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.
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
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 leader. This is often addressed within the framework of nurse education by the hospital chaplain or occasionally a tutor with a particular interest in spiritual matters. Although colleges of nursing are attempting to rectify this apparent omission by revising existing curricula and incorporating spiritual care, one may argue that many are still reluctant to recognise its relevance and importance (Govier 1999a, Harrison and Burnard 1993, Johnson 1998). The hesitancy displayed by nurse educationalists may suggest that a degree of suspicion, misconception and ambiguity still surrounds the spiritual dimension. Furthermore, given nursing’s apparent preoccupation with establishing itself as a scientific and research-based profession, the metaphysical dimension of spiritual care is not one that lends itself easily to scientific scrutiny. Considering that the dominant paradigm at this time supports the scientific model, it is not surprising that nursing has followed suit in its quest to gain greater credibility among the more established health disciplines which claim that practice is based on a rigorously tested theoretical foundation. Martsolf and Mickley (1998) highlight the void surrounding spirituality in nurse education
In an attempt to further clarify what is understood by spiritual care, and following extensive review of the literature, Govier (1999b) has summarised the concept as the ‘five Rs of spirituality’ (Box 1): s Reason. s Reflection. s Religion. s Relationships. s Restoration. Reason and reflection The search for meaning in life experiences has been viewed as an essential universal trait (Cobb and Robshaw 1998, Carson 1989, Highfield and Cason 1983, Murray and Zentner 1989, Stoter 1995, Thompson 1996). Indeed, the view of the renowned psychiatrist Viktor Frankl (1984) is that man’s primary motivational force is the search to find meaning and purpose in life experiences, whether they be in ordinary or extreme circumstances. Patients and carers often...
References: Amenta M, Bohnet N (1986) Nursing Care of the Terminally Ill. Boston MA, Little, Brown and Company. Burkhardt MA, Nathaniel AK (1998) Ethical Issues in Contemporary Nursing. New York NY, Delmar Publishers. Burnard P (1988) The spiritual needs of atheists and agnostics. Professional Nurse. 4, 3, 130-132. Burnard P (1987) Spiritual distress and the nursing response: theoretical considerations and counselling skills. Journal of Advanced Nursing. 12, 3, 377-382. Burnard P (1986) Picking up the pieces. Nursing Times. 82, 17, 37-39. Carson VB (1989) Spiritual Dimensions of Nursing Practice. Philadelphia PA, WB Saunders. Christensen PJ, Kenney JW (1990) Nursing Process: Application of Conceptual Models. Third edition. St Louis MO, Mosby. Cobb M (1998) Assessing spiritual needs: an examination of practice. In Cobb M, Robshaw V (Eds) The Spiritual Challenges of Health Care. Edinburgh, Churchill Livingstone. Cobb M, Robshaw V (1998) The Spiritual Challenges of Health Care. Edinburgh, Churchill Livingstone. Dossey BM, Dossey L (1998) Attending to holistic care. American Journal of Nursing. 98, 8, 35-38. Fawcett J (1995) Analysis and Evaluation of Conceptual Models of Nursing. Third edition. Philadelphia PA, FA Davis. Frankl VE (1984) Man’s Search for Meaning. New York NY, Simon and Schuster. Govier IM (1999a) Holistic nursing without spiritual care: I don’t think so! Assignment: Ongoing Work of Health Care Students. 5, 3, 1-2. Govier IM (1999b) Spirituality in Nursing Care. Unpublished MSc thesis. SIHE, University of Wales. Harrison J (1993) Spirituality and nursing practice. Journal of Clinical Nursing. 2, 211-217. Harrison J, Burnard P (1993) Spirituality and Nursing Practice. Aldershot, Avebury. Highfield M, Cason C (1983) Spiritual needs of patients: are they recognised? Cancer Nursing. 6, 3, 187-192. Johnson A (1998) The notion of spiritual care in professional practice. In Cobb M, Robshaw V (Eds) The Spiritual Challenges of Health Care. Edinburgh, Churchill Livingstone. Kitson A (1985) Spiritual care in chronic illness. In McGilloway O, Myco F (Eds) Nursing and Spiritual Care. London, Harper and Row.
january 12/vol14/no17/2000 nursing standard 35
nursing standard: clinical · research · education
Labun E (1988) Spiritual care: an element in nursing care planning. Journal of Advanced Nursing. 13, 3, 314-320. Langford D (1989) Where is God in All of This? A Study of the Spiritual Care of the Terminally Ill. Southampton, Countess Mountbatten Education. Martsolf DS, Mickley JR (1998) The concept of spirituality in nursing theories: differing world views and extent of focus. Journal of Advanced Nursing. 27, 2, 294-303. McSherry W, Draper P (1997) The spiritual dimension: why the absence within nursing curricula? Nurse Education Today. 17, 5, 413-417. Murray RB, Zentner JP (1989) Nursing Concepts for Health Promotion. New York NY, Prentice-Hall. Narayanasamy A (1996) Spiritual care of chronically ill patients. British Journal of Nursing. 5, 7, 411-416. Narayanasamy A (1993) Nurses’ awareness and educational preparation in meeting their patients’ spiritual needs. Nurse Education Today. 13, 3, 196-201. Narayanasamy A (1991) Spiritual Care: A Resource Guide. Lancaster, Quay Publishing. Neuman B (1995) The Neuman Systems Model. Third edition. Norwalk, Appleton and Lange. Newman MA (1989) The spirit of nursing. Holistic Nursing Practice. 3, 3, 1-6. Newshan G (1998) Transcending the physical: spiritual aspects of pain in patients with HIV and/or cancer. Journal of Advanced Nursing. 28, 6, 1236-1241. Oldnall AS (1996) A critical analysis of nursing: meeting the spiritual needs of patients. Journal of Advanced Nursing. 23, 1, 138-144. Oldnall AS (1995) On the absence of spirituality in nursing theories and models. Journal of Advanced Nursing. 21, 3, 417-418. Parse RR (1992) Human becoming: Parse’s theory of nursing. Nursing Science Quarterly. 5, 1, 35-42. Ross LA (1996) Teaching spiritual care to nurses. Nurse Education Today. 16, 1, 38-43. Ross LA (1995) The spiritual dimension: its importance to patients’ health, wellbeing and quality of life and its implications for nursing practice. International Journal of Nursing Studies. 32, 5, 457-468. Ross LA (1994) Spiritual aspects of nursing. Journal of Advanced Nursing. 19, 3, 439-447. Stoll RL (1979) Guidelines for spiritual assessment. American Journal of Nursing. 1, 9, 574-577. Stoter D (1995) Spiritual Aspects of Health Care. London, Mosby. Thompson SC (1996) Barriers to maintaining a sense of meaning and control in the face of loss. Journal of Personal and Interpersonal Loss. 1, 4, 333-357. Watson J (1985) Nursing: The Philosophy and Science of Caring. Boulder CO, Colorado Associated University Press. Yura H, Walsh MB (Eds) (1982) Human Needs and the Nursing Process. 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
Please join StudyMode to read the full document