espiritual y rehabilitacion karin

7/27/2019 Espiritual y Rehabilitacion Karin

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Rehabilitation Nursing Vol. 31, No. 6 November/December 2006 249

Spiritual care has long been recognized as an essential component in providing holistic care to patients. However, many

nurses have acknowledged that their education lacked practical guidelines on how to provide culturally competent spiri-

tual care. Although all nurses are required to provide spiritual care, rehabilitation nurses are particularly challenged to

be competent in this area, due to the lengthy recovery time and special needs often presented by rehabilitation patients.

This article provides practical guidelines for rehabilitation nurses, to assist patients in meeting their spiritual needs.

Spiritual Care: PracticalGuidelines for Rehabilitation NursesLinda S. Rieg, PhD RN Carolyn H. Mason, MS APRN BC Kelly Preston, MSN RN

From earliest documents to recent literature, there

has been an acceptance that all persons are spiritual

beings and that care of the spirit is an essential and in-

tegral part of healing and wholeness. Although most

would agree with this premise, it is of interest that the

volume and quality of nursing research and writings

related to spirituality and spiritual care is significantly

smaller than that related to the physical, mental, and

social aspects of nursing. However, within the last

20 years there has been increased interest in holistic

nursing, including a focus on spiritual care.

Although a need for spiritual care is recognized

in all healthcare settings, rehabilitation patients often

have significant spiritual care needs related to their

conditions. Due to the longer term relationship be-

tween rehabilitation patients and nurses, more situa-tions occur that are conducive to addressing spiritual

care needs, and that may warrant spiritual care.

Most nurses recognize that spiritual care is an es-

sential component of holistic care. However, many will

acknowledge that it is rarely given the same priority as

other dimensions of care. Not seeing spiritual care as a

top priority is cited as a reason for omitting it (Johnson,

2005). However, another significant barrier that nurses

identify is discomfort due to a perceived lack of com-

petence to provide spiritual care (Page, 2005).

This article provides an overview of the basic

knowledge needed to ensure patients receive cultur-

ally competent spiritual care for rehabilitation nurs-es. This article puts theory into practical guidelines

which can be used when providing spiritual care to

a diverse population of rehabilitation patients and

their families.

Relationship of Worldview to Spirituality

If nurses are expected to provide spiritual care,

they must first understand how a persons worldview

relates to his or her personal concept of spirituality.

Worldview is defined as a basic set of beliefs and

concepts that work together to provide a more-or-

less coherent frame of reference for all thought and

action. Out of ones worldview, a person evaluates,

makes decisions, and makes meaning and sense of

his or her life. Although worldviews may be catego-

rized in various ways, there are basically two major

divisions: theism and naturalism. In theism, God is

the infinite personal Creator and sustainer of the cos-

mos; in naturalism, it is the nature of the cosmos itself

which is primary, and God does not exist (Sire, 1997).

Depending on which worldview a person embraces

as the foundation for meaning and purpose in life, it

will determine many of the persons views and be-

liefs about spirituality, as well as his or her spiritual

care needs.

Nurses must understand that in a multifaith society,

definitions of spirituality differ, based on a variety ofworldviews and opinions (Carson, 1989, 1993; Cus-

veller, Sutton, & OMathuna, 2004; Doornbos, Groen-

hout, & Hotz, 2005; MacLaren, 2004). According to

Burkhart and Nagai-Jacobson (2002), spirituality is

a broad concept, transcending religious boundaries.

Other authors have written about spirituality, spiritual

care related to diagnosis or cultural backgrounds, and

the differences between spirituality and religious belief

(Burkhart & Solari-Twadell, 2001; Conner & Eller, 2004;

MacLaren; McSherry, & Draper, 1998; Reed, 1991; Stoll,

1979; Taylor & Mamier, 2005). Nurses need to recognize

that a persons religious affiliation is not necessarily the

same as a persons spirituality. By virtue of being hu-man, all people are spiritual, regardless of whether or

how they participate in religious observance. Spiritual-

ity is regarded as an essential part of peoples ultimate

concern and quest for meaning and purpose (Emmons,

1999; Frankl, 1984; Wong, 2000).

Rehabilitation Patients: The Need for Spiritual

Care

Because of the issues rehabilitation patients fre-

quently face, spiritual care is often a significant need.

Assisting patients to draw on their faith as a resource

Rehabilitation NURSING

CONT

INUING

EDUCA

TION

KEY WORDS

guidelines

rehabilitation

spiritual care

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250 Rehabilitation Nursing Vol. 31, No. 6 November/December 2006

can be an important way to help them strengthen

their spiritual beliefs and find hope during rehabili-

tation. Patients in rehabilitation are often ready to

learn, and the rehabilitation environment seeks to

maximize potential in every facet of a persons life(Derstine & Drayton-Hargove, 2001; Easton, 1999;

Mauk & Schmidt, 2004).

Schmidt (2004) identified that when faced with the

loss of physical and/or mental abilities, patients and their

families commonly had feelings of anger, bargaining,

and other forms of emotional response to grief. Depres-

sion was not uncommon among those with long-term

health problems; anxiety, frustration, and hopelessness

often loomed with progressive and degenerative health

concerns. In addition, patients expressed feelings of

chronic sorrow with each exacerbation or setback.

Feelings of loss may cause patients and families

to confront their spiritual nature, ask questions about

their spiritual beliefs, and turn toward their faith to

find comfort and hope. Hope is often what patients

say keeps them going through difficult times. Reha-

bilitation promotes hope because its goal is to maxi-

mize function to allow a patient to reach the highest

level of holistic independence possible. A necessary

part of successful rehabilitation is the development

of a different set of coping skillsskills that many

patients or families may not yet have developed, but

which are essential for satisfactory recovery.

During the process of healing from injury or dis-

ease, each patient must work toward integrating hisor her old selfinto a new selfand toward rediscovering

meaning and purpose in life with newfound hope.

In Frankls bookMans Search for Meaning (1984), he

describes tragic optimism as a state where hope and

despair can coexist and in which we can remain opti-

mistic, no matter how helpless and hopeless we feel.

Nurses often work closely with patients and fami-

lies during the rehabilitation process and as a result

establish close, long-term relationships. Due to the

rapport established in these relationships, nurses are

often instrumental in helping patients develop this

tragic optimism.

Wong (2004) identified five key ingredients nec-essary for the development of tragic optimism: ac-

ceptance of the reality of the situation, affirmation

of the value and meaning of life, courage to move

forward, faith in God or a higher power, and self-

transcendence (serving others or a cause larger than

oneself). A first step for rehabilitation patients is a

realistic understanding of their conditions and a rec-

ognition of their losses.

Patients in the contexts of suffering, disability, ter-

minal illnesses, and dying are often struggling with

the meaning of life and death (Puchalski, 2002; Wong,

2000; Wong & Stiller, 1999). This is especially true for

the rehabilitation patient who is struggling to integrate

old self into a new self. Understanding patients beliefs

about spirituality and their identified needs in this

area of life is essential to providing spiritual care.

Nurses Therapeutic Use of Self

Before providing appropriate spiritual care to

patients, a nurse needs to clearly identify his or her

own worldview, understand how that worldview is

foundational to their spiritual beliefs, and recognize

how those beliefs are integrated into their life. In or-

der to do this, several authors have suggested that

nurses need to appreciate the attributes that foster

ones spiritual sense, such as love, understanding,

wisdom, and faith (Cavendish et al., 2000; Fowler,

1981; Haase, Britt, Coward, Leidy, & Penn, 1992)

When a nurse does not understand his or her own

worldview and personal spiritual beliefs, it makes it

more difficult, although not impossible, to address

patients spiritual concerns. By discovering their own

spiritual foundations, nurses are better prepared to

distinguish the actual needs of their patients from

their own spiritual perspectives.

Guidelines for Providing Spiritual Care

Many authors have analyzed the complex issues

inherent in spirituality and how to provide spiritual

care (Barnum, 2003; Brillhart, 2005; Burkhart & So-

lari-Twadell, 2001; Cavendish et al., 2000; Cusveller1998; Goldberg, 1998; Grant, 2004; Gucwa, 2002; Kel-

ly, 2004; Krebs, 2001; MacLaren, 2004). How authors

have identified spiritual needs varies. In one study,

seven major constructsbelonging, meaning, hope,

the sacred, morality, beauty and acceptance of dy-

ingwere revealed in an analysis of the literature

pertaining to patient spiritual needs (Galek, Flannel-

ly, Vane, & Galek, 2005, p. 62). Others have discussed

best practices for approaching spiritual care, spiritua

well-being, spiritual assessment, and spiritual care

interventions (Cavendish et al.; Conner & Eller, 2004

Draper & McSherry, 2002; McGrath & Clarke, 2003;

Van Dover & Bacon, 2001; Walton, Craig, Derwinski-Robinson, & Weinert, 2004).

The essence of providing spiritual care is the

therapeutic use of self. Nurses must be willing to

engage self in this activity while recognizing that

spiritual care must be patient led, not nurse direct-

ed. Nurses need to clearly understand where their

own spiritual needs start and stop and where their

patients needs begin. Skills of listening, observing

and presence are inherent in nursing and support

spiritual care.

Evaluation of the Research Agenda for Rehabilitation Nursing


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Process for Spiritual Care

Spiritual care should be purposeful in the same

way as other nursing care. However, it does not al-

ways require formal planning; in fact, if a nurse is

present and sensitive to a patients cues, then spiri-

tual care often occurs spontaneously and purpose-

fully during that unique patient situation. As with allnursing care, a therapeutic use of the nursing process

is necessary to address spiritual care needs.

Assessment

Todays healthcare environment makes it chal-

lenging for the nurse, with a heavy patient load and

little time, to identify spiritual care needs. Therefore,

nurses need the ability to do a succinct spiritual as-

sessment by asking just a few questions. Not every

patient encounter will necessitate nor warrant a com-

plex, formal spiritual assessment with a detailed plan

of care. However, every patient deserves the nurses

willingness to be present and respond to spiritualneeds, whether expressed verbally or nonverbally.

Spiritual assessment, similar to physical assess-

ment, requires both baseline data and ongoing as-

sessments based on the changing status of the pa-

tient. There are many ways to approach spiritual care

assessment. However, we suggest these approaches

may be grouped into two basic categoriesinten-

tional and situational.Intentional spiritual assessments are completed us-

ing a deliberate, systematic method. These are gen-

erally completed at times of admission or transfer,

or during a crisis event that might trigger spiritual

distress. Several excellent approaches, using mne-

monics, for spiritual assessment are available (see

Figure 1). The most important ability for the nurse

to master is to become comfortable with the types of

questions that elicit spiritual assessment data. The

following key questions can be asked and answered

in a short period of time during the assessment:

Do you have spiritual beliefs that are impor-

tant to you and help you with lifes issuesand problems?

Figure 1. Mnemonic Devices for Intentional Spiritual Assessment

Maugans S.P.I.R.I.T.

S Spiritual belief systemP Personal spiritualityI Integration into a spiritual communityR Rituals and restrictionsI Implications for medical careT Terminal care (as required): How their beliefs impact the care they offer when

patients reach the end of their lives

Maugans, T. A. (1996). The SPIRITual history. Archives of Family Medicine, 5, 1116.

Anandarajah and Hights H.O.P.E.H Sources of hope, meaning, comfort, strength, peace, love and connectionO Organized religionP Personal spirituality/practicesE Effects on medical care, disability, end-of-life decisions

Anandarajah, G., & Hight, E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for

spiritual assessment. American Family Physician, 63(1), 8189.

Puchalski and Romer F.I.C.A.

F Faith or belief: Do you consider yourself spiritual or religious?I Importance / Influence: What importance does your faith or belief have in your life?C Community: Religious or spiritual: Are you part of a spiritual or religious community?

A Address: How would you like me, your healthcare provider, to address these issuesin your healthcare?

Puchalski, C. M., & Romer, A.L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal

of Palliative Medicine, 3, 129137.

Combination of Cultural and Spiritual: E.T.H.N.I.C.S.

E Explanation: Why do you think you have this?T Treatment: What have you tried for this?H Healers: Who have you sought help from for this?N Negotiate: How best do you think I can help you?I Intervention: This is what could be doneC Collaborate: How can we work together on this?S Spirituality: What role does faith/religion/spirituality play in helping you?

Kobylarz, F. A., Heath, J. M., & Like R. C. (2002). The ETHNIC(S) mnemonic: A clinical tool for ethnogeriatric education.

Journal of the American Geriatric Society, 50, 15821589.


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If so, what can we do to assist you in prac-

ticing your faith or receiving spiritual sup-

port?

If you are having a particularly difficult time,

is there someone, such as a spiritual leader,

clergy person, or friend whom you wouldlike us to contact?

If notwhat provides you with the most sup-

port in dealing with lifes issues or problems

and how would you like us to help you?

Situational spiritual assessments are not planned but

depend on the patients or familys behavior or ex-

pressed needs. In almost every rehabilitation setting,

nurses will see patients struggling with physical or

emotional setbacks and perhaps expressing strong

emotions. Many times during a crisis, patients or

families will not express their needs directly. Patients

may not be aware that what they are experiencing is

a spiritual need until they are helped to recognize the

nature of their need.

The nurses role is as a detective who discovers

what a patient believes his or her needs are, as well

as what interventions might be helpful. Nurses are

ideally situated to pick up on verbal and nonverbal

cues. Verbal cues may include expressions of anger or

frustration, requests for help, prayer, and requests for

support from family, friends, clergy, or nurses. Non-

verbal cues may include silence, withdrawing from

others, crying, or a sad appearance. Nurses should

see these as signs that a situational spiritual assess-

ment should be done. Nurses who are sensitive andwilling to listen to these cues and ask key questions

(Figure 2) can often help patients identify spiritual

needs and offer spiritual support. Sensitivity, insight,

and knowing when to ask strategic questions can be

enough to identify a spiritual need.

Diagnosis and Plan

As a nurse analyzes a spiritual assessment, it

leads to nursing diagnoses, which in turn should

determine the appropriate spiritual care interven-

tions. The nursing diagnoses of spiritual well-being

and spiritual distress are well established and have

recognized defining characteristics, related factors,suggested interventions, and evaluative client out-

comes (Burkhart & Solari-Twadell, 2006a, 2006b;

Solari-Twadell & Burkhart, 2006). Familiarity with

these diagnoses can increase a nurses comfort and

confidence in providing spiritual care.

Culturally Competent Spiritual Care

Interventions

The patient or family should set the direction

for spiritual care and should freely give permission

for any interventions. Patients need to feel safe in

expressing their spiritual concerns. Patients will gen-

erally reflect their worldviews and the corresponding

role of spirituality in their lives through information

gathered during assessments or requests for specific

spiritual care interventions.

It is important to determine who is best suited to

meet the patients spiritual needs. Ideally, the best care

can be provided when the nurse and the patient have

the same worldview, with like values and spiritual be-

liefs. Examples include a Christian nurse praying with

a Christian patient, a Buddhist nurse sharing sources

of hope with a Buddhist patient, or a Jewish nurse sup-porting the worship needs of a Jewish patient. How-

ever, in the real world that usually does not happen.

Nurses and patients come from all cultures and

have varied spiritual beliefs. Nurses must decide

upon the most ethical and culturally sensitive man-

ner to provide spiritual care when the patient and

nurse have differing worldviews or spiritual per-

spectives. Most important is that both the patient

and the nurse are treated respectfully and recognize

that each one has a right to embrace his or her own

individual spiritual beliefs.

All nurses have a responsibility to assess spiritual

needs and to help patients identify appropriate spiri-tual care resources. However, every nurse should not

be expected to participate in every type of spiritua

intervention. This is especially important when the

spiritual beliefs and worldviews of the nurse and

patient are different.

For example, many complementary and alternative

therapies are compatible with all worldviews, such as

literature, music, and meditation or quiet times of de-

votion, but other spiritual care interventions that a pa-

tient may desire may not be compatible with the nurses

worldview, or vice versa. Without understanding the

Figure 2. Situational Spiritual Care

Assessment Questions

Ask open ended questions that focus on what

the patient is feeling, such as questions abouttheir concerns, needs, or hurts. Examples of these

types of questions includeWhat is the hardest part of this or the situation?

What hurts the most?What angers you the most right now?

Then direct the conversation to what the patient

believes would help them, such as

What has helped you the most in the past when

you have felt this bad?Does your family, friends, or faith help you?

The patient at that time may express the desire forspiritual support.

Mason, C. H. (1995). Prayer as a nursing intervention.

Journal of Christian Nursing, 12(1), 48.

Evaluation of the Research Agenda for Rehabilitation Nursing


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Table1.SpiritualCareEngagem

entBasedonWorldviews

Pro

cedural/Instrumental

Cultu

ralistic/Instrumental

TherapeuticInteraction

Transformational

Description

Alogicalandtechnicalapproachto

addressingspiritualneedsisused;

thisisbasedonroutinessuchas

standardizedassessmentsforreli-

giousp

referencesandpractices.

Appropria

teculturallydefinedspiritual

practicesareincorporated,basedon

spiritualassessmentandhistory.

Thisappro

achcanbenonreligious.Thenurse

useslistening,empathy,andreflectivetech-

niquestoh

elpthepatientexplorepersonalfeel-

ingsabout

thesituation.

T

hisapproachisbasedonmore

s

piritualknowledgeandcom-

p

assionatecare;itdemandsa

p

ersonalspiritualexperience.

S

piritualcarebecomesnotjust

a

tool,butthesharingofones

o

wnspirituallifewiththepatient.

Itinvolvesahealingconnection

a

ndpresence(Wong,2004).

Typeofnurse-patient

engagement

Minima

lengagementisrequired.

Moderate

engagementisrequired.

Completeengagementisrequired.Thenurse

practicestherapeuticuseofself;nursepresence

isrequired

.

Intenseengagementisrequired.

Apatientmaybeuncomfortable

receivingspiritualcarefrom

anurse

withadifferentworldview.

Nursesmaynotbeabletoparticipate

incertainpracticesbasedonworld-

view.

Considerations

Strength:Anyonecandoitandlittle

timeis

required.

Comfortandrapportbetweennurse

andpatien

tareneededforthesharing

ofbeliefsandpractices.

Emotional

andspiritualneedsoftenoverlap.

M

utualunderstandingandshar-

ingisrequired.Nursesneed

tobeawarethathislevelof

e

ngagementcanleadtoprofes-

s

ionalboundaryconfusion.

Concer

n:Nurseswhousethis

approa

chmaytendtostereotype

patientsbasedonreligiouslabeling;

potenti

alexistsformakinginac-

curateassumptions;patientsreal

needsmaynotbeidentifiedormet.

Worldview

Differencesinworldviewsarenot

problem

atic.

Mostinter

ventionsarenon-worldview-

dependent.

Thisisnot

dependentonhavingsimilarworld-

views.

T

hisisdependentonsharing

s

imilarworldviews.


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patients worldview, a nurse would be intrusive to ap-

ply therapies or interventions without adequate assess-

ment and permission. For example, a nurse would not

expect a Jehovahs Witness to accept a blood transfu-

sion due to religious convictions. Likewise, evangelical

Christian patients should not be offered energy thera-

pies due to their conviction that these therapies are

tied to Eastern mysticism and are in conflict with their

belief that Christ is their source of healing (OMathuna

& Larimore, 2001).

Even if there are differences between a nurses and

patients worldviews and beliefs, it does not absolve

the nurse from the duty to address spiritual needs

Providing spiritual care may be simple or complex,

in addition to requiring different levels of nurse-pa-

tient engagement. Four levels of spiritual care are

described: procedural/instrumental, culturalistic/

instrumental, therapeutic interaction, and transforma-tional. Table 1 describes these four levels, explains the

types of nurse-patient engagement required for each

based on worldviews and certain considerations and

provides examples of spiritual care interventions. De-

pending on the circumstances and unique situations,

the nurse could use any or all of these interventions

In most circumstances, nurses offer care at the proce-

dural/instrumental level and use only the culturalis-

tic/instrumental level as needed. Because therapeutic

interaction requires a more intense use of therapeutic

self and presence, it will probably most often be used

with patients in times of distress. Some nurses may

never interact with a patient at the transformationallevel, because this requires intense nurse-patient en-

gagement, and similar worldviews, and it involves a

healing connection and presence. The nurse should

not feel compelled to provide this level of care; how-

ever, many nurses and patients find great satisfaction

when transformational spiritual care is provided.

Evaluation

Like all other aspects of nursing, spiritual care

should be focused to achieve the best possible out-

comes. Professional expectations for spiritual care

have been established in the Code of Ethics (Ameri-

can Nurses Association, 2001), dictated by patientsrights (American Hospital Association, 1992), and

required for accreditation (Joint Commission on Ac-

creditation of Healthcare Organizations, 2003; Com-

mission on Accreditation of Rehabilitation Facilities,

2004). However, the most important evaluation of

spiritual care should be determined by each patient,

based on that patients personally identified spiritua

needs and desired outcomes. When the patient and

family indicate that their cultural and spiritual needs

have been satisfiedthen spiritual outcomes have

been achieved.Table1.SpiritualCareEngagem

entBasedonWorldviews(Continu

ed)

Procedural/Instrumental

Culturalistic/Instrumental

T

herapeuticInteraction

Transformational

Interventionexample

Thenur

seasksapatientsreligion

andcall

sclergypeopleoffaithas

indicate

dbythepatientandfamily.

Exampleofnon-worldview-related

care:Then

urseincorporatescultural

sensitivity

intocarebyrearrangingthe

Islamicpat

ientsroom,asrequested,

sothatthe

bedfacesMecca.

Anurseuse

stherapeuticlisteningskillstohelp

apatientwhoisstrugglingwithangertoward

anotherperson(emotional)whilefeelingguilty

becausehis

orherfaithrequireshim

orherto

forgivethe

person(spiritual).

EvangelicalChristianpatients

an

dnursesfeelasenseofrela-

tionshipbecauseoftheirshared

beliefs.Prayer,presence,scrip-

tu

res,andmusicmaybeshared

fo

rcomfort.

Worldview-relatedconflict:AMuslim

manorwo

manmaynotwantaJewish

orChristiannursetoprovidespecific

spiritualca

re.

A

Buddhistnurseunderstands

th

eneedforacalm,peaceful

m

indatdeathandtheneedto

av

oidanalgesicsandsedatives

as

thepatientapproachesthe

en

doflife.Thisnursewould

lik

ewisebeabletoaidaBuddhist

patientbyusingappropriate

Buddhistritualsandwritings.

Worldview-relatedconflict:AChristian

nursemigh

thaveaconflictparticipat-

ingwithapatientinavoodooritualor

ceremony.

AdaptedfromKoening&Lewis,2000;Narayanasamy&Owens,2001;Schmidt,2004;andWong,2004.


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Summary

Spirituality is an essential dimension of all human

beings. Patients in rehabilitation settings are in need

of hope and support along with a desire for resources

to help them in recovery. Rehabilitation nurses are in

strategic positions to use appropriate and culturally

competent spiritual care as a resource of hope to helppatients construct a new self. This article provides

an overview of spiritual care and addresses some of

the issues nurses identified as barriers to giving ho-

listic, compassionate care to a diverse set of patients.

Practical guidelines were provided to assist nurses

as they provide spiritual care for culturally diverse

rehabilitation patients.

About the Authors

Linda S. Rieg, PhD RN, is an associate professor at XavierUniversity and can be contacted at 3800 Victory Parkway,Cincinnati, Ohio 45207-7351 or [email protected].

Carolyn Mason, MS BSN, has worked for three years as astaff member for Nurses Christian Fellowship in Michiganteaching nurses about integrating their faith in nursing.She is certified in community health nursing and has taughtnursing for over 23 years. She holds a masters degree fromthe University of Illinois, Chicago and bachelor of sciencein nursing from California State University.

Kelly Preston, MSN, attended the congregational health/parishnursing program at Samford University. The nursing programat Samford focused on whole person health promotion with thespiritual care of patients as the primary focus. After earning her

graduate degree, she coordinated a program within an integratedhealthcare delivery system whereby she and her colleagues workedwith faith communities to help them establish health ministries.

ReferencesAmerican Hospital Association. (1992). A Patients Bill of

Rights. Chicago: Author.Anandarajah G., & Hight, E. (2001). Spirituality and medical

practice: Using the HOPE questions as a practical toolfor spiritual assessment. American Family Physician,63(1),8189.

Barnum, B. S. (2003). Spirituality in nursing: From traditional tonew age (2nd ed.). New York: Springer.

Brillhart, B. (2005). A study of spirituality and life satisfac-tion among persons with spinal cord injury . RehabilitationNursing, 30(1), 3134.

Burkhart, L., & Solari-Twadell, A. (2001). Spirituality and reli-giousness: Differentiating the diagnoses through a reviewof the nursing literature. Nursing Diagnosis, 12(2), 4555.

Burkhart, L., & Solari-Twadell, A. (2006a). Risk for spiritualdistress. In B. J. Ackley & G. B. Ladwig, Nursing diagnosis

handbook(pp. 11471153). St. Louis: Mosby Elsevier.Burkhart, L., & Solari-Twadell, A. (2006b). Spiritual distress.

In B. J. Ackley & G. B. Ladwig, Nursing diagnosis handbook(pp. 11401147). St. Louis: Mosby Elsevier.

Burkhart, M. A., & Nagai-Jacobson, M. G. (2002). Spirituality:Living our connectedness. Albany, NY: Delmar.

CARF International. (2004). Standards manual. Tucson: ArizonaCommission on Accreditation of Rehabilitation Facilities.

Carson, V. B. (1989). Spiritual dimensions of nursing practice.Philadelphia: W. B. Saunders.

Carson, V. B. (1993). Spirituality: Generic or Christian.Journalof Christian Nursing. (1), 2427.

Cavendish, R., Luise, B. K., Horne, K., Bauer, M., Medefindt,J., Gallo, M. A., et al. (2000). Opportunities for enhancedspirituality relevant to well adults. Nursing Diagnosis,11(4), 151164.

Code of Ethics for Nurses: With interpretive statements.(2001). Washington, DC: American Nurses Publishing.

Conner, N. E., & Eller, S. L. (2004). Spiritual perspectives,needs and nursing interventions of Christian African-Americans.Journal of Advanced Nursing, 46(6), 624632.

Cusveller, B. (1998). Cut from the wood: Spiritual and ethi-cal pluralism in professional nursing practice. Journal of

Advanced Nursing, 28(2), 266273.Cusveller, B., Sutton, A., & OMathuna, D. (2004). Commitment

and responsibility in nursing: A faith-based approach. SiouxCenter, IA: Dordt College Press.

Derstine, J., & Drayton-Hargrove, S. (2001). Comprehensiverehabilitation nursing. Philadelphia: W.B. Saunders.

Doornbos, M. M., Groenhout, R. E., & Hotz, K. G. (2005).Transforming care: A Christian vision of nursing practice.Grand Rapids: Eerdmans Publishing Company.

Draper, P., & McSherry, W. (2002). A critical view of spiritual-ity and spiritual assessment. Journal of Advanced Nursing,39(1), 12.

Easton, K. L. (1999). Gerontological rehabilitation nursing.Philadelphia: W. B. Saunders.

Emmons, R. A. (1999). The psychology of ultimate concerns:Motivation and spiritual ity in personality. New York:Guildford Press.

Fowler, J. W. (1981). States of faith development. New York:Harper-Collins.

Frankl, V. E. (1984). Mans search for meaning: Revised and

updated. New York: Washington Square Press.Galek, K., Flannelly, K. J., Vane, A., & Galek, R. M. (2005).

Assessing a patients spiritual needs: A comprehensiveinstrument.Holistic Nursing Practice, 19(2), 6269.

Goldberg, B. (1998). Connection: An exploration of spiritu-ality in nursing care. Journal of Advanced Nursing, 27(4),836842.

Grant, D. (2004). Spiritual Interventions: How, when, and whynurses use them. Holistic Nursing Practice, 18(1), 3642.

Gucwa, D. L. (2002). Healing patients on a spiritual, as well asphysical level. AORN Journal,76(6), 10541056.

Haase, J. E., Britt, T., Coward, D. D., Leidy, N. K., & Penn, P. E.(1992). Simultaneous concept analysis of spiritual perspec-tive, hope, acceptance and self-transcendence. ImageThe

Journal of Nursing Scholarship, 24(20) 141147.Johnson, T. D. (2005). Intensive spiritual care: a case study.

Critical Care Nurse, 25(6),2026.Joint Commission on Accreditation of Healthcare

Organizations. (2203). Joint Commission Resources: 2003comprehensive accreditation manual for hospitals: The officialhandbook. Oakbrook Terrace, IL: Author.

Kelly, J. (2004). Spirituality as a coping mechanism. Dimensionsof Critical Care Nursing, 23(4), 162168.

Kobylarz, F. A., Heath, J. M., & Like, R. C. (2002). TheETHNIC(S) mnemonic: A clinical tool for ethnogeriatriceducation. Journal of the American Geriatrics Society, 50,15821589.

Koenig, H. G., & Lewis, G. (2000). The healing connection.Nashville, TN: Word Publishing.

Krebs, K. (2001). The spiritual aspect of caringAn inte-gral part of health and healing. Nursing AdministrationQuarterly, 25(3), 5561.

MacLaren, J. (2004). A kaleidoscope of understandings:Spiritual nursing in a multi-faith society. Journal of

Advanced Nursing, 45(5), 457464.Mason, C. H. (1995). Prayer as a nursing intervention.Journal

of Christian Nursing, 1(12), 48.Maugans, T. A. (1996). The SPIRITual history. Archives of

Family Medicine, 5,1116.Mauk, K. L., & Schmidt, N. K. (2004). Spiritual care in nursing

practice. Philadelphia: Lippincott Williams & Wilkins.McGrath,P., & Clarke, H. (2003). Creating the space for spiri-

tualtalk: Insights from survivors of haematological malig-nancies.Australian Health Review, 26(3), 116132.

McSherry, W., & Draper, P. (1998). The debates emerging fromthe literature surrounding the concept of spirituality asapplied to nursing.Journal of Advanced Nursing, 27, 683691

McSherry, W., & Ross, L. (2002). Dilemmas of spiritualassessment: Considerations of nursing practice. Journal of

Advanced Nursing,38(5), 479488.Narayanasamy, A., & Owens, J. (2001). A critical incident

study of nurses responses to the spiritual needs of theirpatients.Journal of Advanced Nursing, 33(4), 446455.


8/8


OMathuna, D., & Larimore, W. (2001). Alternative medicineThe Christian handbook. Grand Rapids, MI: Zondervan.

Page, M. (2005). How well do we care for peoples spiritualneeds? Kai Tiaki Nursing New Zealand, 11(10), 1819.

Puchalski, C. M. (2002). Spirituality and end-of-life caring

Journal of Palliative Medicine, 5(22), 259195.Puchalski, C. M., & Romer, A. L. (2000). Taking a spiritual his-

tory allows clinicians to understand patients more fullyJournal of Palliative Medicine,3(1), 129137.

Reed, P. G. (1991). Preferences for spiritually related nursinginterventions among terminally ill and nonterminallyill hospitalized adults and well adults. Applied NursingResearch, 4(3), 122128.

Schmidt, N. A. (2004). Nursing research about spirituality andhealth. In K. L. Mauk & N. A. Schmidt (Eds.), Spiritual carein nursing practice. (pp. 303325). Philadelphia: LippincottWilliams, & Wilkins.

Sire, J. W. (1997). The universe next door: A basic worldview cata-log (3rd ed.). Downers Grove, Ill: Intervarsity Press.

Solari-Twadell, A., & Burkhart, L. (2006). Readiness forspiritual wellbeing. In B. J. Ackley & G. B. Ladwig,Nursing diagnosis handbook (pp. 11531159). St. LouisMosby Elsevier.

Stoll, R. I. (1979). Guidelines for spiritual assessment.AmericanJournal of Nursing, 9, 15741577.

Taylor, E. J., & Mamier, I. (2005). Spiritual care nursing: Whatcancer patients and family caregivers want.Journal of

Advanced Nursing, 49(3), 260267.Van Dover, L. J., & Bacon, J. M. (2001). Spiritual caring in

nursing practice: A close-up view. Nursing Forum, 36(3July-September.

Walton, J., Craig, C., Derwinski-Robinson, B., & Weinert, C(2004). I am not alone: Spirituality of chronically ill ruraldwellers. Rehabilitation Nursing,29(5), 164169.

Wong, P. (2004). Compassionate and spiritual care: A visionof positive holistic medicine. Keynote address presentedat the Consultation on Holistic Healthcare for the MedicalReligious and Academic Professionals in Hong Kong,organized and hosted by The Nethersole Institute ofContinuing Holistic Health Education.

Wong, P. T. P. (2000). Meaning of life and meaning of death in

successful aging. In A.Tomer (Ed.), Death attitudes and theolder adult (pp. 2335). Philadelphia: Burnner-Routledge.

Wong, P. T. P., & Stiller, C. (1999). Living with dignity andpalliative care. In B. deVries (Ed.), End of life issuesInterdisciplinary and multidimensional perspectives (pp. 7794). New York: Springer.

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