Integrating spirituality into advanced professional nursing practice.

Spirituality is synonymous to human existence. Spirituality has different meanings to different people. Spirituality is part of human life as it forms the root of one’s identity and meaning to life (Koenig, 2002). Every one of us is a spiritual being in spite of our different religious beliefs.

The ability to recognize a patient’s spiritual needs and respond to them has become a vital component of nursing. The impact of spirituality as part of the psychological well-being of a patient has caught the attention of both health professionals and national organizations.

In the last decade the focus has shifted from biological and behavioral sciences as well as technological advancements in medicine to the spiritual aspects of health and illness. The importance of spirituality with regard to health has been incorporated into the curricular of nursing institutions. These institutions have acknowledged the importance of meeting patients’ spiritual needs. (Hall, 1997)

This has been necesseciated by the fact that a nurse may be aware that the patient has spiritual needs and fail to respond to these needs. Although clinicians recognize the need for spiritual care in a patient, they are not comfortable asking questions about spirituality or religion.  This may be as a result of inadequate education or the assumption that they are not the right people to address a patient’s spiritual.

Many nurses find themselves in this awkward position as they believe such needs should be addressed by chaplains, clergy, or other spiritual leaders. However nurses are the best people to offer spiritual support to patients as they are the ones who spend most time with patients at the end of life.

Health agencies and clinicians have also addressed spirituality in order to meet accreditation and certification standards. The Joint Commission (2007) has an accreditation standard that provides for the patient’s right to spiritual care and support. However emphasis must not entirely be placed on meeting accreditation and certification standards. The major aim of spirituality in nursing is to provide a powerful inner source so as to help patients cope and find comfort and serenity at the end of life

Americans place a lot of importance in spirituality and religion in their lives.  An estimated ninety six percent of Americans believe in God. Seventy percent are church members, and forty percent have attended a religious ceremony within the past 7 days (Koenig, 2002). In a study to find out the relationship between illness and spirituality for patients who are terminally ill, seventy three percent of the participants reported that illness had made them stronger spiritually and made them more inclined to religious practices. These included praying, reading the Bible, attending church or mass, having visits from a religious leader, and receiving support from the church community (Kruse, 2007).

In a related study, hospice patients identified spiritual needs that were frequently needed, including being with family, focusing on positive thoughts, laughing, talking to people, and being with friends. In a questionnaire sent out by the American Pain Society to hospitalized patients, personal prayers was singled out as the most commonly used non drug method for pain management and the second most common method of pain management after pain pills.

Therefore in order to provide holistic healthcare, an understanding of spirituality and its relationship to health is vital. Clinicians must therefore attempt to provide holistic care, including providing spiritual care particularly when administering care at the end of life.

In attempt to cater for a patient’s spiritual needs, the nursing profession has developed a spiritual assessment which helps to establish the need for spiritual care. Conducting a spiritual assessment is just as important as conducting a physical assessment. It is highly recommended that it should be conducted on admission of the patient.

A spiritual assessment includes establishing what religious and spiritual beliefs are important to the patient and what the patient wishes for as part of spiritual care. A detailed spiritual assessment may be completed with the help of a chaplain (Barnum, 2003). The nurse needs to be trained on know how to conduct a basic spiritual assessment. Conducting the assessment is vital as it gives an opportunity for the patient to discuss his or her spiritual beliefs. This enables the nurse to address the spiritual needs of the patient with the necessary information in hand. It also provides the opportunity to foster a caring relationship between the patient and clinician.

There are a number of tools which the clinician can use to conduct a spiritual assessment including FICA: A Spiritual Assessment Tool and Functional Assessment of Chronic Illness Therapy (FACIT) and Spiritual Well-Being Scale. In general, a spiritual assessment should identify the importance of religion or God in the patient’s life and whether he or she is part of a religious or spiritual community. As part of the spiritual assessment, it is important to know what religious or spiritual beliefs or rituals help the patient cope or carry the most meaning to him or her. If a patient is not religious, the clinician can ask the patient to identify what is important in his or her life or what gives the patient’s life meaning. Through this the nurse can identify what support can help the patient cope with stress, anxiety, fear, and illness related to dying.

Apart from conducting a spiritual assessment, it is necessary to conduct a spiritual distress assessment. This is mainly conducted on a patient suffering spiritual distress as a result of illness. Such a person might have had a strong belief in spirituality and religion but might have developed resentment towards religion as a result of the illness. In such cases the nurse should seek the assistance of a doctor or a religious leader who can better solve the issue psychologically for the doctor or spiritually for the religious leader.

An example is given of Maryann, a 72-year-old woman who had advanced breast cancer. Throughout her lifetime, she had been a staunch Catholic. She attended mass, sung in the church choir, attended all the church social events with her family, and even planned all her vacations with her church group. It was clear that her church group and family were her major social supports. One day while visiting, Maryann told the home health nurse that she saw no reason as to why she was alive and was too anxious to pray.  The nurse asked her if she was having any body pain or if she was depressed. Maryann said that she was in no pain neither was she depressed.

This a case of spiritual distress where a patient who has a strong spiritual or religious background begins to question his or her faith. In Maryann’s case, she might have been angry with          God due to the fact despite having led a religious life she was dying of cancer. Spiritual resentment can worsen a patient’s condition as his or her spirituality well being is important for the physical well being.

In conclusion; with regard to the laws of physics, energy cannot be created or destroyed. Every living being represents a form of energy. This means that human life does not end with death. It is only a transition to another form of energy. This is where spirituality comes to play. An ailing person needs comfort and reassurance that as he or she comes to the end of his journey of life, he or she will rest in peace and embrace a new form of life.





Barnum, B. (2003). Spirituality in nursing: From traditional to new age. New York: Springer Publishing Company.

Hall, B. A. (1997). Spirituality in terminal illness: An alternative view of theory. Journal of Holistic Nursing.

Koenig, H. (2002). Spirituality in patient care. Philadelphia: Templeton Foundation Press.

Kruse, B., Ruder, S., & Martin, L. (2007). Spirituality and coping at end of life. Journal of Hospice and Palliative Nursing.

Schoonover-Shoffner Kathy Journal of Christian Nursing Lippincott Williams & Wilkins ISSN: 07432550 Retrieved on 12th October, 2008 from


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