Unit -V

SPIRITUAL NEEDS of CHILDREN and FAMILIES

Defining Family
No single “objective” definition
The family is an ideal and a contested terrain
Typical definitions are based on: Law, Biology & Nurturance
Law - Two or more or more persons related by blood, marriage, common-
law marriage, or adoption
Biology(see separately)
Nurturance - This is a recent development – nurturance came to the center of
this definition in the 20th century. But why do we assume that people get
nurtured in the family? Some families are nurturant, some are not (abuse,
neglect)

Why do we need to define family?

Policies and legal cases:
– Housing benefits -
– Health insurance benefits – Family health insurance provides medical
coverage for a spouse, children, or other dependents. 
– Immigration system - Family reunification is a recognized reason
for immigration in many countries because of the presence of one or more
family members in a certain country, therefore, enables the rest of
the divided family or only specific members of the family to immigrate to
that country as well.
– Custody cases, e.g., Alison D. v. Virginia M. – Lesbian co-parents
separated and fought over visitation rights for the child.

Why learn about “family”

Family life is important to the health and welfare of the nation.

The modern concept of maternal and child health nursing is not limited to
assessing individuals or individual circumstances but rather examines them
first from a family and community standpoint
Family centered nursing care considers the strength, vulnerabilities and
patterns of families to support families during childbirth and childrearing
and to encourage healthy coping mechanisms in families facing a crisis
 The Family
EO 209, Family Code of the Philippines

Art. 149. The family, being the foundation of the nation, is a basic social institution
which public policy cherishes and protects. Consequently, family relations are
governed by law and no custom, practice or agreement destructive of the family
shall be recognized or given effect. (216a, 218a)
Art. 50. Family relations include those:
(1) Between husband and wife;
(2) Between parents and children;
(3) Among brothers and sisters, whether of the full or half-blood. (217a)

PURPOSE OF THE FAMILY

The family is given great importance as it should form the basis of both the
individual's spiritual development and happiness, and society's cohesion and
advancement. It constitutes "as the bedrock of the whole structure of human
society”. Attitudes and relationships developed in the family, when transformed to
ever-wider circles of the community, can have a direct bearing on the order, peace,
and wealth of an entire nation.

Family Life Cycle

The emotional and intellectual stages you pass through from childhood to your
retirement years as a member of a family are called the family life cycle. In each
stage, you face challenges in your family life that cause you to build or gain new
skills. Gaining these skills helps you work through the changes that nearly every
family goes through.

Not everyone passes through these stages smoothly. Situations such as severe
illness, financial problems, or the death of a loved one can have an effect on how
well you pass through the stages. Fortunately, if you miss skills in one stage, you
can learn them in later stages
Stages of a Family Life Cycle
Purpose: To assess whether a family is using stage appropriate health
promotion activities
• Stage One: Independence: Single young adults leave home
Stage Two: Coupling Stage: The new couple joins their families
through marriage or living together
• Stage Three: Parenting: Families with young children
• Stage Four: Parenting: Families with adolescents
• Stage Five: Empty Nest: Launching adult children and moving
on
• Stage Six: Retirement or Senior Stage of Life: Families in later life

What can disrupt the normal cycle?

The stress of daily living or coping with a chronic medical condition or other crisis
disrupts the normal family cycle. A crisis or ongoing stress can delay the transition
to the next phase of life. Or you may move on without the skills that you need to
succeed
Characteristics of Strong Families
1. Strong families have commitment.
The membership of each family member is recognized and valued. Family
members are committed to help each other succeed and there is an attitude of
"one for all, and all for one." In short, there is allegiance to the family and
family life is a priority
2.Strong Families express appreciation
Appreciation is one of the deepest human needs. We all want our efforts
recognized and appreciated. Strong families make a habit of expressing gratitude.
They look for the good in one another and openly acknowledge it when it is found.
They celebrate their successes. In strong families, communication is positive and
compliments are common

• 3. Strong families spend time together.

• Although quality time is important, so is quantity time. Strong families do
things together and do them often. They enjoy the time they spend with their
families . They eat together, play together, and work together. Frequently they
choose family activities over other non-family activities. This abundance of
time together helps them develop an abundance of shared experiences and
memories that unite and strengthen them.

4. Strong families develop spiritually.

For many families, their faith community becomes a second family that provides
extra support. A spiritual connection can also provide purpose, direction, and
perspective. As the old adage says, "the family that prays together stays together."

5. Strong families deal effectively

with conflict, stress, and crisis.
All families experience conflict, but strong families attack the problem, not each
other. They manage conflict in ways that are respectful of the unique perspective
that each family member brings to a problem. Furthermore, strong families manage
their resources wisely and plan ahead so stress is minimized. When crisis does hit,
strong families unite and draw on one another for strength and support.

ADMITTING AN ILL CHILD AND FAMILY

Whether an ambulatory or inpatient hospital unit admission, children and parents
need to be admitted as a single entity to encourage parents to feel they are true
partners in care.
The nurse should take the time to meet and greet the parents and child and find a
comfortable place for the family to wait until someone is available. When
introducing yourself to children, stoop down so that your face is level with the
child’s face.
All children should have an armband attached giving their name and hospital chart
number.

PRINCIPLES of CARING for CHILDREN WITH

A LIFE-THREATENING CONDITION
Principle one: information and decision making
Children with a life-threatening condition and their families have information
about options for their future care and are actively and appropriately involved in
those decisions.
Expected outcomes
Children and their families are consulted about who is informed about their care
and who makes decisions about their care.
Children are informed about, and involved in, making decisions about their care as
appropriate to their age and developmental stage.
Families of children with a life-threatening condition are informed about and
involved in decision making about their child’s care.
The unique needs of the child with a life threatening condition and their families
are addressed through developing and implementing an agreed care plan.

Principle two: support for families

Families of children with a life-threatening condition are supported by health and

community care providers.
Expected outcomes
Families are adequately supported by health and community care providers so that
they can provide the best possible care for their child.
The health and wellbeing of the family is maintained and enhanced by improved
access to appropriate respite care, education facilities and support services.
Families’ ability to navigate the system will be strengthened through the timely
provision of information about available services and supports.

Principle three: best possible care at all times

Children with a life-threatening condition and their families receive the best
possible care at all times.
Expected outcome:
The primary treating team caring for the child and their family is supported by
specialist services to remain actively engaged in the child’s care throughout their
illness and into bereavement.
The child’s primary treating team is supported to provide the best possible care for
the child and their family, including pain and symptom management, psychosocial
care, spiritual care, practical assistance for the child and their family, respite and
bereavement support.

Principle five: coordinated care

Children with a life-threatening condition and their families have treatment and
support that is coordinated across the continuum of care.
Expected outcomes:
Children and their families receive care which is seamless and continuous.
Children and their families have a key contact person who assists in management
of their care.

Principle seven: community awareness and support

Children with a life-threatening condition and their families are supported by their
communities.
Expected outcomes:
Communities, including family, friends, neighbors, work and social contacts are
able to actively support children with a life-threatening condition and their families
as appropriate.
Community awareness about the needs of children with a life-threatening condition
is enhanced through community promotion and education.

Spirituality and the Child
Children! They are such a joy and such a mystery in our lives!
 Who can ever express sufficiently all that they  are able to
 communicate, through gifts unknown to themselves 
 They make us understand something of the living God by the trust they show us.

ROGER OF TAIZE, 1990
CHILDS MORAL DEVELOPMENT (Kohlberg,1984)
 The child progresses from an initial stage of 
simple acceptance of right and wrong, as identified through punishment or no
n punishment for an act.

THREE PHASES of Morality

1. Preconventional level (early childhood)
2. Conventional level (later childhood to adolescence)
3. Postconventional level (adulthood)

James Fowler (1981) Stages of faith Development

 Stage 2(Intuitive – projective faith)
God similar to an adult figure
 Stage 3 ( Mysthic – literal faith)
Internalizes religious beliefs
 Stage 5 (Synthetic – conventional faith)
Claims one’s faith identity

Burkhardt (1991) 
Children "live in their spirits more than adults," as they are less inhibited and more 
intuitive about spiritual matters  .
Children are very sensitive to the spiritual in others. 
You have to have a spirituality that  projects total acceptance because,
 if not, the kids can read right through it.

Spirituality related themes suggested 
by Burkhardt 

 The child's capacity for searching for meaning in life
A sense of relationship to "self, others, nature,
 and God  or Universal Force
 Spirituality, viewed as the "deepest core" 
of the child's being
THE ILL CHILD AND RELIGIOUS PRACTICES
Children draw on previous experiences of life,
religious and spiritual beliefs
Devotional articles such as holy pictures, statues, crucifixes’ crosses
Bible, bedtime prayers, religious stories, Prayerbook
Older children or school-age participate in Holy Sacraments,
Christmas and Easter, Hanukkah and Ramadan
Healthcare professionals assess and plan
spiritual care interventions

Assessment of the Ill Child’s Spiritual

and Religious Needs
A nursing diagnosis of spiritual distress can be
 identified for the ill child. 

Some defining characteristics of the diagnosis might relate to the child or 
family's lack of  spiritual
 support or  spiritual strength

Nursing interventions for a child reflecting spiritual 
distress may begin by  encouraging the child  to 
verbalize  his or her feelings to a caring adult.
Spiritual needs of the acutely Ill Child
Pediatric nursing care focuses on helping children and their families and
communities achieve their optimum health potentials (American Nurses
association and the Society of pediatric nurses (1996)

Spiritual care of the pediatric patient is directed toward helping the child and
family achieve and maintain the greatest degree of spiritual health
 possible, in light of the present illness  experience. 

 Children have essentially the "same faith needs as adults.

The child experiencing an acute illness, even if being cared for at home, 
may suffer psychosocial sequelae such as loneliness related to isolation
  from a peer group 

For the older school-age child or adolescent, missing classes may 
cause  not only a  sense of alienation from peers, but also anxiety 
about  future goals related to college and career

spiritual Needs of the Chronically Ill Child
A situation of childhood chronic illness may interfere in sibling relationships since 
parental attention is often  heavily focused on the sick child. 

Although some non - ill siblings cope well, jealousy and emotional distress
 can occur for the  well child (Holiday, 1989)

 Feelings of guilt and inadequacy in the chronically ill sibling may occur

Nursing Approaches to Providing Spiritual Care 
1.Therapeutic play - 
to generate understanding of the child's perception of spirituality 
vis-à-vis the illness experience
2. Bibliotherapy -  
employing such techniques as storytelling or journaling to help the 
child  explore the meaning of life
3. The “use of self " in  establishing rapport that may comfort the child 
and decrease  anxiety associated with the illness and treatment
Spiritual needs of a Dying Child
 Spiritual needs are reflective of age , Spiritual or religious background and
the degree of physiologic and cognitive functioning

1.The  desire  of comfort and freedom from pain

2.The security that they will not be alone at the 
time of death 
 Emotional reactions of dying children  
  A school age child, especially, may  experience fear related not so 
much to the death itself but rather to the dying process. 
 The pre - schooler can feel guilty about dying, and leaving parents 
and siblings he  or she may feel responsible for the illness. 
 The dying adolescent, while also experiencing some degree of fear and 
guilt, frequently goes through a period of depression  and anger over
 the  illness and impending death
SPIRITUAL NEEDS OF THE FAMILY
 Healthy families generally function as units, it is important to minister to the
 
spiritual needs of the entire family when one member is ill or in need of support 

 Families faced with serious short term or chronic long -
term illness of one of the members can benefit greatly from spiritual
 support provided by  friends, church members, or pastoral care 
providers both within or outside the health care system
Spiritual Needs in Childbirth and the Postnatal Experience
Interventions to provide spiritual care to parents with a critically 
or terminally ill newborn

a. Attempt to include the entire extended  family in the experience 
in order to engender support and affirmation for the parent or parents
b. Assist the family in facing the reality of the situation rather than  retreating 
into denial or fantasy
c. Create some meaningful and positive interaction with the newborn
Spiritual Needs of the Family in Acute Illness

 The desire for competent care, pain management, compassion, 
and extended family support in coping with the impact of the illness on
  their lives (Durand, 1993,  p. xii). 
 Additional needs perceived by the families of hospitalized acutely ill patients
are information about changes in a patient's condition and honest
  answers to  questions 
The Family in the Intensive Care Unit
Spiritual care interventions for the family in a critical care setting :
  Giving information about the patient, environment, and staff, to the degree po
ssible
   Encouraging the family to verbalize their anxieties and concerns
 Suggesting some coping strategies for attempting to keep up with
 physical needs such as nutrition and  sleep
 Reinforcing the fact  that the family's anxiety is normal in such a situation
Spiritual Needs of the Family in Chronic Illness

 The family of a chronically ill person must continually be alert to changes in 
the health of their loved one; these families need "ongoing support from
 friends, health care providers and communities" 
 The spiritual needs of the families of those living with HIV and AIDS may be 
complicated by the need for privacy related to the 
stigma some still associate with the conditions. Stigma and secrecy can isolate 
a family from usual support systems such as extended family members,
Spiritual Needs of the Homeless Family
Homelessness families suffer from
acute and chronic physical and mental health 
illnesses  especially mothers and children
Friedmann (1992) 
 a nursing model to address the health problems 
of homeless families. 
Berne, Dato, Mason, and Rafferty (1993) 
The key concepts of the  paradigm include: 
a.Individual and group factors," such as prior experiences and coping problemsb. H
ealth promoting factors," including self efficacy and self - esteem
c.Environmental factors including stress and stigma
d.Health damaging factors,'' such as depression, anxiety, and low self esteem
e.Mediating factors, such as  social support
homeless families need to be empowered to develop self esteem.

 Approach the homeless families with empathy  and respect  

to counter the stigmatizing attitudes that they face in encounters with society

Provide a welcoming, accepting,  and respectful

  environment for the homeless family seeking care

 compassionate and  nonjudgmental attitude can  
support the homeless client's fragile self concept .