create,
love, question, contemplate and transcend.” Emeth &
Greenhut (1991). The Holistic Handbook: care of body,
mind and spirit for optimal health. New York: Continuum.
 Here is a link to the
 Standards for Holistic Nursing Practice.

6. 3 Characteristics of Spirituality
by Margaret Burkhardt
 “Unfolding the mystery”– one’s attempt to
understand the meaning & purpose of
life.

“Harmonious interconnectedness”–
individual’s relationship to other Persons
&/or to God.

“Inner strength”– relationship to one’s
personal spiritual resources and “sense
of the sacred”.

7. The Nurse as Healer
 The nurse truly is well situated to be an
instrument of healing. From a Christian
perspective, this is one interpretation.
 “The concept of the nurse as healer
incorporates the characteristics of all
three definitions; that is, the nurse healer
must listen to the voice of God; desire to
restore health either of body or of spirit;
and attempt to assist the patient in
achieving wholeness and integrity of
body, mind, and spirit.”
-- O’Brien, M.E. (1999) Spirituality in nursing. Sudbury,
MA:Jones & Bartlett, p. 10.

8. Nursing Theories of CARING
 Jean Watson’s Theory of Human Caring has been integral to
nursing practice. She describes clinical caritas as a call to care.
(http://www.watsoncaringscience.org/images/features/library/TH
EORY%20OF%20HUMAN%20CARING_Website.pdf )
 M. Leininger described caring as the central focus or dimension
of nursing practice.
(http://nursing.jbpub.com/sitzman/ch15pdf.pdf )
 Sr. Simone Roach postulated 7 attributes of the Caring concept:
compassion, conscience, competence, commitment,
confidence, comportment & creativity
(https://jaimesorianorn.wordpress.com/lecture-handouts/ )

9. Dimensions of Caring–
Practicing Spiritual Caring–
3 essentials
 BEING:BEING: being with a sick person without judgment creates
space for meaning to emerge and for the holy to be revealed.
E. Emeth & J.Greenhut (1991, p.65).

10. 3 essentials of spiritual caring
(cont’d)
 LISTENING:LISTENING: Many people are looking for an
ear that will listen… He who no longer listens
to his brother will soon no longer be listening
to God either… One who cannot listen long
and patiently will presently be talking beside
the point and never really speaking to others,
albeit he be not conscious of it.
--Dietrich Bonhoeffer (1959). Life together.
New York: Harper & Brothers. p.11

11. 3 essentials of spiritual caring
(cont’d)
 TOUCHING:TOUCHING: “Loving, empathetic, compassionate
touch is perhaps the most vital dimension of nursing
theology of caring.”
O’Brien, M.E. (1999) p. 16.
It can be physical touch, or verbal

12. Moral Development (Kohlberg) --
3 Phases
 Preconventional level– early childhood
*simple acceptance of right & wrong as identified
through punishment or nonpunishment for an
act.
 Conventional level– later childhood to
adolescence
*begins as black and white on issues & then
develops more abstract understanding of
morality
 Postconventional level– adulthood
*encompassing a societal view of right and wrong

13. 7 Stages of Faith Development
(James Fowler)
1. Undifferentiated faith
(infancy- 3 years)
 Neonates & toddlers are acquiring the
fundamental spiritual qualities of trust
& mutuality, courage, hope, and love.
 As they develop and begin to
communicate, toddlers develop the use
of symbolism that transitions them to
the next stage (Taylor, 2002).

14. 7 Stages of Faith Development
(James Fowler) cont’d
2. Intuitive- Projective
Faith
(3-7 yrs old)
 Older toddlers and preschooler live in
a world of fantasy and imagination.
They imitate and can be powerfully
influenced by examples moods,
actions & stories of the visible faith
 Santa Claus is real and God may be
perceived as a grandpa depending on
how he is portrayed by adults in the
child’s life (Taylor, 2002).

15. 7 Stages of Faith Development
(James Fowler) cont’d
3. Mythic-Literal Faith
(7-12 yrs old)
 Children attempt to sort out what is
fantasy from what is fact. They want
proofs of reality.
 Stories help this age child learn beliefs
and practices of their community.
 Stories are believed literally rather
than with abstract meanings
(Taylor, 2002)

16. 7 Stages of Faith Development
(James Fowler) cont’d
4. Synthetic-Conventional
Faith (13-20 yrs)
 The adolescent & some adults begin to
notice the incongruities between stories.
 It integrates the individual’s experiences
beyond the family unit (school, media, the
environment around them).
 Faith synthesizes values and information but
also is a basis for identity and outlook.
 Individuals tend to conform to the beliefs
around them because they have not yet
reflected or studied them objectively.
(Taylor, 2002)

17. 7 Stages of Faith Development
(James Fowler) cont’d
5. Individuative-Reflective
faith (21-30 yrs)
 Young adults and beyond develop a
self-identity and worldview that is
different from those of others.
 Individuals form independent
commitments, lifestyles, beliefs, and
attitudes.
 Those who obediently attended their
parents’ church, or synagogue, or
mosque every week, now examine
independently what religious practices
and beliefs to accept personally.

18. 7 Stages of Faith Development
(James Fowler) cont’d
6. Conjunctive Faith (31-40 yrs)
 Past mid-life adults find a new
appreciation for their past, value inner
voices, & become aware of deep-seated
myths, prejudices, and images that are
within them because of their social
background.
 This age may embrace persons of other
faith traditions, recognizing that in their
faith there may be new understanding.
 Persons with conjunctive faith strive to
unify opposites in mind and experience.
(Taylor, 2002)

19. 7 Stages of Faith Development
(James Fowler) cont’d
7. Universalizing Faith
(41+ yrs)
 This level of faith if rarely achieved.
 Fowler describes it as having a sense
of an ultimate environment that is
inclusive of all being. Such persons
have become actualizers of the spirit
of a holistic and fulfilled community.
 Examples of such persons:
Mahatma Gandhi
Mother Teresa
Martin Luther King
Taylor, E.J. (2002) Spiritual care—nursing
theory, research, and practice. Upper Saddle
River, NJ: Prentice Hall.

20. The Spiritual Assessment Scale
—
There are numerous Assessment Scales available
in the literature. Dossey has included the following
3 dimensions in her model. It avoids religious
biases in use of language and offers specific
assessment questions for clinical use.
1. Meaning and Purpose
2. Inner Strength
3. Interconnections

21. The Joint Commission for the Accreditation of
Healthcare Organizations J.A.H.C.O. –
“Standards Clarification” on spiritual assessment
states:
“Spiritual assessment should, at a minimum,
determine the patient’s denomination, beliefs,
and what spiritual practices are important to the
patient.
This information would assist in determining the
impact of spirituality, if any, on the care/services being
provided and will identify if any further assessment is
needed.

22. The standards require organizations to define the
content and scope of spiritual and other assessments
and the qualifications of the individual(s) performing
the assessment.”
Therefore, three elements need to be included in a
spiritual assessment:
•Data Gathering
•Assessment of Data
•Treatment Planning

23. Data Gathering:
•A basic spiritual assessment should include
faith-based data on the patient’s relationship
with:
Institutional religious organizations (or alternative
spiritually based groups e.g., 12-step programs).
•The assessment should also include a description
of the patient’s belief system.
•Finally the assessment needs to identify significant
spiritual practices that may impact care.

24. Assessment of Data:
It is not enough to enumerate the patient’s faith,
beliefs and practices. A spiritual assessment should
also assess the impact of faith, belief and practice on
the patient’s understanding of wellness or illness.
Further, the assessment should indicate if other
assessment is needed (e.g., assessment of spiritual
pain, spiritual injury, moral or ethical issues related to
treatment, etc.).

25. Treatment Planning:
The third element of spiritual assessment is
the development of a plan of care that
includes provisions for caring for the spiritual
needs of the patient. This pastoral or spiritual
care plan should be integrated into the
Multidisciplinary Treatment Team care plan.
Kimble, M.A. (2001). The use of spiritual assessments by
the veteran’s administration health care system
with regards to dying and death. Retrieved online 7/14/03
Joint Commission directives on Spiritual Assessment

26. Resources
 Bridging Science and Religion:
implications for Nursing Practice-
qualitative research—Look at pp. 476-477.
 Borysenko, J., & Borysenko, M.(1994).
The power of the mind to heal.
Carson, CA: Hay House, Inc.
 Dossey, B., Keegan, L., &Guzzetta, C.
(2005).Holistic nursing (4th
ed.)

27. For as Florence Nightingale
asserted so many years ago,
“God’s precious gift of life is often
placed literally” in the nurse’s
hands.
This is spirituality in nursing;
this is standing on holy ground.