Thinking and writing at Masters level: a reflective passage

This article identifies key characteristics of Masters level writing and the underpinning relationship of these characteristics to reflective thought. Classical models of reflective writing are reviewed and their focus on reflection as a progressive process is debated. A linear model of reflection is proposed and its application to reflective writing for Masters level assessments is examined. The classical authors tend to present reflection as a process in which the outcomes of reflection becomes deeper at advanced levels. While this is an appropriate application of the concept of reflection for the traditional academic essay, it might not always be so appropriate for other more applied aspects of thinking and writing particularly in the development of advanced nursing practice. A linear model of reflective writing which offers a more pragmatic perspective on reflection is developed.     

Towards clarification of the meaning of spirituality

BACKGROUND: Rhetoric about spirituality and nursing has greatly increased, as scientific-based approaches are not fully able to address many human problems, such as persistent pain. Despite the renewed interest and growing literature on spirituality, there is no consensus on a definition of this concept. There is also ambiguity on how this concept is incorporated into nursing practice, research, and education. AIM: This paper aims to contribute toward clarification of the meaning of spirituality in relevance to health and nursing today through a conceptual analysis process. METHODS: Information was obtained through dictionary definitions and electronic database searches of literature on spirituality spanning the past 30 years. The criteria for selection included scholarly articles and books with a definition of spirituality, and research studies that investigated the meaning of spirituality to individuals' health. A total of 76 articles and 19 books were retrieved for this analysis. FINDINGS: Spirituality is an inherent component of being human, and is subjective, intangible, and multidimensional. Spirituality and religion are often used interchangeably, but the two concepts are different. Spirituality involves humans' search for meaning in life, while religion involves an organized entity with rituals and practices about a higher power or God. Spirituality may be related to religion for certain individuals, but for others, such as an atheist, it may not be. CONCLUSION: In order to provide clarity and enhance understanding of this concept, this analysis delineates antecedents, attributes, constructed case examples, empirical referents, and consequences of spirituality. A proposed definition of spirituality emerged from this process, which may be applied broadly. Implications for nursing practice, education, and research are discussed.     

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.     

Spirituality and caring in old age and the significance of religion – a hermeneutical study from Norway

Scand J Caring Sci; 2013; 27; 275–284 Spirituality and caring in old age and the significance of religion – a hermeneutical study from Norway Spirituality is an important part of caring for the whole human being. However, there is lack of consensus about the concept parameter, and there is an ongoing discussion in nursing regarding the relation between religion and spirituality. Spirituality and religion is found to support health and well‐being in old age, and this article portrays how older Norwegians understand religion and religious support as part of spirituality and caring. The theoretical framework in this study is Eriksson’s caritative caring theory, and the research aim is to broaden the understanding of spirituality from a caring science perspective. The methodology is hermeneutical according to Gadamer. The study is based upon qualitative content analysis of 30 interviews with 17 participants above 74 years, six men and 11 women. The findings portray connectedness with a Higher power, including how Christianity has influenced upon the philosophy of life of the participants, wonders about the end of life/afterlife, and the meaning of religious symbols and rituals. The study also portrays how religious support may foster dignity, especially near the end of life, and experiences and opinions regarding support from nursing personnel. The study concludes that religiousness cannot be separated from spirituality, and that nurses should be able to provide spiritual care to a certain extent. Spiritual care including religious support according to patients’ desires may foster health and preserve human dignity.     

Religion and spirituality defined according to current use in nursing literature.

The nursing literature published from 1963 to 1989 was screened for definitions to distinguish the concept of religion from that of spirituality. Following concept analysis procedures, definitions were selected from journal articles and textbooks and the key words in the definitions were listed in order of frequency. In definitions of religion, six words appeared most frequently--system, beliefs, organized, person, worship, practices; in definitions of spirituality, nine words appeared most frequently--personal, life, principle, animator, being, God (god), quality, relationship, transcendent. Only the word person(al) appeared on both lists. Using these two lists, the words (defining attributes) that appeared most frequently were formed as consensus definitions. It was concluded that spirituality is currently the broader term and may subsume aspects of religion. If these concepts are not clearly defined, the care related to personal life principles, relationships, and transcendent experiences may be confused with care for personal beliefs and worship practices.     

Spirituality and secularization: nursing and the sociology of religion

Aim. The concept of spirituality is much discussed in the UK nursing literature, despite the fact that Britain is one of the most secular countries in the world, and steadily becoming more so. Here, I pose the following question: given this increasing secularization, what accounts for the current interest in spirituality among UK nurses? Background. The literature on spirituality in nursing has blossomed in the last 10 years, and various attempts have been made to define ‘spirituality’, ‘spiritual need’ and ‘spiritual care’. Most definitions distinguish between ‘spirituality’ and ‘religion’, acknowledging that the latter is more institutional, and theologically more restrictive, than the former; and they suggest that spirituality is universal, something which (unlike religion) all human beings share. Method. I draw on the sociology of religion – neglected, for the most part, in the nursing literature – to establish two main points. Firstly, that the UK and the USA are at opposite ends of the religion/secularity spectrum, implying that it is a mistake to assimilate USA and UK sources. Secondly, that the concept of spirituality, as currently understood, is of very recent origin, and is still ‘under construction’, having become separated from its associations with Christian piety and mysticism only since the 1980s. Conclusions. The extension of spirituality into secular domains is part of a professionalization project in nursing, a claim to jurisdiction over a newly invented sphere of work. For the time being, it remains an academic project (in the UK) as it is not one with which many clinicians identify. Relevance to clinical practice. What counts as ‘spiritual need’ or ‘spiritual care’ may not be the same in both countries, and UK clinicians are unlikely to welcome the role of surrogate chaplain, which their USA colleagues are apparently willing to embrace.     

Religion and the secularisation of health care

Aims and objectives. To assess the claim that conceptualisations of religion and spirituality should be grounded in theology, and acknowledge the global resurgence of religion. Background. Although there is widespread agreement in the nursing literature that ‘spirituality’ is a broader concept than ‘religion,’ and should be understood generically, this approximate consensus has occasionally been challenged. A recent paper by Barbara Pesut and colleagues argues that the generic view not only empties spirituality of powerful religious symbols and narratives, but underestimates the continuing social influence of religion, and its resurgence on a global scale. Accordingly, these authors suggest three principles for conceptualising spirituality and religion in health care, one of which is that conceptualisations should be grounded in philosophical and theological thinking, and should not ignore the global resurgence of religion. Method. Critical review. Conclusion. The Pesut principle privileges theology, disregarding other disciplines which theorise religion. Arguably, it privileges specifically Christian theology, the history of which suggests a politics of orthodoxy and an epistemology of authority and obedience. The global resurgence of religion is not, in fact, global, as the industrialised countries have experienced a marked shift towards secular‐rational values; and the postindustrial phase of development is associated with self‐expression values, which represent a challenge not merely to religious institutions (arguably an affirmation of ‘spirituality’) but to traditional elites and structures of all kinds. Finally, religion ‘resurgent’ is not an attractive model for health care, since many of its most obvious manifestations are incompatible with the ideology of health professionals. Relevance to clinical practice. In the secular societies of Europe, if not North America, there should be no expectation that nurses provide spiritual care. It is a requirement of the great separation between civil order and religion that the health services, as a public space, should remain thoroughly secular.     

Religion and spirituality: a discussion paper about negativity, reductionism and differentiation in nursing texts

BACKGROUND: The last 30 years have seen a proliferation of literature about spirituality in the nursing press. A dominant theme has been the need to differentiate spirituality from religion and this has provoked a number of authors to attempt to define and describe religion. As nursing advocates respect for the person's religious beliefs the way in which it is portrayed is very relevant. AIMS: This work explores how religion is defined and discussed in the nursing literature about spirituality to consider whether the way religion is portrayed could be said to demonstrate 'respect' for religious beliefs. METHODS: Texts about religion were examined in relation to theories of religion from anthropology, sociology and religious studies. These disciplines have produced substantive or irreducible accounts in contrast to functional and reductive theories about religion. RESULTS: The result of this analysis is that there appears to be a tendency to talk about religion without using sources which itself suggests a lack of respect as well as an inclination to view it only in reductive and functional terms. This is proved by the similarity of ideas in the nursing literature to the functionalist and reductionist theories of Frazer, Tylor, Marx, Durkheim and Freud. This approach is criticised with reference to the work of Otto, Bellah, Berger and Pals who suggest that religion should be seen as irreducibly to do with the sacred. It is proposed that this is a more appropriate outlook to take for an occupation which professes to respect the religious beliefs of all individuals. However, viewing religion in this more meaningful way, acknowledging their spirituality has implications for attempts to differentiate religion and spirituality. CONCLUSION: Reductive accounts of religion imply, probably inadvertently but nevertheless negative, attitudes towards religious belief. A more serious and deeper exploration of the meaning of religion from the standpoint of irreducibility might be more respectful and tolerant of religious belief. This is particularly salient in a society where religious practice is increasing both in the indigenous population and as a result of immigration.     

Intuition—A Problematic Form of Knowledge in Nursing

The purpose of this article is to discuss the concept and phenomenon of intuition in nursing. With an overview of theories of intuition in philosophy and empirical research as the starting point, the authors discuss the conceptualization of intuition in nursing. Concept analyses, intuition as phenomenological nursing knowledge, intuition as clinical knowledge and intuition as spiritual connection are discussed. The authors conclude that the conceptions of intuition in nursing differ with respect to their philosophical underpinnings and that it can be questioned whether ‘intuition’ is always a proper term for the kind of knowledge investigated. Intuition is seen as an important concept in nursing, but there are still philosophical as well as empirical and practical problems to investigate.     

Spirituality in nursing: what are the issues?

This article describes the author's attempt to highlight the problem areas associated with providing spiritual care for patients. The focus of this work is to discuss the following areas of interest: What is spirituality? The issue of spirituality in nursing. The impact of spirituality for the patient. The relevance or irrelevance of religion. The concept of serenity as a goal for nursing practice. The author provides examples, specifically regarding older people, explaining why spiritual care of patients is decidedly problematic in the British healthcare system and provides suggestions as to how to reintegrate this essential part of caregiving back into daily practice.     

Spirituality: its relevance and purpose for clinical nursing in a new millennium

? Nurses often make a link between spirituality and religion. This is evidenced in nursing documents when comments about the patient’s religious faith are placed in the space devoted to spirituality. ? While religion may inform and offer direction to an individual’s spirituality the two concepts are not the same. In terms of analogy, hydrogen and oxygen combine to make water although each brings its own defining characteristics to balance the chemical equation. ? Thus, there may be a synergy and symbiosis between religion and spirituality but the essence of each remains unique; indeed, a person’s spirituality can thrive irrespective of religious creed – orthodox or otherwise. ? In this paper, we will develop a narrative that articulates and offers the defining characteristics of spirituality. This will be coupled with a framework that seeks to explain the workings and dynamics of spirituality in clinical nursing.     

Learning spiritual dimensions of care from a historical perspective

The purpose of this article is to bring to focus an historical perspective to the subject of spirituality in nurse education. In doing so, the historical roots of spirituality in nursing are traced and commented. Whilst acknowledging the emerging perspectives on spirituality (Simsen 1986, Burnard 1986, 1987, Narayanasamy 1991, 1993, Harrison 1993, Bradshaw 1994, Ross 1995, Oldnall 1996, McSherry & Draper 1998) this paper attempts to address its historical dimension, which is presently lacking in the nursing literature. In order to address this historical gap in spirituality, this paper begins by looking at the spiritual influences of nursing in ancient civilizations like Egypt, Mesopotamia, China, Palestine, India, Greece and Rome and then examines the influence of Christianity. After this, the spiritual dimension of nursing is portrayed as it was in the Middle Ages, Renaissance, Eighteenth and Nineteenth centuries. Finally, the emerging nursing theories and their positions on spirituality (including those of humanists) are reviewed and commented. It is hoped that this paper, through a brief review of events, has begun to highlight the significance of the precursor to spirituality in nursing from an historical perspective. It is concluded that contemporary literature suggests there is scope for development of educational programmes to better equip nurses to meet patients' spiritual needs.     

Conceptualising spirituality and religion for healthcare

Aims. To discuss some of the challenges of conceptualising spirituality and religion for healthcare practice. Background. With the growing interest in spirituality in healthcare, has come the inevitable task of trying to conceptualise spirituality, a daunting task given the amorphous nature of spirituality, the changing understandings of spirituality among individuals and the diverse globalised society within which this task is taking place. Spirituality’s relationship to religion is a particularly challenging point of debate. Design. Critical review. Conclusions. Three social and historical conditions – located in the context of Western thought – have contributed to current conceptualisations of spirituality and religion: the diminishment of the social authority of religion as a result of the Enlightenment focus on reason, the rise of a postmodern spirituality emphasising spiritual experience and current tensions over the ideological and political roles of religion in society. The trend to minimise the social influence of religion is a particular Western bias that seems to ignore the global megatrend of the resurgence of religion. Current conceptualisations are critiqued on the following grounds: that they tend to be ungrounded from a rich history of theological and philosophical thought, that a particular form of elitist spirituality is emerging and that the individualistic emphasis in recent conceptualisations of spirituality diminishes the potential for societal critique and transformation while opening the door for economic and political self interest. Relevance to clinical practice. Constructing adequate conceptualisations of spirituality and religion for clinical practice entails grounding them in the wealth of centuries of philosophical and theological thinking, ensuring that they represent the diverse society that nursing serves and anchoring them within a moral view of practice.     

The meaning of spirituality: a literature review

This paper presents a literature review in relation to the meaning of spirituality. It is proposed that meeting the spiritual needs of patients is a fundamental part of providing holistic nursing care, but that the assessment and meeting of those needs is impeded by inadequate definitions and conceptual frameworks. It should not be assumed that spirituality is either synonymous, or coterminous, with religion, and it is suggested that to adopt this restrictive view is unhelpful in the provision of individualized care. Reflection on the literature reveals that the self, others and 'God' provide the key elements within a definition of spirituality, and that other emerging themes namely meaning, hope, relatedness/connectedness, beliefs/belief systems and expressions of spirituality, can be articulated in the context of those three key elements. In particular, it is proposed that the nature of 'God' may take many forms and, essentially, is whatever an individual takes to be of highest value in his/her life. It is suggested that the themes emerging from the literature can be utilized as a framework to give practitioners and researchers a direction for future exploration of the concept of spirituality.     

There be dragons: effects of unexplored religion on nurses’ competence in spiritual care

On ancient maps unexplored lands were simply labeled ‘there be dragons’ indicating the fear that attends the unknown. Despite three decades of theoretical and empirical work on spirituality in nursing, evidence still suggests that nurses do not feel competent to engage in spiritual care. In this paper I propose that one of the reasons for this is a theory–theory gap between religion and spirituality. Generalized anxiety about the role of religion in society has led to under‐theorizing in nursing about religious care. As a result, when religion and spirituality overlap at the point of care, nurses are left without the substantive knowledge required for practice. Robust religious theorizing should include thick accounts of lived religion and integrative work that enables nurses to understand commonalities across religions that are relevant to practice. As a starting point to this integrative work, nurses can be introduced to the nature and lexicon of lived religion, religious perspectives on suffering, and religious reasoning that holds meaning and mystery in tension. Such an approach will better prepare them for the realities of practice where the complexities of spirituality and religion come to play.     

Mental health and spiritual care

BACKGROUND: Achieving holistic care is an important goal for nurses. While much is made of the bio-psychosocial model of holistic care, reflecting the allopathic bias inherent in the Western medical model, the issue of spirituality is mostly neglected. Where acknowledged, spirituality is often limited to recording the client's religion. This article asserts that religion and spirituality are not synonymous, although spirituality might sometimes be reflected through religious practices. CONCLUSION: With the move towards provision of modern mental health services in the community, the community mental health nurse will increasingly care for individuals for whom the spiritual is part of their daily lives and not a symptom of their illness. This is set against the backdrop of a multicultural society and as such will call for holistic nursing skills.     

Nursings’ need for the idea of spirituality

PESUT B. Nursing Inquiry 2013; 20 : 5–10
Nursings’ need for the idea of spirituality Spirituality is an idea that has sustained significant interest in nursing over the past quarter century. Extensive conceptual work has generated robust critique around clarity and professional jurisdictional claims. However, less attention has been paid to the challenges nursing has faced that have contributed to the spirituality quest. Reflecting on my own experiences as a scholar writing in this literature over the past decade, I suggest three challenges that spirituality has attempted to redress: to relate across difference in a globalized world, to be good in a world of uncertain morality and to find meaning in a disenchanted world. The idea of spirituality could be viewed as resistance against othering, against law based ethics, and against politics and power. But the impact of the idea of spirituality has yet to be determined and caution is in order. As important as this resistance is, nursing must refrain from creating a new world of insiders and outsiders and from minimizing the role of religious ethics in a globalized world. Spirituality, like its predecessor religion, will likely continue to play an enduring role in providing fundamental meaning for nursing work.     

Developing a nursing perspective on spirituality and healing

The author of this column presents an overview of selected research and nursing theoretical thinking on spirituality and then offers a beginning exploration of the interrelationships of spirituality and healing. Work in both the totality and simultaneity paradigms is highlighted in the belief, following Nightingale, that spirituality and healing are crucial concepts in both paradigms, although currently defined differently if at all. Some nursing theorists give little or no attention to spirituality, while others such as Watson, Neuman, and Roy, in varying degrees, explicitly discuss the concept. Beginning theoretical conceptualizations have been offered in Rogers' science by, most notably, Reed, then Malinski and Smith. Healing and spirituality have been linked, although not necessarily in the same study. General directions for research using nursing theoretical frameworks and, in some cases, research methods derived from particular theories/models, are suggested.     

A kaleidoscope of understandings: Spiritual nursing in a multi-faith society

BACKGROUND: Spirituality is an increasingly discussed topic in nursing. In some parts of the UK there is a policy requirement to establish policies of spiritual health care which are appropriate to a multi-cultural society. In the nursing literature, spirituality is discussed from religious and secular perspectives which seem impossible to reconcile into a coherent philosophy. AIMS: To discuss the relationship of spirituality to nursing and to suggest how we can think about spirituality as nurses working in a society of many faiths and cultures. DISCUSSION: Spirituality can be thought of in relation to individual patients and nurses. It also has significance for the profession of nursing and for health care as a whole. The difficulty of defining spirituality is discussed, and it is suggested that a definition of 'spiritual nursing' may be more achievable. Different concepts of spirituality are compared, including religious and secular spirituality. The relationship between religion and spirituality is seen as potentially problematic, with some religions denying the existence of secular spirituality. Secular spirituality and New Age movements are non-religious but spiritually influential phenomena. The problem for nursing is how to reconcile the immense variety of approaches to spirituality. CONCLUSIONS: The concept of spirituality as a meta-narrative is considered, and a postmodern appreciation of pluralism is employed as a way of embracing different spiritual realities. Spiritual nursing can be an opportunity for nurses to enlarge their understanding of the human condition rather than a narrowly defined concept to be applied within a model of practice.