Spirituality_Reflection_Essay

This essay reflects on a patient's situation from a recent clinical placement experience. The purpose of this reflection is to identify, understand and recognise the role of a nurse in supporting and improving individuals spirituality as a result of chronic illness, dying and disability. Mrs C a 55 year old woman was diagnosed with breast cancer 5 years ago. Mrs C had to go through mastectomy followed by chemotherapy and radiotherapy sessions. She never made any complaint even though she was in a lot of pain because she did not want to burden the nurses. During the handover it was mentioned that the results of her CAT scan showed that the cancer had spread to her lungs,liver and brain. It was obvious that the the cancer was no longer responding to treatment. Mrs C was notified of this news. The next morning, while attending to Mrs C's personal hygiene, she had mentioned that she would like to go home and would like to discuss this matter with the doctors. When the doctors came around, Mrs C was told that they were not keen on the idea of her going home because of other complications with her illness. She also had Ascites and doctors have put into plan of draining the fluid which required for her to stay in the hospital indefinitely. She was to be advised of when the procedure was to take place. They did not think that her husband would be able cope in caring for her as she would need a 24 hour care at home. Her husband lives alone and their two daughters live Interstate. The following day Mrs. C had refused to have her breakfast and seemed very upset. She also had trouble sleeping and very agitated. She had requested for the nurse to call her husband and daughters. While attending to her, she expressed how frustrated and angry she was with the doctors decision. She said she did not want to die alone in the hospital. “ Why are they keeping me here'” “ I do not have long to go and there is nothing more they can do for me” she cried. She wanted to spend her final moments at home with her family. She also explained that she was not “afraid of dying but afraid of dying alone.” Later on that day Mrs. C's husband and daughters came to visit They were just lovely and supportive. They also wanted to take her home and were talking about having another conference with the doctors. Five days later, Mrs C died of Pneumonia at 2 am. Sadly she was alone. This experience, highlights the challenges that nurses face in incorporating holistic care that includes spiritual care in nursing practice. The first key reflection from this situation is “What is Spirituality”. Spirituality can be defined as the “quality of our relationship to whatever or whomever is most important in our life. It can be an individual experience or shared experience in a group, religion, rituals or a culture. Second key reflection from this situation is “ How could I as the nurse have improved the spiritual care for this individual and her family' Firstly, when providing spiritual care for the patient, the nurse must have an understanding of her own beliefs and values because it would be difficult to provide spiritual care if the nurse herself is experiencing unresolved spiritual concerns. The nurse must also recognise her limits of expertise, time and role. The nurse has the responsibility to treat the patient and the patient's family with respect, to protect their dignity and privacy, to be open minded and to be aware of ethnicity and her own biases in this area. Spiritual care can be delivered by following the nursing process of assessment, nursing diagnosis,planning, implementation, and evaluation. Incorporating spiritual needs and spiritual care within this framework along with nursing knowledge has been proven to be very helpful in achieving holistic care for the individual. The first step is to conduct a comprehensive assessment of the patient's situation. This can be done by collecting data from the patient, family, past medical history and test results .The purpose for this is to help nurses identify spiritual needs associated with other health problems that could contribute to spiritual distress in a patient. Spiritual care assessment could take place at any stage during a course of a relationship with a patient and family as it is a very sensitive matter and it is often based on trust between the patient and the nurse. In relation to Mrs C's situation the assessment would involve questions about her culture, beliefs, social or lifestyle history, religious practices and discussions of her terminal diagnosis. The nurse should use open ended questions when asking the patient, she must know when to ask, what type of questions to ask and how to ask. Use language that is not grounded in one spiritual tradition- e.g. use faith instead of church, use religious leader instead of priest and higher power rather than God. The second step is the nursing Diagnosis. This is done to help nurses identify patients strength as well as actual and potential problems. In relation to Mrs C's situation, the nursing diagnosis was spiritual distress related to feelings of fear, pain and anger. She expressed that she “was not afraid of dying but afraid of dying alone” It was very important to her to spend the last moment with her family at home, but it was not recognised as an option by the doctors. This was an actual problem for nurses in providing spiritual care as it would have been difficult to disregard the doctors decision. Mrs C's expression of fear,anger and pain were signs of spiritual distress that she would have experienced during the last days and hours of her life. The third step is to plan.. Planning is the measurable goals/outcomes and nursing interventions . The goal /outcomes are the predicted results of the nursing interventions. The main goal in spiritual care is to restore, improve, remedy the problem and put together the patients spiritual resources. For spiritual nursing interventions relating to the case study, the nurse could do the the following: The nurse could use the Biopsychosocial-spiritual model of care.This model address the patient's existence holistically. ( physical, psychological, social and spiritual) . The nurse must assess the patient's level of distress. Assist the patient in relieving and expressing anger in appropriate ways because anger is a source of freedom when expressed in a constructive manner The interventions should be structured according to the patients belief system because they have a right to their beliefs and practices. Observe and listen empathetically to the patient. Create an accepting, non judgemental environment in order to develop a therapeutic relationship which improves communication and open expression. Educate the patient and family about coping with the symptoms and pain management. Offer pastoral care and with permission provide referral resources because spiritual needs are easily overlooked or ignored. Provide information without interfering with patient’s beliefs, faith, or hopes because it shows respect for patient's individuality. If the nurse fail to provide spiritual needs then interventions are ineffective because it fails to consider what is most important and meaningful to the patient. Failure to recognise this may lead to a distressing and undignified death for the patient. The fourth step is to implement or initiate the care plan followed by evaluation. Evaluation is to see if the desired goal/outcome have been met. The nurse must also recognise the importance of documenting spiritual care because it is one way of ensuring that the spiritual care given was systematic, comprehensive and consistent. In conclusion, this case study have shown the need for nurses to develop awareness, knowledge and insights into spiritual dimension so they can continue to meet the patient's spiritual needs. Using the framework and the biopsychosocial- spiritual model of care could have perhaps helped the nurses provide the needs of Mrs C as a whole person and follow her chosen pathway. Reflection may give nurses opportunities to evaluate nursing practice but it does not necessarily bring about change or improvement. REFERENCING