Discussion Peer/Participation Prompt Due Sunday by 11:59 pm
Instructions:
Construct a response to at least 2 of your peers commenting on their Plan elements that relate to their documented spiritual assessment.
For each colleague that you respond recommend an additional intervention for their Plan and support it with a scholarly resource.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Please review the rubric to ensure that your response meets the criteria.
PLEASE USE UPDATED REFERENCES I WILL PROVIDE PEERS POST TO RESPOND
PEER#1
Kayla McClaren
MondayJul 26 at 10:57am
Module 10 Discussion:
HOPE Questions for Spiritual Assessment: Table 2
H: sources of hope-What are your sources of hope, strength, comfort, and peace? What do you hold on to during difficult times?
O: organized religion-Are you part of a religious or spiritual community? Does it help you? How?
P: personal spirituality and practices-Do you have personal spiritual beliefs? What aspects of your spirituality or spiritual practices do you find most helpful?
E: effects on medical care and end-of life issues-Does your current situation affect your ability to do the things that usually help you spiritually? As a doctor, is there anything that I can do to help you access the resources that usually help you? Are there any specific practices or restrictions I should know about in providing your medical care? If the patient is dying: How do your beliefs affect the kind of medical care you would like me to provide over the next few days/weeks/months?
Subjective (S): Patient is a 47-year-old female who was admitted to the medical unit for increasing weakness, poor appetite, and failure to thrive. She has a PMH of obesity, HTN, and newer diagnosis of esophageal cancer. Prior to being admitted to the hospital, she was living at home with her mother. She had home health set up but she stated “I never really felt like doing much when they came so I didn’t.” States “I am honestly just tired of being tired, weak with no energy, and have no hope.” Patient states “I feel like my family would be better off if I weren’t here anymore because I cause them so much stress.” She denies SI/HI ideations or thoughts when asked. She continues to have conversation throughout interview but is very tearful, emotional, and depressed.
Problem #1: Failure to thrive
Problem #2: Depression/Loss of hope due to medical condition
Problem #3: Weakness
Diagnosis: Failure to thrive (R62.7), Mood disorder due to medical condition (F06.31), Weakness (M62.81)
Plan:
Diagnostic:
Evaluate suicide risk with screening tool
Determine severity of failure to thrive
Labs:
CBC, CMP, CK, UA-due to poor appetite: is there some sort of organ damage occurring or dehydration
Therapeutic:
Educational:
Educate patient on the importance of “trying.” Discuss the necessity of eating, drinking, and attempting to work with PT/OT when able. Educated on goals included reviewing precious moments in the past, preparing and passing love messages to their family members or significant others, reporting something for which they were grateful in daily life, invoking self-appreciation, and finding positive meaning in their illness. Attaining these goals was found to be their source of motivation—agency thoughts (Chan et al., 2019). Educate and discuss her engagement in her own care, treatment, and prognosis. By including her, the engagement has focused on the relationship between patients and providers in making care decisions or how to improve patient efforts to manage their own care (Bombard et al., 2018).
Consultation/Collaboration:
Pastoral Care: to speak with patient regarding “loss of hope” and provide resources for follow up whether that be articles, readings, group therapies, etc.
Dietician: to review appetite history and provide alternative means of nutrition via shakes, ice cream, etc.
PT/OT: to increase strength, mobility, and improve weakness
Psychiatry: possible management of depression, mood disorder.
References:
Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., Onate, K., Denis, J.-L., & Pomey, M.-P. (2018). Engaging patients to improve quality of care: A systematic review. Implementation Science, 13(1). https://doi.org/10.1186/s13012-018-0784-z
Chan, K., Wong, F. K., & Lee, P. H. (2019). A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: A feasibility test. SAGE Open Nursing, 5, 237796081984438. https://doi.org/10.1177/2377960819844381
PEER#2
Ama Slay
MondayJul 26 at 2:08pm
Unit 11 Discussion
The patient that I cared for this week was suffering from depression, and had not reached out for help from anyone. The staff at the clinic were the only people that she was able to confide in about her sense of hopelessness after her sister had been hospitalized with COVID-19. The patient has a history of depression and mental illness in her family. Although genetic, environmental, and developmental factors contribute to the onset of depression, patients can find coping skills to deal with life changing and traumatic experiences through religion and spirituality (Bonelli et al, 2012). In order to utilize support systems their must be a willingness to do so. The patient had isolated herself away from her religious support group due to embarrassment because she was always strong and had great coping skills. I was able to encourage her to be humble and reach out for help.
Plan
Problem 1- sadness
Problem 2: insomnia
Problem 3: anxiety
Problem 4: problems focusing
Diagnosis: Depression F32.9, Anxiety F41.0, Carpal tunnel syndrome G56.00, COPD J44.9
Differential Diagnosis: thyroid disease, dementia, Parkinson’s disease, mononucleosis, substance abuse, bi-polar disorder
Plan: Diagnostics: N/A
Labs: CBC with differential, WBC with differential, TSH,
Therapeutic: Celexa 20mg PO Daily, Klonopin PO 4 mg
Educational: Educate patient on safety at home and when to call 911. Educate on coping skills for depression and anxiety. Motivate patient to use spiritual tools and support in religious community to help her get through challenging and painful situations. Educate on refraining from drinking caffeine before sleep, and using relaxation techniques before sleeping. Educate on suicide prevention and how to use suicide prevention hotline. Emphasize the importance of medication adherence.
Consultation/Collaboration: follow-up appointment in 2-4 weeks. Call the clinic if symptoms do not improve. Refer to psychotherapy and Psychiatrist (preferably faith-based) Patient may need a referral to endocrinologist if TSH levels are out of range.
Impact of Spirituality on Patients Health
Through my experience as a registered nurse, I have listened to patients who had uplifting stories about how their spiritual foundation helped get them through difficulties that they faced related to their health. Some patients had lost their spiritual connection, and needed encouragement to renew their spiritual beliefs and practices. Some patients found pleasure in being able to talk about their beliefs, and even asked for me to pray with them. There are also patients who did not believe in spirituality, but had other support systems that gave them inspiration such as attending Alcoholics Anonymous meetings.
One of the patients that I cared for in clinical last week was a 54 year old woman who was having a difficult experience mentally, because of her sister’s admission to the hospital after being diagnosed with COVID-19. She was diagnosed with depression and prescribed Celexa. This was an opportune time to perform the spiritual assessment. Mental health patients need to be armed with as many coping skills as possible. Patients who claim spiritual well-being, are linked to positive outcomes such as a higher tolerance to mental and physical demands of illness, decreased pain, stress, and negative emotions (Harrad et al, 2019). Because of the positive outcomes of spirituality in patients’ lives, this is a topic that should be discussed at every patient encounter. The social history in the subjective data is a good time to ask about what motivates the patient, such as spirituality. I prefer to use open ended questions when asking about spirituality because I want them to feel comfortable expressing their beliefs in a non-judgmental setting.. Many of my patients have expressed that their only support system are their religious and spiritual affiliations.
Subjective Data
Social History
Employer: retired receptionist. Education: Associates degree. Current smoker: 1 pack a day Alcohol: N/A. Recreational or chemical drug use: N/A. Exercise: water aerobics three times a week. Caffeinated drinks: Green tea 3 times per day Diet: Mediterranean diet Seatbelt use: 100% of the time, Sun Exposure: Frequent (uses sunscreen). Relationships: Married with one child. Spirituality: Christianity (attends church every Sunday and is active in a Christian women’s support group that meets every Wednesday.
Mnemonics for Spiritual Assessment in Subjective Data
The one place where I like to include a spiritual assessment is in the social history. While learning more about the patients’ history and personal interest, spiritual assessment fits in well. It is essential to know if a patient has a spiritual belief or not, and what it is. The best mnemonics to use for newly encountered patients is FICA, which stands for Faith and belief, importance, community, and address in care (Saguil & Phelps, 2012). Because this was my first time meeting the patient and I was not familiar with the patient’s spiritual background, FICA is a good mnemonic to initiate the first conversation about spirituality and find out how to address spirituality in her care for future visits.
FICA Questions to ask:
Do you have any spiritual practices to help deal with stress? (If patient does not have spiritual practice, ask what gives their life meaning)?
Have your beliefs been an influence on how you have taken care of your illnesses?
Are you involved in a religious or spiritual community? Is it supportive and how?
How can I address your beliefs or spiritual practice in your healthcare?
(Saguil & Phelps, 2012).
This set of questions is non-invasive and uses open-ended questions that give the provider an opportunity to understand the patient’s coping skills. Once a good understanding of the patient’s belief system has been confirmed, the provider can reiterate it as strength and remind the patient to utilize their spiritual community in the education part of the SOAP note. For example, I encouraged my patient to reach out to her women’s group and members of her church that she trusts for extra support when she is feeling sad.
References
Bonelli, R., Dew, R. E., Koenig, H. G., Rosmarin, D. H., & Vasegh, S. (2012). Religious and spiritual factors in depression: Review and integration of the research. Depression Research and Treatment, 2012, 962860. https://doi.org/10.1155/2012/962860
Harrad, R., Cosentino, C., Keasley, R., & Sulla, F. (2019). Spiritual care in nursing: An overview of the measures used to assess spiritual care provision and related factors amongst nurses. Acta Bio-Medica: Atenei Parmensis, 90(4-S), 44–55. https://doi.org/10.23750/abm.v90i4-S.8300
Saguil, A., & Phelps, K., (2012). American Family Physician. 86(6):546-550. https://www.aafp.org/afp/2012/0915/p546.html (Links to an external site.)
