Psychiatric nurses' perspectives of spirituality and spiritual needs during an amalgamation

The purpose of this study was to explore the meaning of spirituality and how the spiritual needs of psychiatric nurses could be supported at work during a hospital amalgamation. Forty-six nurses completed the General Information Questionnaire and described the meaning of spirituality and how their spiritual needs could be supported. Data were analysed by the double-coding qualitative method. The themes identified for the meaning of spirituality included: being hopeful, having belief/belief systems, maintaining relatedness/connectedness and the expression of spirituality. The major themes identified to support nursing staffs' spiritual needs at work included communication, offering hope, being valued and support from spiritual sources. Nurses expressed the importance of spirituality in their lives and the need for spiritual support at work. Data for addressing staff spiritual needs are reported; however, further studies are needed to understand the spiritual needs of nursing staff at work during hospital amalgamations.     

A review of the literature in 2006

In this, the first of three papers, attention is drawn to the literature for one year, reflecting a sample of the interrelated themes of ageing, spirituality and nursing. It is clear that nurses are unsure how to include this component of care in their daily practice. However, with the rapidly increasing ageing population, and the recent escalation of literature on spirituality, it seems timely to analyse some of these findings and to consider the implications for practice. Some of the major emerging themes have been identified in this paper, with a view to further exploration of the themes in the second paper, and expanding the discussion in the third paper.     

Meaning of spirituality: implications for nursing practice

Background. This research outlines some preliminary findings emerging from a grounded theory investigation into the ‘meaning of spirituality’. These initial results raise some important questions about the terminology and language that nurses use regarding the term spirituality. It seems that many of the policy directives and statutory guidelines make two major assumptions regarding ‘spirituality’. Firstly, patients and nurses are aware and understand the concept, and secondly, patients may require their spiritual needs to be met. These preliminary findings suggest that a dichotomy is emerging between professional assumption and patient expectation regarding the meaning of spirituality. Aim. The study had one broad research aim, to gain a deeper insight into how patients, nurses, and people from the major world religions understand the concept of ‘spirituality’. Design. A qualitative research design was used involving a grounded theory method of inquiry. It was felt that this qualitative method would aid the investigation of this subjective dimension of peoples’ existence, enabling existing theoretical constructs and arguments to be tested. Methods. The constant comparative method was used throughout the data collection and analysis. Analysis was undertaken at two levels, ‘overview analysis’ and ‘line‐by‐line analysis’. This enabled the creation of categories and central themes. Results. Constant comparative analysis resulted in the formation of several categories and central themes. Two categories presented and discussed in detail are ‘definitions of spirituality’, and ‘diverse perceptions of spirituality’. Conclusion. 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. Relevance to clinical practice. It seems that there may be no ‘precise’ terminology associated with the language used to define spirituality, raising possible implications for nursing practice and nurse education.     

The central importance of spirituality in palliative care

The potential of spirituality to contribute to improving the quality of life of those experiencing life-threatening illness is yet to be fully realised in most palliative care settings. This may be due to many health professionals relegating spiritual issues to the background of palliative care instead of regarding spirituality as a domain equal to the physical, social, and psychological domains. The aim of this paper is to demonstrate, by reviewing the literature and providing examples from the author's personal experience as a chaplain, why spirituality should be considered on an equal footing with other key themes in palliative care, like relieving pain and advance care planning. It is hoped that this will create more self-awareness and generate greater discussion about the subject.     

Spirituality and family nursing: spiritual assessment and interventions for families

AIM: The aim of this paper is to propose a guideline for spiritual assessment and interventions explicitly for families, while considering each family member's unique spirituality. BACKGROUND: Spirituality's positive effect is pervasive in health care and in the lives of many families; therefore, there is a need to integrate spiritual assessment and interventions in total family care. DISCUSSION: The majority of published guidelines on spiritual assessment and interventions are designed predominantly for individuals. They fail to differentiate between individual and family spirituality or offer only brief discussions on family spirituality. Such guidelines are potentially problematic. They may lead nurses to focus only on individual spirituality and neglect to discern family unit spirituality or recognize the presence of conflicts in spiritual perspectives within the family. While other disciplines such as social work and family therapy have several guidelines/strategies to assess family spirituality, there is a dearth of such guidelines in the family health nursing and spirituality literature, in spite of the rhetoric about incorporating spirituality as part of total family assessment. As a beginning solution, guidelines are proposed for spiritual assessment and interventions for the family as a unit, and the category of spiritual interpretation to represent diagnosis is introduced. Case studies exemplify how to integrate the guideline, and illustrate elements that may favour specific interpretations which would guide the interventions. CONCLUSION: As nurses continually strive to assist families with their health needs, they must also attend to their spiritual needs, as one cannot truly assess a family without assessing its spirituality.     

A critical analysis of nursing: meeting the spiritual needs of patients

Nursing, over the past 2 decades, has been concerned with the development of theories which will inform practice and help to establish nursing as an emerging discipline The view that the individual is a biopsychosocial being has occupied a prominent position in the existing catalogue of nursing theories The literature reveals that, although some existing theories do acknowledge that humans do have the advantage of a spiritual dimension, very little significant work appears to have been done in this area This paper explores some of the difficulties in arriving at a definition of spirituality and goes on to examine the extent to which nursing theories incorporate the concept of spirituality Additionally, nurse education does not appear to prepare practitioners adequately to meet the spiritual needs of patients The paper concludes with a discussion of the potential for meeting the spiritual needs of patients in the context of the changes occurring in the British National Health Service     

Practice development in aged care nursing of older people: the perspective of ageing and spiritual care

This third paper on older people nursing and spirituality moves beyond the literature reviewed in the two previous papers, exploring directions for the practice and continuing research in this field. Issues of chronic illness challenge nurses working with older people to focus on continuing health promotion and opportunities for spiritual promotion of resilience and transcendence. The changes from monocultural to multicultural societies challenge nurses to know how to provide culturally and faith appropriate care. The extension of palliative care to the needs of those growing older and dying is noted as an important area for developing spiritual care. It is asserted that spiritual assessment forms a basis for the provision of spiritual care for all of these themes. Ethical perspectives of older people nursing must be carefully addressed as frail and vulnerable older people struggle with issues of compromised autonomy. Further research should focus on spirituality as seen through the eyes of older people and examine the interface between nurses and patients, where the relationship becomes the guiding basis for practice. Education in nursing courses and through continuing programmes of education is needed to ensure adequate understanding of spirituality in the nursing role.     

Integrative review of spirituality in African American breast cancer survivors.

This paper reports findings of an integrative review of the literature on spirituality in AA breast cancer survivors, isolates key spiritual themes, and recommends future research. Inclusion criteria are 1994 to 2004 research studies that included AA breast cancer survivors 18 years old and older. Content analysis was used to isolate spiritual themes and spiritual domains/dimensions. Seven studies resulted that used qualitative, quantitative, and mixed methods. Themes identified were spirituality provided the strength to cope; the need to care for others and receive care; beliefs that God is the healer and in control; God assists in decision-making; and closeness to God. Spiritual domains were beliefs, functions, and social support. Future research should explore the domains/dimensions and meanings of spirituality experienced by diverse groups ofAA breast cancer survivors. Culturally appropriate, evidence-based nursing care should include spiritually based interventions that acknowledge the significance of God.     

Treading lightly: spirituality issues in mental health nursing

ABSTRACT: Spirituality has been recognized as an important part of nursing practice since its early beginnings. However, debate continues about whether and how nurses and other mental health professionals should include spirituality within their daily work. This paper aims to contribute to the discussion of spirituality within mental health nursing, through considering findings from a Heideggerian phenomenological study conducted with six people with mental illness living in regional Australia. This study aimed to provide a greater understanding of the phenomenon of spirituality by answering a primary research question, ‘What does spirituality mean for people with a mental illness?’ Participants were interviewed and data analysed using an iterative approach. Findings emerged through multiple readings and meanings were gradually constructed from the data into themes. The themes describe that spirituality is experienced uniquely for the participants, and that spirituality became vitally important to them when they became mentally unwell. In addition, issues of interest to mental health nurses were raised but not completely addressed by the study. The issues relate to potential interactions about spirituality between nurses and their patients. Although participants wanted to discuss their experiences of spirituality with others, they raised concerns about whether their mental health care providers would be accepting of their beliefs. Spirituality was deemed to be a highly individual phenomenon; it could be experienced as a journey and it was life‐sustaining. For these reasons, it is proposed that mental health professionals must be prepared to discuss patients’ spiritual needs in the context of their health concerns.     

Spiritual care competence for contemporary nursing practice: A quantitative exploration of the guidance provided by fundamental nursing textbooks

Spirituality is receiving unprecedented attention in the nursing literature. Both the volume and scope of literature on the topic is expanding, and it is clear that this topic is of interest to nurses. There is consensus that the spiritual required by clients receiving health ought to be an integrated effort across the health care team. Although undergraduate nurses receive some education on the topic, this is ad hoc and inconsistent across universities. Textbooks are clearly a key resource in this area however the extent to which they form a comprehensive guide for nursing students and nurses is unclear. This study provides a hitherto unperformed analysis of core nursing textbooks to ascertain spirituality related content. 543 books were examined and this provides a range of useful information about inclusions and omissions in this field. Findings revealed that spirituality is not strongly portrayed as a component of holistic care and specific direction for the provision of spiritual care is lacking. Fundamental textbooks used by nurses and nursing students ought to inform and guide integrated spiritual care and reflect a more holistic approach to nursing care. The religious and/or spiritual needs of an increasingly diverse community need to be taken seriously within scholarly texts so that this commitment to individual clients' needs can be mirrored in practice.     

Spirituality in nursing and health-related literature: a concept analysis.

Spirituality has become an increasingly popular concept among the nursing and health-related literature. The purpose for conducting this concept analysis, guided by Walker and Avant's methodology, was to (a) examine how spirituality has been used within the current body of nursing and health-related literature, (b) clarify the meaning of spirituality by discovering what this concept's current critical attributes/characteristics are, and (c) propose a definition of spirituality based on the concept analysis findings. A total of 90 references were reviewed, including 73 nursing and health-related references. Concept analysis findings revealed that spirituality was defined within four main themes in the nursing and health-related literature: (a) spirituality as religious systems of beliefs and values (spirituality = religion); (b) spirituality as life meaning, purpose, and connection with others; (c) spirituality as nonreligious systems of beliefs and values; and (d) spirituality as metaphysical or transcendental phenomena.     

From homeless to hopeless and healthless?: the health impacts of housing challenges among former foster care youth transitioning to adulthood in California

A childhood history of placement in the foster care system makes the emerging adult period more complicated and problematic in a variety of ways including meeting basic needs, such as housing and health. We conducted focus groups with 31 former foster youth in San Francisco and Oakland, California to explore their housing and health care circumstances since "aging out" of the foster care system. Five key themes were identified: 1) housing circumstances have direct and indirect impacts on access to health care; 2) housing instability can impede the flow of information between social services staff and youth; 3) housing circumstances and health care differed for men and women; 4) service agency rules and structures may be developmentally mismatched with participant needs; and 5) emerging adults experience repercussions of institutional life including the suspicion of authority and mistrust of medical providers.     

Existential aspects of living with addiction - part II: caring needs. A hermeneutic expansion of qualitative findings

Aim. This paper aims to describe caring needs associated with existential aspects of living with addiction. Background. Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing. Design. Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction. Method. This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background. Results. The themes presented are: meaning – meaninglessness, connectedness – loneliness, life – death, freedom – adjustment, responsibility – guilt, control – chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability. Conclusions. When caring for patients suffering from addiction nurses should address patients’ spirituality. The caring communion is vital, as it is the foundation for meeting the patients’ needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others. Relevance to clinical practice. Understanding and being able to identify patients’ caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient’s recovery.     

Meeting the needs of minority ethnic patients

BACKGROUND: Certain aspects of nursing care related to minority ethnic patients are being highlighted in the literature, but there is little exploration of nurses' experiences of caring for people from specific minority ethnic groups. AIM: This paper reports an investigation into the experiences of Registered Nurses caring for hospitalized Pakistani patients in the United Kingdom. METHOD: A qualitative study, with a sample of 30 Registered Nurses using semi-structured interviews. The sample was self-selecting from a large health care organization in the north of England, covering adult acute, critical and rehabilitation care settings. RESULTS: Interviewees had difficulty in explaining the meaning of culture and spirituality and their relationship to nursing practice. They also had limited understanding of the Pakistani community, and deficits were identified in meeting the challenges offered by this community. Inadequate implementation of 'holism', poor preparation to meet the needs of an ethnically diverse society and the presence of racism in practice settings emerged as explanations for the deficits participants identified between their expectations and the reality in care settings. CONCLUSION: Although 'holism' is a relevant concept for enhancing nursing practice, its meaning needs to be further debated in order to avoid a tokenistic approach to its implementation in the care of patients from minority ethnic communities.     

Why is it so hard to talk about spirituality?

Although there is recognition of the importance of spirituality in the nursing literature and in nursing theory, many nurses find it difficult to talk about this sensitive area with people for whom they provide care. In this article, the authors discuss why spirituality is integral to nursing care and explore why nurses don't talk about spiritual concerns with their clients. The authors examine the meaning of spirituality and the factors that contribute to the reluctance of nurses to discuss spirituality with others: not having the right words, lack of education, a view that spiritual care is someone else's responsibility, influences of secularism and diversity in society, and the current health-care context. Openness to learning about the spiritual beliefs of individuals and attending to their nursing needs in a holistic way will enhance nursing care.     

The language of spirituality: an emerging taxonomy

BACKGROUND: This paper explores the relationships that exist between the language used to describe spirituality within nursing and the appropriateness of constructing a universal definition acceptable to all individuals. 'Spirituality' is a term that is increasingly used in nursing but there may be problems about exactly what the term means and how it is interpreted and understood by both nurses and patients. AIM: The aim of the paper is to explore some of the commonly cited definitions to establish if the concept of spirituality could be termed 'universal'. METHOD: This paper presents a discussion, based upon a literature review, of the nursing and health care databases, combined with manual searches. The review demonstrates how the term spirituality is being constructed within nursing suggesting that there are numerous definitions each with several layers of meaning. FINDINGS: From the review the authors have developed 'a spiritual taxonomy' that may explain and accommodate the different layers of meaning found within nursing and health care definitions. At the extreme left there is a spirituality based on religious and theist ideals, while at the extreme right there is a spirituality based upon secular, humanistic, existential elements. A middle way is explained containing elements from both the left and right but not as fundamental or radical. CONCLUSION: The authors argue that because there are so many definitions with different layers of meanings, spirituality can imply different things depending upon an individual's personal interpretation or worldview. The results of the review suggest nursing is constructing a 'blanket' definition of spirituality, which has a broad, almost inexhaustible set of defining characteristics. If this approach continues then there is a danger that the word may become so broad in meaning that it loses any real significance.     

Spiritual care

The essence of spirituality and spiritual care is too complex for clear definition. Topics of personal religious belief about life and death, an understanding or sensing of the process of dying, and the various means of influencing a patient's s body and mind may all be implied by the term "spiritual care". All care involving the patient's s thoughts or emotions tends to be put in the same basket, without any distinction between psychic needs, spiritual nature and religious belief. Spirituality connotes a person's s wholeness (body, mind and soul). Spirituality not only affects the individuals psychosocial activities, but also his or her physical condition and behavior. So, what is the scope of spiritual care? Does it include physical and psychological elements? Using clinical examples, the author seeks to clarify the role of spirituality in the process of adapting to a disease, and to expound a definition and goals of spiritual care. In addition, human spiritual needs and the elements of spiritual care are also outlined. It is hoped that this article will be helpful to nurses in their spiritual growth and to those who practice holistic care.     

Striving for independence: experiences and needs of service users with life limiting conditions

Title.  Striving for independence: experiences and needs of service users with lifelimiting conditions.
Aim.  This paper is a report of a study to explore what service users with a range of life-limiting conditions identify as their key experiences and needs generally and, specifically, from health and social care services.
Background.  Whilst internationally palliative care has a primary focus on service users who have cancer, there is growing evidence that those with non-cancer life-limiting conditions have similar palliative care needs. The literature has mainly been focused on independence, choice and control at an individual level, with wider influences on the maintenance or attainment of independence ignored.
Method.  A participatory approach was used in 2003–2004, with both the researcher and a group of service users working together in all stages of the study. Twenty-five participants in receipt of support from an acute hospital, primary care, social services and a hospice took part. Face-to-face individual interviews and small discussion groups were conducted and data were analysed thematically.
Findings.  Eight different but interconnected themes were identified. Independence/dependence was an overarching theme, with negotiation between independence and dependence being evident across all themes. This theme and the influence of health and social care services on the experience of living with life-limiting conditions are the focus of this paper.
Conclusion.  Palliative care and practitioners should focus on maximizing independence at both the individual and structural levels. How services for those with life-limiting conditions are provided and relationships with health and social care staff can directly impact on an individual's experience of independence, choice and control.     

Application to practice guidelines

Drawing on the international literature for 2006 as discussed in the previous paper, this paper explores key issues for translating the evidence into practice. It brings the themes of ageing, spirituality and nursing more sharply into focus, providing practical suggestions for care in a variety of settings. Taking seven identified themes into consideration, the paper draws out implications for practice from each theme. This discussion is intended to provide encouragement for nurses to consider the spiritual domain in holistic care, not as an optional extra but as the centre of a dynamic partnership with the older people in their care. The paper concludes with recommendations for further research and development work.