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Inge B. Corless, PhD, RN, FAAN

Inge B. Corless, PhD, RN, FAAN. Introduction. Facing death prompts human beings to consider spiritual or existential issues. Spirituality is both concrete and elusive. Spirituality is concerned with questions of meaning and, in particular, the meaning of one’s life.

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Inge B. Corless, PhD, RN, FAAN

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  1. Inge B. Corless, PhD, RN, FAAN

  2. Introduction • Facing death prompts human beings to consider spiritual or existential issues. • Spirituality is both concrete and elusive. • Spirituality is concerned with questions of meaning and, in particular, the meaning of one’s life. • Spirituality is often neglected in end-of-life care when the focus is on “heroics.”

  3. Assumptions • All people possess a spiritual nature. • The development of that spiritual component varies with the individual. • Expression of one’s spirituality occurs in a variety of ways.

  4. Case Example: Ms. Galea • Dr. James, an advance practice nurse, had been caring for Dorothy Galea, a sixteen-year-old with recurrent leukemia. • Dorothy had decided to spend her final days in the Hospice to spare her younger brothers and sisters the memory of her dying at home. • Dorothy arranged with Dr. James to give her parents a tour of the Hospice. • Mrs.Galea, Dorothy’s mother, said to Dr. James at the end of the tour: ”Of course, like us, you are Catholic." Dr. James replied that she was not. • Prior to any further discussion, the elevator door opened and Dorothy and her parents left. • Questions • How might Dr. James have handled this situation? Is Dr. James' religion important in this instance? To whom? Should Dr. James follow up on this discussion? If so, should the discussion entail religion and spirituality?

  5. Defining Spirituality I • Spirituality is the human dimension that transcends the biological, psychological and social aspects of living. • Pace & Stables note that spirituality is a factor that: • “Helps the dying individual maintain a sense of well-being when faced with physical, perceptual and emotional losses.” This definition focuses on what spirituality does, not what it is. • Ley & Corless: • “(Spirituality) manifests itself as a state of “connectedness” to God, to one’s neighbors, to one’s inner self.”

  6. Defining Spirituality II • The 1971 White House Council on Aging defined spiritualconcerns as: “The human need to deal with sociocultural deprivations, anxieties and fears, death and dying, personality integration, self-image, personal dignity, social alienation, and philosophy of life.” • The breadth of this definition melds psychosocial considerations with those of the spiritual domain.

  7. Definitions III • Spiritual needs have been depicted as: “Factors necessary to establish and maintain a relationship with God, however ‘God’ is defined by the individual.” • Spiritual well-being is portrayed as “the affirmation of life in a relationship with God, self, community, and environment that nurtures and celebrates wholeness.”

  8. Spirituality vs. Religion I • How do these definitions of spiritual concerns, needs,and well-being, differ from definitions of what it means to be religious? • “To be religious is to be conscious of the connection to an extra-mundane authority that’s beyond oneself, beyond one’s parents, beyond one’s society.” • “Being religious also involves an openness to experience and to love, a capacity and desire to ‘introject,’ to take in the being and goodness that’s made available to us.” (Ulanov, 1975)

  9. Spirituality vs. Religion II • “Spiritual” is defined by Webster as: • “Things of a spiritual, ecclesiastical, or religious nature; of breathing, of wind; of or relating to, consisting of, or affecting the spirit; of or relating to sacred matters.” • “Spirituality” is defined as: • Something that in ecclesiastical law belongs to the church or to a cleric as such; clergy; sensitivity or attachment to religious values; the quality or state of being spiritual.

  10. Spirituality vs. Religion III • The terms spiritual and spirituality are defined with reference to ecclesiastical and religious matters. “Religion” is noted to be: • The service and worship of God or the supernatural; • Commitment or devotion to religious faith or observance; • A personal set or institutionalized system of religious attitudes, beliefs, and practices.

  11. Personal Integration Expression Community Response to Others Homo Ethicus Spirituality vs. Religion IV Beliefs Practices Rituals Denominational Life Religious Life Spiritual - Interior Life

  12. Stages of Spiritual Development • Children: Magical view of life. • First 12 years: Transition to a reality base. • Dependence: Adolescence when the individual feels a personal relationship with God who loves the individual unconditionally and serves as an idealized parent. • Independence: Late adolescence and young adulthood. Spirituality is found from within and spirituality and religiosity are differentiated. • Interdependence: Later in adult life. Individuals “are able to read scriptures simultaneously at the literal, allegorical, conceptual and inspirational levels.” • Unity: Few Adults achieve this final stage; “awareness of the oneness of all existence.”

  13. Spiritual Well-being • Spiritual well-being (SWB) depicts a state of equanimity, of what some would call “grace.” • “Indications of SWB may include a satisfying philosophy of life, supportive relationships with others, realistic orientations toward loss and deprivation, wholesome self concepts and ethical conduct.” (Pace & Stables, 1997)

  14. Transcendence • People achieve transcendence by: • Giving to the world creatively through family/significant others, occupation, and creative works; • Experiencing the world through receptiveness to others and to the environment; • Adopting an attitude of acceptance when faced with a predicament such as an unchangeable situation. • Some individuals at the end of life are able to transcend their circumstances and achieve a harmony and integrity that enriches the quality of their lives. • Spirituality has a role to play in achieving such an outcome.

  15. Spiritual Needs of those with Far-advanced Disease • Consensus exists in the literature regarding the spiritual needs of individuals who are dying. • These include: The need for meaning, relatedness, hope, to give and receive love, for creativity, a sense of forgiveness, trust, and purpose of life. • These needs are intrapsychic, interpersonal, and existential. • Some, if not all, may be considered spiritual. • The approaches taken to meeting these needs may be spiritual, religious, denominational, and ritual.

  16. Principles of Care “Assumptions and Principles of Spiritual Care” • This is not a clinical standard of care document. • It does provide principles for care of persons at the end of their lives and is a useful guide for all health care providers. • Special note: Before the health care provider can attend to others, he or she must understand his or her own spirituality and its influence on professional practice and personal life.

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