Holly Ehrke NURS 317 Journal

Transcription

1 1 Holly Ehrke NURS 317 Journal Week 1: 5/15-5/21/ Spend some time reflecting on the word spirituality. What images does it bring to mind? Write down the thoughts and feelings and images that come to mind while reflecting on its meaning. Spirituality means something different to everyone. To me, spirituality is a concept that incorporates the mind, body and soul of a person and transcends their beliefs, actions, and goals towards a divine being. It is a board concept and each person s spiritual experience may be different. (This was included with my initial post so I could reflect back on my definition). When I think of the word spirituality, I think of a divine or Supreme Being. I also think of a state of peace. Each person may have their own concept of what spirituality is and how it is obtained. Some of the images that come to mind are: crosses, the face of Jesus, Mary the mother of Jesus, Buddha, doves, and lilies. 2. Having thought about what the word spirituality means to you, now consider and reflect upon the things in life that are important to you and that you most value-e.g., family, health, friends, etc. anything that is important to you as an individual. Are there linkages and/or congruencies with your definition of spirituality? If not, why? Does this reflection make you consider any changes? My definition of spirituality is board and I feel that each person may have their own definition of spirituality. As I examine my definition of spirituality, I also look at the things that I most value in life: my family, friends, and religion. Although I was raised in a very closed-mind family, I am very open to others views and opinions. I respect my family and friends for their individuality. I respect their opinion on controversial subjects and accept them for our differences; just as I would for clients and their differences on religion, culture, and spirituality. My reflection does not make me consider any changes regarding my spirituality or religion. Week 2:5/22-5/28/2012 Being aware of your own cultural and spiritual values is the first step toward understanding your clients. Complete the self-assessments (spiritual and cultural) on page 116 of Young & Koopsen. Did you uncover any hidden biases that might interfere with your ability to provide spiritually competent care? If so, what are one or two steps you could take to dissolve them? Upon completion of the self-assessment, I did find that I have some hidden biases that might interfere with my ability to provide spiritually competent care. Although I respect individuality

2 2 regarding religion, spirituality, belief systems, and values, I do favor Christianity as this is what I am accustomed too. I was born and raised a Christian and do not have many other personal experiences. I can expand my experiences by reading about other religious beliefs and practices and by furthering assessing my patient s needs; by getting to know my patients more and asking them questions about their spiritual preferences. I know when I wear a cross necklace to work patients, sometimes, would ask me about my religious preference; maybe this could be a door opener. Week 3: 5/29-6/3/2012 Week 3: Understanding Your World View-Journal Seven Basic Questions 1. What is prime reality-the really real? The prime reality is the Triune God-Father-Son- Holy Ghost 2. What is the nature of external reality, that is, the world around us? The nature of external reality is In the beginning, God created the heavens and the earth Genesis 1:1. God has a plan for each and every one of us. God had planned something better for us so that only together with us would they be made perfect. Hebrews 11: What is human being? A human being is a highly developed living species that has high levels of thought processes; capable of critical thinking, reasoning, self-awareness and effective communication. Humans were created in Gods image. So God created man in his own image, in the image of God he created him; male and female, he created them. Genesis 1: What happens to a person at death? What happens to a person at death depends if they believe in Jesus Christ. Believers will receive eternal life with God. He that believeth and is baptized shall be saved; but he that believeth not shall be damned. Mark 16:16. For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life. John 3: Why is it possible to know anything at all? We are made in the image of God. So God created man in his own image, in the image of God he created him; male and female, he created them. Genesis 1:27. And this is how we know that he lives in us: We know it by the Spirit he gave us. 1 John 3: How do we know right from wrong?

3 3 The Lord commands us to follow the Ten Commandments. Do what is right and good in the Lord s sight Deuteronomy 5:8. Turn form evil and do good Psalm 37:27. Love your neighbor as yourself Mark 12:31. For we are God s workmanship, created in Christ Jesus to do good works which God prepared in advance for us to do. Ephesians 2:10. The Golden Rule state to treat others the way you want to be treated. 7. What is the meaning of human history? God has prepared a place for us of eternal life. In my Father s house are many rooms; if it were not so, I would have told you. I am going there to prepare a place for you. And if I go and prepare a place for you, I will come back, and take you with me that you may also be where I am. John 14:2-3. Week 4: 6/5-6/11/2012 Now that you have studied Fowler s Stages of Faith Development, discuss the stage that best describes your own faith development. How might this stage of faith development affect your spiritual care giving? My own faith development according to Fowler s Stages of Faith Development is at Stage 5 (Conjunctive faith). At this stage, as Fowler describes it, the person has a sense of detachment that allows him to let the world reveal itself as it is (Barnum, 2011, p.20). This stage of faith has a tolerance for diversity. I have come to realize that there will be more denominations in Heaven other than Missouri-German Lutherans (lol). I commonly have conversations with a coworker regarding our faith and religion. She is Baptist and I am Lutheran. They are enlightening and I respect her diversity. We will all be surprised when we get to Heaven (or other life there-after) if God turns out to be a large, African-American woman as stated in the book The Shack by William Paul Young. ( If you have not read this book.you need too. It is enlightening). Fowler s stage 5 of development allows me to see the world as it is; with diversity Although, I have my own belief system and feel that this is right for me, I am also very respectful of other people and the own belief systems and/ or spirituality. I don t feel that the diversity would affect my nursing care to patients. The one thing that I may have to do is if I was not familiar with a particular belief system or religious preference, I would educate myself about it. How can you deliver spiritual care to a client who is at a different stage of faith development? Yes, I can deliver spiritual care to an individual who is at a different stage of faith development. I have delivered spiritual care to children, new believers of faith, and adults whom are at the same level of spiritual faith as my own. If I was faced with delivering spiritual care to someone as Gandhi or Mother Teresa, I would admit, I would feel intimidated, but I would deliver care at the level I was at and look to them for guidance.

4 4 If you are not comfortable discussing Fowler, what other literature might support your current faith development. Elaborate. NA Week 5: 6/12-6/18/2012 Journal Entry: Think back to a time when you observed a client, friend or family member whose response to grief seemed unusual or inappropriate to you. Is it possible that the person s response was based on different religious or cultural beliefs than your own? Describe how any of your recent learning may guide you in responding to similar situations in the future. Many years ago, while I was working in OB, I had a mother bleed out after the delivery of her baby. The mother was Jehovah s Witness and refused blood to treat her post-partum hemorrhage. The mother and the family were very calm and collected as the mother continued to bleed-out. They were very adamant about not excepting blood and realized the consequences. They were very accepting of this impending death, while the rest of the staff was bewildered. It was very difficult for me to accept her decision, especially after she just gave birth to a healthy newborn baby. I respected her decision, yet was torn inside. I know that the look on my face probably said it all to this mother; although I never revealed to her my disapproval of not accepting the blood that may have saved her life. After our recent learning, although I know that my thoughts would probably remain the same, my actions and nursing care would hopefully be different. With being faced with this similar situation in the future, I would offer the patient and her family spiritual care. I would call in a minister if they chose. I would discuss her decisions in a positive manner. I would have discussed with the physician, upon this impending death, to deliver supportive and spiritual care as opposed to life-saving measures. I would have offered spiritual care to the family afterwards instead of my basic nursing functions. I would have hoped to transcend the patient to a higher level of consciousness as she faced her impending death. Week 6: 6/19-6/25/2012 In your experience, do you think that if you asked a client the question Do you have any spiritual needs? they would understand what you were asking? I think that if I were asking an adult client Do you have any spiritual needs? most would understand what I was asking. They might rephrase it and state Do you mean religious needs? Many nursing assessments in the hospital are more religion focused as opposed to spiritual based and the clients would probably think of the two words as one in the same. How could you phase this to obtain the information you need to determine the client s spiritual needs?

5 5 Many of the nursing assessments that I have seen are religion focused as opposed to being spiritual based. I think that if the questions were changed to be more spiritual based that more client s needs may be addressed. Not all people that are spiritual are religious. Questions could include: What give meaning to your life? What brings you joy and peace? What do you believe in? What spiritual practices do you have? What is your comfort level in discussing spirituality with your clients? I feel that my comfort level is good when it comes to discussing spirituality with my clients. I discuss religion and spirituality with my co-worked quite frequently and challenge her thoughts. I discus spirituality with my family on a regular basis. When appropriate, I discus spirituality with my clients. Week 7: 6/26-7/2/2012 Refer to the spirituality of health care providers p. 52 of Young & Koopsen. Complete the personal inventory of your spirituality. What did you discover? Conducting a personal inventory of your own spirituality can assist healthcare providers in their own spiritual education. (Young & Koopsen, 2011, p.52). This self-assessment can assist healthcare providers in examining their own spiritual/religious beliefs, their commitment to spiritual care, their strengths and weakness related to spiritual care, and their need for further development of spiritual education and care. Is faith important to me? Yes, faith is important to me. It is my belief in the Triune God that gives meaning and purpose to my life. It is the strength of my faith that has lifted me up during times of tribulation. Do I believe in God or a Higher Power? I believe in the Triune God; Father, Son, & Holy Spirit. Do I participate in religious activities? Yes, I participate in religious activities. I assist with Sunday school and the church youth group. I read the Bible and pray daily. I read devotions to my youngest daughter and discuss religious topics with my children. I try to be a role-model for my children, living a Godly-life. Do I pray? I pray daily. The types of prayers that I recite include prayers of repentance, thanksgiving and adoration, petitionary, ritual, colloquial, and intercessory prayer. I usually start my prayer ritual off with thanking God for what He has given me; followed by a prayer of repentance. I recite ritual prayers and then pray for others. Lastly, I pray for guidance and just talk to God. Do I believe that spiritual care is an important component in providing healthcare? Yes, I believe that spiritual care is an important component in providing healthcare.

6 6 What strengths do I have to offer as a spiritual care provider? As a spiritual caregiver, I am comfortable discussing spirituality with my patients. I am patient, comforting, and non-discriminatory. I can differentiate religion from spirituality. I try to offer spiritual care when applicable. What areas do I need to strengthen in order to provide sensitivity, compassionate spiritual care to my clients? In order to provide sensitive, compassionate spiritual care to my patients, I need to take more time to address their needs. Shifts can become very busy and sometimes the time is not taken to address this need of my patients What did I discover? I discovered that I am a spiritual person. I practice spirituality in my life daily. I have many good qualities of a spiritual caregiver, but I need to take the time with my patients to provide them with appropriate care. Week 8: 7/3-7/9/2012 Journal Entry: What are some of the barriers you experience in providing spiritual care for your patients? What are some strategies or measures you could take to try to address some of these barriers within yourself +/or your organization? I think that time is the biggest barrier to providing spiritual care in the ER. Although I do feel comfortable discussing spirituality in my daily life with friends and family, I do feel insecure at times discussing spirituality with patients; not that they (my patients) will take offense, but that my co-workers will feel that it is inappropriate. The ER can be a very busy place at times and I feel that my co-workers will feel that I am spending too much time with a patient. On the flipside, when I have provided spiritual care to my patients in the ER, the patients are always very appreciative. One of my favorite sayings is: The right decision is not always the popular decision. We as nurses need to remember this and do what is right for our patients and provide spiritual care. Week 11: 7/24-7/30/2012 Journal Entry: Spend some time reflecting upon the main findings of the research that has been presented in the discussion forum. Write down possible implications for the ways in which you provide spiritual care.

7 7 Interestingly enough, both research presentations provided evidence that music and prayer can provide positive effects on health outcomes. Both interventions can provide positive effects on patients that are faced with illness and prevent illness. Evidenced based research states that music therapy can even improve the health of communities by motivating patients to move with the music. Music therapy and prayer can provide positive physiological and psychological effects that directly improve patient s health. My question is, if evidence based research states that music and prayer provide such positive effects, then why isn t it used more often as a nursing intervention? I know that I have been faced with barriers when it comes to providing spiritual care to my patients. Time, co-worker acceptance, and a predominantly medical model have been my barriers. But the right decision is not always the popular decision; and my patients have always been very appreciative when I have taken the time to provide spiritual care. Some of the ways in which I already provide spiritual care include my assessment and care within the ER. Although the admitting desks asks the generic questions about religion upon admission to the ER, I try to ask my patients if there is anything that I can do for them or that I need to be aware of regarding their spirituality. I will call in the hospital chaplain as needed, I pray with and for patients, and I play soft music as appropriate when a patient has died. In the past, I have burned incense during a delivery and recited a prayer for a family. I am always very respectful of diversity by allowing patient s time to meditate (Native American) or adhering to a plan of care that was different than my own view (Jehovah s Witness). Week 12: 7/31-8/8/2012 Journal entry: Summarize your learning from this course. Discuss what was meaningful for your development personally and professionally as related to spirituality and health. I have learned a lot about myself and others during this class. I have learned that spirituality is different for everyone; even among people of similar culture and religion. Prior to this class, I thought of spirituality and religion as two different topics. I have learned that the two can interrelate and provide many benefits to individuals. Spirituality can be expressed many ways that can provide positive health benefits to persons and communities. Although the readings in this class provided me with knowledge that I did not have prior to this class, the discussion board posts with my classmates is where I learned the most knowledge. The life experiences and outside readings that my classmates brought to this class made me want to read and inquire more. This class has assisted in my transformation from RN to BSN. This class has made me look at my current nursing practice and improve my practice as a nurse. I have realized the positive implications that spirituality can have on patient health outcomes and have changed some of my practices as a nurse. I never knew that there were spiritual assessments for patients. After reading about some of the assessment tools, I have found that some were more applicable than others to my practice. I have started to ask, when the timing is right, additional assessment questions to my patients as related to spirituality. In the past I have prayed with patients and

8 8 attended a spiritual ceremony after a delivery. After taking this class, I am more aware of my own spirituality and ability to discuss this topic with my patients. When I provide spiritual care I have found that it is not only healing to the patient, but also to myself. Our research topic of music therapy was very interesting and I am excited to try to implement it more within the ER. My one concern after taking this class is, why spiritual care is not used more often within the medical field. As nurses we care for patients and are patient advocates. We (the nursing profession) need to implement spiritual care more often within our practice. It is often low-cost, non-invasive and has evidence based research to support our practice. I know personally, I will change my own practice; as it provides me with positive effects also. Grading of my journal: The grade that I give myself for my nursing spirituality journal is a 30/30 points. The journal portion of my grade has been just as important to me as my weekly discussion board postings and my research topic presentation. In fact, I have learned more about myself in this portion of the class because it is a journal that is only going to be viewed by you, the instructor. Just as my weekly discussion boards were all high quality, in-depth postings, my journal entries reflected the same quality of material. I did my weekly journal entries at the end of each week so I could reflect on what I knew prior to the readings and then record my thoughts when the week was completed. Weekly journal entries allowed me to monitor my own personal growth within this class. Although I am a religious person, I feel that my own personal spirituality has grown throughout this class. I have fine-tuned communication skills to integrate spiritual care for my patients. After completing the readings on nursing theorists and assessment tools regarding spiritual care, I have reformed my own assessments regarding religion/spirituality. I have learned that a nursing spiritual assessment goes beyond: What is your religious preference? or Would you like the hospital chaplain to visit you while you are in the hospital? I have identified implications for my own professional practice. Immediately after completing the readings on nursing spiritual care assessments, I began to ask patients additional questions on spirituality as appropriate to the situation. Questions included: Do you consider yourself spiritual or religious? Is there anything that I can do to assist you with spiritual care during your time the hospital? The implementation of these two simple questions provided me with a variety of answers. Some patients did not care to share any information with me, while others told me about their church, asked me to call their pastor or family, asked me to pray for them and their family, or play some quiet music. One patient asked me to get them a Bible to read. The patients that responded to my two simple questions commented on my caring nature. It made me feel good. I plan to implement more of the music therapy during the loss of life if family will allow it. My journal entire were always done weekly and in a timely manner for myself to reflect on the journal questions. I pondered the questions and honestly answered them for my own growth and reflection. The structure of my journal was done professionally with good grammar, spelling and sentence structure.

9 9 Thank you for a great semester and an awesome learning experience! Holly Ehrke, RN