In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of religious and spiritual influences on health in order to:

  • Identify the emotional problems of client or client needs that are related to religious/spiritual beliefs (e.g., spiritual distress, conflict between recommended treatment and beliefs)
  • Assess psychosocial, spiritual and occupational factors affecting care, and plan interventions
  • Assess and plan interventions that meet the client's emotional and spiritual needs
  • Evaluate whether the client's religious/spiritual needs are met

Identifying the Emotional Problems of the Client or Client Needs Related to Religious and Spiritual Beliefs

Briefly defined, religion is an organized and formalized set of beliefs and practices that are based on a god or a number of different gods; and spirituality is defined as connectedness of the individual with others, the environment, the universe, an unseen higher power which is not a god, and connectedness within the self which is also referred to intrapersonal connectedness.

Religions are formal institutions, which can often have sects or subsets of the religion, have a formalized and established set of beliefs, practices, values and rituals. Many religions around the globe are geographically centered, and because of this fact many religions may have cultural and ethnical underpinnings. Some clients very strictly follow their religion, some follow their religion and religious practices more loosely, and still more consider themselves a member of a religion but they may rarely or never follow its dictates and practices.

Spirituality, on the other hand and quite contrary to popular opinion, is informal, rather than formal and it often does not have any established set of beliefs, practices, values or rituals. Some of the concepts and practices like meditation and connectedness are, at times, shared by some religious and spiritual people. Similarly, some religious people can also be spiritual and some spiritual people can also be religious in terms of some things.

Some of the major religions of the world are Christianity with its sects such as Catholicism and Baptist, Judaism, Hinduism, Buddhism, Islam, Mormonism, and Jehovah's Witnesses.

Each of these religions, among other things, has a unique set of beliefs and rituals that can, and do, impact on the client and the nurse-client relationship. Some of the basic differences among these major world religions in terms of their beliefs in god and their practices are discussed below.

Christianity with Its Sects Such as Catholicism and Baptist

This religion believes in one God; some of the practices among Christians, according to the particular sect, can include end of life rituals like the Sacrament of the Sick, baptisms for newborns, fasting, and the Eucharist.

Judaism

The different sects of Judaism are the Sephardic Jews, the Ashkenazi Jews, both are which geographically based and culturally and religiously passed from generation to generations in the United States, the strictly adhering Orthodox Jewish religion, and the more loose practices of the conservative Jewish religion. Some of the practices associated with Judaism are religious based circumcisions, a kosher diet which separates dairy foods from meat based foods, and death rituals called a Shiva.

Hinduism

Hinduism is the third most popular religion in the world and it is most popular among those from India and Nepal. The religious holy book of Hinduism is called the Vedas which is unlike that of the Bible of the Christians or the Koran of the Islam religion; Hinduism does not have a holy leader like the Pope is among the members of the Catholic religion. The followers of Hinduism can choose to follow a religious philosophy of their choice including being monotheistic, pantheistic, polytheistic, monistic, agnostic, humanist and even atheistic.

There is a belief in the soul and the members of the Hindu religion practice yoga and other forms of spirituality and they can also perform rituals and routines such as pilgrimages. Many followers are vegetarian; personal hygiene is paramount and they also have death rituals without the prolongation of life.

Islam

This religion follows the holy book, the Koran, and they pray facing Mecca up to five times per day. Pork in all forms and alcohol are prohibited; handwashing rituals are adhered to and there are also fasting rituals during the holy season of Ramadan. Attire covers the body and part of the female's face when the believer in the presence of males who are not part of the immediate family. The Islam members also believe that females, rather than males, should care for the sick. At the time of death the body is wrapped in a white cloth and it is the placed in a direction so that the body faces Mecca, the holy city of this faith.

Mormonism

Mormonism, also referred to as the Church of Jesus Christ of Latter Day Saints, is less popular than other major religious sects of Christianity. Mormonism is characterized with the beliefs that were put forward by the Prophet Joseph Smith. Very similar to other Christian religions, members of this religion believe in Jesus Christ, forgiveness, baptism for the newborn, last rites at the time of death, communion, and burials of the dead. Additionally, the Mormon religion prohibits alcohol, tobacco, and caffeine.

Jehovah's Witnesses

In contrast to other religions, the Jehovah's Witnesses religion and its beliefs are found in this religion's Governing Body's Doctrines of Jehovah's Witnesses. Jehovah is the God; there is no Trinity so, therefore, there is no Jesus, and the religious services for this religion are conducted in Kingdom Halls, rather than in churches or synagogues, like the places of worship for other Christians and members of Judaism do. The Watch Tower is the means of communication among members of this religion and the vehicle with which members of this church study their religion, its beliefs and its practices.

Jehovah's Witnesses prohibit blood transfusions, foods containing blood, homosexuality, sex before marriage, abortion, suicide, gambling, alcoholic beverages, tobacco and illicit drugs.

Clients can experience all types of emotional problems relating to their religious and spiritual beliefs and practices, therefore, nurses must assess clients in respect to their religious and spiritual beliefs and practices and then modify the treatment plan to accommodate for these preferences, beliefs and practices. Nursing care must be consistent and congruent with these beliefs and practices or dissonance and distress can occur. Conflicts with one's religious beliefs and treatment plans can lead to spiritual or religious distress as well as the refusal of treatments and nonadherence to the plan of care.

The signs and symptoms of spiritual or religious distress can include emotional and psychological signs and symptoms such as those associated with a lack of connectedness with others, with the greater power and within self. Some of these manifestations can include feelings of abandonment, anger, loss of sense and meaning, alienation, hopelessness, suffering, distress, guilt, maladaptive coping, and a loss of hope.

Assessing Psychosocial, Spiritual and Occupational Factors Affecting Care, and Planning Interventions

Like all other parts of the client assessment, the nurse assesses the psychosocial, spiritual and occupational factors affecting care and planning interventions.

The assessment and planning of care relating to the client's psychological and social needs include the consideration of the client's coping mechanisms, their level of stress, and any signs or symptoms of emotional or psychological distress.

The assessment of the clients' spiritual and religious needs, preferences, practices and values was detailed immediately above under the section entitled "Identifying the Emotional Problems of the Client or Client Needs Related to Religious and Spiritual Beliefs".

Some of the occupational related factors that affect and impact on the client's plan of care and interventions include things like the dangerous nature of one's occupation and the lack of day time hours to go to the client's health care provider because their work and employment hours are not such that they can go to these day time appointments. For example, nurses will assess the occupational and education needs of clients like welders who need education and instruction about the need to wear safety goggles and they will accommodate for the need of clients to have evening and weekend hours for their health care related appointments.

Assessing and Planning Interventions to Meet the Client's Emotional and Spiritual Needs

As with all other assessments and planning, the registered nurse, often in collaboration with others such as psychologists, psychiatrists, and members of the clergy, develops a plan of care for the client that is specific to the unique needs of the unique client. The unique emotional and spiritual needs of clients have been discussed throughout this major section entitled "Psychosocial Integrity".

Evaluating Whether the Client's Religious and Spiritual Needs Are Met

Religious and spiritual needs, when assessed, are integrated into the client's plan of care. For example, the diet for an Orthodox Jewish person should consist of either a dairy or a meat meal and not combined, and kosher foods are indicated. The deceased Islamic person should be placed facing Mecca and the room of the live Islamic follower and believer should also face Mecca so that the person is able to pray according to their religion. Additionally, all clients should also be assisted to attend formal religious services when they have the desire to do so.

The outcomes of these modifications of care and special attention to the spiritual and religious needs of the client can include things like the fact that the client is without any spiritual or religious distress and that the client has a sense of spiritual connectedness, a sense of meaning, hope, peace, serenity and other positive emotional outcomes.

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