How Nursing Today View Spiritual Care?
Outline:
a. For a long time, spiritual care was frankly
religious functions and interventions limited
(at least officially) to calling the hospital chaplain
b. 1960-1970 – a growing interest in the spiritual, psychosocial and emotional aspects of nursing
process
c. 1971 – the nurse ministering to the whole person
d. Spiritual care - a natural part of total care which fits easily into the nursing process
Learning Outcome:
a. Understand the history and development of nursing care in terms of meeting the
spiritual needs of patient
b. Compare Health Care Provider of today to one of those in 1960-1970
Unity and Diversity in Spiritual Care
We are told that the very essence of good nursing is to help a person attain or maintain
wholeness in every dimension of their being. 'Holism' has become the buzz word of the nineties,
and nurses are frequently exhorted to care for the whole person. A new wave of terminology has
evolved around this concept, and now in nursing theory you'll sometimes find a person described
as a biopsychosocial unit! Is this a new direction or focus for nursing, or are we simply revisiting
something we have always known to be important?
The nursing profession has traditionally viewed persons holistically, even though the term itself
was not introduced into the nursing literature until the1980s by Rogers, Parse, Newman and
others. In fact it would have been hard to find a nurse in any era who saw only the physical aspect
of care as that which defines nursing. FLORENCE NIGHTINGALE, who brought to nursing not only
her traditional Christian values but also some very 'modern' nursing values such as autonomy
and professionalism, was a firm believer in holistic care. She claimed, "The needs of the spirit are
as critical to health as those individual organs which make up the body". We've all observed that a
physical condition can affect the mind and spirit. We're also aware that when a person is hurting
emotionally or spiritually, all sorts of physical ailments may be manifested. What has changed is
that we're now giving more attention and time to those other less tangible dimensions of a
person's need.
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RESTORING WHOLENESS
If we accept that restoring wholeness is a legitimate
goal of nursing, the term 'holistic' from the Greek
'Holos' meaning whole or complete, is a very
appropriate way to describe what we aim to do.
Even so, we may not always stop to consider the
full implications of that concept. Holism has been
defined as "concerned with the inter-relationship of body, mind and spirit in an everchanging
environment"1 (Dossey 1995), while the American Holistic Nurses Association define wellness
(health) as "a state of harmony between body, mind and spirit". So if we're aiming to help a person
attain or maintain wholeness in all dimensions of their being, we need to be prepared to provide
care in each of those areas.
SPIRITUALITY IN NURSING TODAY
How does nursing today view spiritual care? For a long time,
nursing literature concerning spiritual care was directed
towards belief systems and religious practices. If considered at all, it was largely defined in a very
narrow way as relating to frankly religious functions and intervention limited (at least officially) to
calling the hospital chaplain. Regardless of that, we were often confronted with spiritual need and
recognized at least the more overt expressions of this. For example, statements such as "God must
be punishing me" or questions like, "Nurse, do you think there is anything after death?" were
recognized as indicating a spiritual concern.
By the late 1960s and 1970s the nursing literature had begun to reveal a growing interest in the
spiritual, as well as the psychosocial and emotional aspects of nursing care. Nursing theorists of
this era saw the human person as an integrated whole with different dimensions or capabilities (as
they put it) for discerning the world around and within. Their writings suggest that when they
spoke of spirituality or spiritual need, they had in mind a much broader concept than just religious
or denominational adherence and practice.
In 1971, Joyce Travelbee declared, "A nurse does not only seek to alleviate physical pain or render
physical care - she ministers to the whole person. The existence of suffering, whether physical,
mental or spiritual is the proper concern of the nurse".4 (Travelbee, 1971: 159). Here we see clear
evidence of a return to the traditional focus of nursing, a concern for the whole person. This focus
is even more evident today.
The North American Diagnosis Association [NANDA] approved list of Nursing Diagnoses which is
widely used in Australia, includes SPIRITUAL DISTRESS which is described as
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, "Distress of the human spirit; disruption in the life
principle that pervades a person's entire being and
integrates and transcends one's biological and
psychosocial nature." (Alfaro, 1990: 203)
This classification, first approved in its present form in
1988, recognizes that suffering extends beyond the
physical, mental and emotional.
Spiritual care can be a natural part of total care which fits easily into the nursing process of
assessment, nursing diagnosis, planning, implementation and evaluation. Placing spiritual need
and spiritual care within this framework, has proved to be very helpful, for both philosophical and
practical reasons. Firstly spiritual care can become more tangible as well as more assessable. And
secondly, the types of knowledge utilized by the Nursing Process - practice wisdom, ethics of
practice, and scientific knowledge (Ziegler et al, 1986:14-18) - are all relevant to assessing spiritual
needs and planning spiritual care. It can also then be documented in nursing care plans, to ensure
a continuity of care.
Like all other areas of care, spiritual care should be a
team effort. If spiritual needs are accurately assessed
and documented, all staff will be encouraged to see
that care is provided. Members of the team who for
any reason, don't feel comfortable about providing that
care themselves, will be able to use referral. The result
will be a united approach to spiritual care which is seen
as a natural part of nursing
practice.
IMPORTANT PRINCIPLES
(1) Nursing diagnosis is intended to identify strengths
of the client as well as actual and potential problems.
(2) Our primary goal in spiritual care is to mobilize the
patient's spiritual resources.
(3) Nursing staff should be
aware that spiritual care is
responding to a client's expressed needs.
Interventions are by their request or permission.
(4) Spiritual assessment and care should be sensitive and based on a relationship of trust between
client and nurse. It will involve awareness of the person's culture, social and spiritual preferences,
as well as a respect for their beliefs and religious practices.
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(5) Recognizing our own limitations and knowing when to make a referral, or utilize other
members of the team is as important for spiritual care as it is for other aspects of care.
(6) The importance of documenting spiritual care in nursing plans must be recognized, since this
will ensure that care is systematic, well thought out, and consistent.
MEETING THE CHALLENGE
Spiritual care can still be a daunting prospect for
many nurses. The differing beliefs, requirements
and expectations of our clients, face us with a
significant challenge. How can we become more
confident and better equipped to meet it?
1. Consider the myriad of personal resources nurses use in their day to day work. Many nursing
interventions already provide a degree of spiritual support. Simply being with clients, listening to
their concerns, empathizing and responding, is therapeutic when it comes to meeting the needs
of the human spirit - the need for love and relatedness, meaning and purpose, and hope. Often
nurses fail to recognize and document this excellent and appropriate care.
2. Building up a knowledge base that will equip us for understanding the particular spiritual and
religious needs of our clients. This information will be obtained primarily from our clients, or
where that is not possible, from their families. Interacting with colleagues and liaising with hospital
chaplains will also be helpful. Attending workshops and courses which deal with this aspect of
nursing care will help to increase our knowledge and skills.
Then there are nursing texts that give an overview of
the religious/spiritual requirements of a number of
major faiths. eg. Kozier and Erb's chapter on
Spiritual Preferences in Fundamentals of Nursing, or
Lippincott's Nursing and Spiritual Care (McGilloway
and Myco eds.). This is important because in many
societies culture and religion are closely woven
together. A working knowledge of major religions –
especially their beliefs regarding issues such as health and illness, suffering and death - will be
highly relevant to nursing care. Knowledge of customs, ceremonies, cleanliness/hygiene rules, and
food laws will be of practical value.
3. Be aware that most religions accept
that there is a presence or dimension in man that
survives the death of the body - Christians believe
in bodily resurrection, judgment and eternal life - in
heaven or hell.
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“But when the Son of Man comes in his glory, and all
the angels with him, then he will sit upon his glorious
throne. All the nations will be gathered in his presence
, and he will separate the people as a shepherd
separates the sheep from the goats. He will place the
sheep at his right hand and the goats at his left.
“Then the King will say to those on his right, ‘Come,
you who are blessed by my Father, inherit the
Kingdom prepared for you from the creation of the
world. For I was hungry, and you fed me. I was thirsty
, and you gave me a drink. I was a stranger, and you
invited me into your home. I was naked, and you
gave me clothing. I was sick, and you cared for me.
I was in prison, and you visited me.’
“Then these righteous ones will reply, ‘Lord, when did we ever see you hungry and feed you? Or
thirsty and give you something to drink? Or a stranger and show you hospitality? Or naked and
give you clothing? When did we ever see you sick or in prison and visit you?’
“And the King will say, ‘I tell you the truth, when you did it to one of the least of these my brothers
and sisters, you were doing it to me!’
“Then the King will turn to those on the left and say, ‘Away with you, you cursed ones, into the
eternal fire prepared for the devil and his demons. For I was hungry, and you didn’t feed me. I was
thirsty, and you didn’t give me a drink. I was a stranger, and you didn’t invite me into your home. I
was naked, and you didn’t give me clothing. I was sick and in prison, and you didn’t visit me.’
“Then they will reply, ‘Lord, when did we ever see you
hungry or thirsty or a stranger or naked or sick or in
prison, and not help you?’
“And he will answer, ‘I tell you the truth, when you
refused to help the least of these my brothers and
sisters, you were refusing to help me.’
“And they will go away into eternal punishment, but
the righteous will go into eternal life.” (NLT, Matthew 25:31-46)
It is commonly argued that the need for spiritual nourishment is
not only found in individuals who are severely ill in hospital, but also the whole of humankind
(Myco, 1985:40). The anxiety of death or the helplessness experienced in illness - whether
occurring through old age, severe illness or any other life crisis - produces a heightened need for
security, meaning, hope, love & acceptance, which are all basic human needs. People may seek
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fulfillment of these needs purely on a horizontal level, eg. through human relationships, OR on
what has been called a transcendent level, through a relationship with God.
Other factors which will affect our confidence and competence in providing spiritual care include
an understanding of our own beliefs and values, and the degree to which our own spiritual needs
are being met. It's difficult to respond to spiritual needs of others if we ourselves are experiencing
unresolved spiritual concerns or distress. Sometimes we'll need to seek out help and support for
ourselves so that we are more able to help others.
Nursing today acknowledges that the needs of the spirit
are as important as physical needs for a person's well-being.
Increased awareness and preparation, together with a united
approach to this dimension of nursing practice, will be shown
to enhance the quality of our care and strengthen our contribution
to the ongoing development of our profession. Recognizing and meeting the diversity of spiritual
needs in our clients will call for a person centered, flexible approach. It will also require teamwork
and unity in order to provide comprehensive, consistent and ongoing spiritual care. There is
strength in a diverse yet united approach to the challenge of spiritual care in nursing practice.
References: The Holy Bible
[Link]
Hutchison, [Link] and Diversity in Spiritual Care. Australia
[Link]
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LANI C. MUECA, MAN, RN, RES, MAEDc
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