nursing ethics

1. • VALUES AND BELIEFS
At the end of this chapter you will be able to;
• Define values and beliefs
• Discuss what normal spirituality
• Discuss characteristics of spirituality
• Discuss spirituality at different developmental
stages
• List factors affecting normal spirituality function
• Discuss altered spirituality function and its
manifestations
• Discuss application of nursing process

2. Spirituality is multidimensional in that it refers to
one’s relationship with one’s self, a sense of
connection with others, and a relationship with a
higher power or divine source.
• Spirituality assists a person in determining the sense
of meaning or purpose in one’s life.
• It is an integral component, or core, of one’s being.
• “spirituality is hope that there is something better”
• Spirituality is not the same as religion which refers to
a set of beliefs and practices associated with a
particular church, mosque, or other formal organized
group.
• Spirituality is a personal, individualized set of beliefs
and practices that are not church related.

3. A person’s value and belief system is the core of
his or her existence, his or her interconnectedness
with his or her spiritual side as well as his or her
interconnectedness with the environment.
• This value-belief system gives meaning and
purpose to life.
• Some call this faith. “Faith carries us forward
when there is no longer reason to carry on.
• It enables us to exist during the in-between times:
between meanings, amid dangers of radical
discontinuity, even in the face of death.
• Faith can be in many things—a superior being, the
environment, self, family, or community.

4. • This faith, belief, or value system is exhibited by
the individual in the form of organized religion,
attitudes, and actions related to the individual’s
sense of what is right, cultural beliefs, and the
individual’s internal motivations.
• The values a person holds influence all aspects of
life. How one perceives the world about him or
her, as well as his or her basic philosophy, guides
all interactions with others and ultimately reflects
a person’s individuality.

5. • All persons have some philosophical orientation to
life that assists in constructing their reality, regardless
of whether or not they practice a formal religion.
• Spirituality is interwoven into a person’s cultural
background, beliefs, and individual value system.
• This spirituality is what gives life meaning and allows
the person to function in a more total manner.
• These beliefs and values influence a person’s
behavior and attitudes toward what is right and what
is wrong and with the lifestyle he or she practices.

6. Developmental Considerations
• The geographic, social, political, and home
environment in which one lives has a major effect on
how a person develops, how he or she will view
health, and how spirituality, values, and beliefs are
formulated.
INFANT
• The infant is totally dependent on the parents and
those about him or her and is busy building trust or
mistrust.
• The parent’s method of interaction, communication,
and fulfillment of the emotional and physiologic
needs of the infant forms the basis for value
development.

7.  TODDLER AND PRESCHOOLER
• The toddler imitates those about him or her: parents,
siblings, and other adults.
• The toddler develops by mimicking observed behavior and
receiving either positive or negative reinforcement.
• Values begin to form as the toddler begins to become aware
of others and to interact with those around him or her.
 SCHOOL-AGE CHILD
• The school-age child begins to be influenced by peers
outside the family structure and begins to question and
make choices.
• The school-age child actively participates in his or her own
moral development.
• Play is the major mechanism of learning throughout the
school-age years.

8. ADOLESCENT
• The adolescent searches for his or her own identity
and begins to practice values that are separate and yet
congruent with his or her family unit.
• The adolescent is constantly questioning, trying, and
searching for the “truth of life” and for his or her
identity in the scheme of things.
• The adolescent is still struggling with his or her own
independence and formulating his or her own values,
beliefs, and spirituality.
YOUNG ADULT
• Young adults are constantly examining reformulating,
and changing their values, beliefs, and spirituality.
• Often they change completely the values and beliefs
they developed during adolescence.

9. ADULT
• Adults usually strengthen the values and beliefs they
have formed according to their life experiences.
• The adult is continually exploring and trying to see
whether his or her value system fits within his or her
lifestyle.
• They are busy teaching children the values and beliefs
that they wish their children to adopt for their lives.
OLDER ADULT
• Older adults find great solace in their spirituality and
the values and beliefs they have formed through a
lifetime.
• In general, the older adult continues to use the values,
beliefs, and spiritual patterns adopted in adulthood.

10. Characteristics of Normal Spirituality
• Relationship with self; Knowledge of who one is
and one’s capabilities
• Relationship with others; Caring for others when
they need help, Sharing of self
• Harmony with nature; Knowledge of plants and
animals Preserving nature Communing with nature
(being outdoors)
• Relationship with a higher power
Prayer
Participating in religious services
Performing religious rituals

11. Spiritual Quest
• Life may be looked on as a spiritual quest, not only to
answer the philosophic questions, but also to seek a
higher level of consciousness or a deeper awareness
of spiritual life.
• Spiritual health includes” . . . our ability to discover
and articulate our own basic purpose in life, learn how
to experience love, joy, peace and fulfillment. . .“
Spiritual Well- being
• Is a condition marked by and affirmation of life,
peace, harmony, and a sense of interconnectedness
with super natural power, self, community and
environment that nurtures and celebrates wholeness

12. Factors Affecting Normal Spiritual Expression
Culture
• Attitudes, beliefs, and values arise out of one’s
sociocultural back ground.
• Usually, but not always, people follow the spiritual
and religious traditions of the family.
• Whatever the religious tradition or belief system the
person follows, the inner spiritual experience is
uniquely personal.
Gender
• One’s spiritual expression also depends on the
societies and religious group’s beliefs and teachings
about gender or expected behaviors in male and
female roles.

13.  Previous experience
• During a crisis period, past coping styles or learned ways of
handling situations are likely to be in evidence.
• These coping patterns can be healthy and adaptive, or they
can be maladaptive.
• Additionally, the life experiences in general are an
influence. Such experiences may be related to age, but not
necessarily.
 Crisis
• A crisis may strengthen a person’s spirituality. This often
happens when people face death, for example, as a soldier
on a battlefield or a terminally ill patient
 Life span considerations
• The expression of the spiritual dimension is also influenced
by the person’s level of growth and development.

14. Altered Spiritual Function
Crisis and Change
• Just as crisis may strengthen one’s faith, it may also
deal it a blow.
• Many people do not consciously reflect on their
personal philosophy of life.
• They live life as if it were going to continue forever.
• “often it is not until the crisis, illness, aging, loss,
limitation, or suffering occurs that the illusion [or
security] is shattered . . .
• Therefore, illness, suffering, aging, loss and
ultimately death, by their very nature, become
spiritual experiences as well as physical and
emotional experiences.

15.  Separation Form Spiritual Ties
• The experience of being a patient in the hospital or a
resident in a retirement or nursing home can be shattering
initially.
• One is isolated, to some extent, from personal freedom,
personal privileges, and social support systems.
• This separation form spiritual ties places the person at risk
for altered spiritual function.
 Moral Issues Regarding Therapy
• The choice to treat may be difficult to make if the religious
beliefs say “no” and the health care system says “yes”.
 Inadequate or Inappropriate care
• Care providers insecurity in their own spiritual lives,
assigning less value and importance to spiritual care, having
little or no educational preparation in spiritual care, or
believing that it is the clergy’s territory can place the patient
at increased risk of altered spiritual function.

16.  Manifestations of altered spiritual Function
Verbalization of Distress: The person suffering
spiritual dysfunction may verbalize that distress or
express a need for help.
• The manifestation may be precise. “I feel guilty
because I should have realized earlier he was having a
heart attack.”
Altered Behavior
• A patient who is nervous about the outcome of
diagnostic test or who shows anger after hearing the
results may be suffering form spiritual distress.
• Sleeplessness or lack of concentration, guilt, fear,
depression, and anxiety may indicate altered spiritual
function.

17.  APPLICATION OF NURSING PROCESS
 ASSESSMENT
Subjective Data
• Four areas are identified and some questions are
suggested. (1) Concept of God or Deity, (2) source of
hope and strength, (3) religious practices and rituals and
(4) relationship between spiritual beliefs and state of
health. Some of the questions include.
– To whom do you turn when you need help?
– Do you feel your faith (religion) is helpful to you? If
yes tell me how.
– Has being sick (or what has happened to you) made
any difference in your feeling about God or the
practice of your faith?

18. Objective Data
• The care provider can obtain much information
about the patient form general appearance, facial
expression, eye contact, body posture and
movement, sleeplessness, anxiety, crying, and
inappropriate humor or anger.
• Materials such as religious articles, books, cards
and pictures also indicate the spiritual dimension,
as do visitors form the church or clergy.

19. NURSING DIAGNOSES AND PATIENT GOALS
• Spiritual Distress is the nursing diagnosis used for
acknowledging and identifying the spiritual
dimension and needs of patients.
– Diagnostic Statement spiritual distress (Distress of
Human spirit)
– Definition
• Spiritual Distress is disruption in the life principle
that pervades a person’s entire being and integrates
and go beyond one’s biologic and psychosocial
nature.

20. Related Nursing Diagnosis
• Some of the related nursing diagnoses for patient
with altered spiritual function include:
• Anxiety; decisional conflict; Altered family process;
personal identity disturbance; Fear; Hopelessness;
self-Esteem Disturbance; sleep pattern Disturbance;
and social Isolation.
Patient Goals
• Examples of goals for the patient with spiritual
distress include:
• The patient will express acceptance of current life
situation.
• The patient will participate in spiritual practices that
are personally supportive.

21.  Implementation
Selected Nursing Interventions for Common
Spirituality Problems
• Spiritual Distress
• Listen empathetically and sensitively
• Encourage verbalization about faith and hope
• Identify the patient’s personal coping mechanisms.
• Arrange for opportunities for privacy to express
spiritual beliefs.
• Assist with requested spiritual practices
• Refer to appropriate resources for spiritual support

22. EVALUATION
• Patient identifies support provided by staff, family,
and friends during period of questioning and
despairs.
• Patient expresses satisfaction with being able to
maintain relationships.

23. The end!!!!!!!!!!!!!