Question 1

The nursing student is completing her clinical rotation in the intensive care unit.While caring for a patient,she says to the primary nurse,"This family is bringing in all kinds of beads and medals and putting them on the patient and bed.This is intensive care! What should I do?" What is the most appropriate response by the nurse?

Accepted Answer

Nurses must respect a patient's dress and other requirements or symbols as determined by his religion.It is not uncommon for religious groups such as Hindus and Roman Catholics to wear medals or beads as symbolic icons of their religion.The most appropriate response by the nurse is to inform the student that this practice is common in all units of care and must be respected.If the nurse needs to remove any items,she should first obtain permission from the patient or significant other.

Question 2

What is meant by the nurse's being "present" with a patient? Select all that apply.

Accepted Answer

Being "present" means to be with the patient and family in meaningful ways.This requires not only a nurse's actual presence at the bedside,but also for him to be open to issues and concerns of the patient.Presence is allowing the patient to lead discussions,set the agenda,and control the conversation.It involves sincere communication and being fully available to the patient,and might include listening to the patient's "stories" about his illness.Active and focused listening is also a quality of being present with the patient.

Question 3

The nurse is caring for a patient in the hospital.The patient states,"No matter what happens to me,I believe my path is already predetermined.Nothing is going to change my destiny." This patient is most likely exhibiting:

Accepted Answer

The patient is exhibiting fatalism.Fatalism,which is rooted in Buddhism,views fatal diseases as destined by nature and acceptance as a sign of wisdom and maturity.In this view,diseases are predetermined with a predictable outcome.Faith is an evolving pattern of believing that grounds and guides us,helps us make sense of the world,and helps us confront the challenges we face.It allows us to trust and to maintain an optimistic perspective on life events and to find purpose in life.Hope is a dynamic process that reflects a positive orientation towards future outcomes.There is no evidence in this item that this patient is exhibiting self-pity or hopelessness.

Question 4

The nurse is working in a pediatric intensive care unit.A young couple has just been informed that their 6-year-old son has died after being in the unit for 1 month.The couple is grief stricken and says to the nurse,"We can't believe this has happened.He was too young.God is watching over him.Do you believe in God?" What is the most appropriate response by the nurse?

Accepted Answer

The death of a child is one of the most difficult life events for a family as well as for the nurse who may witness it.In this item,a seemingly harmless statement such as "He is in a better place" or "He has suffered enough" may be hurtful and even offensive for the family.It is better not to offer opinions or judgments.If a family asks what you,the nurse,think,you can briefly share your beliefs and answer their question,but reflect their questions back to them.The most appropriate response by the nurse is to briefly answer the question and refer back to the family.The answer,"It doesn't matter what I think ..." sounds abrupt and opinionated.

Question 5

The nurse is asking the patient reflective,clarifying questions to help the patient make a list of what is important and unimportant in life and the time commitment for each.Which standardized (NIC)nursing intervention does this action implement?

Accepted Answer

One of the steps of most valued clarification processes is to list values (what is important and not important in life)and the time commitment for each.The nurse facilitates this by asking reflective,clarifying questions of the patient.Values clarification does not necessarily directly enhance self-esteem,inspire hope,or provide spiritual support,although the process can indirectly contribute to development of spiritual identity.

Question 6

What are some possible barrier(s)for nurses in providing spiritual care? Select all that apply.

Accepted Answer

Although most nurses would acknowledge that patients have a spiritual dimension,few actually identify spiritual problems or provide spiritual interventions.This may be a result of economic constraints,poor staffing,and high-tech care,which force nurses to focus only on physical needs.Other barriers include a general lack of awareness of spirituality and a lack of awareness of one's own spirituality.Spiritual interventions and care,although prevalent in critical care areas and at end-of-life events,can take place in any area and at any time in the patient's life journey.

Question 7

Which statement made by the student nurse to a Jehovah's Witness patient indicates a need for further learning?

Accepted Answer

Jehovah's Witnesses do not celebrate birthdays or holidays,with the exception of the anniversary of Christ's death.Thus,asking the dietary department to send up a birthday cake for celebration indicates that the nurse does not understand the Jehovah's Witnesses beliefs and practices.The nurse is correct in noting that Jehovah's Witnesses do not accept blood transfusions or products or donate their organs.Decorating the patient's room for Christmas shows the nurse does not understand the patient's religion.

Question 8

The nurse is a Christian.She is caring for a Jewish patient who has asked her to offer a prayer at the bedside.The nurse feels comfortable doing so.Which of the following actions by the nurse is appropriate?

Accepted Answer

Ask how the patient prefers to address the divine.Some people prefer the use of parental language in their prayers,for example,Father God or Divine Mother.Some use Jehovah,Yahweh,or Allah.Hindus may address one or more multiple gods,each of whom has several names.Seek direction from the patient in these matters: most people are honored to be able to explain their beliefs and practices to someone who is open to the experience.The nurse should not assume that using the names "Jesus" and "Jehovah God" would be supportive to the patient,although they might not offend in any way.The nurse does not need to avoid addressing god by a name,but the most supportive way to do so is to find out the name the patient wishes to use.Furthermore,the nurse should not assume that the patient would find a New Testament Bible verse to be helpful spiritually.

Question 9

Which type of medicine do those of the Hindu faith typically practice?

Accepted Answer

Those of Hindu faith typically practice Ayurvedic medicine,which encompasses all aspects of life,including diet,sleep,elimination,and hygiene.Some believe in the medicinal properties of "hot" and "cold" foods,which have nothing to do with temperature or degree of spiciness.People who practice Hinduism do not typically practice Western medicine,chiropractic medicine,or tribal medicine.Native Americans practice tribal medicine or remedies that incorporates natural remedies.

Question 10

Over the past few centuries,nurses have placed less attention on spiritual care primarily because:

Accepted Answer

By the mid-20th century,nursing in the United States began to see spiritual care as less important.As science has continued to develop and expand,and as more nurses studied in university settings,nursing joined ranks with scientific disciplines: Its spiritual underpinnings were replaced by what could be "seen and tested" by the scientific method.Only recently has nursing reclaimed the spiritual dimension as a vital part of its identity and recognized its power to influence health.

Question 11

A female patient tells the charge nurse that she does not want a male nurse caring for her.Which intervention by the charge nurse is best?

Accepted Answer

The nurse should explore reason behind the patient's request,which may have implications for additional nursing needs.If the reason is religious or spiritual,this provides an optimal time to engage in spiritual care.Explaining hospital policy or reassuring the patient of the nurse's competence does not help the nurse understand the primary reason for the request,nor promote patient trust.The same is true of simply complying with the patient's request.

Question 12

The nurse is caring for a patient recently diagnosed with cancer.The patient states,"I really never believed in a god or followed any religion.Should I do something now?" What is the most appropriate response by the nurse?

Accepted Answer

There are times when a nurse may not know the answer to a patient question regarding spirituality or religion.Clearly,there are times when the nurse should then refer to others with more knowledge and experience and with the patient's permission.Referring the patient to a facility chaplain is the best response by the nurse.A person may not have any religion or spirituality in his life; however,this does not mean that with changes in health status,aging,and developmental levels,a person should not reach out to ask for help or seek guidance.It is also important to understand the point at which a patient is in his thinking and not impose or convert others to ones own beliefs.

Question 13

A patient tells the nurse,"I feel that God has abandoned me.I am so angry that I can't even pray." The patient refuses to see his minister when he calls.Which is the most appropriate nursing diagnosis for this patient?

Accepted Answer

This patient exhibits three defining characteristics for Spiritual Distress (feeling abandoned by God,inability to pray,refusing to see a religious leader).Therefore,the actual problem of Spiritual Distress exists,not the potential problem,Risk for Spiritual Distress.Impaired Religiosity is difficulty in exercising or impaired ability to exercise reliance on beliefs or to participate in rituals of a faith tradition (e.g.,going to church).This patient is not unable to see the minister,but chooses not to.Moral Distress occurs when a person makes a moral decision but is prevented from carrying out the chosen action.

Question 14

A patient has a nursing diagnosis of Noncompliance with medication regimen related to a belief that God will heal her and that it would show a lack of faith to take the medications.The nurse and a clergyman have spent some time discussing spiritual and treatment issues with the patient.Which of the following statements made by the patient would indicate that progress is being made toward achieving compliance with healthcare therapy? Select all that apply.

Accepted Answer

Agreeing to consider treatment ("think about it")and recognizing that sometimes faithful people are not cured both suggest that the patient is at least considering that it is all right for her to question her beliefs.Praying for stronger faith in God's healing suggests that she is holding strong in her belief that she will be healed if she only has enough faith.Having "no confusion" about the right thing to do would be evidence of problem resolution,provided the "right thing" to do is to take the medication.However,you need more information to know whether that is what the patient means.It could just as easily mean that she is more sure than ever that she should not take the medication.

Question 15

Which special consideration may the nurse need to make when caring for a female Rastafarian patient?

Accepted Answer

Wearing second-hand clothes is taboo in the Rastafarian faith; therefore,the nurse should allow the patient to wear her own bedclothes instead of a hospital gown.Rastafarians typically consume tea; however,some do not drink milk or coffee.Muslim women may wear a locket containing religious writing around the neck in a small leather bag.These are worn for protection and strength and should not be removed.Hindus prefer washing with free-flowing water for bathing,which should be provided when possible.

Question 16

A patient of Orthodox Jewish faith is admitted to the hospital with heart failure on Yom Kippur.The physician prescribes digoxin 0.25 mg to be given orally for this patient.Based on the patient's religious affiliation,which of the following actions should the nurse take?

Accepted Answer

Yom Kippur is one of the holiest of the Jewish holidays.Self-denial includes abstaining from eating,drinking,bathing,and other rituals.Digoxin is not a non-kosher medication,so the most spiritually appropriate nursing intervention is to ask the provider to change the route of administration.The patient is in heart failure and needs the medication; thus,withholding the medication is not an option.Although the patient may understand the importance of the medication,it is not appropriate to create internal conflict between adhering to religious practices and complying with the medical regimen,when changing the route would address both concerns.

Question 17

The nurse is speaking with a 40-year-old woman at a fund-raiser.The woman states,"I have never had a mammogram.I am a Buddhist and I believe if I get cancer,then that is what my fate will be." What is the most appropriate response by the nurse?

Accepted Answer

The focus of this item is to demonstrate that certain religions,spirituality,and ways of thinking can and do have an effect on patients' willingness to seek out healthcare,most specifically,preventive screening.Researchers have investigated the effect of religious beliefs on health disparities.Fatalism,which is rooted in Buddhism,views fatal diseases as destined by nature and acceptance as a sign of wisdom and maturity.This group is known to have a highly pessimistic perception that preventive screening would lower their risk of getting cancer.The patient in this item is less likely to obtain a mammogram as a screening tool.The most appropriate response by the nurse is to first acknowledge and accept the patient's belief in her religion or way of life; however,the nurse should also provide a nonthreatening and educated response by giving the facts in support of what research has demonstrated and what prevention can do.Nurses cannot tell patients what they should and should not do,nor should they be critical of a person's religion.

Question 18

What is the most effective action for the nurse to take when delivering spiritual care to a patient of the same religion as the nurse?

Accepted Answer

The nurse can best deliver spiritual care by developing a greater awareness of her own spirituality.This allows the nurse to be a better listener and provide better care for the patient.The nurse should avoid assuming that a patient who shares the same religious affiliation has the same beliefs.Moreover,the nurse should avoid trying to meet the patient's spiritual needs independently.A team approach to spirituality provides more comprehensive care.Also,unless asked,the nurse should avoid explaining her own religious beliefs,which might offend the patient.

Question 19

Which question is most important to ask of a newly admitted patient to effectively incorporate spiritual care in the nursing care plan?

Accepted Answer

Identifying the patient's personal spiritual belief will provide you with more information to incorporate into the plan of care.These beliefs may be associated with or independent of religious affiliations.Not all people of a religious group adhere to its norms,rituals,and/or practices; therefore,questions should extend beyond focusing only on the patient's or his family's religion.

Question 20

A student nurse is preparing a Mormon female for surgery.Which statement made or question asked by the nurse indicates an understanding of the patient's religious practices or beliefs?

Accepted Answer

Both male and female Mormons wear special sacred undergarments that are removed only for hygiene,intimacy,and bathroom use.Nurses may also remove it before surgery,but it must be considered intensely private and be treated with respect.Rastafarian females will not wear second-hand clothes and require a gown that has not been worn by others.Muslim women prefer to be treated by female staff.Inquiring about prayer is inappropriate because the patient should initiate the request; further,prayer is not specific to this religion.

Quiz 16: Spirituality