- Email: [email protected]
Nursing, healing and spirituality
Nursing, healing and spirituality Carol I. Smucker The premise of this article is that nurses are healers, primarily through the caring relationships they form with patients. Caring calls out an individual's inner strengths. These strengths include spiritual resources which support integration or wholeness of body, mind and spirit. Many nurses are unsure about giving spiritual care. This author encourages nurses to reflect on their own spirituality and learn spiritual care skills. By addressing the spiritual dimension in patient care, nurses can truly be holistic practitioners and positively affect the mental and physical health of their patients.
Nursing has always been more than the tasks it performs.
INTRODUCTION Disease, pain, and suffering have long been a part of the human experience. In their desire for relief, restoration, and healing, individuals and communities have tested natural substances and implemented various health practices. Such practices often invoked the supernatural, or transcendent aspect of life (Droege 1979). Whether awareness of the spiritual dimension arose from the reality of a god or whether it was a natural part of dealing with an unpredictable and threatening environment is not the concern of this paper. This author merely recognizes that the majority of people do at one time or another experience something they could label as 'spiritual' and that these feelings, thoughts, and beliefs impact human life. This paper seeks to explore the relationship of nursing to these two aspects of life; healing and spirituality.
NURSES AS HEALERS
Carol l. Smucker PhD, 4435 Beav's Bend Road, Louisville, T N 37777, USA
Nursing has always been more than the tasks it performs. Even the most recent attempt to describe nursing using the Nursing Intervention Classification system (McCloskey & Bulechek 1996) falls short of fully defining the profession. Like the terms spirituality and healing, nursing is difficult to put into words. As a nurse, you know when a trusting relationship has been established with your patient, when some word or action became the turning point for your patient's healing, or when you sensed something was 'not quite right' with your patient's condition (Benner 1984). But how do you fully document those realities or report them to others on the health team? You have this knowledge at some
level and its reality is borne out in your practice time and time again. You are convinced that you have contributed to your patient's healing not only by proficient administration of nursing tasks, but also through the way you give care, the encouragement and support you give to the 'will to live', the listening ear that hears the cry of physical and emotional pain, and the surveillance and presence you maintain around the clock. Yes, nurses contribute to the healing process, although we have difficulty identifying exactly what it is we do or say to bring this about. Despite the phenomenal growth in knowledge about the body's functions and disease processes, we know little of the effects of nurses' caring on health and healing. How is caring related to health and healing?
HEALING The Anglo-Saxon word haelan is one of the roots of the word heal, and means to be or to become whole (Quinn 1989). Nurses claim to be holistic practitioners; to view humans as greater than their parts (Rogers 1970). We perform holistic assessments, considering all aspects of the human experience that relate to health. Or do we? We probably do best with physical and emotional care because that is the backbone of our educational preparation. Instruction on spiritual care is usually limited to considering aspects of various religions and how they may be impacted by medical care. Only recently in the USA have schools of nursing started to develop courses that address the relationship between faith and health (Larson & Larson 1994). The purpose of these courses is to create an awareness of what is being referred to as the 'faith factor' in mental and
ComplementaryTherapiesin Nursing& Midwifery (I 998) 4, 95-97 9 1998Harcourt Brace& Co. Ltd
96
Spiritual needs are those resources that nourish the life force or spirit within each one of us. These include meaning and purpose, the ability to give and receive love, hope, forgiveness, and faith.
ComplementaryTherapies in Nursing & Midwifery
physical health. Or, as researcher David Larson (1994) so aptly puts it, the 'forgotten factor'. Larson has found in his review of research studies which included religious variables that the impact of religious commitment on physical and mental health has been demonstrated to be overwhelmingly positive. Also, recent developments in the field of psychoneuroimmunology have brought to our attention the complexity of our body's interconnectedness; the relationships between mind, body, and spirit (Borysenko 1988) and the ramifications of these relationships on health.
SPIRITUALITY What is this thing called spirituality? Although there are many definitions, there are common themes across definitions. These speak of harmony, balance, connectedness, wholeness, meaning and purpose, our identity, and our search for the transcendent or something beyond the physical realm. In addition to these, Ellison (1983) states that it is our spirit which synthesizes the total personality and provides some sense of energizing direction and order. While spirituality can be experienced at any time, one is more likely to be aware of it during the highs and lows of life - the mountain-top experiences or the valleys of despair (Smucker 1996). It is often experienced as a feeling of great love, comfort or peace, or as a feeling of security or knowledge that somehow all will be well. It sometimes comes in the face of evidence to the contrary, providing a glimmer of hope not thought possible. Nurses are often with people at these times, whether in an acute care setting, community health practice, church setting as a parish nurse, or mental health practice. If the spiritual aspects of care are neglected, can we truly claim to practice holistically? But how do we give spiritual care with the same respect and sensitivity that we give other care? Are we not crossing into dangerous territory or practising outside nursing's boundaries? Realistically, what should nurses be doing to address spiritual issues with their patients? Spiritual needs are those resources that nourish the life force or spirit within each one of us. These include meaning and purpose, the ability to give and receive love, hope, forgiveness, and faith or trust in someone or something of ultimate value. As a nurse, you have probably attended to these needs without specifically identifying them as spiritual. Any nursing action that facilitates or strengthens these aspects can be considered spiritual care. There are a variety of resources available for the nurse interested in learning more about spiritual care (Fish & Shelly 1983; Carson 1989). Prior to giving spiritual care, the nurse must value the spiritual aspect and respect others' spiritual beliefs and practices. Every nurse should have basic skills in spiritual assessment (the ability to assess for spiritual
well-being and spiritual distress) and to know when to refer patients to professional spiritual caregivers. Nurses must take time to get in touch with their own spirituality. It has been found that nurses who are most comfortable with their own beliefs are the most comfortable giving spiritual care (Ross 1994). Giving spiritual care is not proselytizing. Sharing your own faith should only be done with a patient's permission.
SPIRITUAL CARE The nurse's role in spiritual care, then, is to nurture those aspects of spiritual well-being and attend to aspects of spiritual distress seen in patients. The essence of spiritual well-being is wholeness or connectedness. Two recent nursing studies conceptualized these aspects in practical terms for nurses. Their research findings identified spiritual wellbeing as harmonious relationships in all aspects of life - with self, others, God, and the world (Barker 1989; Burkhardt 1991). Hunglemann's et al (1985) definition of spiritual well-being is similar and has been used for the new nursing diagnosis. Potential For Enhanced Spiritual Well-Being (North American Nursing Diagnosis Association or N A N D A 1994). In this diagnosis, spiritual wellbeing is defined as the process of an individual's developing/unfolding of mystery through harmonious interconnectedness that springs from inner strengths. Because spirituality is an inner process, it is often invisible. Spiritual concerns, or spiritual distress (created by NANDA 1980) will most likely come to the nurse's attention through emotional or behavioural cues. Your patient may be angry or crying, anxious or withdrawn. To discern if these cues are spiritual in nature will require not only a knowledge of the defining characteristics of both diagnoses but validation by your client. While spiritual concerns may be difficult to diagnose, what is most important is to listen and attend to your patient's pain, support them in their spiritual struggle, and help them to identify and use their spiritual resources.
SPIRITUAL CARE A N D HEALING Spiritual care is an area that is difficult for most nurses. Nurses can begin to gain confidence in this area by reflecting on their own spirituality. This increased awareness of the spiritual dimension will enable them to identify it more readily in their patients. To be spiritually well is to be whole - integrated in mind, body, and spirit. Spirituality is a resource for nurses as well as for patients. To be holistic practitioners, nurses must be more aware of spirituality, its relationship to health and how they can implement this 'faith factor' in practice.
97
Nursing, healing and spirituality
Nightingale's (1860/1969) premise that healing comes from within the individual as a natural function and that nurses are to facilitate that process is just as relevant for spiritual care as it is for physical care. 'Nurses,' said Nightingale, 'are to help put the "patient in the best condition for nature to act on h i m " . ' W e must work to make our health care environments healing environments. Creating a healing environment is one of the c o m m o n threads healers identify in their work (Carlson & Shield 1989). Myers (1997) also speaks of the importance of environment, or 'hospitable space', in nourishing spirituality. Within that hospitable space, a healing relationship is the second most important factor. And that is primarily what nurses have to offer their patients. Through that relationship, nourishing the spirit may be one of the most important things nurses can do to encourage health and healing (McGlone 1990). How patients perceive you value faith may help or hinder them in this process (Larson & Larson 1994). It is important to remember that spiritual variables are operating in the health care environment, whether we are aware of them or not. If we are to be nurse healers, we will not neglect them. I would like to close with a quote from a nurse who values spiritual care and makes it a part of his nursing practice. He speaks eloquently about the connections I have attempted to make in this article between nursing, healing, and spirituality. Peter R a m m e (Nursenet Digest 1996) writes: I think nursing develops a unique kind of spirituality in its way of establishing relationships of intimacy and trust across barriers that disappear when need for nursing care arises. In nursing, a touch, a kind look, a kind word, passage of a few seconds in mutual contact with this kind of spirituality is a wonderful way to exchange healing ways. It doesn't always take a long time, or involve a phone call to a minister, rabbi, or shaman. Our spirits meet, we trust we can make things feel better, and we m o v e towards healing.
REFERENCES Barker E 1989 Being whole: spiritual well-being in Appalachian women, a phenomenological study. Dissertation Abstracts International 51 02B-658 Benner P 1984 From Novice to Expert. Addison-Wesley, Meno Park, California Borysenko J 1988 Minding the Body, Mending the Mind. Bantam, Toronto Burkhardt M 1991 Exploring understandings of spirituality among women in Appalachia. Dissertation Abstracts International 52 07B-3523 Carlson R, Shield B 1989 Healers on Healing. Jeremy P. Tarcher, Los Angeles Carlson V 1989 Spiritual Dimensions of Nursing Practice. W.B. Saunders, Philadelphia Droege T 1979 The Religious Roots of Wholistic Health Care. In: Westberg G. Theological Roots of Wholistic Health Care. Wholistic Health Centers, Inc., Hinsdale, Illinois Ellison C 1983 Spiritual Well-Being: Conceptualization and Measurement. Journal of Psychology and Theology 11: 330--340 Fish S, Shelly J 1983 Spiritual Care, 2nd edn. InterVarsity, Downers Grove, Illinois Hungelmann J, Kenkel-Rossi E, Klassen L, Stollenwerk R 1985 Spiritual well-being in older adults: harmonious interconnectedness. Journal of Religion and Health 24(2): 147-153 Larson D, Larson S 1994 The Forgotten Factor in Physical and Mental Health: What Does the Research Show? National Institute for Healthcare Research, Rockville, Maryland McCloskey J, Bulechek G 1996 Nursing Interventions Classification (NIC). Mosby, St Louis Nightingale (1860/1969) Notes on Nursing. Dover, NY McGlone M 1990 Healing the spirit. Holistic Nursing Practice 4(4): 77-84 Myers B 1997 Young Children and Spirituality. Routledge, New York Quinn J 1989 On Healing, Wholeness, and the Haelen Effect. Nursing & Health Care 10(10): 553-556 Ramme P 1996 Re: Spirituality [on-line]. Nursenet Digest 7-8 Rogers M 1970 An Introduction to the Theoretical Basis of Nursing. FA Davis, Philadelphia Ross L 1994 Spiritual aspects of nursing. Journal of Advanced Nursing 19:439447 Smucker C 1996 A phenomenological description of the experience of spiritual distress. Nursing Diagnosis 7(2): 81-91
Nursing has always been more than the tasks it performs.
INTRODUCTION Disease, pain, and suffering have long been a part of the human experience. In their desire for relief, restoration, and healing, individuals and communities have tested natural substances and implemented various health practices. Such practices often invoked the supernatural, or transcendent aspect of life (Droege 1979). Whether awareness of the spiritual dimension arose from the reality of a god or whether it was a natural part of dealing with an unpredictable and threatening environment is not the concern of this paper. This author merely recognizes that the majority of people do at one time or another experience something they could label as 'spiritual' and that these feelings, thoughts, and beliefs impact human life. This paper seeks to explore the relationship of nursing to these two aspects of life; healing and spirituality.
NURSES AS HEALERS
Carol l. Smucker PhD, 4435 Beav's Bend Road, Louisville, T N 37777, USA
Nursing has always been more than the tasks it performs. Even the most recent attempt to describe nursing using the Nursing Intervention Classification system (McCloskey & Bulechek 1996) falls short of fully defining the profession. Like the terms spirituality and healing, nursing is difficult to put into words. As a nurse, you know when a trusting relationship has been established with your patient, when some word or action became the turning point for your patient's healing, or when you sensed something was 'not quite right' with your patient's condition (Benner 1984). But how do you fully document those realities or report them to others on the health team? You have this knowledge at some
level and its reality is borne out in your practice time and time again. You are convinced that you have contributed to your patient's healing not only by proficient administration of nursing tasks, but also through the way you give care, the encouragement and support you give to the 'will to live', the listening ear that hears the cry of physical and emotional pain, and the surveillance and presence you maintain around the clock. Yes, nurses contribute to the healing process, although we have difficulty identifying exactly what it is we do or say to bring this about. Despite the phenomenal growth in knowledge about the body's functions and disease processes, we know little of the effects of nurses' caring on health and healing. How is caring related to health and healing?
HEALING The Anglo-Saxon word haelan is one of the roots of the word heal, and means to be or to become whole (Quinn 1989). Nurses claim to be holistic practitioners; to view humans as greater than their parts (Rogers 1970). We perform holistic assessments, considering all aspects of the human experience that relate to health. Or do we? We probably do best with physical and emotional care because that is the backbone of our educational preparation. Instruction on spiritual care is usually limited to considering aspects of various religions and how they may be impacted by medical care. Only recently in the USA have schools of nursing started to develop courses that address the relationship between faith and health (Larson & Larson 1994). The purpose of these courses is to create an awareness of what is being referred to as the 'faith factor' in mental and
ComplementaryTherapiesin Nursing& Midwifery (I 998) 4, 95-97 9 1998Harcourt Brace& Co. Ltd
96
Spiritual needs are those resources that nourish the life force or spirit within each one of us. These include meaning and purpose, the ability to give and receive love, hope, forgiveness, and faith.
ComplementaryTherapies in Nursing & Midwifery
physical health. Or, as researcher David Larson (1994) so aptly puts it, the 'forgotten factor'. Larson has found in his review of research studies which included religious variables that the impact of religious commitment on physical and mental health has been demonstrated to be overwhelmingly positive. Also, recent developments in the field of psychoneuroimmunology have brought to our attention the complexity of our body's interconnectedness; the relationships between mind, body, and spirit (Borysenko 1988) and the ramifications of these relationships on health.
SPIRITUALITY What is this thing called spirituality? Although there are many definitions, there are common themes across definitions. These speak of harmony, balance, connectedness, wholeness, meaning and purpose, our identity, and our search for the transcendent or something beyond the physical realm. In addition to these, Ellison (1983) states that it is our spirit which synthesizes the total personality and provides some sense of energizing direction and order. While spirituality can be experienced at any time, one is more likely to be aware of it during the highs and lows of life - the mountain-top experiences or the valleys of despair (Smucker 1996). It is often experienced as a feeling of great love, comfort or peace, or as a feeling of security or knowledge that somehow all will be well. It sometimes comes in the face of evidence to the contrary, providing a glimmer of hope not thought possible. Nurses are often with people at these times, whether in an acute care setting, community health practice, church setting as a parish nurse, or mental health practice. If the spiritual aspects of care are neglected, can we truly claim to practice holistically? But how do we give spiritual care with the same respect and sensitivity that we give other care? Are we not crossing into dangerous territory or practising outside nursing's boundaries? Realistically, what should nurses be doing to address spiritual issues with their patients? Spiritual needs are those resources that nourish the life force or spirit within each one of us. These include meaning and purpose, the ability to give and receive love, hope, forgiveness, and faith or trust in someone or something of ultimate value. As a nurse, you have probably attended to these needs without specifically identifying them as spiritual. Any nursing action that facilitates or strengthens these aspects can be considered spiritual care. There are a variety of resources available for the nurse interested in learning more about spiritual care (Fish & Shelly 1983; Carson 1989). Prior to giving spiritual care, the nurse must value the spiritual aspect and respect others' spiritual beliefs and practices. Every nurse should have basic skills in spiritual assessment (the ability to assess for spiritual
well-being and spiritual distress) and to know when to refer patients to professional spiritual caregivers. Nurses must take time to get in touch with their own spirituality. It has been found that nurses who are most comfortable with their own beliefs are the most comfortable giving spiritual care (Ross 1994). Giving spiritual care is not proselytizing. Sharing your own faith should only be done with a patient's permission.
SPIRITUAL CARE The nurse's role in spiritual care, then, is to nurture those aspects of spiritual well-being and attend to aspects of spiritual distress seen in patients. The essence of spiritual well-being is wholeness or connectedness. Two recent nursing studies conceptualized these aspects in practical terms for nurses. Their research findings identified spiritual wellbeing as harmonious relationships in all aspects of life - with self, others, God, and the world (Barker 1989; Burkhardt 1991). Hunglemann's et al (1985) definition of spiritual well-being is similar and has been used for the new nursing diagnosis. Potential For Enhanced Spiritual Well-Being (North American Nursing Diagnosis Association or N A N D A 1994). In this diagnosis, spiritual wellbeing is defined as the process of an individual's developing/unfolding of mystery through harmonious interconnectedness that springs from inner strengths. Because spirituality is an inner process, it is often invisible. Spiritual concerns, or spiritual distress (created by NANDA 1980) will most likely come to the nurse's attention through emotional or behavioural cues. Your patient may be angry or crying, anxious or withdrawn. To discern if these cues are spiritual in nature will require not only a knowledge of the defining characteristics of both diagnoses but validation by your client. While spiritual concerns may be difficult to diagnose, what is most important is to listen and attend to your patient's pain, support them in their spiritual struggle, and help them to identify and use their spiritual resources.
SPIRITUAL CARE A N D HEALING Spiritual care is an area that is difficult for most nurses. Nurses can begin to gain confidence in this area by reflecting on their own spirituality. This increased awareness of the spiritual dimension will enable them to identify it more readily in their patients. To be spiritually well is to be whole - integrated in mind, body, and spirit. Spirituality is a resource for nurses as well as for patients. To be holistic practitioners, nurses must be more aware of spirituality, its relationship to health and how they can implement this 'faith factor' in practice.
97
Nursing, healing and spirituality
Nightingale's (1860/1969) premise that healing comes from within the individual as a natural function and that nurses are to facilitate that process is just as relevant for spiritual care as it is for physical care. 'Nurses,' said Nightingale, 'are to help put the "patient in the best condition for nature to act on h i m " . ' W e must work to make our health care environments healing environments. Creating a healing environment is one of the c o m m o n threads healers identify in their work (Carlson & Shield 1989). Myers (1997) also speaks of the importance of environment, or 'hospitable space', in nourishing spirituality. Within that hospitable space, a healing relationship is the second most important factor. And that is primarily what nurses have to offer their patients. Through that relationship, nourishing the spirit may be one of the most important things nurses can do to encourage health and healing (McGlone 1990). How patients perceive you value faith may help or hinder them in this process (Larson & Larson 1994). It is important to remember that spiritual variables are operating in the health care environment, whether we are aware of them or not. If we are to be nurse healers, we will not neglect them. I would like to close with a quote from a nurse who values spiritual care and makes it a part of his nursing practice. He speaks eloquently about the connections I have attempted to make in this article between nursing, healing, and spirituality. Peter R a m m e (Nursenet Digest 1996) writes: I think nursing develops a unique kind of spirituality in its way of establishing relationships of intimacy and trust across barriers that disappear when need for nursing care arises. In nursing, a touch, a kind look, a kind word, passage of a few seconds in mutual contact with this kind of spirituality is a wonderful way to exchange healing ways. It doesn't always take a long time, or involve a phone call to a minister, rabbi, or shaman. Our spirits meet, we trust we can make things feel better, and we m o v e towards healing.
REFERENCES Barker E 1989 Being whole: spiritual well-being in Appalachian women, a phenomenological study. Dissertation Abstracts International 51 02B-658 Benner P 1984 From Novice to Expert. Addison-Wesley, Meno Park, California Borysenko J 1988 Minding the Body, Mending the Mind. Bantam, Toronto Burkhardt M 1991 Exploring understandings of spirituality among women in Appalachia. Dissertation Abstracts International 52 07B-3523 Carlson R, Shield B 1989 Healers on Healing. Jeremy P. Tarcher, Los Angeles Carlson V 1989 Spiritual Dimensions of Nursing Practice. W.B. Saunders, Philadelphia Droege T 1979 The Religious Roots of Wholistic Health Care. In: Westberg G. Theological Roots of Wholistic Health Care. Wholistic Health Centers, Inc., Hinsdale, Illinois Ellison C 1983 Spiritual Well-Being: Conceptualization and Measurement. Journal of Psychology and Theology 11: 330--340 Fish S, Shelly J 1983 Spiritual Care, 2nd edn. InterVarsity, Downers Grove, Illinois Hungelmann J, Kenkel-Rossi E, Klassen L, Stollenwerk R 1985 Spiritual well-being in older adults: harmonious interconnectedness. Journal of Religion and Health 24(2): 147-153 Larson D, Larson S 1994 The Forgotten Factor in Physical and Mental Health: What Does the Research Show? National Institute for Healthcare Research, Rockville, Maryland McCloskey J, Bulechek G 1996 Nursing Interventions Classification (NIC). Mosby, St Louis Nightingale (1860/1969) Notes on Nursing. Dover, NY McGlone M 1990 Healing the spirit. Holistic Nursing Practice 4(4): 77-84 Myers B 1997 Young Children and Spirituality. Routledge, New York Quinn J 1989 On Healing, Wholeness, and the Haelen Effect. Nursing & Health Care 10(10): 553-556 Ramme P 1996 Re: Spirituality [on-line]. Nursenet Digest 7-8 Rogers M 1970 An Introduction to the Theoretical Basis of Nursing. FA Davis, Philadelphia Ross L 1994 Spiritual aspects of nursing. Journal of Advanced Nursing 19:439447 Smucker C 1996 A phenomenological description of the experience of spiritual distress. Nursing Diagnosis 7(2): 81-91