Spirituality in Nursing: the Nurse’s Role in Holistic Care

With the incredible advancements in technology, it seems that the spiritual dimension of nursing is an area that has been neglected. Because spiritual care is an important aspect of health care, nurses must be knowledgeable about and in touch with their own spirituality in order to be completely available to their patients. Nursing faculty need to have tools available in their curricula that may be used to develop spiritual knowledge in their nursing students. There are several strategies that can be used to implement a higher degree of spiritual awareness in today’s nurses. Given the increased focus on spirituality, it is imperative that nurse educators teach spiritual assessment techniques, the art and science of spiritual care, and measure students’ knowledge and understanding of spirituality and spiritual care.
Arriving at a common definition of spirituality presents a challenge. Many experience spirituality as an abiding presence. As the essence of being, spirituality manifests in relationships with one’s self, others, nature, and a divine being or life force. “Nurses are better prepared to promote the spiritual health of patients within clinical settings when they are aware of their own spirituality” (Lovanio, 2007, ¶ 8). Students must be able to assess their own spirituality before they can relate to someone else’s spiritual needs. Nurses spend more time with their patients than do other health care workers. Spirituality can be referred to as ‘a way of seeing’, not with our eyes, but with our inner eye, our consciousness (Wright, 2007, ¶ 5). Therefore, the spiritual needs of patients must be recognized as a domain of nursing care. How should spirituality be addressed in the nursing curricula?
One nursing strategy is to integrate a spiritual assessment skills course into nursing curricula. “Emphasis on spirituality in the nursing program as rated by students and faculty served as the most significant environmental predictor of the student’s perceived ability to provide spiritual care” (Mitchell, 2006, ¶ 10). The student’s ability to provide spiritual care is a two part process. Before the students can assess a client’s spirituality, they must be capable of a spiritual self-assessment. If a student can recognize their own woundedness and the source of strength that they used to grow from that experience, the self-assessment exercise can be used to promote reflection and introspection. This can be a non-judgmental, supportive assignment that transcends reflection from an academic exercise to a working part of the mind for the student. The self-assessment can help the student recognize the client’s strengths and coping styles, while enhancing the student’s capability of assessing the client’s spiritual needs. The nurse’s ability to connect with the client on a spiritual level can contribute to the client’s healing process, sometimes more so than technology (Pesut, 2003, ¶ 6).
Nursing faculty have been responsible for delivering knowledge regarding spiritual care to nursing students since the beginning of modern day nursing with Florence Nightingale. Another key strategy to incorporate spirituality in nursing is to base curriculum on ethical principles. There are several ethical principles on which a spiritual care curriculum is based. The first principle outlines respect for others and for human rights. Nurses must have the ability to respect religious choice and the client’s use or neglect of these. A second ethical principle is autonomy, which involves the client’s right to self-determination. Nurses must set aside their own belief systems and support their client’s autonomous needs for spiritual care. A third ethical principle is advocacy. Nurses must become advocates for client’s spiritual needs. Taking into account the client’s spiritual needs and advocating for them is part of the ethical duty of the nurse. Both the client and the nurse benefit from the interpersonal relationship that is forged through spiritual care. “When all is said and done, a nurse needs to look into his or her soul and ask, ‘Am I am nurse or a technician?’”(Nussbaum, 2003, ¶ 12).
A third key strategy is to measure students knowledge and understanding of spirituality and spiritual care before and after implementing some simple tools such as reflective journaling, spiritual writing assignments, discussion, and faith-based clinical experiences to promote spiritual awareness. A sample of ten traditional undergraduate nursing students experiencing their first clinical rotation was selected to participate in this study. The students’ knowledge was measured with the Spirituality and Spiritual Care Rating Scale (SSCRS). After participating in these activities, the students’ scores were higher on the post-test than the pre-test. They verbalized an appreciation of the strategies associated with improving spirituality. The students also demonstrated “increased awareness of the main principles associated with spiritual care” (Lovanio, 2007, ¶ 18). The project focused on the importance of addressing the spiritual needs of clients when providing holistic care, while augmenting the student’s perception of spirituality, facilitating them to be involved in giving spiritual care.
Nursing students have the capability to promote spiritual well-being and transcend barriers between themselves and their clients with a spiritual connectedness that can be more powerful than technological advances. Implementing curricula into current day nursing programs that enhances the nursing students’ spiritual awareness needs to be an integral component of the educational process. Because spiritual care is an important aspect of health care, nurses must be knowledgeable about and in touch with their own spirituality in order to be completely available to their patients. A few simple strategies such as teaching assessment techniques, the art and science of spiritual care, and measuring students’ knowledge and understanding of spirituality can work towards the development of spiritually competent nurses.
Spirituality in Nursing: the Nurse’s Role in Holistic Care
Intervention #1
There is a need for more emphasis on spiritual assessment skills and the education of these skills in current nursing curricula.
Disadvantage #1
Nursing education has risen to the challenge of teaching spiritual care theories and interventions to students, despite the absence of policy to guide educators. According to Lantz (2007) “there seems to be a conflict with traditional nursing education being based on Western medical methods, and that perhaps a shift to a partnership model that includes holistic and intuitive approaches may enhance the educational process.” Without a clear cut policy guiding the education of spirituality in current nursing curricula; implementing more spirituality courses will be continually hindered.
Disadvantage #2
Nursing education textbooks lack information that provides clear direction in the matter of integrating spirituality into the curricula. Textbooks focusing on professional issues, medical-surgical nursing, maternal-child health nursing, critical care nursing, and community health nursing contained the least spiritual content (McEwen, 2004, ¶ 3).
One of the most prominent reasons for nurses’ lack of preparedness to provide spiritual care, is that their basic education only minimally discusses spirituality and related issues.
If nurses are to enhance incorporation of spiritual care in their practice, they need instruction. It falls in the hands of nursing authors and faculty to address the current educational deficits throughout the entire nursing curricula.
Intervention #2
Another intervention is incorporating spirituality into nursing by basing curricula on ethical principles.
Disadvantage #1
By basing curricula on ethical principles, nurses must have respect for their patients’ religious choices and religious differences. Respect for human rights can be viewed as inclusive of religion and as a component of spirituality to be valued ethically. Public institutions are bound by the First Amendment regarding the separation of church and state. “Public institutions must maintain a neutral stance regarding religious beliefs and activities” (Lantz, 2007, ¶ 20). It can prove difficult for nurse faculty to educate their students about the concept of spirituality and how the patients’ spirituality is intertwined with their religion, while staying within the boundaries of the First Amendment.
Disadvantage #2
It is also possible that with a multitude of spirituality teaching based on ethical principles incorporated into nursing curriculum; there are still going to be nurses who do not have it in their mental armory to offer this facet of care. The nurse may not have the ability to derive inspiration from the workplace or the nurse-patient relationship. According to McEwan (2004), “nursing is too biologic, professionalism is synonymous with distancing, and nurses are not comfortable with or able to recognize their own spirituality.” To achieve self-fulfillment at work depends on the individual philosophy cherished by the nurse.
References
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Mitchell, D. L., & Bennett, M. J., & Manfrin-Ledet, L. (2006, Sep). Spiritual development of nursing students: Developing competence to provide spiritual care to patients at the end of life. Journal of Nursing Education. 45(9), 365-370. Retrieved April 10, 2007, from Proquest database.
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