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. Present the relationships between each of these concepts
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 well
Spiritually unwell
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 Energetic Trusting
Expressive Interested Loving
Interactive Hopeful Thankful

5. Causal and Dependent relationship between Spirit and Body
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
רוּחַ ruwach
πνεῦμα pneuma
378 occurrences
Translation
spirit n = 232
wind n = 92
breath n = 27
385 occurrences
Translation
spirit n = 111
Holy Ghost n = 89
Spirit of God n = 13
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 of God Other spirits
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 of the Person Spirit is the seat of the emotions
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 of the Person Spirit is the seat of the emotions
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 of the Person Spirit is the seat of the emotions
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 death Spirit 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 of the Person Spirit is the seat of the emotions
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 of the Person Spirit is the seat of the emotions
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. 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.
Spirit

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

24. And now these three remain: faith, hope, and love.
Faith-Hope-Love Model of Spiritual Wellness
Person
Non material self
Material self
Spirit
Body
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. Fear, Hopelessness, Loneliness Faith Hope Love needs met
Faith-Hope-Love Model of Spiritual Wellness
Person
Non material self
Material self
Spirit
Body
Spirituality
Spiritually well
Spiritually unwell
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.

29. Faith/Fear Hope/Hopelessness Love/Loneliness
Fear/anxiety4,5
Concerns/questions about life after death2
Need to talk7
Helplessness/losing control3,4,5
Hope/hopelessness4,5,6
Connection with a higher power/God2,5,6
Religious obligation6
Despair3
Relationships with others5,6
Religious activity2,4,5,6,7
Depression4,7
Emotional support7
Dread3
Plans for the future/sense of normalcy7
Alienation3
Prayer2
Positive outlook5
Broken3
Asked “Why me?”2
Family support7
Reassurance7
Need for connection/loneliness4,7
Forgiveness/guilt2,3,5
Meaning/purpose2,3,4,5,6,7

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.

36. Concept Measurement R&V Spiritual Wellbeing Faith α = 0.87
Meaning & Peace Subscale of the FACIT-sp
8-item Likert scale
α = 0.78
α = 0.83
Faith
Faith Subscale of the FACIT-sp
4-item Likert scale
α = 0.87
Fear/Anxiety
Generalized Anxiety Disorder Scale (GAD 7)
7-item Likert Scale
α = 0.92
Hope
Herth Hope Index
12-item Likert Scale
α = 0.97
Loneliness
Social & Emotional Loneliness Scale (SELSA-S)
Romantic
Family
Social
α = 0.89
α = 0.90

37. Hypothesis Testing Variable Score Gender 55% female Pain 0-10 23% none
50% or above
Age
66 years (34-91)
Nausea
40% none
Diagnosis
Lung CA 27%
Breast CA 13%
Colon CA 12%
Depression
25% none
25% 5 or higher
Stage IV Cancer
50%
Anxiety
17% none
50% 3 or higher
Undergoing Chemo
65%
Wellbeing
7% “best”
1% “worse”
42% 5 or 6
Hypothesis Testing

38. Spirituality: Meaning
Faith-Hope-Love Model of Spiritual Wellness
Person
Non material self
Material self
Spiritually Well
Spiritually Unwell
Spirit
Body
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
-.32
-.26 39
12-48
.59
2.7
1-7
-.54
Hope
2.8
1-7
Romantic Loneliness
9.7
0-28
Anxiety

39. 53% of the Variance in Peace
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
Clinical Application

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,
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)
Meraviglia, Sutter, Gaskamp (2008). Providing spiritual care to terminally ill older adults. Journal of Gerontological Nursing, 34(7)
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)
Hodge & Horvath (2011). Spiritual needs in health care settings: A qualitative meta-synthesis of clients perpsectives. Social Work, 56(4)
Nixon & Narayanasamy (2010). The spiritual needs of neuro-oncology patients from patients’ perspective. Journal of Clinical Nursing,