Care of the Older Adult

STUDENT ACTIVITY SHEET BS NURSING / THIRD YEAR

Session # 7

Materials:
LESSON TITLE: Spirituality among older adults, Ethical
Dilemma Book, pen and notebook, index card/class list

References:
LEARNING OUTCOMES: Mauk, K. L. (2018). Gerontological Nursing:
Competencies for Care (4th ed.). Jones & Bartlett
Upon completion of this lesson, the nursing student can: Learning.
1. Discuss the vital role of spirituality in older adults, and Brent, Nancy. (1997). Nurses and The Law, A
in patients/caregiver relationships Guide to Principles and Applications. W.B.
2. Identify several methods for taking a spiritual history Saunders Company.
and know when it is appropriate to make such an
assessment. Potter PA, Perry AG. Fundamentals of Nursing.
6th edn. Mosby ;st Louis.2005.

LESSON PREVIEW (5 minutes)

The instructor should summarize the previous topic. Explain the Hook Activity.

Today, we will be discussing your initial thoughts about this topic. You will answer the given questions below. Please write
your answers on the space provided.

1. Discuss your reactions to the term Spirituality and Healthcare (as a combined term).
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2. Have you had experiences where spirituality played a role in your healing, or a patient’s healing? ( Make sure to
define spirituality).
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MAIN LESSON (25 minutes)

A spiritual connection can boost seniors’ wellness, especially when their senior living community supports faith practices.
Spirituality is a significant part of many people’s lives, and it can become even more important as we grow older.

Best practice increasingly identifies spiritual care as a component of care in general (International Council of Nurses,
2012; World Health Organization, 1998).

Spirituality Religion

Root-words (Hebrew, Latin and Greek): wind, breath, or Root-word: Latin, to tie/secure/bind/fasten together to
air which gives life. create system of attitudes and beliefs.

Allows a person to experience transcendent meaning in Participation in an “organized” religion may involve:
life…whatever beliefs and values give a person a sense of
meaning and purpose in life.” - Practices
- Adherence to certain beliefs

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 - Participation in a religious community
Organizational
Individual

Institutional/Organized
Where do I find meaning?

What is true and right?

Test have personal meaning

Religious text of tradition

Spirituality, Religion, and Culture

Gerotranscendence

 Considered the 9th stage of lifecycle development (Erik Erikson developed 8 stages of lifecycle).
o Asserts that spiritual development gradually and steadily increases from middle age onward.
 3 Dimensions:
1. Cosmic (life, death)
2. Self-transcendent (personal self no longer center of attention),
3. Social selectivity (focus on close friends and family) elements.

Spirituality and Suffering

 Suffering: “the state of severe distress associated with events that threaten the intactness of person.”
 We need to learn to stay with suffering without trying to change it or fix it. Only when we are able to be present
for our own suffering are we able to be present for the suffering of others.”
 The presence of pain compounds suffering and can result in spiritual distress.

Prayer
➢ It has positive impact on patient outcomes, such as fewer complications, less medication needed and quicker
return to health (prayed for by a religious group or receiving special bedside spiritual therapies, or both
interventions)

Spirituality, Depression and Acute Heart Failure

 In an exploratory study of older persons hospitalized with acute heart failure, where depressive symptoms are
often exhibited, there was a significant negative correlation between spiritual well-being and depression: those
who had more depressive symptoms had a lower level of spiritual well- being.

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Dementia and Spirituality
 In a study on Cognitive Decline in Alzheimer ’s disease: Impact of Spirituality, Religiosity and Quality of Life, 70
patients with AD were given the MMS to monitor rate of cognitive decline.
➢ Religiosity and spirituality were measured.
➢ A slower rate of cognitive decline was associated with higher levels of spirituality and private religious
practices.
➢ The study concluded that higher levels of spirituality and private religious practices, but not quality of life, are
associated with slower progression of Alzheimer’s Disease.

End-of-Life
 This study examined resiliency factors and processes of older adults who experienced positive dying.
 Based on interviews with hospice patients and their caregivers, core resiliency factors identified:
- empowering relationships with others
- spiritual beliefs and practices
- ability to skillfully confront mortality
- Stable caregiving environment.
- Personal growth
- Spiritual well-being were interrelated in the dying older adult’s experience of life fulfillment.

Improving Care for the End-of-Life

Patient and Family Needs:
❏ Being held and comforted by loved ones.
❏ Being Listened to: sharing hopes, dreams, fears and anxiety.
❏ Having the opportunity to pray, meditate, participate in sacred rituals, listen to music.
❏ Receiving blessings form family, friends, clergy.
❏ Seeking Forgiveness form God, family and loved ones.
❏ Being at peace with themselves and others.

Taking Spiritual History and Assessment

The models guide the nurse in domains of questions that need to be addressed.
Available tools:
1. FICA

2. HOPE Model Developed by Anadarajah & Hight

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3.Three Questions Model Developed by C. Kinney, PhD, RN

Settings of Care: Spiritual Advisors

➢ Know who is available for spiritual support in all care settings -- from the home to the nursing home.
➢ Chaplains, clergy, pastoral care, or other spiritual leaders.

Healthcare Chaplains
➢ Chaplains: generic term that refers to any clergy or qualified layperson who assists patients, families and staff in
addressing spiritual/religious needs.
➢ Exist in hospitals, prisons, military, mental health institutes.
➢ May come from any religious tradition, they may be certified.

When to Refer to Chaplains

❏ Grief
❏ Major Change
❏ Desire for Comfort
❏ Decision-Making
❏ Stress & Distress
❏ Isolation
❏ Difficult Ethical Issues
❏ Desire for Rituals
❏ Desire for “Sacred”

Community Clergy/Community Support

➢ Can be vital resource for home settings.
➢ Often have the big picture of the older adult and their practical situation.
➢ Support groups may offer support -i.e. breast cancer, grief, Alcoholics Anonymous.
➢ May not have a degree.
➢ May have congregational health ministry, faith community nurse, and parish nurse activities.

Interventions of Spiritual Care: Overlap with Cultural/Psychosocial Care

a. Creative/Expressive Arts
➢ Mastery and Control and Social Engagement through engaging arts programs yields better health
outcome
➢ The New research on Creativity and Aging demonstrates, “The very act of engaging one’s mind in
creative ways affects health directly via the many mind/body connections.” - Dr. Gene Cohen
➢ “Art is like chocolate to the brain.” - Dr. Gene Cohen
Art forms:
❏ Dance/Movement
❏ Music
❏ Visual arts
❏ Theatre
❏ Poetry
❏ Writing
❏ Visual Art is viewed as an integral component of spiritual care.
❏ Art heals dis-ease through expression, integration, imagery, symbols and imagination.

b. Music
➢ Studies have shown that a person’s favorite music can be a powerful distraction from pain.
➢ Music can be a bridge to connecting and to companioning.

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 ➢ Assess for older adult’s musical preferences, mood, identification of music that produces happiness,
sadness, relaxation, and the importance of music in their life.

c. Story:
➢ “The stories people tell have a way of taking care of them. If stories come to you, care for them. And learn to
give them away when they are needed. Sometimes a person needs a story more than food to stay alive.”
Jean Shinoda Bolen, Crossing to Avalon, Harper Collins, 1994.

d. Spiritual Reminiscence
➢ Focuses on gathering meaning through life story which becomes more significant with frailty, dementia,
and disability.
➢ Considers past experiences and stories about: connectedness, faith context, joy, sadness.
➢ Reframes present events through reminiscence, allowing possibility for transcendence and finding hope
amidst vulnerability.

e. Compassionate Presence
➢ Deep and attentive listening connects you to the person you are caring for.
➢ “Bearing Witness” to whatever arises.
➢ “Being there” …being fully present in the moment and acknowledging deep belief systems and life world
of self and other.
➢ The word compassion means “to suffer with.” Developed by Jean Watson, Nursing Human Science &
Human Care, A Theory of Nursing, Jones & Barlett, MA,
f. Humor:
➢ Can be a source of spiritual uplifting and a coping mechanism during difficult times.
➢ Is viewed as transcendent.
➢ Connects and bonds people together-connectedness is a component of spiritual well-being.
➢ Releases endorphins and increases body’s ability to heal and to tolerate pain.
➢ Can reveal the truth about ourselves, melt barriers, and release stress.
➢ Cultural Sensitivity is an important consideration

T. Self-Care as Spiritual Practice The ANA Code of Ethics requires self-care.

➢ Know what renews and restores your spirit.
➢ Care for your body, mind and spirit.
➢ Create your home as a place to restore you.
➢ Create an “inner home” that you can go to throughout the day.
➢ Practice resilience throughout the day.

U. Integrating Self-Care Into Your Day

➢ How do you enter the room of your patient? Can you take a moment for yourself beforehand?
➢ How/where do you eat your lunch?
➢ How do you leave the room of your patient?

CHECK FOR UNDERSTANDING (15 minutes)

You will answer and rationalize this by yourself. One (1) point will be given to correct answer and another one (1) point for
the correct ratio. You are given 15 minutes for this activity:

Multiple Choice

1.The word spirituality derives from the Latin word spiritus, which refers to breath or wind. Today, spirituality is
a. Awareness of one's inner self and a sense of connection to a higher being.
b. Less important than coping with the patient's illness.
c. Patient centered and has no bearing on the nurse's belief patterns.
d. Equated to formal religious practice and has a minor effect on health care.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. The nurse is caring for a patient who claims that he does not believe in God, nor does he believe in an "ultimate reality."
The nurse realizes that this patient
a. Is devoid of spirituality.
b. Is an atheist/agnostic.
c. Finds no meaning through relationships with others.
d. Believes that what he does is meaningless.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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3. The nurse is caring for a patient who is terminally ill with very little time left to live. The patient states, "I always believed
that there was life after death. Now, I'm not so sure. Do you think there is?" The nurse states, "I believe there is." The
nurse has attempted to
a. Strengthen the patient's religion.
b. Provide hope.
c. Support the patient's agnostic beliefs.
d. Support the horizontal dimension of spiritual well-being.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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4.The nurse is admitting a patient to the hospital. The patient states that he is a very spiritual person but does not practice
any specific religion. The nurse understands that these statements
a. Are contradictory.
b. Indicate a strong religious affiliation.
c. Indicate a lack of faith.
d. Are reasonable.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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5. Which of the following statement about religion and spirituality is true?

a. Religion is a unifying theme in people's lives.
b. Spirituality is unique to the individual.
c. Spirituality encompasses religion.
d. Religion and spirituality are synonymous.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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6.The nurse creates a referral to pastoral care when he/she realizes that the patient is in need of
a. Psychiatric care.
b. Return to religious affiliation.
c. Spiritual care.
d. Transfer to the psychiatric unit.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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7. When caring for a terminally ill, 90 yr old patient, the nurse should focus on the fact that
a. Spiritual care is possibly the least important nursing intervention.
b. Spiritual needs often need to be sacrificed for physical care priorities.
c. The nurse's relationship with the patient allows for an understanding of patient priorities.
d. Members of the church or synagogue play no part in the patient's plan of care.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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8. The nurse is caring for an elderly patient who is in the final stages of his terminal disease. The patient is very weak but
refuses to use a bedpan, and wants to get up to use the bedside commode. What should the nurse do?
a. Explain to the patient that he is too weak and needs to use the bedpan.
b. Insert a rectal tube so that the patient no longer needs to actively defecate.
c. Enlist assistance from family members if possible and assist the patient to get up.
d. Put the patient on a bedpan and stay with him until he is finished.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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9.When evaluating a patient's risk for spiritual crises, which of the following are part of the evaluation process? (Select all
that apply.)
a. Review the patient's self-perception regarding spiritual health.
b. Review the patient's view of his/her purpose in life.
c. Discuss with family and associates the patient's connectedness.
d. Ask whether the patient's expectations are being met.
e. Impress on the patient that spiritual health is permanent once obtained.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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10. The nurse is caring for a patient who has been diagnosed with a terminal illness. The patient states, "I just don't feel
like going to work. I have no energy, and I can't eat or sleep." The patient shows no interest in taking part in his care. The
nurse should
a. Not be concerned about self-harm because the patient has not indicated any desire toward suicide.
b. Ignore individual patient goals until the current crisis is over.
c. Encourage the patient to purchase over-the-counter sleep aids to help him sleep.
d. Assess the potential for suicide and make appropriate referrals.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
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3. ANSWER: ________
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LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

CAT: Muddiest Point

Now it’s time for your feedback. Please answer the question as briefly as possible.

In today’s session, what was least clear to you?

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