The Relationship of Spiritual Well-Being and Quality of Life in the Elderly sample essay

Palliative care is a rapidly evolving discipline of nursing, where nursing process approach may be utilized in a similar manner as in other areas of nursing. It is to be remembered that nursing process is a systematic approach for planning, documentation, and measurement of outcomes of care that focused on nursing outcomes along with clinical outcomes. In palliative care for people with chronic illnesses at older age group, these assessments must be conducted in a participatory manner with the patients in order to set the goal so achievable and desirable outcomes may be set.

It must be noted that nursing process and related assessment is a dynamic process in that the health needs of older individuals in palliative care may change rapidly. While assessing these ongoing needs, nursing assessment must assess the symptoms, functional status, and physical problems associated with terminal illnesses. In palliative nursing, however, the nurse must be able to recognise the complexity and differences in each person’s experience and it must allow assessment of the wider context of the patient’s social, cultural, emotional, and spiritual needs.

It is well known that older people living with serious chronic diseases lead to a wide range of problems with specific symptoms which tend to affect the quality of life. However quality of life is interpreted with subjective meanings attached to it. Toward the end of life this meaning keeps on changing, and it ranges from physical concerns to spiritual or religious concerns or may be varied depending on the effects of the end-stage disease on self or the family.

These concerns have been integrated into the psychological and spiritual aspects of care, and when incorporated into the nursing process, the nursing care may provide a support system to these patients to live the best possible quality life. Spirituality is perceived differently by different individuals. At the personal level, it implies personhood through values, beliefs, and achievements. It also indicates relationship with self, others, the universe, a life force, or God. From the religious perspective, it means prayer, vocation, commitment, and worship.

In the context of this assignment, the personhood model relates to humanitarian aspects of a subject which involves embodiment, cognition, emotions, and the relationships. This means from that aspect spirituality has been associated with connectedness through which loving relationships provide meaning and fulfillment. This relationship can be extended to patient-nurse interface, which exemplifies the activities of sharing the space, hopes, and fears of the patient. There is evidence that coordinated palliative care can improve the quality of life even when it fulfills the spiritual needs.

It is to be remembered that spiritual needs are often the felt needs, signifying the needs for meaning, purpose, and fulfillment of life. In the area of quality of life, existential issues have been included in the McGill Quality of Life Questionnaire (Cohen et al. 1996) and in Wyatt and Friedman’s (1996) quality of life model for long-term survivors of breast cancer. Studies have recognized the key factors in the provision of spiritual health care that intends to improve the quality of life. This demands the expertise of the nurses who can create a spiritual ethos.

Other qualities that the nurses must possess are good communication skills, notions of “being there”, ability to “share the patient’s journey”, and helping the person to find meaning. These can engage a person on a spiritual level (Wyatt and Friedman, 1996). Nurses must be able to give time and listen. A standardized instrument by O’Brien can be used in these patients who are adult and cognitively aware. This is known as spiritual assessment scale tending to measure the construct of spiritual wellbeing. This contains 21 items organized into three subscales, Personal Faith, Religious Practice, and Spiritual Contentment.

This tool may be used by the practicing nurses even in the healthcare settings enabling them to have a broad overview of the patient’s personal faith beliefs, the type of spiritual support he receives, and the type and degree of spiritual distress that the patient is currently experiencing (O’Brien, 2004). It is now recognized that palliative nurses must take into account the customs, beliefs, and spiritual values of patients. Now the nurses are required to identify the spiritual needs of the patients and to devise a plan of care based on those.

The theoretical model of spiritual needs by Kellehear’s (2000) is a framework into which the spiritual needs can be analyzed and articulated. This framework suggests that human beings have a desire to transcend their suffering and find meaning, and therefore, connectedness may produce situational transcendence (Kellehear, 2000). The sense of impending death and suffering from diseases that compromises the quality of life can be persistent and overwhelming. These are the circumstances where people fell depressed and hopeless. Their faith gets shattered, and they feel abandoned.

At this level, spiritual suffering can be equated to depression. These patients may literally give up, become withdrawn, and become disconnected from people. The nurse at this point may help contain this sense of dereliction and maintain a consistent presence that may bear witness to the possibility of reconnecting. A nursing process approach to assess the spiritual health is possible, only when the nurse can respond in a supportive, caring, and useful way. This implies a strong ethical dimension to assessment since it builds upon a very trusting relationship between the patient and the nurse where spirituality has been articulated.

Moreover a reliable and sensitive assessment must be customised, responsive, informed, and mindful of the problematic subject area. Spiritual suffering manifests through threats to personhood and hence would need a wider perspective to comprehend the patient’s understanding of their spirituality. This can be done by an assessment process that begins with the question if at all spirituality is important to a patient. Good communication skills, informed approach, wording of the question, and knowledge about the patient are important prerequisites of a spiritual nurse.

Terminal illness affects the integrity of a person, this can lead to suffering. A person can suffer through many dimensions of the personhood. Terminal illness poses a threat to the person’s existence in the world and affects severely his social roles and identity, relatedness to self and others, well-being and fulfillment. It has been suggested that when people cannot find the meaning of happenings and when then find these out of the ways of their meaning frameworks, then the suffering is related to the spiritual dimension.

Family members and relations of such patients may struggle with different spiritual issues as the patient. It has been reported by Zika and Chamberlain that “meaning in life is consistently related to positive mental health outcomes, while meaninglessness is associated with pathological outcomes (Zika and Chamberlain, 1992). ” Conclusion From practice, it evident that nursing can play important role in healthcare and health promotion to people who need care, support, and education through a spiritual connectedness so they can achieve, regain, and maintain a state of wholeness, wellness of body, mind, and spirit.

The nurse must assess the spiritual dimension of these people and through relationship building can provide comfort and care to strengthen them in spiritual health so they can find a meaning of their suffering and strengthen them in coping with the trajectory of a chronic, terminal illness with or without experience of death.

Reference List

Cohen, S. R. , Mount, B. M. , Tomas, J. J. N. and Mount, L. F. (1996) Existential wellbeing is an important determinant of quality of life. Cancer, 77: 576–86. Kellehear, A. (2000) Spirituality and palliative care: a model of needs. Palliative Medicine, 14: 149–55. O’Brien, E. , (2004). A nurse’s handbook of spiritual care: standing on holy ground. Jones & Bartlett Publishers, Boston, 16-21. Wyatt, G. K. H. and Friedman, L. L. (1996) Developing and testing of a quality of life model for long-term female cancer survivors. Quality of Life Research, 5: 387–94. Zika S, Chamberlain, K. (1992). On the relation between meaning in life and psychological well-being. Br J Psychol 1992; 83:135–145.