Spirituality and Caring: Dialogue and Inquiry with Literature Review
This article is both a personal story and a literature review on the challenges nurses face when caring for patients spirituality. Although it is important to spiritually care for patients, there have been difficulties when trying to define spirituality. Taking care of a patient spiritually is vital to the importance of creating a caring environment, yet it is a difficult task to achieve.
Spirituality is a personal, abstract component in people's lives that can have different meanings based on different life experiences. One's own experiences help to shape what spirituality means to oneself. Spirituality can be a very personal subject, and I was very lucky that Leslie Lobel, a social worker at my place of work, shared her personal views on the subject with me.
Although religion and spirituality are not the same, Leslie's view on spirituality reflects her own religious beliefs. Leslie defined spirituality as one's personal relationship with Christ, a "spiritual person walks with the Lord."Leslie is not only describing her personal definition of spirituality, but a religious belief as well. Leslie identifies herself as a spiritual Seventh Day Adventist, who has grown into her own spirituality as she has grown as a person.
Leslie has always been on a quest for spirituality and had a love for "philosophical wonder." Leslie believes her spirituality matured when she was introduced to the faith. Leslie tries to live her life as a good person, and her spiritual growth increases on a daily basis. There are personal challenges working in the healthcare setting that test Leslie's spirituality.
Part of Leslie's spiritual philosophy is that life is to be balanced and harmonious. Leslie explained, "as Eve was made from Adam's rib, and Adam was made by God in his image, everything was good and harmonious." "We are to live our lives that way," Leslie believes, "thy life is supposed to reflect the good of others." Caring for patients who lead their life differently is a personal challenge, as Leslie must put aside her own spiritual belief system.
Spiritual care and spirituality are concepts inseparable from nursing and healthcare (McSherry, Cash, & Ross, 2004). Many government documents mention spirituality and spiritual care as part of health care, but difficulties arise when establishing the exact meaning of what spiritual care is to each individual.
An article, written by McSherry, Cash, and Ross (2004), sought to understand the definition of spirituality in regards to the four major world religions. The nurses who partook in McSherry, Cash, and Ross' study were able to define spirituality, keeping it separate from religion. However, the patients involved in this study were unable to come to a definition that would separate spirituality from religion (2004).
When looking at the way spirituality was viewed by different groups of people, multiple variances arose. The span of answers led the researchers to conclude that it is impossible to define spirituality as it applies to all religious groups. The result from this study implies "that any attempt to define precisely what constitutes spirituality may be fraught with difficulty" (McSherry et al., 2004, p. 939). McSherry, Cash, and Ross concluded that, if an individual's spirituality is not addressed and taken into consideration, then the spiritual care being given by a caregiver may be broken (2004).
The second article, written by Clarke (2009), sheds light on the lack of criticism within the sources used by nurses to define spirituality. The author mentions how several literature reviews have never been critiqued and that these reviews lack sources for definitions, which creates biased literature (Clarke, 2009). Also, Clarke's article critiques many definitions by labeling them as too broad or unable to be used in practice (2009).
Many of the sources used in nursing literature to define spirituality come from many disciplines, not just from the nursing profession. Yet, the literature makes no mention of this variability (Clarke, 2009). Although most literature defines spirituality as being separate from religion, Clarke's article states that researchers should define both spirituality and religion, and then come to a conclusion on how to define spirituality separately from religion (Clarke, 2009).
Psychosocial care is not the same as spiritual care, but due to the lack of exact definition of spiritual care, many nurses believe they are the same (Clarke, 2009). Clarke believes that using religious language terms such as "holy" will help to define spirituality; however, due to the forced separation of spirituality and religion, religious language cannot be used (Clarke, 2009). Difficulty arises when trying to define spirituality in the scholarly setting due to anxiety surrounding the topic and the inability to define spirituality as an exact science (Clarke, 2009). If the nursing field starts "accepting that a one size fits all model is inappropriate and by directing our attention to finding if there is a more practical and user friendly way to incorporate spirituality into practice," then we can explore a better spirituality model (Clarke, 2009, p. 1672).
The third article written by Ronaldson et al. studied the influence of the work environment on nursing perspectives of spirituality and spiritual caring (2012). The authors assessed the spiritual practices of both acute care and palliative care nurses when caring for their patients. Each group of nurses had different factors to consider. The acute care nurses averaged ten years younger than the palliative care nurses. Moreover, the palliative care nurses had more time with their patients and support when performing spiritual care. The biggest barrier in preventing spiritual care in practice for both nursing populations was the lack of time when caring for patients. The palliative care nurses were found to have advanced spiritual care practice skills and an intensified personal spirituality, which contributed to the frequent practice of spiritual caring-an integral part of holistic nursing (Ronaldson et al., 2012).
Patients who are ill with life threatening diseases may find comfort, control, meaning, and personal growth through spirituality (Van Leeuwen, Schep-Akkerman, & Van Laarhoven, 2013). A nurse must perform a spiritual assessment in order to tend to patients' spiritual needs. The nurse participants in this research study evaluated two spiritual assessment tools: the Spiritual Health Inventory and the Spiritual History. The Spiritual Health Inventory tool was found to be the most direct method, allowing the nurse to speak with patients' and more properly asses their spiritual needs (Van Leeuwen et al., 2013). All nurses should become accustomed with the concept of spirituality and the "implementation of spiritual assessment in daily nursing practice is urgently needed" (Van Leeuwen et al., 2013, p. 214).
When taking care of a patient, one way to implement spiritual care is to use artistic creativity to create a relaxed emotional state in a patient, which helps the patient to heal. The change in attitude from stress to relaxation arouses the parasympathetic nervous system, alerts the autonomic nervous system, and can decrease a patient's pain perception (Lane, 2005). The Lane article gave a brief overview of the history of spirituality and creativity in healing, noting that this concept is not new.
Nurses and hospitals which incorporate art when caring for patients (music, poetry, dance, writing, guided imagery and prayer) create opportunities for spirit-body healing experiences (Lane, 2005). The most widely studied art form in the hospital is music, which has been shown to decrease pain and anxiety (Lane, 2005).
Lane's article also reflected on the healing effects of drawing, dance and writing in journals on patients in the hospital setting, and concluded that creativity and spirituality should be part of the healing modality (Lane, 2005). The nurse must implement creativity and spirituality, since "creativity and spirituality allow nurses to transform learning and change nursing care" (Lane, 2005, p. 125).
Giving spirituality a distinct definition has proven to be a difficult task. Many researchers have unsuccessfully tried to define spirituality. Nursing, as a profession, agrees that spiritual care is important to healing, but being able to implement the current nursing literature on spirituality in the healthcare setting is virtually impossible. Much of the current nursing literature on spirituality lacks criticism, and the sources lack merit. The degree of spiritual care a patient receives in the hospital setting varies, dependent upon the nurse's own view of spirituality. Spirituality assessment tools should be used to close the gap in the variance of care. Art and creativity can help in the spiritual caring process, putting patients in a more relaxed state, helping them to heal holistically.
To me, spirituality means to be at peace with the mind, body and spirit, and have serenity with my own feelings. This state of spiritual peacefulness is not one that we are born with, but one that evolves through time and different situations. I believe that the definition of spirituality is different on an individual basis because it is based upon one's personal view on caring. I tend to prioritize making myself happy. When I am stressed or do not feel good about a current situation, I am in a place of emotional turmoil, unable to heal, chaotic and in need spiritual comfort.
The articles I have chosen were meant to create a caring, full-circle, spiritual experience. These articles included: the ability to define spirituality, the problems with current spiritual definitions and literature, how individual spiritual beliefs of nurses can effect spiritual caring, tools that can be used to assess a patient's spirituality, and how creativity can be used to help patients achieve a sense of spiritual peace and healing necessary for health.
I agree that spirituality is not definable on a broad spectrum and that the literature surrounding spirituality in nursing needs to be carefully scrutinized prior to publishing to determine if it is based upon poor sources. I believe in holistic nursing, providing the best care to my patients and that spiritual assessment should be included upon the admission process to the hospital. I hope that more hospitals seek resources to help all nurses explore to define a personal spirituality, and and allow for an incorporation of the spiritual care of the patient as part of the hospitals caring modality.
One aspect, not included in the articles I chose, was how nursing "burn out" effects spirituality. The article written by Ronaldson et al spoke about barriers to spiritual caring and never mentioned any spiritual fatigue. I think that a nurse who is unsupported in their spiritual caring can face a spiritual fatigue similar to caretaker fatigue.
I am spiritual by trying to keep my emotions at peace at all times. I have come to the realization, that when I am emotionally and spiritually at peace, I treat others differently and become more intuitive to others' needs. I cannot control the emotions of others, but I can offer teaching tools for others to create emotional serenity in their life. Spirituality is a characteristic of being human that is shaped by one's personal experiences and surroundings.
The articles used in my literature review have given me further insight into the difficulties and challenges surrounding the ability to define spirituality and partake in the spiritual caring of patients. I hope that the topic of spiritual care in nursing will progress forward and more resources will arise to make spiritual caring an integral part of the health care system.Last edit by Joe V on Apr 14, '14
Apr 26, '14I wonder about the NANDA-I dx "Impaired Religiosity". I read the Defining Characteristics and agree that it is indeed a diagnostic category that is useful to have and I understand the terminology they use etc...
But I have wondered about their choice of the word "Religiosity". It is a term with several layers of meaning but is most commonly used in its pejorative sense... exaggerated piety... religious practice for the purpose of appearing religious and devout.
The choice of this word to describe the defining characteristics seems ill-informed.