INTEGRATING SPIRITUAL HEALTHCARE INTERVENTIONS
INTO NURSING AND CLINICAL PRACTICE

 

Teresa Durbak Sipos DMin, RN

Trinity Counseling LLC 

Spiritual Care for Nurses and other Healthcare Professionals

 

 

DESCRIPTION OF COURSE 

Participants are introduced to basic theological concepts and will develop spiritual interventions applied to nursing and clinical praxis.

Participants utilize the nursing process of assessment, therapeutic communication, nursing diagnosis e.g. Spiritual Distress, and develop appropriate spiritual interventions to meet patient's holistic care needs while reflecting on their own spirituality.

COURSE OBJECTIVES:

1. Demonstrate effective clinical communication skills, distinguishing between therapeutic (e.g., use of silence, offering self) and non-therapeutic (e.g. making stereotyped comments, giving advice) communication techniques (see Townsend).
2. Engage in theological reflection and apply to nursing or clinical practice. 
3. Increase self-awareness of personal spiritual beliefs and its impact on healthcare provision, by comparing and contrasting one's own spiritual beliefs with peer's spiritual beliefs, respectfully.
4. Demonstrate knowledge of these specific theological concepts*
5. Grow in respect and awareness of a faith tradition other than their own.
6.  Critique research articles related to spiritual care.
7. Discuss how to apply ANA professional nursing standards of practice regarding spiritual nursing care, e.g. "render compassionate, respectful, and competent care".
8. Demonstrate an awareness of professional boundaries when providing spiritual care.
9. Create an effective Nursing Treatment Plan with the patient.
10. Reflect on one's own efficacy in the provision of effective, safe spiritual nursing or clinical care and create a personal spiritual growth plan.

* Theological concepts: 

• Fruits & Gifts of the Holy Spirit;
• Theology of Grace, Suffering, and Holiness;
• Theological and Cardinal Virtues (and vices);
• Ethics;
• The Beatitudes; and
• Corporal & Spiritual Works of Mercy applied to nursing or clinical practice

 

WEEKLY LEARNING ACTIVITIES:

Student will provide a weekly, concise, one-page typed reflection paper, double-spaced, Times New Roman 12 pt. font

1. Participant will complete a pre-course survey of patient spiritual care self-efficacy; view PowerPoint lecture "Spiritual Healthcare in Clinical Practice"; and review clinical communication techniques.
2. Participant will write their own belief statement, including a sample prayer, meditation, or spiritual reflection and compare & contrast with peers' belief statement as applied to nursing or clinical practice and present to class. Course facilitator will provide examples from clinical practice.
3. Participantwill write a concise one page Reflection each week in the above format applied to a patient interaction on the topics of:

       1 each of the spiritual fruits & gifts of the Holy Spirit,

       1 each of the Theological and Cardinal virtues,

       1 aspect of suffering, after reading Salvifici Doloris

       1 Ethics topic of their choice, related to patient care

       1 application of The Beatitudes

       1 of  the seven corporal or spiritual works of mercy.

4. Participant will attend a spiritual service of their choice (not their own religious group), write a theological reflection and present to class. This may include non-traditional spiritual services e.g. 12-step meeting, NAI Pow-wow, non-Christian service.
5. Participant will present to class one evidenced-based research article regarding patient spiritual care and impact on patient outcomes.
6. Participant will be tested on ANA & AHNA Spiritual Care standards and scope of practice, P/F, and glossary of Moral Theology terms
7. Participant will be tested on professional boundaries, P/F (see Ethics Statement). See also ANA's Faith Community Nursing: Scope and Standards of Practice, 3rd Edition, to be discussed in class.
8. Participant will provide a Treatment Care Plan for a patient diagnosed with a spiritual disorder, e.g. Spiritual Distress, P/F
9. Participant will complete a post-course efficacy survey regarding provision of spiritual care
10. Participant will demonstrate concepts of spiritual literacy, recognition of personal bias, and recognition of other's belief systems in their writings and presentations

 

ASSESSMENT METHOD:
All weekly Reflection papers will be emailed to course facilitator by the due date, before 10 pm and graded P/F.

All exams, Nursing or Treatment Care Plans and Final Essay graded P/F

Requirement to attend a spiritual service (not of student's own faith background), complete a written reflection, and provide an oral report to class for discussion

All coursework and discussions are expected to meet professional standards demonstrating respect towards diverse points of view, spiritual beliefs, and practices.

 

UNITS OF INSTRUCTION

 

Week 1

• Unit of Instruction: Orientation & Overview; pre-efficacy survey. Discussion of basic therapeutic and non-therapeutic communication techniques (see nursing text). View PowerPoint presentation on Nursing Spirituality.
• Learning Objectives/Goals: Discuss the Fruits & Gifts of the Holy Spirit applied to nursing or clinical practice
• Discuss Group Process and Reflection Paper guidelines
• Discussion
• Nursing or treatment interventions

 

Week 2

• Unit of Instruction: Discussion of the 7 Theological & Cardinal Virtues (quiz on terminology to follow). Learning Objectives/Goals: Understanding the grace of Virtues, related to holiness, in order to give strength applied to nursing or clinical practice. Compare and contrast virtues e.g. prudence (see power & control wheel) & vices (see Jeff Cavins "If deadly Sins Had Babies" P. 1 https://share.fireside.fm/episode/m7G8OqB6+q555cV-i  and P. 2  https://share.fireside.fm/episode/m7G8OqB6+Yo8OzawK . The 7 deadly sins ("pale gas") and corresponding virtues:

• PRIDE                                                       HUMILITY
• ANGER                                                     FORGIVENESS
• LUST                                                         CHASTITY
• ENVY                                                        ADMIRATION/RESPECT 
• GLUTTONY                                             ACETECISM
• AVARICE                                                  GENEROSITY
• SLOTH                                                      ZEAL

 

• Assignment: Write one-page reflection paper on 1 of the Theological Virtues or 1 of the Cardinal Virtues, noting corresponding vices, applied to nursing or clinical practice
• Nursing or treatment interventions
• Discussion
• Evaluation of nursing or treatment interventions

 

Week 3

• Unit of Instruction: Discussion of Suffering & Grace. Forgiveness Discussion https://www.vatican.va/content/john-paul-ii/en/apost_letters/1984/documents/hf_jp-ii_apl_11021984_salvifici-doloris.html
• Learning Objectives/Goals: Apply these theological concepts to Nursing Praxis
• Assignment: Write one-page reflection paper on the above
• Discussion
• Nursing Interventions

 

Mid-term

Write a one-page Treatment Care Plan on the nursing diagnosis Spiritual Distress or similar. What are your goals and interventions? What therapeutic and non-therapeutic communication techniques did you use? How does this relate to mental health and addictions? What are the generational and cultural contexts? Include in your summary, one evidenced-based research article regarding outcomes of spiritual care interventions in healthcare settings.

 

Week 4

Unit of Instruction: Discuss Ethical Religious Directives (ERDs), The Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition, which is a document that offers moral guidance, drawn from the Catholic Church's theological and moral teachings, on various aspects of health care delivery. The Directives can be found on the website of the United States Conference of Catholic Bishops or

• https://www.usccb.org/about/doctrine/ethical-and-religious-directives/upload/ethical-religious-directives-catholic-health-service-sixth-edition-2016-06.pdf
• Learning Objectives/Goals: Awareness of Ethical Issues with support
• Assignment: Submit one-page reflection paper on one Ethical issue of your choice
• Assessment Methods: Email by due date, before 10 pm, P/F.
• Discussion
• Nursing Interventions

 

Week 5

• Unit of Instruction: Discuss Corporal and Spiritual Works of Mercy as examples of spiritual nursing or clinical interventions
• Learning Objectives/Goals: Reflect on the above in your nursing praxis/clinical practice
• Assignment: Write you own Belief Statement with a prayer/meditation/spiritual teaching and then compare & contrast with one peer. Present to class
• Discussion
• Nursing/Clinical Interventions

 

Week 6

• Unit of Instruction: Attendance at an outside Spiritual Service (not your own)
• Learning Objectives/Goals: Increase awareness of differences and similarities of other religions; examine religious biases; apply to nursing praxis/clinical practice
• Assignment: Attend 1 Religious Service not of your faith group and submit a one-page reflection paper. Present your findings as a class presentation on this religious service compared to your own religious service and The Joint Commission Cultural and Religious Sensitivity: A Pocket Guide for Health Care Professionals, Third, Expanded Edition (item # CSB18) store.jcrinc.com/shopping-cart/  
• Discussion
• Nursing/Clinical Interventions

 

 

Final Evaluation: Meet with Course Facilitator; Complete Post-Efficacy Survey

 

GRADING SCALE (1 page paper each week related to patient care):

 

Paper # 1         10 points Review "Spiritual Healthcare in Clinical                                                              Practice" video. Written assignment, choose 1 each                                                              from Fruits & Gifts of the Holy Spirit

Paper # 2         10 points 1 each of Theological and Cardinal Virtues               

Paper # 3         10 points 3 definitions of Grace related to suffering

Paper # 4         10 points 1 Ethics topic, related to patient care

Paper # 5         10 points Class Presentation: Belief statement w/                                                                 prayer/meditation.

Paper # 6         10 points on one example of suffering found in nursing                                                      praxis from SD*

Research         10 points 1 Evidenced-Based Research article on                                                                  Spiritual Care Outcomes

Discussion      10 points Spiritual Care Scope and Standards of Practice                                                      and Professional Boundaries

Mid-term        10 points

Care Plan       10 points Spiritual Care Interventions for Nursing/Clinical                                                   Tx Plan e.g. Spiritual Distress

Service            10 points Attend an outside faith group Service (not own                                                    faith group)

                        ____________________________________________________

110 points Total (includes 10 bonus points for attending outside service) 

 

A total of 75 points is required to receive a certificate for this course graded as Pass/Fail

 

OUTCOMES BASED ASSESSMENT OF STUDENT LEARNING

For this course, students are expected to demonstrate the skills associated with the Institutional Learning Goals (ILG) identified below and will reflect a "Train the Trainer" model.

• Critical Thinking including written reflections
• Ethical Reasoning
• Communication Competence
• Simulation leading to nursing care plan development of appropriate spiritual interventions
• Cultural and Social Awareness including respect for other students viewpoints
• Professional & Life Skills
• In class students are assessed on their achievement of these outcomes. Names will not be used when reporting results. Outcomes-based assessment is used to improve instructional planning and design and the quality of student learning throughout the college.

 

 

COURSE MATERIALS REQUIRED [Most articles can be found easily on-line]

 

Arvonio, Maria Marra. "Cultural Compentency, autonomy, and spiritual conflicts related to Reiki/CAM therapies: Should patients be informed?" The Linacre Quarterly 2014: 47-56.

Association, American Nurses Association and American Holistic Nurses. Holistic Nursing: Scope and Standards of Practice, Third Edition. Silver Springs, Maryland: American Nurses Association and American Holistic Nurses Association, 2019. [Instuctor will provide excerpts]

Aquinas, Thomas. Summa Theologica Complete American edition translated by Faithers of the English Dominican Province. Claremont, California: Coyote Canyon Press, 2018.

            [Instructor will provide an excerpt to demonstrate the Socratic Method]

Bishops, Committee on Doctrine of the United States Conference of Catholic. "Ethical and Religious Directives for the Catholic Health Care Service, Sixth Edition." Directives. Washington, DC: United States Conference of Catholic Bishops, 2019. 1-42. [can be downloaded free]

Brykczynska, Gosia. Blessed Hanna Chrzanowska, RN: A Nurse of Mercy. Stockbridge, MA: Marian Press, 2019. [Instructor will provide a free copy of "Nurses's Examination of Conscience"]

Judy Davidson, Janet Mendis, Amy R. Stuck, Gianni DeMichele, and Sidney Zisook. "Nurse Suicide: Breaking the Silence." National Academy of Medicine. January 8, 2018. https://nam.edu/nurse-suicide-breaking-the-silence/ (accessed September 6, 2018).

Miller, Elliot. "Theophostic Prayer Ministry (Part One)." Christian Research Journal, Volume 29, Number 2 http://www.equip.org, 2006.

VanderWeele, Tyler J, Alexander Tsai, Ichiro Kawachi, Shanshan Li. "Association Between Religious Service Attendance and Lower Suicide Rates Among US Women." JAMA Psychiatry, 2016: 845-51.

*On-line article on suffering:

https://www.vatican.va/content/john-paul-ii/en/apost_letters/1984/documents/hf_jp-ii_apl_11021984_salvifici-doloris.html

 

*ANA resource on religion and cultures:

Cultural and Religious Sensitivity: A Pocket Guide for Health Care Professionals, Third, Expanded Edition (item # CSB18) store.jcrinc.com/shopping-cart/

 

American Nurses Association and American Holistic Nurses Association Holistic Nursing, 3rd Ed.: Scope and Standards of Practice. (Silver Spring, MD: ANA & AHNA, 2000), 32.

 

American Nurses Association and the Health Ministries Association. Faith Community Nursing: Scope and Standards of Practice, 3rd Edition. (Silver Spring, MD: ANA & HMA, 2017), 14-15.

 

*On-line article on nursing founder's faith:

Nightingale, Florence, and Lynn McDonald, Editor. The Collected Works of Florence Nightingale "Nightingales Spiritual Journey", (2001), https://cwfn.uoguelph.ca/ . 

 

See Jeff Cavins podcasts #116 "If deadly sins had babies, part 1", May 17, 2019 & # 117 "If deadly sins had babies, part 2", May 24, 2019

 

 

GENERAL INSTRUCTIONAL METHODS

 

• On-line recorded lecture
• In-person weekly lectures
• Class Discussion
• Attendance at an outside Spiritual Service, of student's choice, not of their own faith background
• Weekly Reflective essays related to patient care
• Student Class Presentations/Discussions

 

 

STANDARDS AND METHODS FOR EVALUATION

 

• Weekly Reflective essays related to topic and patient care
• 2 quizzes or Mid-term
• Student Class Presentation
• Spiritual Care Service Observation Experience Paper
• Pre-and Post-Spiritual Care Efficacy surveys

 

SPECIAL COURSE REQUIREMENTS

 

Demonstrate respect of other's belief systems

 

ATTENDANCE POLICY

 

Student is required to complete all assignments, quizzes, presentations, and an outside Spiritual Care Service observation. Discuss special circumstances, and/or disabilities with Professor in advance of class assignment due dates.

 

WEATHER RELATED DEPARTMENT SPECIFIC POLICY

 

If not covered by College Policy, relative to clinical, practicum, of other missed time due to weather related college closings.

OBSERVATION EXPERIENCE PAPER:

ATTEND SPIRITUAL SERVICE OF YOUR OWN CHOICE/NOT YOUR OWN FAITH

The Spiritual Service Observation Experience Paper is a professionally written paper using APA style. A formal, professional 3-page paper (1 page for the title page; 1 pages for text; and 1 page for references) is written using a minimum of one evidence-based, scholarly sources related to the topic of the paper. Papers should not include an Abstract. The paper is limited to 3 pages total. Students should not submit more than 3 pages total. Students plagiarizing or otherwise cheating earn 0 points and risk academic sanctions. The paper is due as indicated on the course calendar. Papers submitted late will receive a zero. The paper is to be submitted through Blackboard in the course room. The paper should strictly follow APA formatting guidelines. Papers that are not written professionally or have excessive spelling, grammar, punctuation, etc. errors will receive a zero.

After attending the Service, students professionally document their observations including the following:

I. Discuss the structure of the Service:

 

a. Purpose of the Service—Teaching, Praise & Worship, Liturgy, Community

b. Similarities and differences of this Service with yours

c. Formal and informal leaders

d. Seating arrangements and proxemics; formal or informal Service; on-line or    

in-person?

 

II. Discuss the process within the Service:

 

a. Analyze what happened within the Service

b. Describe themes

c. Describe the impact of the religious leader's behavior on the group dynamics

d. Describe the phase of the group's development

e. Describe your feeling/beliefs/reflections generated by the Service

f. Compare & contrast this Service to your experience at your own religious service

g. Reflect on Service and discuss how it applies to you nursing praxis