Chapter 6: Spiritual Issues in Psychiatric Nursing

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Welcome back to the Deep Dive.

Today we are going to do something a little bit different.

We are going right to the root of things.

And when I say root, I mean we are digging all the way down to the etymology of the profession itself.

Literally the root words.

Yeah.

Etymologically speaking, of course.

Exactly.

So we talk about psychiatry all the time on this show.

We talk about the brain, the biology, the meds, the neurotransmitters, you know, all the hard science stuff.

All the tangible things you can see in a microscope or at least measure.

Right.

But if you actually take a step back and break down the word psychiatry into its original Greek roots, you get a bit of a surprise.

Because you have psyche and you have iatria.

Right.

Psyche meaning soul and iatria meaning healing.

Healing of the soul.

That is the literal dictionary translation of psychiatry.

And yet, if you walk into a modern hospital unit or sit in a pharmacology lecture, how often do we actually talk about the soul?

Not nearly enough.

I mean, in fact, it's often the elephant in the room.

And that is exactly what we are unpacking today.

We're doing a deep dive into chapter six of Psychiatric Nursing, the seventh edition by Gordon I .G .Pew.

The chapter is titled Spiritual Issues.

And before you tune out, because you think we're about to get metaphysical or, you know, preach at you, hold on.

This is specifically for our listeners who are nursing students or really anyone working in the healthcare field.

We are sticking strictly to the text here.

That's right.

This isn't a theology debate.

This is about clinical practice.

The mission today is to help you, the student or practitioner, move beyond just the biology of the brain and the pharmacology and address that intangible spirit of the patient.

Because believe it or not, this stuff is on the exams.

It's in the Nanda diagnoses.

And it is definitely in the hospital room waiting for you.

Absolutely.

When you're at the bedside at three in the morning, these are the conversations that come up.

But it's tricky, right?

The text highlights this core challenge almost immediately.

We all have a spirit.

We feel it.

It's intuitive.

But spirits will care attempts to deal with that intangible part of our being in a clinical setting.

The tension is how does a nurse address spirituality without imposing their own worldview on the patient?

It's the ultimate balancing act.

You can't force your values on a patient.

That's that's unethical.

But you also can't ignore their spiritual needs just because you're afraid of overstepping.

That's negligent.

Yeah, that's a really good way to put it.

Negligent.

The text says we have to find a way to deal with these competing forces without reducing spiritual care to just a meaningless behavior or a box sticking exercise on a form.

So here is our roadmap for the hour.

We are going to start by trying to define the undefinable what actually is spirituality in a medical context.

We'll look at the demographics.

Who believes what and how is that changing?

Then we're going to get into the theoretical models.

And these are the names you need to know for the why questions on your boards.

We've got Xavier, Victor Frankl and Loder.

We need to understand their frameworks to really understand the patient.

Then we will get very, very practical.

We're going to open up the Nanda diagnoses and the DSM -5.

We'll look at the intersection of spirituality and mental illness, specifically schizophrenia and why getting the language wrong there can be genuinely dangerous.

And finally, we'll arm you with some assessment tools, HOPE and FICA, so you know exactly what to say when you're standing at the bedside and the conversation.

Well, it turns deep.

It's a full agenda.

Let's dive in.

I want to start with a quote from the text that I think frames this perfectly.

It's from Carl Jung and he's critiquing psychology, essentially saying it can sometimes be psychology without the psyche.

It's such a powerful critique.

Jung writing back in 1984,

he noted that some modern psychological theories completely ignore the psyche or the soul.

He said this approach sues people who think they have no spiritual needs.

Like it's a convenient omission for them.

Exactly.

But he calls it a deception.

He says, in a word, they do not give enough meaning to life and it is only meaning that liberates.

Only meaning that liberates.

That's a heavy statement for a medical text.

It is.

And it sets the stage for why we care about this in nursing.

If we treat the body and even the neurochemistry, but we ignore the meaning, we aren't fully healing the person.

So what does the text put under this umbrella of spirituality?

It's not just one thing.

No, it's a whole constellation of concepts.

The text lists things like forgiveness, peace, trust, hope, grief, meaning and purpose.

It's it's the stuff of life, really.

And because that list is so broad and I mean, so abstract, research becomes a nightmare, doesn't it?

It is absolute chaos for researchers.

The text brings up Koenig, who in 2008 pointed out that because there is no single agreed upon definition of spirituality,

doing hard scientific research on spirituality itself is almost impossible.

How can you measure something if you can't even define it?

Exactly.

In science, you need operational definitions.

You need to be able to measure things.

How do you measure meaning or hope?

It's incredibly difficult.

So what do they do instead?

How do they study this?

They look for proxies.

They measure religious expressions, things you can count like church attendance, right?

Church attendance, frequency of prayer, reading scripture.

For research purposes, spirituality is often treated as a subset of religiosity.

Because those are things you can quantify on a survey.

But that's not the full picture.

Not even close.

Yeah.

So for you, the nurse, the takeaway is that you can't rely on a strict dictionary definition or a stat sheet.

You have to understand what the patient means when they use those words.

And to understand the patient, you have to understand the landscape they are living in.

The text provides this really great breakdown.

Table six to one covering major religious traditions in the US.

Let's walk through the demographics because they might surprise people.

They really might.

Well, the headline number, and this is something to really internalize, is that over 80 % of adults in the United States identify with a monotheistic religion.

Monotheistic meaning believing in one God.

So we are talking mostly Christian, Jewish, and Muslim traditions.

Correct.

That is the vast majority of your patient pool.

So statistically speaking, when you walk into a room, the odds are very, very high that the person in that bed operates under a worldview where there is one God.

However, there is a massive shift happening underneath those numbers, and that's the rise in the unaffiliated.

The knowns.

That's N -O -N -E -S.

Exactly.

The people who check none of the above on the religion question, the text says greater than 16 % of American adults identify as unaffiliated.

Which is already a big number.

That's more than one in 10.

But if you look closer at the age groups, a 2012 survey found that one third of adults younger than 30 were religiously unaffiliated.

One third.

That is a huge chunk of the younger demographic.

So if you're a nerf treating a 25 -year -old, there's a one in three chance they don't check a specific religious box.

Now here is where we need to be really careful with our assumptions.

Does unaffiliated mean atheist?

No, and this is so crucial.

Do not assume unaffiliated means atheist.

The text points out that this group is widely diverse.

It ranges from committed atheists and agnostics to people who say religion is actually very important to them.

They just don't belong to a specific institution.

So they believe, but they don't belong.

You got it.

In fact, 68 % of these unaffiliated people still believe in God or a universal spirit.

Wow, so more than two thirds of the nuns still believe.

They just don't like the label or the building.

Precisely.

They are believers without a membership card.

This brings us to that famous phrase, spiritual but not religious.

I feel like I hear that all the time.

You do, and the text actually breaks down who uses that phrase.

It's mostly baby boomers and Gen X or so, people born between about 1945 and 1980.

For that generation, the phrase makes perfect sense.

It's kind of a rebellion.

Right, it is.

It's a rejection of the rigid institutions they grew up with, but an embracing of the inner life, the spirit.

But here is where it gets really interesting for the nursing students listening.

If you are treating a teenager today, do not use that phrase.

Right.

Smith and Denton did this huge national study for religion and youth back in 2005.

They found that most modern teenagers had never even heard the phrase spiritual but not religious.

Never heard it.

Or if they had, they had no clue what it meant.

It didn't resonate with them at all.

That is wild.

I really assumed that was the default setting for young people.

Apparently not.

The research indicates teens are actually more conventional.

They either are religious -like, they go to youth group and believe the doctrine, or they aren't.

They don't really parse it into this nuanced spiritual but not religious category.

So the clinical takeaway is crystal clear.

It is.

Don't assume a patient's spiritual language based on your own generation.

You have to ask them what they mean.

You have to use their words, not yours.

OK, so we know the demographics.

A lot of believers, a growing number of nones, and different language for different generations.

But we still need to pin down what we are talking about.

The text gives us a clinical definition from the Royal College of Psychiatrists.

Yes,

and it's a good one.

They describe spirituality as finding meaning, purpose,

and this is the key, relationships.

Relationships.

Yes, relationships with self, with others, and with what lies beyond.

What lies beyond.

I like that.

It's a beautiful, open -ended phrase.

It's not prescriptive.

It emphasizes healing the person, not just the disease.

It views life as a journey.

But to make this useful for us in a clinical setting, the text breaks spirituality down into two distinct views.

You need to know these two paths to understand where your patient is standing.

The theistic view and the humanistic view.

Let's unpack the theistic view first.

The theistic view is what most people traditionally think of when they hear the word religion.

It sees the human spirit as inextricably connected to a transcendent source God, a higher power, a universal spirit.

And it's usually expressed within a community, right?

Usually, yes.

Yeah.

A religious community like a church, or a synagogue, or a mosque.

The text references the creation story here, right?

As a way to explain the logic of this view.

It does.

It goes back to that image from Genesis of God breathing life into humans.

The idea is that we are living souls because we were inspired, literally breathed into, by a supreme being.

Our spirit is a gift from that source.

What is the primary emotion or the primary state of being associated with this view?

Gratitude.

A sense of gratitude for basic existence.

The feeling is I am here because I was made to be here and I am thankful to the maker.

It's a very foundational sense of thankfulness.

Okay, now let's contrast that with the humanistic view.

This brings us back to Jung again.

He describes spirituality as the sum total of intellectual and cultural possessions.

That sounds a lot more internal, like something you build for yourself rather than something you receive.

It is.

The humanistic view includes how people attempt to bring meaning to their lives apart from a religious community or a concept of God.

It emphasizes the human spirit.

So instead of a transcendent source, it's about self -transcendence.

Precisely.

It's about connecting with other people, leaving a legacy, finding purpose in humanity itself or in nature or in art.

It's about finding meaning in the here and now in the connections we make.

And the text makes a point that these two views aren't necessarily enemies.

No, not at all.

They're not always mutually exclusive.

But the humanistic view is often the past for those who de -emphasize or reject the theistic approach.

It's an alternative way of finding that deep meaning.

So as a nurse, you need to be able to toggle between these two.

You might have a patient who finds meaning in God and the very next patient finds meaning in their connection to their family or their work.

And both are spiritual issues.

Exactly.

And you have to validate both.

You have to meet the patient where they are using their framework, not yours.

Let's move into the theoretical perspectives.

This is the why section for the students.

If you're writing an essay or answering a board question, these are the names you need to know.

Xavier, Frankel, and Loder.

These are the heavy hitters.

Let's start with Xavier.

He was a clinical psychiatrist who offered a very, very useful distinction between healthy spirituality and sick religiosity.

Sick religiosity.

That sounds like a diagnosis.

It's more of a descriptive construct, but yeah, it's a powerful term.

Xavier noticed that people often have really negative opinions of religion because of painful dehumanizing experiences they've had.

Sure, I think we've all seen that.

Right, so he defined sick religiosity as being marked by a sense of exclusiveness and absolutism.

The my way or the highway approach.

I am right, you are wrong, and you are doomed.

Pretty much.

And here is the interesting bias part that the text points out.

Psychiatrists often see more of this sick religiosity than the general public does.

Why is that?

Because they are seeing people who are unwell.

There's a selection bias in their patient pool.

If religion is part of a patient's pathology, say a religious delusion or a scrupulous obsession,

the psychiatrist sees the negative side of it.

They see the religion that punishes or the religion that terrifies.

So the danger is that the psychiatrist then starts to assume that all religion is sick.

Exactly.

Xavier warns us,

do not let the existence of sick religiosity blind you to the benefits of healthy spirituality.

Healthy spirituality helps people cope.

It brings community, it brings peace, it gives meaning.

Don't throw the baby out with the bathwater just because some patients manifest religious rigidity.

That is a crucial clinical tip.

Okay, next up is Viktor Frankl.

This is one of the most powerful sections of the chapter.

It really is.

I mean, Viktor Frankl was a psychiatrist, but he was also a prisoner in a Nazi concentration camp during World War II.

His insights come from the most extreme suffering imaginable.

He talks about finding meaning in suffering, not just despite it.

Yes.

He observed that prisoners who lost hope died first.

He has this haunting example in the text regarding cigarettes.

The cigarette trade.

Right, in the camps, cigarettes were like currency.

You could trade them for a little extra soup, for a piece of bread for survival.

Frankl noticed that when a prisoner stopped trading their cigarettes and started smoking them instead, it was a sign.

A sign of what?

That they had given up the will to live.

They had decided to just enjoy their last few days.

They had lost that sense of future.

The meaning that kept them fighting, they usually died shortly after.

That is absolutely chilling.

But the lesson is so profound for nursing.

Frankl taught that meaning and attitude are choices.

Even when you have zero control over your circumstances, like being in a concentration camp or getting a terminal diagnosis or living with chronic pain, you always have a choice about your attitude toward those experiences.

So for a patient who is suffering, finding meaning isn't just a nice bonus, it's a survival mechanism.

It is like,

almost anyhow.

That was Frankl's core belief.

Your job as a nurse is sometimes to help the patient find their why.

Let's talk about the third theorist, Loder.

This one is a bit more abstract, it deals with development.

Loder connects spirituality to our earliest development as infants.

He focuses on the concept of trust.

It's a really fascinating link.

He does this linguistic thing with the word face, right?

He points out that in biblical languages, the word for face also means presence.

And he maps this onto the stages of infant development.

Okay, walk us through that timeline.

So at around three months old, an infant smiles at the face of the mother.

It's a primal response to presence.

At this stage, the infant has no concept of time, the mother is just there.

It is a state of pure being and connection.

There's no past, no future, just this loving presence.

And then what happens?

By around nine months, the infant develops a sense of time and absence.

They realize mom can leave, they experience anxiety when the face is gone.

That's classic separation anxiety.

Right, but Loder argues that this experience sets the stage for our spiritual lives, that deep spiritual searching we feel as adults.

Loder says it's a desire to be given a place in the cosmos and addressed by a loving other, similar to the infant's reliance on the mother's presence.

It's like we're looking for that face again, that feeling of being totally safe and seen.

Exactly.

We wanna feel that presence that orders our world and loves us unconditionally.

And practically, how does a nurse use this?

This feels very theoretical.

It's incredibly useful for patients dealing with abandonment and shame.

Loder noted that the infant feels no shame when gazing at the mother's face,

reconnecting a patient to that sense of being held or seen by a loving presence, whether that's God or nature or their community, can be deeply therapeutic.

It strikes at the root of loneliness.

That's beautiful.

So we have Xavier on healthy versus sick religion, Frankel on meaning and suffering, and Loder on trust and presence.

Those are your theoretical pillars.

They give you a framework for understanding what's happening inside the patient.

Okay, now let's move to the nurse's role specifically.

We have to talk about Nanda.

We do.

Nanda International, which for the students listening, defines our nursing diagnoses, actually includes spiritual diagnoses under domains like life principles and ego integrity.

This is important because it legitimizes spiritual care as nursing care.

It's not just fluff.

It's part of your scope of practice.

It is officially part of your job.

We'll get to the specific diagnoses in a second, but first, I wanna touch on the four Bs of resilience.

This comes from Levine and Ion.

This is a great, really practical framework.

Levine and Ion studied resilient children, kids who survived war, trauma, poverty.

They ask, how did these kids survive when so many others didn't?

And they found four factors that helped them cope.

Break them down for us, the four Bs.

First is being.

This is about self -respect and self -acceptance, just knowing who you are and being okay with it, having a sense of identity.

Okay, that makes sense.

The second B, belonging.

This is having a supportive group, family, community, church, a group of friends, knowing you aren't alone in the world.

You're connected to something larger than yourself.

Third.

Belief.

This is having a mission, a vision, a purpose.

And Levine and Ion make a really strong point here.

Belief sustains you when being and belonging fail.

What do they mean by that?

Well, even if you are isolated and your self -esteem is crushed, if you have a higher purpose, a belief in something that transcends your current situation, you can keep going.

Frankel would have agreed with this 100%.

And the fourth B?

Benevolence.

This is kindness.

And specifically, we are kind because people have been kind to us.

It's the reciprocity of goodness.

It gives the world a sense of moral order and hope.

Being, belonging, belief, benevolence.

That's a great checklist for assessing a patient's resilience, their spiritual and emotional resources.

Absolutely.

And it ties directly into palliative care too.

We know there are four domains of suffering, physical, psychological, social, and spiritual.

If you're only treating the physical pain with morphine, you are missing three quarters of the suffering.

You need all the Bs.

Let's open the books now.

I wanna visualize that text box labeled DSM -5 and Nanda International Definitions of Spiritual Problems.

This is core knowledge for exams.

Okay, let's open it up.

First, the DSM -5.

This is the psychiatrist's Bible.

They have a category called religious or spiritual problem.

What does that actually cover?

It's what they call a focus of clinical attention.

It's not a mental disorder itself, but it's a problem that's serious enough to warrant professional help.

It covers distressing experiences like a loss of faith, problems with converting to a new faith, or questioning your core spiritual values.

So it's for when a spiritual struggle is the primary problem.

Exactly.

The DSM is acknowledging, hey, this person is struggling with their worldview, and that's a valid reason to seek help.

Okay, now Nanda, this is the nursing language.

There are quite a few here, and the distinctions matter for your care plans.

Let's define them so the students know the difference.

First up, moral distress.

Moral distress is the response to the inability to carry out one's chosen ethical or moral decision.

It's when you know what the right thing to do is, but you can't do it.

And that happens a lot in nursing, right?

Oh, all the time.

Maybe because of hospital policy, or legal constraints, or resource shortages.

You feel like you're violating your own conscience, and that causes real spiritual pain.

Okay, next, hopelessness.

This is a subjective state where the patient sees limited or unavailable alternatives.

The key phrase Nanda uses is inability to mobilize energy.

They just can't get moving on their own behalf.

They're completely stuck in the mud.

Next is impaired religiosity.

And this one is very specific.

It's the inability to participate in the rituals or beliefs of a particular faith tradition.

It's a practical problem.

So like, if a patient is hospitalized and can't go to mass on Sunday.

Or can't face Mecca to pray because they're in traction, or they can't keep their dietary laws because of the hospital food.

That is impaired religiosity.

It is a practical barrier to their practice.

Okay, so how is that different from spiritual distress?

Spiritual distress is much broader and deeper.

It's an impaired ability to experience meaning and purpose in life.

This affects their connectedness with self, others, nature, or higher power.

You can have spiritual distress without being religious at all.

It is a full -grown existential crisis.

A crisis of meaning.

Precisely.

And finally, Nanda isn't all negative.

There's spiritual wellbeing, readiness for enhanced.

Right, this is a positive diagnosis.

It means the patient has the ability to integrate meaning and purpose, and they're ready to strengthen it.

It's an opportunity for growth.

It's the patient saying, this is important to me and I wanna go deeper.

So we have the definitions, we have the codes.

But let's talk about the reality gap because the text is pretty blunt about this.

It is.

We have all these codes, we had these frameworks, but are we using them?

The stats say,

not really.

Hit us with the numbers.

The text cites a survey from 2010 of British psychiatrists.

Only 50 % reported taking a spiritual history.

And even when they did, it was sporadic and usually just to check if the patient was delusional.

So it was a, do you think you're Jesus?

Kind of question.

We say, no, okay, spiritual history done.

It was a symptom check, not a care check.

And for adolescents, it's even worse.

Much worse.

Another study found that 60 % of adolescent inpatients were never asked about their beliefs by a mental health professional.

60%, we're just not asking.

But here is the paradox we mentioned in the intro.

The text calls it the psychiatrist paradox.

This is so fascinating.

Research shows that psychiatrists are personally less religious than other doctors.

They are more likely to identify as spiritual, but not religious or even atheist.

Okay, so you'd think they'd be less likely to talk about it.

Right, you'd think that.

But T, they're more likely than other physicians to ask about spiritual concerns.

Why?

What's the reason for that?

Because they recognize the power of emotion and suffering.

They are more comfortable talking about the negative emotions that lead to suffering.

They see the connection between the spirit and the mind, even if they aren't religious themselves.

So they understand that if the patient believes they are damned, that belief has real clinical consequences.

Oh, whether the psychiatrist believes in damnation or not, it's about the patient's reality, not their own.

That makes a lot of sense.

But there is a caution here from a researcher named Liu.

Yes, and this is a big one.

Liu cautions against the error of misjudging cultural or spiritual behaviors as psychopathology.

Just because a behavior seems strange to you doesn't mean it's a symptom of mental illness.

Can you give an example?

Sure, things like speaking in tongues or falling into a trance during a religious service or communicating with ancestral spirits.

In some cultures, that is a high spiritual state.

In a Western clinical setting, it could easily be misdiagnosed as psychosis.

You have to know the difference.

You have to ask about cultural context.

Which leads us directly into the intersection of spirituality and mental illness,

specifically schizophrenia.

This is a critical safety section for nurses.

It is.

If you take one thing away from this whole deep dive, let it be this.

We have to talk about concrete thinking.

Okay, explain that concept for us.

Patients with schizophrenia often have a diminished capacity for symbolic language.

They think concretely.

They engage in literal interpretations of words.

Metaphors just don't land.

And religious language is almost entirely symbolic.

It's all metaphor.

Exactly, think about it.

Jesus in your heart, born again, washed in the blood, the fire of the spirit.

If you take those literally, they are absolutely terrifying.

The text gives a really stark example from an author named Oates.

Yes.

A patient with schizophrenia was at a Pentecostal meeting.

The preacher was talking passionately about Jesus entering her heart.

For most people there, that's a comforting symbolic idea.

For this patient, it was something else entirely.

She decompensated.

She was terrified.

Because she thought it was a biological invasion.

She thought a man was literally gonna invade her body.

It was a literal physical invasion to her.

It wasn't a comforting metaphor.

It was a scene from a horror movie.

That is a massive and dangerous misunderstanding.

And the problem is clergy often don't understand this medical side of things.

They don't know about concrete thinking.

They keep using the symbolic language, thinking they're offering comfort.

And the patient gets more and more terrified or agitated.

So the nurse has to be the translator, the bridge between the two.

You absolutely have to bridge that gap.

You have to explain to the clergy or the family, hey, we need to speak in concrete terms right now.

The symbols are scary for them.

What about the issue of trust?

Trust is a huge issue.

The text notes that while the content of hallucinations might vary by culture, the diminished capacity for trust is universal in these disorders.

Paranoia blocks trust.

So what is the advice from the patients themselves?

The text actually asks them, what do they want from us?

It's so simple and so important, they want two things.

One,

authenticity and respect.

Don't fake it, they can tell.

And two, speak slowly and in concrete terms.

That is the golden rule for spiritual care in schizophrenia, concrete terms.

Absolutely, say, you are safe here.

I am your nurse, my name is.

Not God is watching over you because to a patient experiencing paranoia, that might feel like surveillance.

That's a very practical, very important distinction.

Okay, let's pivot to something a bit brighter.

Positive emotions.

Yes, the text brings up George Valenck's work from 2008.

He knows that psychiatry textbooks often ignore positive emotions.

We have chapters and chapters on depression, anxiety, fear, but what about joy?

Gratitude.

Valenck lists eight positive emotions that are central to the human experience.

Joy, gratitude, love, hope, forgiveness, compassion, trust, and awe.

And here is the key characteristic that links them all.

None of these emotions are all about me.

What do you mean by that?

They're relational.

They're self -transcendent.

You can't feel compassion alone.

You need someone to be compassionate toward.

You can't feel forgiveness alone.

You can't feel awe without being in the presence of something vast and bigger than yourself.

They connect you to something outside your own ego.

And does this actually help with health?

Is there a measurable benefit?

There is.

The book cites a study by Brown and others from 2013 that showed higher levels of religiosity and spiritual wellbeing correlate with a reduced anxiety and depression.

It's not just nice to have, it is protective.

It buffers the brain against stress.

So fostering these positive transcendent emotions is actually a mental health intervention.

Yeah, it absolutely is.

Okay, so we're convinced it's important.

We're in the hospital room.

How do we actually do this?

The text talks about existential urgency.

Right.

Suffering and mortality crises, like end -of -life care or an acute diagnosis,

force this urgency.

People who maybe never thought about meaning in their day -to -day life are suddenly desperate for it.

When you face death, the question, what does it all mean, becomes the only question that matters.

So as a nurse, you're gonna encounter this urgency.

Kona gives us five simple actions for nurses, a checklist to handle this.

Let's run through them.

They're very straightforward.

Number one, take a history.

Just ask the questions, don't assume.

Number two.

Support beliefs, validate them, even if they aren't your beliefs.

The goal is to support the patient, not to win a debate.

Number three is prayer, but with a big caveat.

A huge caveat.

Pray, but only if you're comfortable doing it and only if the patient requests it.

This is not something you initiate.

Number four is more universal.

Yes, number four is be kind and gentle.

This is what the text calls, providing spiritual care through presence.

Sometimes the most spiritual thing you can do is just sit quietly with someone.

Your presence is the care.

And number five is about knowing your limits.

Exactly.

Refer to pastoral care.

Know when to call the pros.

Okay, so for that first step, taking a history, we have tools, we have hope and FRIKA.

These are acronyms.

And nursing students love acronyms.

They do save lives on exams.

Let's do hope first.

This comes from Anandaraja and Hightate.

H is for sources of hope, you ask.

What gives you hope or strength right now?

O is for organized religion.

What role does organized religion play in your life?

Is it a source of comfort or stress?

P is for personal spirituality and practices.

This is where you get beyond the institution.

Do you have personal spiritual beliefs?

Do you pray?

Do you meditate?

Do you hike in nature to feel connected?

And finally, E.

E is for effects on medical care and end -of -life issues.

This is the really practical part.

Does your faith affect your decisions about medical care?

Does it stop you from taking blood products?

Does it affect your end -of -life wishes?

That's a great tool.

It covers all the bases from the personal to the practical.

Now what about FRIKA?

This is Pichalsky's model.

FRIKA is very similar.

Just structured a little differently.

It's also excellent.

F is faith tradition.

Do you consider yourself spiritual or religious?

Or do you have a faith that is important to you?

I is for importance and influence.

How important is your faith to you?

How does it influence how you cope with illness?

C is next.

C is for church or community.

Are you part of a spiritual community?

Is that community a source of support for you?

And the final letter A.

A is for address.

How should we address these needs in your healthcare?

I really like the A in FRIKA.

It's so collaborative.

It puts the ball in the patient's court.

How do you want us to handle this?

Exactly, it respects their autonomy.

But let's be real.

If you are rushing, and let's be honest, nurses are almost always rushing.

Koenig offers a single question shortcut.

What is it?

Do you have any spiritual needs or concerns related to your health?

Simple,

direct, to the point.

And very effective.

It opens the door without forcing the patient to walk through it.

It gives them permission to talk about it if they want to.

Finally, let's talk about referrals.

We mentioned calling the pros.

The text makes a really important distinction between community clergy and board -certified chaplains.

This is a vital distinction for patient safety.

Community clergy, your local pastor, rabbi, or imam, are great.

They are the patient's own support system.

But they're usually not trained in psychiatry or clinical care.

Which goes right back to the schizophrenia issue and concrete thinking.

They might not understand the medical side of things and could inadvertently cause distress.

A board -certified chaplain has clinical training.

They've done residencies in hospitals.

They are part of the interdisciplinary team.

They know how to navigate the mental health landscape.

They know the difference between a spiritual crisis and a psychotic break.

Yes, a very important difference.

But the text notes that families often prefer their own religious professionals.

It does.

A study found that families of patients with schizophrenia often have a caution toward mental health professionals.

There's still stigma.

They trust their pastor more.

So the nurse has to navigate that relationship too?

You have to work with the community clergy respectfully.

Yes.

And the text suggests specifically for you students listening that you should try to shadow a chaplain.

That's a specific assignment suggestion right there in the textbook.

It is.

Go see what they do.

Understand their role so you know when it's appropriate to call them.

Koenig says hospital staff should refer all but the simplest spiritual needs to the chaplain.

So don't try to be the priest.

Be the nurse who calls the priest.

Exactly.

Know your scope, stay in your lane, but make sure the traffic flows smoothly between all the lanes.

Okay, we have covered a massive amount of ground.

Let's just recap quickly the key study notes before we sign off.

First, we define spirituality looking at both the theistic or God -centered view and the humanistic or meaning -centered view.

We saw that while the knowns are rising, most of your patients will still believe in something.

We looked at the theories you need to know.

Xavier's sick religiosity versus healthy spirituality, Frankel's teaching that we can choose our attitude in suffering,

and Loader's idea about infant trust and presence.

We covered the four Bs of resilience, being, belonging, belief, and benevolence, a great way to assess a patient's inner resources.

We dove into the text box for DSM -5 and Nanda, knowing the difference between spiritual distress, which is a crisis of meaning, and impaired religiosity, which is a practical barrier to worship.

And we gave that critical warning about the concrete thinking trap with schizophrenia.

Patients, avoid symbolic language.

Be direct, be clear, be simple.

And we gave you the tools to take a spiritual history, hope, FICA, and the importance of referring complex issues to a trained, board -certified chaplain.

It's a comprehensive toolkit for a part of nursing that is often overlooked.

I wanna end with a final provocative thought from the text.

It mentions that patients often find comfort in the transcendent view, the God view, even if it makes the healthcare provider personally uncomfortable.

That's the challenge, isn't it?

When the patient's worldview doesn't match your own.

So the question for you, the listener, as you prepare for your clinicals is, are you ready to sit with that discomfort?

Can you let the patient have their meaning, even if it's not your meaning?

Because that is where the real healing of the soul, the real psychiatry happens.

In that space of acceptance.

Thank you for joining us on this deep dive.

A huge thank you from the last minute lecture team for tuning in.

Keep learning.

We'll see you next time.