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A patient who lost their home, spouse, and children in a fire is depressed and states that they have no reason to live. The patient states, "My family was my life." The nurse documents a health problem of Spiritual Distress based on the patient's inability to find meaning and purpose in their current situation. What is the priority nursing action for this patient?
- A. Asking the patient which spiritual advisor they would like you to call
- B. Recommending that the patient engage in spiritual or religious readings
- C. Determining what has given the patient meaning and purpose in the past
- D. Reminding the patient that God is a loving and personal God
Correct Answer: C
Rationale: The nurse prioritizes determining what, in addition to their family, has given the patient's life meaning and purpose in the past. This helps the patient focus on their strengths. This assessment data can be used to further plan individualized spiritual care.
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A surgeon tells a patient who is a Jehovah's Witness that they need emergency surgery to repair an aortic aneurysm, which will require blood transfusions. The patient states, "If I receive blood, I will not go to paradise. It is against my religion." What nursing response to the patient is appropriate?
- A. "I understand you will not receive blood products, even if it means you will die."
- B. "Please listen to the surgeon; I've seen many aneurysms successfully repaired"
- C. "Have you discussed your decision to refuse surgery with your family?"
- D. "What can I say to help you through this difficult decision?"
Correct Answer: A
Rationale: Patients who practice the Jehovah's Witness faith believe blood transfusions violate God's laws and do not allow them. The nurse supports the patient's beliefs. It is disrespectful of the nurse to attempt to coerce a decision or impose their beliefs on the patient.
A nurse who was raised as a strict Roman Catholic but is no longer practicing stated they could not assist patients with spiritual distress because they recognize only a "field of power" in each person. The nurse says to her colleague, "My parents and I hardly talk because I've deserted my faith. Sometimes I feel really isolated from them and God-if there is a God." These statements reveal which unmet spiritual need?
- A. Meaning and purpose
- B. Forgiveness
- C. Love and relatedness
- D. Strength for everyday living
Correct Answer: C
Rationale: The data point to an unmet spiritual need to experience love and belonging, given the nurse's estrangement from their family and God after leaving the church. The other options may represent other needs this nurse has, but the nurse's statements do not support them.
A nurse who is comfortable with spirituality is caring for a patient who needs spiritual counseling. What action will the nurse take first?
- A. Calling the patient's own spiritual advisor
- B. Asking if the patient has a spiritual advisor they wish to consult
- C. Counseling the patient and, if unsuccessful, making a referral to a spiritual advisor
- D. Explaining the best health options for the patient to the spiritual advisor
Correct Answer: B
Rationale: Even when a nurse feels comfortable discussing spiritual concerns, they should always determine whether the patient has a spiritual advisor they would like to consult. Calling the patient's spiritual advisor may be premature if it is a matter the nurse can handle.
A nurse in a long-term care facility is performing spirituality assessments of residents on their unit. What is the best question the nurse could use to assess for spiritual needs?
- A. "Can you describe your usual spiritual practices and how you maintain them daily?"
- B. "Are your spiritual beliefs causing you any concern?"
- C. "How can I and the other nurses help you maintain your spiritual practices?"
- D. "How do your religious beliefs help you to feel at peace?"
Correct Answer: C
Rationale: Questioning how the staff can meet patients' spiritual practices assesses spiritual needs. Asking the patient to describe spiritual practices is an assessment of spiritual practices. Asking about concerns assesses spiritual distress, and asking about feeling at peace assesses the need for forgiveness.
A nurse who is caring for patients on a pediatric unit is assessing children's spiritual needs. Which is the most important source of learning for a child's own spirituality?
- A. Child's church or religious organization
- B. What their parents say about God and religion
- C. Their parents' behavior in relationship to the family, others, and to God
- D. Family's spiritual advisor
Correct Answer: C
Rationale: Children learn most about their own spirituality from how their parents behave in relationship to one another, their children, others, and God (or a higher being). What parents say about God and religion, the family's spiritual advisor, and the child's church or religious organization are less important sources of learning.