c. The top of the bedside table should be free of
items and covered with a clean, white cover if a
sacrament is to be administered.
d.The bed curtains should be drawn to provide
privacy, or the patient should be moved to a
private setting.
13.Sample answers:
a.Deficit: Meaning and purpose: Explore with the
patient what has given his/her life meaning and
purpose to the present, sources of meaning for
other people, and possible meaning of illness.
Refer the patient to a spiritual advisor and
appropriate support groups.
b.Deficit: Love and relatedness: Treat the patient
at all times with respect, empathy, and genuine
caring.
c. Deficit: Forgiveness: Offer a supportive presence
to the patient that demonstrates your
acceptance of him/her. Explore the patient’s
self-expectations and assist the patient in deter-
mining how realistic they are. Explore the
importance of learning to accept oneself and
others.APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.How might the nurse use blended nursing skills to
provide holistic, competent nursing care for Ms.
Zeuner?
Ms. Zeuner is in need of assistance at home to help
her care for her husband. The nurse could check
with social services or look into community services
that would allow her to attend her church services
and other community support groups.
2.What would be a successful outcome for this
patient?
By next visit, Ms. Zeuner vocalizes a connectedness
with her church and community stimulated by
receiving help at home with her husband.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: Ability to identify spirituality as a
source of patient support, strength, or conflict,
incorporating this information into the patient’s
plan of care
Interpersonal: ability to establish trusting relation-
ships, even in times of distress, crisis, and conflict.
Ability to demonstrate respect, empathy, and caring
for the patient
4.What resources might be helpful to Ms. Zeuner?
Respite care, meals-on-wheels, parish nursing, com-
munity support groupsPATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Jeffrey Stein, a 31-year-old attorney,is in a step-
down unit following his transfer from the cardiac
care unit, where he was treated for a massive heart
attack. “Bad hearts run in my family, but I never
thought it would happen to me,” he says. “I jog
several times a week and work out at the gym,
eat a low-fat diet, and I don’t smoke.”Jeffrey is 5
feet 7 inches tall, weighs about 150 pounds, and
is well-built. During his second night in the step-
down unit, he is unable to sleepand tells the nurse,
“I’ve really got a lot on my mind tonight. I can’t
stop thinking about how close I was to death.If
I wasn’t with someone who knew how to do CPR
when I keeled over, I probably wouldn’t be here
today.” Gentle questioning reveals that Mr. Stein is
worried about what would have happened had he
died. “I don’t think I’ve ever thought seriously
about my mortality, and I sure don’t think much
about God.My parents were semiobservant Jews,
but I don’t go to synagogue myself. I celebrate the
holidays,but that’s about all. If there is a God, I
wonder what he thinks about me.”He asks if there
is a rabbi or anyone he can talk with in the morning
who could answer some questions for him and per-
haps help him get himself back on track. “For the
last couple of years, all I’ve been concerned about
is paying off my school debts and making money.
I guess there’s a whole lot more to life, and maybe
this was my invitation to sort out my priorities.”
2.Nursing Process Worksheet
Health Problem: Spiritual distress: spiritual anxiety
Etiology:Challenged belief and value system
Signs and Symptoms: Recent massive heart attack;
unable to sleep; raised in semiobservant Jewish fam-
ily but, “for the last couple of years all I’ve been
concerned about is paying off my school debts and
making money”; questions about afterlife.
Expected Outcome: After meeting with Rabbi White
2/12/11, patient reported feeling “less anxious”
about his religious belief system and re-evaluated
sense of priorities.
Nursing Interventions:
a.Encourage patient to continue to share concerns
about his religious beliefs and value system.
b.Arrange for patient to talk with the hospital’s
Jewish chaplain in the morning.
c. Normalize this experience by sharing with the
patient that serious illness often prompts a life
review.
d.Recommend that the patient begin to list the
things in life that are most important to him.
Evaluative Statement: Patient slept last 2 nights after
meeting with Rabbi White and reports being “less
anxious” about “religion.” He says there are some
things he wants to change about his life, and that
this is a good time to start.—T. Michael Gray, RNCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:ANSWER KEY 423
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