Using a Christian Philosophy to Incorporate Spiritual Assessment in Practice and Research

1. Using a Christian Philosophy to Incorporate Spiritual Assessment in Practice and Research Sharon K Christman PhD, RN Beth Delaney FNP-BC, RN, OCN, ACHPN Cedarville University School of Nursing

2. The purpose of this workshop will be to conceptually and operationally define the terms • spirit • spirituality • spiritual well-being • Present the relationships between each of these concepts • Clinical application to spiritual care

3. Grounded in Christian theology & Biblical text • Healthcare providers have trouble conceptualizing spiritual care outside of religion • Pew Report 2012: Identify with Christian religion • Americas 86% • Europe 76% • Sub-Saharan Africa 63%

4. Faith-Hope-Love Model of Spiritual Wellness Person Faith Hope Love Model of Spiritual Wellness Non material self Material self Spirit Body Spirituality Spiritually unwell Spiritually well Faith Hope Love needs not met: Fear, Hopelessness, Loneliness Faith Hope Love needs met Angry Worried Nervous Fearful Anxious Lonely Distrustful Impatient Irritable Restless Loss of interest Tired Pain Sleep changes Eating changes Smiling Joyful Patient EnergeticTrusting Expressive Interested Loving Interactive Hopeful Thankful

5. Person Non-material self Material Self Spirit Body Substance Dualism: belief that the human person is made up of two parts, the physical (material) and the non-physical (non-material) Causal and Dependent relationship between Spirit and Body

6. Ruwach: Hebrew Pneuma: Greek

7. Spirit in the Old and New Testaments רוּחַruwach πνεῦμαpneuma 385 occurrences Translation spirit n = 111 Holy Ghost n = 89 Spirit of God n = 13 • 378 occurrences Translation • spirit n = 232 • wind n = 92 • breath n = 27 Strong, James: The Exhaustive Concordance of the Bible : Showing Every Word of the Text of the Common English Version of the Canonical Books, and Every Occurrence of Each Word in Regular Order. electronic ed. Ontario : Woodside Bible Fellowship., 1996, S. H7307

8. Three primary themes Ruach: Hebrew Spirit of God Other spirits Pneuma: Greek Spirit of the Person

9. Three primary themes Ruach: Hebrew Spirit is the seat of the emotions Spirit of God Other spirits Pneuma: Greek Spirit of the Person

10. Seat of the emotions • Multiple references to a person’s spirit as fearful, sad, troubled Josh 2:11; Eccles 7:9; Daniel 2:1; Mark 8:12; Romans 12:11 • Fewer refer to the spirit as happy Luke 1:47 • Joy can be found in the midst of suffering and is not an emotion per se John 15:11

11. Spirit is the seat of the emotions Spirit of the Person Character is grounded in the spirit

12. Character is grounded in the spirit • Honest Psalm 32:2 • Steadfast Psalm 51:10 • Unfaithful Psalm 78:8 • Excellent Prov 17:27 • Humble Isaiah 57:15 • Proud Prov 16:18 • “pride goes before destruction, [and] a haughty spirit before a fall” Proverbs 16:18 • “a talebearer reveals secrets: but they that are of a faithful spirit conceal the matter” Proverbs 11:13

13. Spirit is the seat of the emotions Spirit of the Person Spirit can move a person to action Spirit demonstrates character

14. Spirit can move a person to action or a person can ignore their spiritual urges toward action • The spirits of the Israelites were “stirred” and as a result they “came and began to work on the house of the Lord Almighty, their God” Haggai 1:14 • a King’s spirit was “stubborn” and “refused to let [the Israelites] pass through [his land]” Deuteronomy 2:30 • “Therefore take heed to your spirit, and let none deal treacherously against the wife of his youth” Malachi 2:15b • Man can rule his spirit Prov 16:32

15. Spirit is the seat of the emotions Spirit of the Person Spirit can move a person to action Spirit demonstrates character Spirit leaves the body after physical death (brings life to the body)

16. Spirit leaves the body after physical deathSpirit is what gives life to the body • The body without the spirit is dead James 2:26a • Jesus gave up his spirit when he died Matt 27:50 • When Stephen died he prayed “Lord Jesus receive my spirit” Acts 7:59 • Spirit is the breath of life Genesis 6:17; 7:15; 7:22 • Wooden idols have no “breath” in them Jeremiah 10:14 • When the spirit is returned to the body, it comes back to life Luke 8:55 • Spirit returns to God after physical death Eccles 12:7 • Spirit is committed to God at death Psalm 31:5; Luke 23:46

17. Spirit is the seat of the emotions Spirit of the Person Spirit can move a person to action Spirit demonstrates character Spirit leaves the body after physical death (brings life to the body) Spirit can be broken or grow faint/Spirit can be revived

18. Spirit can be broken or grow weak • The human spirit can endure in sickness, but a crushed spirit who can bear? Prov 18:14 • Spirit can be broken from • Harsh treatment Ex 6:9 • Hope unfulfilled 1 Sam 1:15 • Sorrow Prov 15:13 • God’s anger Isaiah 57:16 • Distress Psalm 77:3 • In contrast, a person’s spirit can be revived/refreshed • Good news Genesis 45:27 • Food and water Judges 15:19; 1 San 30:12 • Interactions with other spirits 1 Cor 16:18; 2 Cor 7:13

19. Spirit is the seat of the emotions Spirit of the Person Spirit can move a person to action Spirit demonstrates character Spirit leaves the body after physical death (brings life to the body) Spirit can be broken or grow faint/Spirit can be revived Spirit can know or understand

20. Spirit can know or understand Mark 2:8 Immediately Jesus knew in his spirit that this was what they were thinking in their hearts, and he said to them, “Why are you thinking these things?

21. Spirit Immortal seat of the emotions in which the character of the person is grounded. Each human spirit is unique and has the potential to learn and understand, think, and analyze, and demonstrate free will. The human spirit has the ability to interact with other spirits as well as the physical world, and as such can be hurt or helped, discouraged or encouraged; and is the vital force that gives life to the physical body.

22. Faith-Hope-Love Model of Spiritual Wellness Person Non material self Material self Spirit Body Spirituality The term most often used to describe the state of the human spirit meaning & purpose relationship connection

23. Spirituality The relationship of our embodied selves to God, others, the environment and self. Results in a search for meaning and purpose

24. Person Faith-Hope-Love Model of Spiritual Wellness Non material self Material self Body Spirit Spirituality Spiritually well Spiritually unwell I Corinthians 13:13 And now these three remain: faith, hope, and love. But the greatest of these is love Since the human spirit is immortal, the needs of the spirit which remain after physical death are the same needs of the embodied spirit after death

25. Faith-Hope-Love Model of Spiritual Wellness Person Non material self Material self Spirit Body Spirituality Spiritually unwell Spiritually well Faith Hope Love needs not met: Fear, Hopelessness, Loneliness Faith Hope Love needs met

26. Faith Hope & Love Colossians 1:3-6 We always thank God, the Father of our Lord Jesus Christ, when we pray for you, because we have heard of your faith in Christ Jesus and of the love you have for all God’s people— the faith and love that spring from the hope stored up for you in heaven and about which you have already heard in the true message of the gospel that has come to you. In the same way, the gospel is bearing fruit and growing throughout the whole world—just as it has been doing among you since the day you heard it and truly understood God’s grace.

27. Faith Hope & Love I Thessalonians 1:3 We remember before our God and Father your work produced by faith, your labor prompted by love, and your endurance inspired by hope in our Lord Jesus Christ.

28. Faith Hope & Love Romans 5:1-5 Therefore, since we have been justified through faith, we have peace with God through our Lord Jesus Christ, through whom we have gained access by faith into this grace in which we now stand. And we boast in the hope of the glory of God. Not only so, but we also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us.

30. Faith versus Fear • Faith: A strong belief or trust in someone or something Merriam-Webster • Patients put faith in: doctors, nurses, medicine, insurance company, family • Biblical faith: A conviction of truth; the conviction that God exists and is the creator and ruler of all things Greek Lexicon::G4102 • Matthew 8:26 He replied, “You of little faith, why are you so afraid?” Then he got up and rebuked the winds and the waves, and it was completely calm. • Matthew 9:22 Jesus turned and saw her. “Take heart, daughter,” he said, “your faith has healed you.” And the woman was healed at that moment.

31. Faith definition Belief or trust in someone or something. For the Christian this need is primarily met through faith in Jesus Christ; however all people need to have faith in something whether temporal or eternal. When this need is not met, fear is the result.

32. Hope versus Hopelessness • Hope is a desire with expectation of attainment or expectation with confidence Merriam-Webster • Patients hope to be able to care for themselves and families, to be able to physical interact with the world around them, to have intimate relationships with others, to have food to eat and a safe place to live, and to be free of pain and injury • Hope have been found to positively correlate with health, quality of life, well-being, happiness, and comfort in the hospital Butt 2011 • Biblical hope is defined as a joyful and confident expectation of eternal salvation Greek Lexicon::G1680

33. Hope definition Hope is a person’s confidence that their faith has not been misplaced. For the Christian, this need is met by their hope that Jesus is powerful enough to keep His promise of life with Him in heaven; however all people have a need to be confident that what they believe will come to pass. When this need is not met, hopelessness is the result.

34. Love versus Loneliness • Love is used to describe many kinds of emotions such as affection, sexual desire, and tenderness Merriam Webster • Biblical love is agape: 1 Cor 13 • Patient • Kind • Not proud or boastful • Not easily angered • Not self-seeking • Holding no grudges • Always protecting • Always enduring • This selfless, humble love is the greatest spiritual need of all men and women

35. Love definition Love is every person’s greatest spiritual need and for the Christian is met by a love relationship with Jesus Christ. However, all people have the need to receive love from others through expressions of: patience, kindness, forgiveness, humbleness, protection from harm, truthfulness, endurance, and selflessness. When the need for love is not met, loneliness is the result.

37. Hypothesis Testing

38. Faith-Hope-Love Model of Spiritual Wellness Person Non material self Material self Spiritually Well Spiritually Unwell Body Spirit 13.6 0-16 -.57 2.2 1-7 Spirituality: Meaning Family Loneliness 13 0-16 -.49 .59 Spirituality: Peace 11.6 0-16 Faith -.52 .62 .65 Social Loneliness -.40 -.26 -.32 .59 39 12-48 2.7 1-7 -.54 Hope 2.8 1-7 Romantic Loneliness 9.7 0-28 Anxiety

39. Faith-Hope-Love Model of Spiritual Wellness 53% of the Variance in Peace 50% of the Variance in Meaning Spiritually Well Spiritually Unwell Spirituality: Meaning Spirituality: Peace Faith Social Loneliness Hope Anxiety

40. Clinical Application • History of palliative care. • What the results mean to the practitioner. • How could this work in your setting • Find the right people • DNP PhD relationship • Practical approaches: • Integrate students for data collection • Research topic selection • Office Logistics • Positives and negatives of making it work • Patient story • Where we are heading next

41. Bibliography • Moreland, J. P., & Rae, S. B. (2000). Body & soul: Human nature & the crisis in ethics. Downers Grove, IL: InterVarsity Press. • Pearce, Coan, Herndon, Koenig, Abernethy (2012). Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients. Support Care Cancer, 20. 2269-2276. • Hui, de la Cruz, Thorney, Parsons, Delgado-Guay, Bruera (2011). The frequency and correlates of spiritual distress among patients with advanced cancer admitted to an acute palliative care unit. American Journal of Hospice and Palliative Medicine, 28(4). 264-270. • Meraviglia, Sutter, Gaskamp (2008). Providing spiritual care to terminally ill older adults. Journal of Gerontological Nursing, 34(7). 8-14. • Edwards, Pang, Shiu, Chan (2010). The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research. Palliative Medicine, 24(8). 753-770. • Hodge & Horvath (2011). Spiritual needs in health care settings: A qualitative meta-synthesis of clients perpsectives. Social Work, 56(4). 306-316. • Nixon & Narayanasamy (2010). The spiritual needs of neuro-oncology patients from patients’ perspective. Journal of Clinical Nursing, 19. 2259-2270.