SPIRITUAL INTERVENTION AND THE SCIENCE OF UNITARY HUMAN BEINGS

1
SPIRITUAL INTERVENTION AND THE SCIENCE OF UNITARY
HUMAN BEINGS

• Australian College of Holistic Nurses
• 5th INTERNATIONAL CONFERENCE 2002
• Touching the Spirit
• Ancient Wisdom in the Art and Science of Future
  Nursing
• Hahndorf, SA Australia
• Thomas Cox RN, MS, MSW, MS (Nursing)
• Doctoral Candidate
• Virginia Commonwealth University
• School of Nursing
• November, 2002

2
Objectives

• Describe the context for spiritual interventions
  from a Rogerian paradigm
• Review literature on spirituality relevant to
  spiritual interventions
• Describe two successful interventions delivered
  with minimal organizational backing
• Suggest paths to spiritual intervention in
  practice

3
Premises

• Opportunities for spiritual interventions arise
  naturally when we attend to the integrality of
  the human-environment fields, can be provided
  with minimal cost, time, and help if the
  caregiver is attentive, responsive and creative.
• Barriers to spiritual expression impair the
  ability of clients to address their own
  spirituality - whether the clients and staff
  perceive them as internal or external to the
  client, or do not see them at all.
• Removing obstacles to spiritual expression are
  likely to be more effective than efforts to
  compensate for such obstacles, allowing people to
  engage naturally in spiritually meaningful
  activities is easier than mobilizing resources

4
Science of Unitary Human Beings

• Humans are energy fields - integral with and in
  continuous mutual process with environmental
  energy fields
• Though Rogers does not specifically address
  spirituality, integrality is similar to other
  spiritual conceptions such as oneness, prime
  mover, Freuds oceanic feeling, flow,
  presence, nature, being
• Malinski - integrality is what is experienced
  when people have spiritual experiences.
• SUHB nurses often center and meditate before
  nursing activities, as do other nurses

5
Dimensions of Spirituality

• Meaning-making
• Meaning, purpose, or significance of human life
• Values clarification
• beliefs and standards about what we hold to be
  true, beautiful, sacred, profane
• Transcendental or integral relationship to the
  infinite
• experience and appreciation of pandimensionality
  oceanic feeling, synchronicity, archetypes,
  unboundedness
• Connecting with self and others
• including relationship with God(dess), higher
  power, Gaia
• Unfolding/Becoming
• Beliefs regarding an evolutionary course to
  life, that we evolve consciously, and to a higher
  state of being

6
Defining Characteristics of Spiritual Distress

• Necessary Experiencing a disturbance ones
  belief system.
• Possible
• Questioning of ones own belief system.
• Experiences discouragement, despair, spiritual
  emptiness
• Unable to practice usual religious rituals.
• Has ambivalent feelings (doubts) about beliefs.
• Believe (s)he has no reason to live.
• Emotionally detached from oneself and significant
  others.
• Is concerned, angry, resentful, afraid
  regarding life, anguish, death.
• Asks for help dealing with spiritual issues/doubts

7
S 1

• Impaired Coping
• Humor
• to facilitate appreciation of that which is
  funny, to relieve tensions
• Hopelessness
• Hope instillation
• to promote a positive sense of the future
• Spiritual Distress
• Spiritual support
• to facilitate a sense of inner peace
• Spiritual Well-Being
• Spiritual growth facilitation
• to support growth/reflection reexamination of
  values

8
Institutional Support for Spiritual Work

• Joint Commission for Accreditation of Healthcare
  Organizations (JCAHO)
• Address the spiritual needs of diverse clients
• World Health Organization
• The definition of health includes four domains of
  well-being physical, mental, social and
  spiritual.
• The North American Nursing Diagnosis Association
  
• spiritual distress is a nursing diagnosis
• International Council of Nurses Code for Nurses
• Requires that nurses address patients spiritual
  needs
• Nursing Interventions Classification System
• "hope instillation", "spiritual growth
  facilitation" and "spiritual support" are
  appropriate nursing interventions

9
Examples of Spiritual Interventions
10
Impediments to Spiritual Intervention

• Lack of specific resources
• Differing definitions of spirituality and
  religion
• Uncertainty of the appropriateness of spiritual
  intervention
• Lack of peer support and limited continuity for
  spiritual interventions
• Inadequate resources for specific spiritual
  interventions.

11
The Clients

• J - A short term, though considered to be a
  potentially long-term referral for chronic care,
  voluntary, acute admission to a university
  affiliated in-patient, mental health facility
• S a long-term (15 years) patient at a state
  run psychiatric hospital on a ward for aggressive
  male clients

12
J 1

• Young, White/American-Indian male, severe
  depression, suicidal ideation deemed long-term.
• Had not spoken since admission and refused
  medications
• Approached casually, sat side by side for 20
  minutes, and eventually asked how he felt about
  being here.
• He stated distaste for being unable to be
  outside.

13
J 2

• Upon further gentle probing around Native
  American issues explains that he spent most of
  his time hunting, fishing and scavenging on
  family land.
• Intervention - pharmaceuticals are a method of
  healing, blended by powerful, shamanic figures,
  based on natural healing remedies found in nature
• J accepts meds, works on several healing issues,
  and leaves in a matter of days.

14
S 1

• Older, African-American male.
• Hospitalized in a public psychiatric hospital for
  20 years.
• Refuses to sleep in a bed
• Frequently heard mumbling Come to Jesus
• Behavioral intervention team tries traditional
  behavior modification approach with edible
  re-inforcers.

15
S 2

• S eats treats and refuses to stay in room
• Intervention secure a tape player from
  behavioral team and play Gospel music in clients
  room.
• Client eats snack, listens to music, unfolds
  unused bed, climbs in and sleeps for several
  hours first use of a bed in 8 years
• Over several days, when nursing staff took the
  time to set the environment in his new room up,
  and sit with him for a few minutes, S would
  quietly eat his snacks and spend some time
  sleeping in his room

16
Recommendations 1

• Spiritual interventions are as much a matter of
  recognizing the need as of developing the
  intervention.
• Often, all that is needed is permissions
  frequently denied in the setting, to be
  themselves.
• Resources for spiritual interventions are low
  cost, flexible, and need not present conflicts
  for staff.
• Attend to the expressed needs, the impediments to
  immediate gratification, and use a little
  creativity.

17
Recommendations 2

• Js behavior and ideation could have been
  interpreted as delusional or a symptom of
  substance abuse rather than spirituality
  accepting his frame of reference for his behavior
  as spiritual was a key to working with him.

18
Recommendations 2

• S was a frequently violent and nearly impossible
  to understand when agitated. Nobody ever thought
  about why he was singing or how it might be used
  to help him.
• In fact, it was conventional wisdom on the unit
  that when S started singing he was soon likely to
  get violent.
• In fact, an entire team of psychologists, nurses,
  behavior therapists, and social workers designed
  a behavioral intervention that was nowhere near
  as effective as a cassette tape with hyms.

19
S 1

• Older,

20
(No Transcript)
21
S 1

• Older,