Spirituality in Nursing - Essay Example

 Introduction All people are spiritual to a lesser or greater extent, but not all are religious., according to Dunn 2008. Most modern schools of nursing teach that total and holistic biopsychosocialspiritual care is what is required of nurses. Vance in 2001 stated that ‘The role of spirituality in promoting health and improving patients' responses to illness is receiving increasing attention’. Ross ( 2006) found 47 stuides on th etopic since 1987. 'Spirare' is a Latin word meaning 'to breathe life', Yet as Rogers points out, ( 2004) although the topic of spirituality is mentioned as part of any teaching nursing students receive on the wider topic of holistic nursing, the subject is not fully explored. Yet in modern day nursing the emphasis is on the patient as a whole person , not the heart case in bed three, but rather, John , husband of Mary, father of 4 , post man and church warden, dying slowly of cancer - or perhaps Preema , Indian born Hindu new wife of Ravi, with very limited English and a baby arriving prematurely with only a small hope of survival. So nurses are aware that every one has a spiritual dimension to their persona. Even those who would claim to not believe in God under any name have a spiritual space inside. In many cases though those same nurses find themselves unable to respond to these needs and do not know where to turn to for help. Nursing education simply does not prepare nurses to offer spiritual care in any form. If recognized as a responsibility it is too often seen as part of the patient’s psychosocial assessment or the responsibility of pastoral care workers such as hospital chaplains and their staff. Pragmatically though it is nurses on the ward, rather than staff who only visit occasionally, and often only when requested, who are best placed to deal with this part of holistic nursing care. This is especially so where life-threatening illness is involved and there is much one to one interaction between nurse and patient. Thompson in 1993 spoke of the way in which by maintaining a bond with a distressed patient the nurse is making an act 'unconditional love'. Even if their own beliefs are different from those of the patient, by being both good communicators and listeners, nurses can be supportive. They are often providing spiritual care simply be allowing the patient the opportunity to express themselves about beliefs and spiritual matters. Nurses have been encouraged to care for the whole person as a spiritual being, as well as biological and psychological beings, since the 1970’s and books appeared such those by Roper, Logan and Tierney and their ‘Elements of Nursing’ each edition of which includes a chapter about dying and such things as grief and bereavement. Definitions of Spirituality Mark Pettinell – Spirit is someone's soul, so spirituality would be focused on the self, but focused on the self in a manner in which they can understand it more deeply than just standard cognitive thinking about it, so religion might help you understand yourself in that "higher" manner. That is, it is almost like faith To believe in yourself like that, so it is like religion. Laburn ( 1988) 'That which inspires in one the desire to transcend the realm of the material', Living Words of Wisdom :- You are surrounded by spirituality everyday. The definition of spirituality is that which relates to or affects the human spirit or soul as opposed to material or physical things. Spirituality touches that part of you that is not dependant on material things or physical comforts Dictionary Definitions of Spirituality There are any number of variations on the subject of spirituality. It is defined most often as the quality or state of being spiritual . this doesn’t get you much further on unless you then look up what spiritual means. This however can be defined as simply to do with the spirit. It then follows that one must first of all define spirit. The Concise Oxford Thesaurus gives the soul, the psyche, the ego and the inner self, before going on to include such things as ghost and life force. Further still spirit is linked to attitude, frame of mind, point of view. Ojnik ( undated defines spirituality in nursing :- Spirituality provides a means for service providers to empower and encourage patients to engage in their healing process. According to this experienced hospice nurse spirituality may or may not include a particular religious beliefs. She points out that nurses are best placed to deal with a patient’s need for a spirituality dimension, especially she says when caring for those with mental illnesses or who are terminally ill. She goes on to say that such care needs to be ‘respectful and non-biased. It is about listening, identity, being respected and valued.’ These variations in definitions show how wide ranging and complex is the whole subject of spirituality. One definition links it with things that affect the spirit rather than the spirit itself. Others seem more connected to psychology than spirituality. The thing they most clearly have in common is that they are concerned with what cannot be measured. A patient may be weighed, hi s height and even his blood pressure and blood sugar levels measured. Scans and x-rays reveal a person’s inner being – but not his soul or his spiritual needs. When a patient arrives it is easy to question him, test him, make measurements and to arrive at a diagnosis and then a treatment plan. Nurses are busy people. It is the easy option to take a temperature, tidy a bed, hand out medication, but it can be just that bit harder to find out about someone’s spiritual needs and see that these are met just as his need for analgesia , fluids or antibiotics will be. Also too often one finds pairs of nurses caring for someone, perhaps making their bed, and spending the whole time talking to each other and ignoring the patient except as a physical body to be dealt with. The Sociological View of Religion and Spirituality. Sociology takes an unbiased view of religion i.e. it does not consider any one form of spirituality to be more valuable or important than another. It does however consider it to be an important subject for study and discussion because of the impact it has upon society. As it says in the undated article ’The Sociological Perspective on Religion’:- Religious values influence many people’s actions, and religious meaning help them to interpret their experiences. There is in interactive and dynamic relationship between religion and society and the impact of one on the other. And so a sociologist might ask questions such as ‘How does this person’s religion help them to make sense of life’s difficulties? ‘or ‘How does belonging to a communion of believers affect a person’s interactions with the wider society?’ The Psychological View of Spirituality The founder of modern day psychology, Sigmund Freud was a non-practicing Jew who sought hard to understand the religion he did not have. He did not however see it as being of any positive value, believing it to be merely an expression of underlying psychological problems. He saw it rather as an attempt to control the world, according to Cherry ( undated) , a sort of wish fulfillment and even an infantile delusion. Religion is an illusion and it derives its strength from the fact that it falls in with our instinctual desires. In 1939 Freud claimed that religion was just a stage to be passed through on the way to mature adulthood. So, as opposed to the more objective sociologists, he had a totally negative view of the whole topic. Freud came from a 19th century perspective. Nelson, in his 2009 text describes how the situation has changed over time 100 years ago psychology and religion were enemies, then they gradually moved closer together until today they are complementary. The Implications of Spirituality in Practice Grant ( 2004) is quoted by Dunn, 2008, as saying that patients report repeatedly that they are not being cared for spirituality. How can this gap be filled? Cassidy in 1988, being especially concerned with the most seriously ill, described the spirituality of caring :- The spirituality of those who care for the dying must be the spirituality of companion, of the friend who walks alongside, helping, sharing and sometimes jus t sitting empty-handed, when we would rather run away. It is the spirituality of presence……enter into the suffering and share in some small way their pain, confusion and desolation. There is statisically relevent research evidence which clearly demonstrates that when the spiritual dimension of nursing is addressed in a proper way it can make a difference in both psychosocial, but also th eophysical outcomes of illness. It has been clearly shown that is is possible to correlate a person’s religious faith with a reduction in complications after surgery and reduced mortality rates, as decribed by Vance 2001.She cites Byrd, 1988; Harris, Kolbet al, 1999 and Oxman, Freeman, & Manheimer, 1995).However there is a problem with this kind of research as Hussain points oput - how is it possible to measure prayer - on eeprson may just pray with a cahplain, others will have many people praying for them, perhaps even a whole churhc. Is tha t more effective? Until it is possible to measure th enumber of people praying at any one time and what they are praying this somewhat flawed research is all that i s available. McSherry, Cash and Ross ( 2004) state that:- It would seem that there is now an urgent need for nursing to evaluate and perhaps adjust its vision regarding what constitutes spirituality. Such an approach may serve to reduce the gap between policy and public expectation When a person is first admitted to hospital a nurse or ward clerk will spend quite a time checking details, medical ones, but also contact numbers, insurance details if required and so on. The person may be quite distracted, worried about their illness and situation, especially if they are admitted in pain and/or as an emergency. Could a welcome pack be devised? It could include details of what to expect, how to use facilities such as hospital telephones, details of visiting hours, how to order special diets and so on. Obviously each patient will be different, but there will be things common to almost all. Such a pack could also include details about any chaplaincy or counseling services that are available and passing over such information could be used to advantage for the nurse to come to some understanding of a person’s spiritual state and needs. But can every nurse be expected to be able to offer spiritual care. If the term is being used in its narrowest sense of being to do with a particular system of religious belief then th eanswer must be no. Not all nurses after all are themselves religious in the sense described. Every nurse however, should be aware , and sympahtetic to , the fact that many find such belief system of comfort. She should have access to contacts – the hospitla chaplaincy service and others, who can provide the support needed. In this way they are providing apiritual care in an indirect way, even to those of very different religioins from their own. If she has some links to or knowledge of a particular system she may be able to help not by giving advice , or listening to confessions, but by asking simple questions – ‘Do you have a favourite passage of scripture?’ or perhaps ask about a favourite prayer. Simply thinking about such things may give the patient the comfort they need in a difficult situation, as described by Matthew, 2000 . There should be no attempt to impose ones own religion on another - they are after all in a vulnerable position, but nurses, even those who have no particular religious beliefs of their own should be supportive of those who have.Some authorities in hospitals may be over , concerned that nurses could impose their personal religious beliefs upon patients who are in a particularly delicate period in their lives. Such administrators may therefore insist that the nurse call the chaplain to come to the bedside, rather than making any attempt themselves to comfort their patients. Some hospitals may have thousands of patients, and only one chaplain on duty .Matthew ( 2000) claims that nurses should object strongly to the imposition of any such directive as being to an infringement upon their correct responsibilities as holistic nurses. In Britain, with its current fashion for ever more political correctness, having a spiritual dimension to nursing would in theory be commended – but possibly not if put into actual practice. In 2009 a U.K. nurse was ssupended because she offered to pray for a patient, as reported by Alderson, January 2009 .For this reason many would hesitiate to suggest praying with a patient , unless in a specifically faith situation e.g. a hospice run by a religious order. That does not mean that there isn’t a spiritual need to be met, whatever the faith or lack of it on the part of both patient and nurse. . Too often chapels in hospital hold one service a week and those in charge of wards are reluctnat for their patients to attend such services because they feel that a nurse must be spared form the ward in order to escort the patient there and back. Yet those same people often allow patients to go to the hospital shop, or even outside for a smoke, without escort. There should be a positive move to let patients know on the day that there is a service, and if they are mobile enough they can attend or they can request a visit from a member of the chaplaincy team.. . Many chapels also have a prayer room which can be used by people of any faith. Although people can of course pray anywhere chapels should be available for private prayer 24 hours a day, and not locked. If it is considered necessary to lock it for percieved security reasons, then there should be a clear notice explaining where the key is kept and how to obtain it. Prayer request forms should be distributed, as many feel comforted to know that they are being prayed for, whatever one feels about the efficacy of such prayers. That being said it is always nurses, ou tof th ewhole health care team, who spend the most time on a one to one basis with their patients, so they should not merely rely upon the chaplaincy team who are few in number, often rely on volunteers and are usually trying to meet th e needs of many , many people. Spiritual care is part of nursing responsibility. Reed, in 1987, stated that a nurse’s own spirituality will affect the way she interacts with her patients , and , Dunn, ciitng this , suggests that this means that nurses need to evaluate their own spiritual position. She goes on to cite Ross ( 2006) as saying that :- Becoming aware of one’s spiritual perspectives will enhance personal awareness and, thereby, contribute to the provision of spiritual care to patients. Barriers to the provision of holistic care including spirituality. There are barriers of a personal nature and those implicit within a health care establishment. Guidelines for instance may dogmatically state that spiritual care must be provided, but a nurse may feel that she is not trained to do so or ‘not spiritual’ enough. McSherry ( 2006, page 127) states that the ’nurses commitment to, or confidence about, spiritual care is not as strong as it might be. On the other hand a patient may decline to accept the care offered – he may for instance not want company, even when in intense difficulties. Many people would find it easier to talk about almost any aspect of their life than their spiritual beliefs and so it is often up to nursing staff to introduce the subject, making it clear that, although the topic won’t be pushed against the patient’s wishes, yet at the same time it should be made clear that the nurse or other carer , is willing and able to discuss such matters if this is wanted. There may be economic barriers – there simply isn’t the money to pay staff just to spend time with patients, for porters to take patients to chapels, or the chaplaincy service may be understaffed for instance. Patients may be in crowded wards where there is little privacy, rather than in individual rooms. McSherry ( 2006, page 127) states that spiritual provision depends upon three things – the health care profesional, the service user or patient, and the environment they are both invloved in. All three mus t work together if success is to be achieved. The ward team for instance must be in agreement tha tsuch care is necessary , the staff must be both willing and able to provide such care whatever that involves. This goes back to their training and hopspital policies. Care take stime and mus tbe allowed for when schedules are planned – iniital assessments for instance should not be rushed. The patient must feel that they have time and freedom to talk about their concerns and needs. The nurse must not appear to be rushing on ot the next task or only concerned with clinical matters. Conclusion Lee Bladon in his article ‘The Science of Spirituality, although he admits that science and spirituality are very unlikely to have common ground, also points out how science is now taking a much more holistic view of the universe. He also discusses the way in which :- Respected doctors and medical practitioners are now openly investigating near-death experiences, out-of-body experiences and past life regression, and are beginning to discover the multi-dimnesional nature of human beings. The spiritual dimension is obviously important, more important than the exingencies of ward life are too often geared to deal with. Nurses who spend time listening to patients as well as just doing things to them may even be activley discouraged to do so. There must be a change of attitudes on the part of all staff if true holistic care is going to be carried out to the benefit of those in hospital care. Nurses must not be taught about the need for spiritual care, but taught how this can be accomplished - perhaps by something as simple as helping a patient to complete a form on arrival which requests spiritual support from the chaplaincy service. This could lead to a conversation about their faith even if as basic as ‘I attend ……church.’ This having been said there is a basis for further talk as opportuniy arises. This is where having a dedicated nurse is useful as she will get to know a particular patient, and so help to enable those needs to be built. In all these ways, each only a small thing perhaps, the nurse can better achieve the so desired holistic care that her patient needs. 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