Spirituality: Nursing and Spiritual Care

art&scienceliterature review nursing standard: clinical · research · education

Spiritual care in nursing: a systematic approach
Govier I (2000) Spiritual care in nursing: a systematic approach. Nursing Standard. 14, 17, 32-36. Date of acceptance: November 11 1999.

Ian Govier MSc, BN, DipN, RGN, PGCE, RNT, is Charge Nurse/Ward Manager, Powys Ward, Welsh Regional Burns Unit, Morriston Hospital, Swansea NHS Trust.

Summary
Ian Govier suggests that patients will benefit if nurses adopt a systematic approach to assessing spiritual needs. However, it may be necessary to evaluate personal spirituality before applying this approach.

and encourage continued theoretical development to further our understanding of the concept and ultimately guide practice. In response to this call to promote nurses’ understanding of spiritual care, guidelines for the assessment of spiritual needs are presented as part of a systematic approach to nursing care.

Defining spiritual care

T

key words s Patients: attitudes and perceptions s Spiritual care s Care planning
These key words are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review.

HE TERM holistic care in nursing is one that many nurses who have trained or undergone further nurse education in the past decade will be familiar with (Harrison 1993, Narayanasamy 1996, Oldnall 1996). Indeed, many nurses will probably claim to have a commitment to the concept of holistic care, in that they will recognise the importance of considering the physical, psychological/emotional, social, cultural and spiritual aspects of need and care (Dossey and Dossey 1998, Stoter 1995). There is evidence to suggest that the first four of these needs are recognised, taught and practised in nursing curricula and care (McSherry and Draper 1997, Narayanasamy 1993, Ross 1995 and 1996), but the area of spiritual care is one that is frequently overlooked and delegated to a religious

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Connecticut, Appleton-Century-Crofts. s Need to listen in an authentic manner. s Actual presence of the nurse. s Ability of the nurse to accept what the patient says. s Use of judicious self-disclosure. Other tools would include intuition and appropriate behavioural interventions. These require a high degree of self-awareness from the nurse, especially in the use of self-disclosure. The nurse must be able to distinguish the need to share personal experiences as a means of positively helping, from just disclosing information to make conversation or as a means of imposing personal beliefs. Carson (1989) suggests that two principles be incorporated when implementing spiritual care. She reminds nurses that if someone claims a relationship with a higher being, it can be both complex and individual. Therefore, it is not possible to write a list of ‘standing orders’ for each person and care should reflect individual requirements. Secondly, she supports the notion of a nurse becoming more self-aware of his or her own spiritual needs before he or she can become deeply involved with others. Narayanasamy (1996) and Burkhardt and Nathaniel (1998) ask carers to observe certain protocols when delivering spiritual care and highlight the importance of a caring nurse-patient relationship which should not include the imposition of personal beliefs. It must also be recognised that although a nurse might become involved in addressing spiritual needs, he or she may play the role of facilitator and seek the assistance of those qualified to provide for this significant care need. To those who argue that a nurse has no role in spiritual care and should leave this obligation to hospital chaplains and other trained representatives, they are reminded that if nursing is to be truly holistic, nurses must embrace the spiritual dimension of care. However, a nurse must recognise his or her own limitations and involve other professionals, where and when appropriate. The nurse, in partnership with the hospital chaplain, can play a vital role in supporting the spiritual needs of patients and will hopefully recognise that spiritual care goes beyond the realm of religious affiliation. in which to evaluate the efficacy of spiritual care. Cues should be taken from patients, with Johnson (1998) stating that these cues will take the form of expressing a feeling of wellbeing, being in control or simply not feeling anxious about their care or situation. Conclusion A problem-solving approach to the organisation and delivery of spiritual care allows the nurse to perform his or her role in a truly systematic manner, while still maintaining the ability to use intuitive processes. The nursing process, especially the assessment stage, used in conjunction with a conceptual framework or appropriate guidelines, will enhance spiritual care in nursing and promote the recognition of spiritual care needs in the formulation and delivery of care plans. This expanded role of the nurse presents immense challenges, with a move away from the refuge of the body and all things physical to a role that includes the recognition and acceptance of things spiritual. The challenge to nurse educators and practitioners is to avoid the stereotypical view of spirituality as being purely religious and tied to a higher being, as well as recognising that spirituality affects and embraces all that we are and do. Spiritual care, although mostly subjective and often complex, can be developed, practised and refined by the nurse, especially when adopting a systematic approach to the dimension of spiritual care. It would be an erroneous claim that there are no examples of systematic approaches to spiritual care, but when these exist, they remain in the minority. Spiritual care is an essential component of nursing practice and often the arbiter of how someone responds to his or her illness and associated life experiences. It would appear that when people encounter certain life events like serious trauma and illness, fundamental spiritual issues emerge that question their very existence. If medicine involves the recovery of the body, spiritual care involves a recovery of the patient as a person. These areas do not sit in contention, but aim to complement each other and remind us that: ‘There is no profit in curing the body if in the process we destroy the soul’ (Anon) Evaluating spiritual care To complete the cyclical nature of the nursing process, evaluation of care must be undertaken by determining whether outcome criteria or goals have been met. This can be somewhat difficult and imprecise due to the subjective nature of the spiritual dimension and, unfortunately, evaluation of spiritual care is not always simply a case of cause and effect. For example, it cannot be compared to receiving analgesia in response to a specific injury and waiting for the pain to be eradicated. It is far more complex and therefore more difficult to evaluate. Discussing outcomes with the patient seems to be the most obvious manner 36 nursing standard january 12/vol14/no17/2000