SPIRITUALITAS, KEPERCAYAAN, AGAMA,

DAN IMPLIKASINYA BAGI KEPERAWATAN

Kusman Ibrahim, Ph.D

FAKULTAS ILMU KEPERAWATAN

UNIVERSITAS PADJADJARAN

DEFINITIONS
Spirituality: 'spirare' (Latin) = 'to breathe life',
expressing one's values and beliefs about self,
humanity, life and God.
Literature spirituality religion, spirituality
religion
Spirituality: the unifying force of person;the
essence of being that permeates all of life and is
manifested in ones being, knowing, and doing;
the interconnectedness with self, others, nature,
and God/life (Dossey & Guzzetta, 2000)

DEFINITIONS (Cont.)
Spirituality: a belief in or relationship with some
higher power, creative force,divine being, or
infinite source of energy (God, Allah, a higher
power)
Faith: a universal; a feature of living, acting, and
self understanding
Religion: a belief system and practices of
worship related to that system.

SPIRITUAL DEVELOPMENT
Undifferentiated Faith (Infancy-Toddler)
The seeds of trust, courage, hope, and love are
joined to combat such issues as possible
inconsistency and abandonment in the infants
environment
Intuitive-Projective Faith (3-6 years)
Fantasy-filled period, a young child is
strongly influenced by examples, moods,
actions and stories of visible faith primarily
related adults

SPIRITUAL DEVELOPMENT (Cont.)

Mythic-Literal Faith (7-12 years)

The time when the child begins to internalize

stories, beliefs, and observances that
symbolize belonging to his or her own faith
community
Synthetic-Conventional Faith (13-20 years)
Adolescents experiences outside the family
unit (school, peers, media, religion). Faith
provide a basis for identity and outlook

Individuative- Reflective Faith (21- 30 years)

A young adult begins to claim a faith identity no
longer defined by the composite of ones roles or
meanings to others. time of personal creativity,
individualism, and autonomy
Conjunctive Faith (31- 40 years)
A time of opening to the voices of ones deeper self,
and the development of one social conscience
more mature spirituality especially finding meaning
of his/her illness
Universalizing Faith (> 40 years)
Culmination of the work of all of the previous faith
stages, a time of relating to the imperative of
absolute love and justice toward all humankind

SPIRITUAL NEEDS
A persons need to maintain,
increase, or restore beliefs and
faith and to fulfill religious
obligations
Certain spiritual needs underlie
all religion;
(1) need for meaning and purpose
(2) need for love and relatedness
(3) need for forgiveness

SPIRITUAL, RELIGION AND ILLNESS

Spiritual and religious beliefs are important in many
peoples lives influence life-style, attitudes, and feeling
about illness and death
Spiritual beliefs may assume greater importance at time
of illness than at any other time in a persons life
Some people may look illness as a test of faith, or
punishment for past sins
Spiritual beliefs help people to accept illness and to plan
for the future, religion help people prepare for death and
strengthen them during life
Certain spiritual beliefs are in conflict with accepted
medical practice

THEORETICAL FOUNDATIONS
FOR SPIRITUAL CARE
Whole person care as the essence
of nursing care
Spiritual component of Nursing
Supportive theories in other
disciplines (e.g., Lazarus stress
and coping framework spiritual
beliefs and religious practices can
be viewed as coping strategies)

RELIGIOUS BELIEFS RELATED TO HEALTH

CARE
Agnosticism and Atheism
Agnostic : a person who doubts the
existence of God or a supreme being
Atheist: denies the existence of God
Monotheism: belief in the existence of one
God

RELIGIOUS BELIEFS RELATED TO HEALTH CARE (Cont.)

Islam
Islam for Muslim is not only a religion but a complete
way of life that advocate peace, mercy and forgiveness
Beliefs; all Muslims have to fulfill five essential
religious duties (To declare that there is no other god
but Allah, and that the Prophet Mohammed is his
messenger, To offer prayers five times a day; during
illness, prayers can be performed sitting up or lying
down, providing that the chair or bed is facing Mecca,
To fast in the month of Ramadan, To give money to
charity, To go on a pilgrimage to Mecca (Hajj) at least
once in a lifetime if they can afford it

 The Holy Quran; the sacred book of Islam, the essential

guide for all aspects of a Muslims life
Gender and modesty; Muslims prefer to be cared for by
someone of the same sex, however, men are not seen as
superior to women
Cleanliness; the Islamic faith emphasizes cleanliness
(cloth, house, environment) before any type of worship
(Ghusal or Wudlu/ablution), Muslim prefer to wash their
genitals with running water after using the toilet (Istinja)
Family and marriage; family as the building block of
society, marriage is sacred and the foundation of Islamic
society, providing stability and security, Men are seen as
the protectors of women, and important decision in giving
consent for treatment. The patients immediate and
extended family structure, even the community elders,
should be considered where there are important treatment
issues

Homosexuality; is condemned, considered sinful

and punishable by Allah
Children; as a gift from Allah, listening adzan to the
ears of newborn baby, tahnic, aqiqah
Contraception; Muslim couple are encouraged to
have children, sex outside marriage is discouraged,
however contraception and family planning are
allowed, health care professionals should discuss
appropriate methods with either the woman or the
couple
Abortion; is not permitted, except if the pregnancy
threatens the mothers life

 Circumcision; baby boys are circumcised as it

enables them to maintain Wudlu by preventing urine
for collecting in the foreskin
Diet; Muslim eat with their right hand and consider it
rude to be handed anything in the left hand, eat only
permissible and good food (halal & thayib), nonpermissible (haram) food include pork, non-halal
meat, alcoholic drinks, gelatin products, and illegal
drugs
Organ donation and blood transfusion; acceptable
End of life issues, suicide and euthanasia; human
life is regarded as precious and taking a life is
considered a major sin

Life support; a person certified as brain-stem dead

should not be kept alive artificially, resuscitation is
allowed, but in some cases the will of Allah should be
allowed to prevail
Death/rituals; believe in life after death, the Day of
judgment. Sickness and suffering in this life are seen as
a form of purification or recompense for wrong deeds.
Terminally ill patients should be treated with sympathy
and compassion and their spiritual need should be
accommodated. When dying, privacy is appreciated
while declare their faith (Talkin), or recitation the Quran.
Died person; close the eyes and mouth, straighten the
body and limbs, a complete Ghusal performed by family
or the same sex, covered with a plain sheet, prayer,
some Muslim may request that non-muslim do not touch
the body (or use disposable gloves), buried

Roman Catholicism
Belief that an infant has soul from the
moment of conception baptized
Encouraged anointing of the sick
(sacrament of the sick) as a source of
strength or healing and preparation for
death
Donor transplant, biopsies, amputations,
autopsy accepted
Strict laws govern birth control, sterilization,
and abortion, both demand and therapeutic
abortion are prohibited, even to save the
mothers life

Some Catholics observe certain dietary and

fasting (abstain from animal dairy products)
practices but are excused from otherwise
obligatory fasting or abstaining from meat on
Ash Wednesday and Good Friday
Sunday is the day of worship
Oppose euthanasia, however they do not
support the excessive use technology to
prolong life
Belief in life after death, cremation is not
condemned, but rare, the body is buried
complete to await resurrection

Seventh-Day Adventist (Church of God, Advent Christian

Church)
Conduct baptism of adults by immersion
Diet; prohibits alcohol, tobacco, tea, coffee, and the use
of illegal drugs, some members advocate
ovolactovegetarian diets

Some sects practice divine healing and anointing with oil

Saturday Sabbath by some
Avoid drugs, but blood transfusion, vaccines, and drugs
are sometimes necessary
Birth control and sterilization are left to individual
conscience
Abortion is approved if the mothers life is endangered or
if pregnancy is due to rape or incest

The use of hypnotism is opposed

Salvation Army
No restitutions on medical procedures,
including transplants and autopsies
Birth control and and sterilization are
acceptable within marriage
Demand abortions are opposed, but
therapeutic ones are approved
Has many hospitals and social centers
for people

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Lutheran
No restitutions on medical procedures,
including autopsies and therapeutic
abortions
No dietary restrictions
Birth control and sterilization are left to
individual conscience
Members are baptized 6 to 8 weeks after
birth, those who wish may be anointed
and blessed before death buried

Pentecostal (Assemblies of God)

No doctrine against modern medical
science
Members are encouraged to abstain
from use of alcohol, tobacco, and illegal
drugs, some members dont eat pork
Pray for divine healing, and anointing
with oil in some congregations

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Hinduism
Belief begins with the assumption that all
living things have a soul, which passes
through successive cycles of birth and rebirth
Belief in karma laws, reincarnation, and
transmigration of the soul, that avoid killing
even the smallest insect
Person is viewed as a combination of mind,
soul and body in the context of family, culture,
and environment
The society is divided according to a caste
system (social divisions) including Brahmins,
Kshatriaya, Vaisya, and Sudra

Have many dietary variations according to the

particular sect (avoid beef and its derivatives,
vegetarians)
Accept modern medical practices, artificial
insemination is rejected
When giving medication, avoid touching the clients
lips
Death is considered rebirth special rites, the priest
pours water into the mouth of the corpse and ties a
thread around the wrist or neck to indicate blessing,
dead body undergoes cremation, and the ashes are
disposed of in holy rivers
Some injuries, such as loss of a limb are considered
signs of wrongdoing in a previous life

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Buddhism
Buddhism is a chameleon religion that exist in many
forms central teaching of the Buddha amalgamated
with the cultures and people that embrace it
Has no beliefs (a religion with no god), instead of
teachings to guide one through daily life, focus on
individual effort and commend reflective practice
Aim of the Buddhist is to achieve Nirvana (state of
liberation, which is characterized by freedom from
suffering, death and rebirth)
Commends mindfulness; being aware of the impact
and effect of ones behavior
Buddhist chant teaching, practice silent meditation,
chant meditative mantras, burn incense, light candles,
and try to sit in the lotus position

No childbirth ritual, no concern about birth control, no

consent to abortion
Diet, some prefer vegetarian, vegan (refuse food after
midday)
Alcohol, psychotropic drugs, opiates, sedatives,
tranquilizers are likely to be resisted
Blood donation, transplantation be received
Euthanasia is not countenanced
Resuscitation is an acceptable procedure
Dying Buddhist may request a monk or nun be present
to chant or assist in the passing from this life

Cremation for the dead body

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SPIRITUAL HELATH AND THE NURSING PROCESS

Assessing
Spiritual health, or spiritual well-being is a feeling
of beinggenerally alive, purposeful, and fulfilled
(Ellison,1983)
Spiritual wellness is a way of living, a lifestyle
that views and live life as purposeful and
pleasurable, that seek out life sustaining and lifeenriching options to be chosen freely at every
opportunity, and that sinks its roots deeply into
spiritual values and/or specific religious belief
(Pilch, 1988)

SPIRITUAL HELATH AND THE NURSING PROCESS

Spiritual well being (Ellison & Paloutzian, 1982):
Religious component;
I believe that God loves me and care about me
I have a personal and meaningful relationship with
God
I believe God is concerned about my problem
My relationship with God helps me not to feel
lonely
I feel most fulfilled when I am in close
communication with God
My relationship with God contributes to my sense
of well being

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Meaning and purpose in life;

I feel that life is a positive experience
I feel very fulfilled and satisfied with life
I feel a sense of well-being about the
direction my life is headed in
I feel good about my future
I believe there is some real purpose in
life

Nursing History
Stoll (1979) four areas of spiritual history:
The person's concept of God or deity
The persons source of hope and strength
The significance of religious practices and
ritual to the person
The relationship between the individuals
spiritual beliefs and state of health
Spiritual assessment is best taken at the end of
the assessment process or following the
psychosocial assessment

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Nursing History (continued)

Clinical assessment spiritual distress, one or more of the following:
Affect and attitude; Does the client appear lonely, depressed, angry,
anxious, agitated, apathetic?
Behavior; pray before meals or other times, read religious
literature,need unusually high doses of sedation, pace the halls at
night, joke inappropriately
Verbalization; Mention God, prayer, faith, the
mosque/church/temple, or religious topic, ask to be visited by
clergy, express fear of death, concern with meaning of life,inner
conflict about religious beliefs,concern relationship with the God,
meaning of existence, meaning of suffering, and moral/ethical
implications of therapy
Interpersonal relationships; who visits, how respond to visitors
Environment; having Quran, bible, prayer book, religious books, a
rosary

Nursing Diagnosis
Spiritual distress; a disruption in the life principle that
pervades a persons entire being and that integrates and
transcends one biologic and psychological nature (Kim
et.al, 1989), or, the state in which the individual
experiencing a disturbance in the belief or value systems
which provides strength, hope, and meaning to life
(Carpenito, 1989)
OBrien (1982) subcategories spiritual distress as follows:
Spiritual pain, i.e difficulty accepting the loss of loved one
or intense suffering (physical or emotional)
Spiritual alienation, i.e separation from religious or faith
community

Spiritual anxiety, i.e challenge to beliefs and value

systems ( e.g by moral/ethical nature or therapy such as
abortion, blood transfusion, surgery, etc.)

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OBrien (1982) subcategories spiritual distress as follows:

Spiritual guilt, i.e failure to abide by religious rule
Spiritual anger, i.e difficulty accepting illness, loss, or
suffering
Spiritual loss, i.e difficulty finding comfort in religion
Spiritual despair, i.e feeling that no one cares
NANDA Spiritual distress related to:
Crisis of illness/suffering/death (e.g terminal illness,
debilitating disease, chronic pain, or death or illness of
significant other
Inability to practice spiritual beliefs
Conflict between religious or spiritual belief and
prescribed health regimen (e.g blood transfusion, dietary
restrictions, amputation, or medication)

Planning
Should be designed to meet one or more of the
following needs:
Fulfill religious obligations
Draw on and use inner resources more
effectively to meet the present situation
Maintain a dynamic, personal relationship with
the supreme being in the face of unpleasant
circumstances
Find meaning in existence and present situation
Promote sense of hope
Provide spiritual resources otherwise
unavailable

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Clients who may desire spiritual assistance:

Appear lonely and have few visitors
Express fear and anxiety
Having surgery
Having illness related to the emotions or
religious or social implication
Life-style change as a result of illness or
injury

Outcome Criteria of spiritual distress, the client:

Expresses comfort with spiritual beliefs
Continuous spiritual practices appropriate to health
status
Expresses decreased feeling of guilt
States acceptance of moral decision
Displays positive affect
Expresses finding positive meaning in the present
situation and in own existence
Verbalizes relief from or acceptance of suffering
Verbalizes relief of anger toward transcendent being,
self, and other
Verbalizes a closeness with God
Experiences a sense of forgiveness

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Implementation
To be effective intervention, nurses should have already
examine and clarified their own spiritual beliefs and values
To decrease spiritual distress nurses should focus
attention on the clients perception of his or her spiritual
needs rather than on the practices or beliefs of the clients
religious affiliation
Ns should not assume that client has no spiritual needs
because has no religious affiliation
When orienting client, Ns can provide information about
hospital services to help client meet spiritual needs
If there is a conflict between spiritual beliefs and medical
therapy, Ns encourages the client and physician to discuss
and consider alternative methods of therapy
Evaluation
whether or not the client achieved the goal of care

Terima Kasih

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